What is hypo?

For discussion of general issues pertaining to asexuality.
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Mr. Paradox
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What is hypo?

Postby Mr. Paradox » Mon Feb 04, 2008 3:37 pm

Speaking of unhelpful labels, it's just as bad when the people using the labels think they know what they mean, but don't. For example, I don't believe "hyposexuality" (ie, hypoactive sexual desire disorder or inhibited sexual desire) has ever been used on AVEN in its recognised medical sense. It doesn't mean "asexual lite." It appears to refer to any disorder in which a) normal sexual desire is being inhibited by health or relationship problems; and/or b) the lack of desire is causing personal or interpersonal distress. It can go either way, but it's a clinical state by definition -- if someone simply has a low level of sexual desire by nature, and is fine with it, that's explicitly not HSD. Psychiatric professionals have been busily de-pathologising sexual preference for the last few decades, so they don't have a term for the sorts of healthy variation we talk about.

At least, that's my understanding. The literature on HSD and ISD is hard to follow, not least because the terms get swapped around so much. But I really think we need to try and sort out what we're actually saying before we try to buy credibility with medical words.
"He cannot, however, long remain asexual when he sees the great peasant girls, as ardent as mares in heat, abandoning themselves to the arms of robust youths."
--Havelock Ellis, Studies in the Psychology of Sex

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Shockwave
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Re: What is hypo?

Postby Shockwave » Mon Feb 04, 2008 3:49 pm

The word "hyposexual" does not appear in the DSM IV.

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Mr. Paradox
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Re: What is hypo?

Postby Mr. Paradox » Mon Feb 04, 2008 3:56 pm

Did you look up hypoactive sexual desire or inhibited sexual desire? ISD seems to be on the rise as the preferred term.
"He cannot, however, long remain asexual when he sees the great peasant girls, as ardent as mares in heat, abandoning themselves to the arms of robust youths."
--Havelock Ellis, Studies in the Psychology of Sex

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Shockwave
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Re: What is hypo?

Postby Shockwave » Mon Feb 04, 2008 4:03 pm

I just searched the DSM IV for the word "hyposexual" and got no hits. I also looked at the article on HSDD but not the one on ISD. I understand your point about the term being used in a non-medical context but I'm also curious about the medical sources that use the term to mean HSDD/ISD. So far all I have found are sources that use it to mean sexual desire that is much lower than normal, which is pretty much the way people on AVEN have been using it.

Edit: I found a dissertation that uses the term "Hyposexual Desire Disorder" as a shorthand for "Hypoactive Sexual Desire Disorder" but that's the closest I've come so far.

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Olivier
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Re: What is hypo?

Postby Olivier » Mon Feb 04, 2008 6:22 pm

I'd have to say that I don't agree with you on this one. Hyposexual is a perfectly intelligible word to anyone who understands the prefix hypo- and the adjective sexual.

And to someone who understands that a disorder is something that causes distress, Hyposexual Desire Disorder clearly has to do with distress caused by lowered sexual desire. I couldn't find any reference on AVEN where someone used HSDD (rather than hyposexual) to mean a low level of desire that caused no problems. Certainly any suggestion that asexuality is just HSDD by another name is usually dealt with pretty swiftly. And the reason that HSDD or ISD are the terms used in medical literature, rather than hyposexuality, would seem to indicate that they want to be clear they are talking about the disorder and the associated distress, and not the general state of being.

Hyposexual on its own shouldn't carry the implication that we're talking about a disorder just as personality doesn't carry that implication despite the extensive literature on personality disorder. Even anxiety and panic are clearly different from anxiety disorder and panic disorder, and so I have no trouble at all with using hyposexual to mean barely sexual.

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Gadfly-in-Chief
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Re: What is hypo?

Postby Gadfly-in-Chief » Mon Feb 04, 2008 6:47 pm

"Hyposexual" isn't in the DSM IV. Nor aparently is "Hyposexual Desire Disorder". I don't have an online version to try to find it in. But "Hypoactive Sexual Desire Disorder" is listed as 302.71 in DSM-IV-TR. (My housemate among other things is a psychologist. Handy at times.)

