The DSM Diagnostic Criteria for Hypoactive Sexual Desire Disorder in Women

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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 defined by the monosymptomatic criterion "persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity" that causes "marked distress or interpersonal difficulty." 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. Problems in coming to a clear operational definition of desire, the fact that sexual activity often occurs in the absence of desire for women, conceptual issues in understanding untriggered versus responsive desire, the relative infrequency of unprovoked sexual fantasies in women, and the significant overlap between desire and arousal are reviewed and highlight the need for revised DSM criteria for HSDD that accurately reflect women's experiences. The article concludes with the recommendation that desire and arousal be combined into one disorder with polythetic criteria.

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Sexual problems among women and men aged 40-80 y: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors.

E O Laumann, A. Nicolosi, D Glasser … (2004)

The Global Study of Sexual Attitudes and Behaviors (GSSAB) is an international survey of various aspects of sex and relationships among adults aged 40-80 y. An analysis of GSSAB data was performed to estimate the prevalence and correlates of sexual problems in 13,882 women and 13,618 men from 29 countries. The overall response rate was modest; however, the estimates of prevalence of sexual problems are comparable with published values. Several factors consistently elevated the likelihood of sexual problems. Age was an important correlate of lubrication difficulties among women and of several sexual problems, including a lack of interest in sex, the inability to reach orgasm, and erectile difficulties among men. We conclude that sexual difficulties are relatively common among mature adults throughout the world. Sexual problems tend to be more associated with physical health and aging among men than women.

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Why humans have sex.

Cindy M. Meston, David Buss (2007)

Historically, the reasons people have sex have been assumed to be few in number and simple in nature-to reproduce, to experience pleasure, or to relieve sexual tension. Several theoretical perspectives suggest that motives for engaging in sexual intercourse may be larger in number and psychologically complex in nature. Study 1 used a nomination procedure that identified 237 expressed reasons for having sex, ranging from the mundane (e.g., "I wanted to experience physical pleasure") to the spiritual (e.g., "I wanted to get closer to God"), from altruistic (e.g., "I wanted the person to feel good about himself/herself") to vengeful (e.g., "I wanted to get back at my partner for having cheated on me"). Study 2 asked participants (N = 1,549) to evaluate the degree to which each of the 237 reasons had led them to have sexual intercourse. Factor analyses yielded four large factors and 13 subfactors, producing a hierarchical taxonomy. The Physical reasons subfactors included Stress Reduction, Pleasure, Physical Desirability, and Experience Seeking. The Goal Attainment subfactors included Resources, Social Status, Revenge, and Utilitarian. The Emotional subfactors included Love and Commitment and Expression. The three Insecurity subfactors included Self-Esteem Boost, Duty/Pressure, and Mate Guarding. Significant gender differences supported several previously advanced theories. Individual differences in expressed reasons for having sex were coherently linked with personality traits and with individual differences in sexual strategies. Discussion focused on the complexity of sexual motivation and directions for future research.

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The sexual desire inventory: development, factor structure, and evidence of reliability.

I P Spector, Daniel I Spector, Leeanne M. Carey (1996)

The purpose of this investigation was to develop a self-administered questionnaire to measure sexual desire. In the development phase, items were generated and pilot-tested with 24 subjects. Based on these data, items were deleted, added, or modified. Next, in Study One, the Sexual Desire Inventory (SDI) was administered to 197 females and 117 males. Factor analyses revealed that the SDI was multifactorial; however, none of the generated factor solutions up to five factors yielded a good fit. Interpretation of the factors led to revisions of the SDI. It was hypothesized that sexual desire might consist of two related dimensions; dyadic sexual desire and solitary sexual desire. Items on the SDI were modified to measure these two dimensions, and the revised SDI was administered to 249 females and 131 males. Factor analysis supported the presence of these two dimensions. Internal consistency estimates using Cronbach's alpha revealed coefficients of .86 for dyadic sexual desire and .96 for solitary sexual desire, providing preliminary evidence for the reliability of the SDI. The implications of these findings are discussed.