Why was homosexuality removed from the DSM?

[Nat]

I am trying to find out why homosexuality was taken out of the DSM-II in 1973 as a mental disorder - I mean the real reason. Other sexual 'variations' or 'deviations' (if I can use that word) are still in the DSM-IV-TR under 'paraphilias'. These include pedophilia, exhibitionism, fetishism, voyeurism, sexual sadism and transvestic fetishism. How do the authors of the DSM-IV-TR distinguish between these paraphilias and homosexuality?

I guess what I'm getting at is, is there a scientific basis for any of these paraphilias to be included or excluded or is it purely ideologically (or politically) driven?

I am not saying that homosexuality should be in the DSM. I'm just trying to understand their criteria for a paraphilia. It seems to me that almost any criteria you use, except one that was ideologically or politically driven, would either put all the paraphilias (including homosexuality) in the DSM as mental disorders, or all of them out of the DSM (as therefore 'normal' or 'acceptable' behaviours). I can't for example, see how you can have fetishism in there and not homosexuality.

[Pete]

The short answer is that the DSM-IV-TR is a culturally relative document due to its pragmatic approach. It aims to be reliable rather than valid, and clinically relevant rather then conceptually accurate. Therefore, as homosexuality is not culturally viewed as being a behavioural, psychological or biological dysfunction; and it is not treatable by culturally known or accepted means, then it is not considered a disorder. In contrast, the paraphilias are considered culturally as being dysfunctional in one way or another. So yes, it's ideologically and politically driven. The ideology is pragmatism. Politically, the APA wants to keep making money. They make millions from the DSM.

To be precise, this is what the DSM-IV-TR says: "[A mental disorder is] conceptualized as a clinically significant behavioral of psychological syndrome or pattern than occurs in an individual and that is associated with present distress or disability or with significantly increased risk of suffering death, pain, disability, or an important loss of freedom."

This brings about questions such as:
- How do you assess what is clinically significant?
- How do you assess distress? Is it a professional judgment or the individual's judgment?

But that's pretty irrelevant really, because the DSM never claims to be an accurate document. That's not its aim. It simply aims to be a useful way to split people into groups in order to create a common language for people to discuss patterns of behaviours and effective treatments. This is useful in promoting short-term, treatment-orientated research, but it's hardly useful in directing research that aims to cut nature at its joints. That's simply not what the DSM intends to be. Future versions are aiming to be more more informed by biological approaches, but even those are based on research that is based on the DSM categorical system.

So the 'disorders' in the DSM don't actually exist. The authors don't even claim that they do (They just suggest that the DSM categories are likely to relate to something real)! But the categories are useful in some contexts. If we want a diagnostic system that actually tries to identify human problems in a valid and accurate sort of way, then we'll have to create something new which has that intention. See The Human Diagnostic Manual.

Also see Cooper, R. What's wrong with the DSM? History of Psychiatry, 15, 5-25.