Low Desire, Trauma, and Femininity in the DSM-5: A Case for Sequelae

The recently released DSM-5 (2013) includes a new sexual dysfunction: Female Sexual Interest/Arousal Disorder (FSIAD). For the first time, the low sexual desire disorders are split along gender lines, and lack of sexual ‘receptivity’ is offered as a criterion for diagnosis in women only. Although ‘severe relationship distress’ or other ‘significant stressors’ are to be considered during evaluation for FSIAD, the patient’s trauma history is not evaluated as part of the protocol. The presence of violence or distress can potentially elicit a differential diagnosis, but what constitutes ‘severity’ is not articulated either, except to designate ‘partner violence’ as the primary example. Thus, past relational violence, sexual abuse, and trauma are not explicitly considered—nor is the vast spectrum of gendered violations that many women describe experiencing on a regular basis. I examine potential problems with separating the trauma diagnoses (i.e., Posttraumatic Stress Disorder, Depersonalization/Derealization Disorder, and other Trauma- and Stressor-Related or Dissociative Disorders) from FSIAD in the DSM-5. Drawing on interviews with low-desiring women who describe being violated, I elaborate how this diagnostic separation may be re-traumatizing for women who have experienced such violence and have low sexual desire as a result. I also question the utility of framing psychological disorders and symptoms as comorbid (i.e., concomitant but unrelated) and argue instead for more thorough etiological or sequelic investigations of low desire