Abnormal Psychology

504 CHAPTER 11

Criticisms of the Sexual Dysfunctions in DSM-IV-TR

Criticisms of the DSM-IV-TR classifi cation of and criteria for sexual dysfunctions

focus on several issues:

1. The sexual dysfunctions are based on the lock-step, sequential progression in
   Masters and Johnson’s model of the sexual response cycle. However, this may not
   be the best model for understanding sexual dysfunctions in women. As shown
   in Figure 11.3, for women, arousal and desire often occur at the same time, or
   arousal can lead to desire rather than desire always preceding arousal. In this
   alternative model for females, emotional and physical satisfaction may include
   orgasm, although not all women need to have an orgasm to feel satisfi ed.

11.3 • An Alternative Female Sexual

Response Cycle An alternative model of the female

sexual response cycle (Basson, 2001)—in the context

of relationships—is analogous to a circle. The cycle

starts with sexual neutrality: not feeling very sexual,

but with an openness to seek or be receptive to sexual

stimuli. In turn, such sexual stimuli may, depending on

neurological (and other biological), psychological, and

social factors operating at that moment, lead to sexual

arousal, which in turn leads to a sense of desire and

further arousal. The desire creates positive feedback

loops () that lead to heightened arousal, which

then leads to emotional and physical satisfaction. This

satisfaction in turn produces a sense of emotional

intimacy with her partner, making her more likely to be

receptive to or seek out sexual stimuli in the future. She

may also feel spontaneous sexual desire, which leads to

positive feedback loops among the fi rst three phases.

Source: Adapted from Basson, 2001. For more information see the

Permissions section.

Figure 11.3g3

seeks or is

receptive to

neurological (and

other biological),

psychological,

social influences

Emotional

+ + intimacy

+ +

+ +

+ +

Emotional and

physical

satisfaction

Sexual desire

and arousal

Sexual neutrality

Sexual stimuli

Sexual arousal

CriticismsoftheSexualDysfunctionsinDSMIVTR

pleasure is gone, and there is only the expectation of discomfort and frustration. Our mar-

riage is suffering and it feels like a deep chasm is growing between us as sex has become im-

possible. My husband and I fi ght a lot more and I know he is growing impatient. I don’t want

my children to be another statistic of divorce because of this. I just don’t know what to do.

(Vaginismus.com, 2007)

2. DSM-IV-TR focuses on body parts (heart rate, genital engorgement) rather than
   the whole person (Apfelbaum, 2000; Kleinplatz, 2001). Psychological and so-
   cial factors—such as the subjective experience, thoughts and feelings, the qual-
   ity of the relationship with the partner and the interaction of the couple, and
   the context of sexual activity—are generally overlooked (Tiefer, 1991). These
   factors play a larger role for women than is recognized by the DSM-IV-TR cri-
   teria (Basson, 2005; Basson et al., 2004, 2005).


3. The emphasis is on orgasm as the conclusion of sexual activity (Tiefer, 1991).
   Sexual activity that does not end in orgasm is implicitly considered not satisfy-
   ing (Kleinplatz, 2001). Nevertheless, as noted above, some women feel satisfi ed
   even without having an orgasm.


4. The DSM-IV-TR criteria rest on a cultural defi nition of “normal” to defi ne
   abnormal sexual functioning (Moynihan, 2003). Critics note that the norm
   promoted by American culture is that of an adolescent male, ever ready for