DSM Finally Acknowledges Matters of the Heart

Most therapists are pretty unhappy with the American Psychiatric Association’s Diagnostic and Statistical Manual. We don’t like to be pigeon-holed into pathologizing our clients with disorders that meet DSM criteria for insurance purposes. We also find that DSM omits huge problems such as sexual addiction and the use of pornography, while including arcane and relatively inconsequential diagnoses such as trichotillomania (hair-pulling disorder), admittedly a behavior that DSM itself may provoke in many of us.  In our work with men at the Men’s Counseling Center of Northern Michigan, we certainly treat conventional diagnoses, but find that these diagnoses frequently fail to address men’s core issues: matters of the heart.

An Alternative DSM Model

Celebrating Matters of the HeartI recently wandered around the pages of DSM-5 in preparation for my presentation on treating men at the American Men’s Studies Association conference later this month. I discovered something that finally seemed to touch on the core issues of men — and, for that matter, women. One can only imagine what happens in the boardrooms of APA, but it appears that perhaps somebody — or a group of somebodies — revolted against the traditional DSM model. Perhaps you already know about it.  Anyway, on page 761, not entirely buried in the back of the book, there’s an Alternative DSM-5 Model for Personality Disorders which, surprise, up-ends the single-minded pathologizing of human beings by offering qualities of healthy human functioning. Here’s a sample from the list:

  • The experience of oneself as unique, with clear boundaries between self and others.
  • Stability of self-esteem and accuracy of self-appraisal.
  • Capacity for, and ability to regulate a range of emotional experience.
  • Utilization of pro-social internal standards for behavior.
  • Empathy: the comprehension and appreciation of others’ experiences and motivations, tolerance of different perspectives.
  • Intimacy: Depth and duration of connection with others. Desire and capacity for closeness. Mutuality of regard reflected in interpersonal behavior.

New Diagnostic Criteria

Wow. Among other desired attributes, are the characteristics of empathy and intimacy, elsewhere absent from the almost 1000 pages of DSM-5. Here is a proposal that the descriptions of personality disorders use empathy and intimacy as categories for diagnostic criteria. Could it be that APA has found heart?

In its appendage of empathy and intimacy, APA is finally getting with the program, elucidating what we want so badly for men, and what’s so hard for many to achieve. The addition of empathy and intimacy to DSM’s vision of human beings could promote new treatment goals and correspondingly novel interventions for men.

Maybe the Alternative DSM-5 Model could even become the new standard. Or, maybe that’s a fantasy: there’s still an overwhelming conventionally masculine culture at APA. If only some of these guys who still dominate the DSM process would join a men’s group. Probably an even bigger fantasy.

2 Responses to “DSM Finally Acknowledges Matters of the Heart”

  1. Ted May 15, 2017 at 6:10 pm #

    Are you implying that the use of pornography should be classified as a mental disorder? Your first paragraph seems to think so.

    You’d better back that claim up with some rigorous data and analysis. Otherwise, making such claims does more harm than good!

    • Randy Flood June 30, 2017 at 6:02 pm #


      I hope that you read this post in its entirety and were not hung up completely on the sentence about sexual addiction and the use of pornography. Further into the piece, we mention the Alternative DSM-5 Model for Personality Disorders which offers qualities of healthy human functioning. The list includes:

      Intimacy: Depth and duration of connection with others. Desire and capacity for closeness. Mutuality of regard reflected in interpersonal behavior.

      In our experience, we have found that the abuse of pornography and sexual addiction can take away from what’s needed to form long-term, healthy, and fulfilling intimate relationships.

      Recently, the American Society of Addiction Medicine (ASAM) comprised of medical doctors whose qualifications entail specific training in addiction treatment, pharmacology, board certification, and clinical experience, formulated a more accurate definition for addiction—one that incorporates current neuroscientific findings—as a “brain disease affecting memory systems, reward pathways, and motivation.” (The Therapist, Jan/Feb 2017, “Sex Addiction is not a Myth when Neuroscience Keeps the Score”)
      ASAM confidently applies this updated definition informed by brain research to both substances and process addictions (explicitly including sex and gambling), based on the commonality of the reward brain pathways involved in both types.

      “In the last decade researchers and mental health professionals have worked diligently to improve the efficacy of sex addiction treatment based on the neurophysiological addiction paradigm. The resulting theoretical construct — that all addictions, whether substance or process (i.e., gambling, overeating, overspending, or sex) are developmental self-regulation disorders triggered by neurobiological deficits from early relational (attachment) trauma — informs cutting edge addiction treatments. This understanding means that sex addiction treatment must weave together neuroscientific knowledge with genuine therapeutic connection if it is to nourish the client’s self-acceptance and relational capacities.” (The Therapist)

      I hope this answers your question with regard to sex addiction and pornography. For more insight and information about treatment programs, visit the Men’s Resource Center website.

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