“Balon & Clayton (2014). Female sexual interest/arousal disorder: A diagnosis out of thin air.” – Article summary

In psychiatric illness, the criteria for establishing diagnostic validity are clinical description (1), laboratory studies (2), exclusion of or delineation from other disorders (3), a follow-up study (4) and a family study (5). These criteria are typically not fulfilled or psychiatric illnesses.

According to Balon and Clayton, the primary reason for the creation of the female sexual interest/arousal disorder (FSAID) was to get rid of the linear concept of the sexual response cycle in women and replace it with a circular model of sexual response. However, no diagnosis has been presented for this diagnosis. There are several things wrong with this diagnosis:

• There is no scientific study which supports the separations of gender in regards to desire and arousal that demonstrates that the FSIAD diagnosis more accurately reflects the sexual experience of women compared to the DSM-IV diagnoses.
• There is no information regarding whether the criteria of FSIAD are useful to clinicians.
• There is a lack of continuity with the DSM-IV.
• The concept of female sexual arousal in the DSM-V is unclear (e.g. lubrication is not used in the diagnostic criteria).
• The evidence supporting the inclusion of genital or non-genital sensations with disordered desire is not presented.
• The diagnosis of FSIAD could be made without any impairment of arousal (e.g. three criteria are unrelated to arousal and are sufficient for a diagnosis).
• The terms sexual excitement and pleasure are seen as the same although no definition is provided and there is no relationship provided with either arousal or desire.
• There is no broad consensus or expert clinical opinion supporting the establishment of the diagnosis.
• Genetic evidence supporting FSIAD is lacking while there is genetic evidence that argues against the diagnosis (e.g. genetic sharing between arousal, lubrication and orgasm).
• The reliability of the FSIAD criteria is unclear.
• The validity of the FSIAD criteria is questionable because of the lack of genetic evidence (1), symptom criteria not related to arousal (2) and lack of any study of this disorder (3).
• There is no indication of what treatment should be used.
• There is no evidence regarding the existence of the combined disorder (i.e. underlying pathology).
• There is not an unmet need which is served by the creation of FSIAD.

According to Balon and Clayton, the establishment of this diagnosis has the potential to inflict harm by excluding women who currently have an ‘old’ diagnosis (HSDD) and it is not clear what will happen with regard to treatment.