Until 2013, any lack of sexual desire was considered a disorder by the primary guide used by healthcare providers to define and classify mental disorders—the Diagnostic and Statistical Manual of Mental Disorders (DSM) created by the American Psychiatric Association (APA).
More specifically, the DSM considered a lack of sexual desire to be a condition called “Hypoactive Sexual Desire Disorder”, or HSDD, defined as "low sexual desire accompanied by marked distress or interpersonal difficulties." Understandably, many ace people felt that this criteria was indistinguishable from their experience of asexuality, and they argued that it was wrong to diagnose a sexual orientation as a mental disorder.
After the APA started work on the fifth edition of the DSM in 2007, members of the Asexuality Visibility Education Network (AVEN) responded by forming a committee to advocate for the exclusion of ace people from the diagnosis of HSDD. The five members of this committee prepared and submitted a 78-page long report that included a literature review of research on asexuality alongside interviews with psychologists and personal statements.
When it was published in 2013, the DSM-V ultimately replaced HSDD with two new disorders: Female Sexual Interest/Arousal Disorder (FSIAD) and Male Hypoactive Sexual Desire Disorder (MHSDD). Both of these definitions state, “If a lifelong lack of sexual desire is better explained by one’s self-identification as ‘asexual,’ then a diagnosis of [FSAID or MHSDD] would not be made.”
While this change is a step in the right direction, it is far from perfect. Various asexual people have criticized the scare quotes around the term asexual and the omission of this ‘exception clause’ in the handbook version of the DSM-V. Perhaps most significantly, the DSM-V still leaves behind aces who have not yet heard of asexuality.
In many ways, this controversy around asexuality and the DSM could be seen as a successor to the removal of homosexuality from the DSM in 1973. That revision marked a shift in the perspective of the medical community towards no longer viewing same-sex attraction as an illness that needed to be 'cured'. But I also think that the idea of asexuality can push the envelope even further: most people still think of the desire for sex as a universal human experience. Just by existing, asexuality challenges this idea.
Particularly, if we accept that asexuality is a sexual orientation and not a medical disorder, we also accept the idea that, perhaps, desiring sex is not necessarily a universal experience. When the AVEN task force fought to exclude asexuality from the DSM, they also asked the medical world to reconceptualize how they defined disorder and normalcy. Hopefully this revision of the DSM-V represents a step to better align the world with the wonderful, varied experiences of those living in it.
We can expand this idea even further: if a lack of desire for sex shouldn’t be treated as a sickness, what then should the DSM define?
I don’t have a list of what is and isn't appropriate to be defined in the DSM, but I do think that the controversy surrounding asexuality and the revision of the DSM in 2013 poses some important questions that we haven’t given enough attention to yet. Certainly we need to think more complexly about the ways we define illness and disorder.
Ultimately, it makes me wonder: why is difference—in mobility or neurodivergence or anything else—only acceptable if someone can’t be made to move, think, or feel in a way that others consider ‘normal’? Is someone’s quality of life improved by treating their differences as sickness and attempting to eliminate the ways they deviate from ‘normal’, or is it better to change our overall idea of what normal is?
I, for one, may feel broken sometimes—not because I feel my body is broken, but because others make me feel that my asexuality is something that should be fixed. These big questions brought up by the revision of the DSM require more thought and more voices than I can provide in this short article, but I do know one thing: understanding asexuality can have an enormous impact on the way we understand the world and the things we consider ‘normal’. That means it’s important for everyone, not only for asexual people like me, to learn about asexuality. Hopefully, understanding asexuality makes the world a little more complex and a lot more genuine and welcoming to the breadth of our different experiences.
This article was adapted from a 2017 essay I wrote, Asexuality and the DSM: Challenging the Divide between the Healthy and the Sick, submitted for credit in INDEV 300 at the University of Waterloo.