Criteria:
A: Defeciency or abscence of sexual fantisies and desire for sexual activity.
B. Must cause marked distress or interpersonal difficulty.
C. Not better accounted for by another Axis I disorder (except another Sexual Dysfunction) or a medical condition.

I don't have the time or motivation to type up the whole thing. But if you're asexual and you're happy, clap your hands: you don't have it.

"Hyposexual" quite possibly has no meaning in the diagnostic community. So it may be fitting that it has never been used correctly on AVEN: it has no correct usage.
Yes, the unexamined life is not worth living. But as a student of logic, you must realize that this does not imply that the examined life is.

pretzelboy
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Re: What is hypo?

Postby pretzelboy » Mon Feb 04, 2008 8:59 pm

DSM-IV TR
You can check it out on google books, p. 539

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Shockwave
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Re: What is hypo?

Postby Shockwave » Mon Feb 04, 2008 11:00 pm

pretzelboy wrote:DSM-IV TR
You can check it out on google books, p. 539


Yeah, that's the diagnostic criteria for Hypoactive Sexual Desire Disorder but the word "hyposexual" isn't used there or anywhere else in the DSM-IV.

Also, as Gadfly pointed out it says, "The disturbance must cause marked distress or interpersonal difficulty." That's something most laypeople don't understand about asexuality; if it doesn't cause problems it isn't a disorder. That's also one thing that really annoys me about Dr. Joy Davidson; she's supposed to be an expert on this but she seems to completely ignore that criterion. Hey, wait a minute...if taking her advice would cause some of us such distress, doesn't that make her a disorder?

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Mr. Paradox
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Re: What is hypo?

Postby Mr. Paradox » Tue Feb 05, 2008 3:41 am

Hahaha.

Okay, I see the general point. I was just noticing a bunch of "see: hypoactive sexual desire" entries under hyposexual and "also known as hyposexuality" notes on pages about HSDD. The two seem to be linked in a lot of sources, if not the DSM-IV.

At any rate, I'm not terribly fond of the term, because in most conversations it serves to fill an artificial space between pure asexuality and full sexuality, normalising both of them more than they need to be. I'd much rather we all develop a healthy appreciation for sexual variability. But in the meantime I can see how people find it a useful descriptor.
"He cannot, however, long remain asexual when he sees the great peasant girls, as ardent as mares in heat, abandoning themselves to the arms of robust youths."
--Havelock Ellis, Studies in the Psychology of Sex

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Shockwave
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Re: What is hypo?

Postby Shockwave » Tue Feb 05, 2008 7:28 am

So, your point is a lot like my comment about "gray-A" in the other thread. It's another dividing line within the community that can cause problems whenever elitism rears its ugly head.

How many of these elitists actually fit their own definition of a "true asexual"?

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Mr. Paradox
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Re: What is hypo?

Postby Mr. Paradox » Tue Feb 05, 2008 1:49 pm

Yeah, it's pretty much exactly like your comment on grey-A. I realised that after the fact. If it weren't for elitism, people wouldn't feel the need to come up with terms like these.
"He cannot, however, long remain asexual when he sees the great peasant girls, as ardent as mares in heat, abandoning themselves to the arms of robust youths."
--Havelock Ellis, Studies in the Psychology of Sex

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Emmarainbow
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Re: What is hypo?

Postby Emmarainbow » Tue Feb 05, 2008 7:08 pm

The very description of 'grey a' frustrates me... fair enough, the name comes from the aven triangle, the grrey between the black corner and white top - but what do we call the non-greys? They're not black asexuals, as they would be on the triangle, but pure or true, suggesting that everyone else is sullied and stained in some way. :/

Hyposexual can kinda be seen the same way, less than a sexual, not a.

I know it's the minority who actually think this way, but words mean a lot to me, and can change people's attitudes without their realising it.

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Re: What is hypo?

