Sexual Disorder Not Otherwise Specified
If the clinician is uncertain about how to categorize a person’s problem, it is more reasonable to use this diagnosis than one that does not encompass the range of the patient’s suffering. Sexual disorder not otherwise specified can be used when the therapist perceives a dramatic interplay between issues of sexual identity and sexual dysfunction, or when “everything” seems to be amiss. DSM-IV-TR, however, encourages the clinician to make multiple sexual diagnoses involving, for instance, a gender identity disor-der, a desire disorder, erectile and orgasmic disorder.
DSM-IV-TR provides two examples when it would be ap-propriate to use the diagnosis sexual disorder NOS: 1) nonpara-philic compulsive sexual behaviors, that is, relentless pursuit of masturbatory or heterosexual or homosexual partner experiences without evidence of paraphilic imagery; and 2) complicated or exaggerated struggles to manage homosexual urges. Despite the removal of homosexuality from the DSM in 1974 men (particu-larly) and women still generate symptoms in their struggle to bal-ance the demands of their homoeroticism with their ambitions to participate in conventional family life. This ongoing struggle can generate a variety of anxiety, depressive, compulsive, substance abusing and suicidal states.