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which will wrestle with ques- tions such as: Are sadomasochism or pedophilia mental disorders? Are dysfunctions like female hypoactive sexual desire disorder (low sex drive) psychiatric issues, or hormonal issues? Perhaps the most important question is whether, when it comes to many sexual in- terests and issues, it’s even possible or desirable to create diagnostic criteria.
    At least one petition, spearheaded by transgender activists, is
    being circulated to oppose the appointment of some members to the Sexual and Gender Identity Disorders work group and its chair, Kenneth Zucker, head of the Gender Identity Service at the Center for Addiction and Mental Health in Toronto, Canada.The petition accuses Zucker of having engaged in “junk science” and promoting “hurtful theories” during his career, especially advocating the idea that children who are unambiguously male or female anatomically, but seem confused about their gender identity, can be treated by encouraging gender expression in line with their anatomy.
    Zucker rejects the junk-science charge, saying that there “has to be an empirical basis to modify anything” in the DSM. As for hurting people, “in my own career, my primary motivation in working with children, adolescents, and families is to help them with the distress and suffering they are experiencing, whatever the reasons they are having these struggles. I want to help people feel better about themselves, not hurt them.”
    That sex is controversial comes as no surprise to Dr. Darrel Regier, the vice-chair of the APA’s DSM-V Task Force, based in Arlington, Virginia.
    Sex, he says, in an understatement,“is an area that obviously has lots of emotion attached to it.” But the APA, he says, is doing its best to put science and evidence first, both in who it appoints to work- ing groups and in the process it will use to create the DSM-V (so called because it is the fifth complete version). Each working group will accept input from many experts with varying views, reach a consensus on DSM content, and then put that work group’s prod- uct before the board of trustees of the APA and the APA assembly. All that may be true, but Regier does not expect such reas- surances to quell the forces already swirling around the DSM-V as it moves toward a 2012 publication date. Currently, the DSM- IV includes sex-related activities as varied as paraphilias like
    voyeurism, klismaphilia (erotic use of enemas), and sadism, and functional disorders like dyspareunia (pain with intercourse), erec- tile disorders, and premature ejaculation.

“A Set of Scientific Hypotheses”
    The first DSM was issued in 1952. The idea was to create a more standardized way of talking about psychiatric disorders. As psychiatrist Dr. Gail Saltz, a “Today Show” contributor who also practices in New York, explains, the DSM is best viewed as “a lan- guage we have chosen to speak, a talking point we mental health professionals have created to communicate as well as we can with each other and with other professions.”
    It is not a final arbiter of who’s crazy and who’s not. Saltz, who says she thinks the DSM can be limiting in clinical practice, prefers to take a holistic approach and look at each patient’s collection of symptoms and concerns without being restricted by the DSM’ s various criteria.
    Regier agrees that’s how doctors should use it, arguing that the DSM “really needs to be seen as a set of scientific hypotheses.” It is, he believes,“a living document” changeable with new research.
    But if the DSM is a book of “hypotheses,” why the fuss? Does the DSM matter?
    Yes. A lot.
    The first reason why is prosaic. If you want your insurance to reimburse your visit to a mental health professional, you are prob- ably going to need a DSM code signifying a diagnosis.
    But the more profound reason is that it shapes how doctors, and even the rest of society, view sexuality.
    “A psychiatric diagnosis is more than