Postby pretzelboy » Tue Feb 05, 2008 7:54 pm

I know that for a while the term gray-A bothered me for pretty much the same reasons as everyone else, but I never heard anyone saying anything about it so I figured I was alone in thinking that. Evidently not. Now, for whatever reason, I've sort of come to be okay with it. I guess I do think of some people as being "more" asexual or less "asexual" in terms of how I think of asexuality as a sexual orientation. (because I think of asexuality as being the bottom-left region of a 2-Dimensional model with no boundary between sexual and asexual.) I feel like I'm not supposed to, and I do strongly oppose elitism where some people are more or less asexual in terms of an identity, or that they, based on their "true asexuality" can say who is and who isn't asexual (for people who could reasonably identify that way.) I don't know why I think this way exactly, or if it is even rationally coherent. Probably if I had people telling me that I wasn't *really* asexual, I would feel very differently about it.

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Re: What is hypo?

Postby pretzelboy » Sat Feb 09, 2008 8:07 pm

I've spent some time this afternoon looking up things on HSDD, and I'm inclined to think that when they made the subtype "lifelong," it was exactly the group that we call asexuals that they had in mind. I read "interpersonal difficulty" as meaning people who want a Relationship but have a lot of difficult/frustration getting one because they don't want it to have to include sex, or people who are married and are having problems because their spouse wants to have sex but they don't. "Individuals with Hypoactive Sexual desire Disorder may have difficulties developing stable sexual relationships and may have marital dissatisfaction and disruption." I saw one therapist say that that pretty much the only time they saw people with lifelong HSDD was when the spouse pressured them to go see a therapist. Also, a few of the people described in the brief case studies that I've read sound exactly like asexuals. Perhaps we ought to read up on what is known about this category of people.

I find this line telling: "The age of onset for individuals with Lifelong forms of Hypoactive Sexual Desire Disorder is puberty." (i.e. "marked distress or interpersonal difficulty" is necessary for a clinician to diagnose someone with HSDD, but the time of onset has nothing to do with meeting this requirement.)

The next thing described in the DSM-IV is Sexual Aversion Disorder. It says that someone can be diagnosed with both that and HSDD. Someone with the lifelong subtypes of both seems to be referring precisely to the group of people that we sometimes call "repulsed asexuals."

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Re: What is hypo?

Postby xaida » Sun Feb 10, 2008 6:04 am

This is my most prominent question about the theory of asexuality: What is the difference between HSDD and asexuality? Thanks for bringing it up here.

pretzelboy wrote:I've spent some time this afternoon looking up things on HSDD, and I'm inclined to think that when they made the subtype "lifelong," it was exactly the group that we call asexuals that they had in mind.


Thats exactly what I think. The only difference between the pathologized version of asexuality and what Id call asexuality is a question of self-confidence. You might find an HSDD person at doctors, therapists and self-aid groups and an asexual on CSDs, media or other places to make a "quest" for public acceptance visible. While the HSDD person tries to change himself in order to make a (sexual) relationship work, the asexual might rather want to change society/public opinion to allow for (asexual) relationships. While the HSDD person might or hope for the state to be too transitory and pathological to self-identify as such, the asexual sees asexuality a part of identity. Of course this is all way too simplified, but I think one can change from HSDD to asexuality with a change of perspective.

So I offered this theory to a colleague of mine and she said, she knows "asexual" phases in her life. Some of them are just as happy as any other, some of them really burden her. She then feels blindfolded, bereaved of the greatest joy, the indifference spreads to other areas in her life leaving her depressed and having an asexual partner then, who doesnt demand sexual functioning of her would not settle the case and make them live in peace and harmony, but further hopelessness. That's what I think personal distress is and what should be talked about at max in the DSM and ICD. The way we approach that seems to be different even though. We all know what therapist with such a diagnosis and which is "proven" to be rather successful. While the AVEN FAQs would say to such a personal distress:
I'm afraid that there's no evidence to show that it's possible to change someone's sexuality. You can choose to change the way you act upon your desires or lack of desires, but you can't change what your desires are. It is possible for someone's sexuality to drift and change in orientation and intensity with time but this doesn't happen intentionally and doesn't happen to everyone. The best solution is to learn to be comfortable with who and what you are. You can't change your sexuality and you didn't choose it, but you can accept it.
and thereby doesnt claim it to be pathological, right? So its even debatable if marked personal distress makes asexuality a disease.

