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Arch Sex Behav (2010) 39:221239 DOI 10.1007/s10508-009-9543-1
ORIGINAL PAPER
The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women
Lori A. Brotto
Published online: 24 September 2009 American Psychiatric Association 2009
Abstract Hypoactive Sexual Desire Disorder (HSDD) is one of two sexual desire disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and is dened by the monosymptomatic criterion persistently or recurrently decient (or absent) sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difculty. This article reviews the diagnosis of HSDD in prior and current (DSM-IV-TR) editions of the DSM, critiques the existing criteria, and proposes criteria for consideration in DSM-V. Problemsincomingtoaclearoperationaldenitionofdesire,thefact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsivedesire,therelativeinfrequencyofunprovokedsexual fantasies in women, and the signicant overlap between desire andarousalarereviewedandhighlighttheneedforrevisedDSM criteria for HSDD that accurately reect womens experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.
Keywords Hypoactive sexual desire disorder
Sexual interest Sexual desire DSM-V
Introduction
The goal of this review is to provide an overview on the history and current status for making a diagnosis of hypoactive sexual desire disorder (HSDD). In line with the recommendation by Segraves, Balon, and Clayton (2007) that criteria sets be listed separately by sex, this article will focus on sexual desire in
women. This review will also discuss criticisms of the existing Diagnostic and Statistical Manual of Mental Disorders (DSMIV-TR; American Psychiatric Association, 2000) criteria and summarize prior attempts to offer alternate diagnostic criteria and taxonomies. The issues to be considered for DSM-V include: (1) the utility of including lack of sexual fantasies in the criteria; (2) whether or not responsive desire should be added to the criteria; (3) how to capture relational inuences and consequences; (4) the overlap between sexual desire and sexual arousal/arousability; and (5) whether or not associated distress should be part of the diagnostic criteria.
It is important to rst clarify terminology used. In the professional literature,the termssexualdesire, drive,motivation, interest, libido, hunger, and appetite are often used interchangeably. In the DSM-IV-TR, whereas the disorder itself and the associated criteria focus on sexual desire, the Associated Features and Disorders section also uses the term sexual...