Unfortunately, like pretzelboy, I saw case studies to HSDD even as early as in Krafft-Ebing's Pathologia sexualis, where a (most likely) asexual guy was diagnosed by "anaesthesia sexualis" for not being as lucky as to find an asexual woman (he died lonely and desparate in civil war). Over the centuries we havent made much progress. The idea about just making asexuals find each other and make them found romantic relationships made my professor of sexology laugh, because "there is always something rotten within the relationship if sex is not desired". Having problems finding a partner or maintaining a sexual relationship is considered interpersonal difficulty and thereby turns asexuality into a disease with psychotherapies paid by health insurances (at least here in Germany ;)) and a pharmaceutical industry to research fervently for the anti-HSDD pill. We mourn there is not enough research on asexuality, although there is an overwhelming research on HSDD we'd have to equip with a de-pathologizing view instead.

Now this is a common issue within sexual minorities. Homosexuality has been climbing out of the DSM only in the early 70's, I think, and fetishism is still in there. Homosexuality could be seen just as much of a disease if the wish for a homosexual partner cannot be expressed and consequently there cannot be found any: difficulties in finding and maintaining a sexual relationship then -> disease. So, may it now be that we are grey-a or black-and-white-a, we are always at the verge or deeply within pathologization and I dont think this is a great setting to explore, embrace, express and experiment with ones asexuality.

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Re: What is hypo?

Postby pretzelboy » Sun Feb 10, 2008 12:14 pm

In most asexual discussions of HSDD, people tend to emphasize the point that low sex drive isn’t of itself a problem—it is only diagnosable if there is distress or interpersonal difficulties (and usually the distress part is emphasized, interpersonal difficulties played down.) While there is some value in this in pointing that under current “science” asexuality is not necessarily a mental disorder, it, I think, grants too much to the current establishment.
Suppose that there were some diagnosis called, “homosexual desire disorder” (HSD) that was characterized by a) persistent patterns of sexual attraction toward and/or sexual fantasies about people of the same sex and b) consequent marked distress and/or interpersonal difficulties. Would it be most appropriate to say that having homosexual desires is only a problem under this definition if the person felt it to be a problem? Thus, people who accept their sexuality are not pathologized under the definition. Or would it be better to challenge the validity of the entire diagnosis?
From what I’ve seen about HSDD, if we look at one pair of subtypes—lifelong vs. acquired—there seems to be a big difference between them in terms of treatment. I haven’t seen anything I could cite as authoritative, but the impression I get is that there is reasonable hope of successful treatment for the acquired variety. Sometime decrease in sexual desire (not better accounted for by a medical reason or another disorder, like depression) is caused by emotional distance in the relationship (hardly a mental disorder, but that’s beside the point.) In these cases, improving communication and non-sexual intimacy can improve things a lot. Sometimes stress can cause the loss of sexual desire. In these cases, normal means for better dealing with stress can be helpful. However, attempts to treat lifelong HSDD have, I’ve read, been pretty much failures. They’re still trying, however (especially the drug companies.) If we can find the research backing this up, this would be good reason to stop trying to cure people (‘cause it doesn’t work) and instead tell people that they’d just be better of accepting themselves for who they are and make their life decisions accordingly.
Under this view, acquired HSDD could be kept (as treatment can help) and lifelong HSDD should be entirely dropped from the books because it can’t be cured and there is no reason why we should assume that it needs to be (and I would imagine that people trying hard to cure their asexuality would have considerably increased personal distress caused by a strong felt need to get fixed combined with utter failure to do so. I know that this is not uncommon with homosexual to heterosexual sexual orientation conversion therapies and is one reason why they have become taboo in the mental health professions.)

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Re: What is hypo?

Postby andrew_w » Tue Feb 12, 2008 12:05 am

I think that HSDD (especially the "lifelong"/"primary" subtype) is bogus. Mismatched levels of desire in a relationship should be considered a problem of the relationship, and not of the person who is less sexual. Dysphoria with level of attraction or desire could be considered a disorder, but the treatment for that would not be to make the person more sexual, but simply to help them accept their level of desire. The only time when I would say that attempts to make someone more sexual would be valid is if they have lost their desire due to some kind of physical problems or as a side effect of drugs.

My definition of "hyposexual" is "someone who is basically sexual, but experiences weak or infrequent drive or attraction" (in other words, someone on the "sexual" end of grey-A).

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Re: What is hypo?

Postby Omnes et Nihil » Wed Feb 13, 2008 11:48 pm

pretzelboy wrote:In most asexual discussions of HSDD, people tend to emphasize the point that low sex drive isn’t of itself a problem—it is only diagnosable if there is distress or interpersonal difficulties (and usually the distress part is emphasized, interpersonal difficulties played down.) While there is some value in this in pointing that under current “science” asexuality is not necessarily a mental disorder, it, I think, grants too much to the current establishment.
Suppose that there were some diagnosis called, “homosexual desire disorder” (HSD) that was characterized by a) persistent patterns of sexual attraction toward and/or sexual fantasies about people of the same sex and b) consequent marked distress and/or interpersonal difficulties. Would it be most appropriate to say that having homosexual desires is only a problem under this definition if the person felt it to be a problem? Thus, people who accept their sexuality are not pathologized under the definition. Or would it be better to challenge the validity of the entire diagnosis?


I think you raise a very important point-- one that I would like to take a step further. I don't think this discussion grants enough to the establishment-- what is and isn't a disorder is entirely about what the establishment says.

Talking about "validity" of a mental disorder is a little misleading-- that's posing the question of whether or not the diagnosis of HSDD corresponds to something that's actually a disorder in reality. The problem with that... "actual disorders" don't exist objectively out there in the world. Disorders are categories people have made up to organise characteristics about people in the world. DSM diagnostic categories define what is and isn't a "disorder". People got together and made them up. They didn't pull them out of thin air of course, but this still came down to a group of people deciding what should and shouldn't be considered a "disorder" based on nothing more than their clinical intuition, experiences, and their personal opinions.

Key point: People invented and declared mental disorders. This declaration is what makes them real, by definition.

HSDD is a disorder because it's in the book-- because people have decided it's a disorder. Why is it there? That's a purely historical question.

Can HSDD (lifelong) be "treated"? "Treatment" is a misleading word. It basically amounts to changing someone to make them fit their environment better. Either way, whether HSDD can be "treated" happens to be irrelevant.

There are also many characteristics of a person that can be changed that are not considered disorders.

Some disorders (e.g. anti-social personality disorder) aren't really treatable. Gender-related disorders are "treated" with surgery, among other things-- treating a mental disorder by changing the shape of someone's physical body. There is a whole set of disorders that are arguably life-long aspects of a person's personality. These are still "disorders" because the right people believe they should be considered "disorders". Particularly in the case of gender-related disorders... I believe it's very clear that the decision about what constitutes a disorder is a value judgement.

Long story short?

Mental disorders are political categories, constructed socially (through a form of recognised and authoritative consensus known as the development of the DSM). They are grounded in, and reproduce, popular ideas about what is and is not "functional", which characteristics and experiences are "problems", and which ones are not. Diagnoses do not map onto any "objective reality" of "functional" or "dysfunctional" people, characteristics or experiences.

Wanting to remove HSDD (lifelong) from the DSM is a political goal, similar in many ways to the removal of homosexuality from the DSM. It's about proclaiming that asexuality is not a problem, and that the established powers should recognise that.



If history serves us to follow that example:
Step 1: create large numbers of asexual-identified psychologists and psychiatrists, and have them attain relevant positions of status and power
Step 2: develop social visibility so that asexuality seems politically and socially relevant
Step 3: hold the relevant conference in Hawaii, go the nearest bar, and discuss the issue of asexuality over large quantities of beer