Divergent Conceptualizations of Sexual Dysfunctions in DSM-5 and ICD-11: Implications for Diagnosis, Research, and Practice

Introduction Over the past decades, the diagnostic criteria of mental disorders in DSM-5 and ICD-11 have been harmonized in many areas. However, this does not extend to the area of sexual dysfunctions. Objectives The purpose of this review is to compare the conceptualizations of sexual dysfunctions in DSM-5 and ICD-11. Furthermore, we aim to analyze and discuss advantages and disadvantages of both conceptualizations as well as their consequences for diagnosis, research, and practice. Methods We contrast the conceptualizations of sexual dysfunctions in the two classification systems and examine similarities and differences on the symptom and disorder level. Results In ICD-11, sexual dysfunctions are no longer grouped under mental disorders but rather located in a new chapter called "Conditions related to sexual health". While ICD-11 and DSM-5 have converged significantly in their operationalization of disorder and symptom descriptions, they now differ fundamentally in their approach to the etiology of sexual dysfunction. This is especially due to significant changes in ICD-11: The new inclusive, multifactorial, (regarding the assignment of the diagnosis) non-etiological approach of ICD-11 is opposed by the etiology-driven approach of DSM-5, which aims to define sexual dysfunction exclusively as a psychological disorder. Conclusion Differences in the conceptualization of sexual dysfunction complicate international communication and research collaboration and have significant consequences for clinical practice. Therefore, a uniform classification of sexual dysfunction would be highly desirable. However, due to different priorities and target groups of the World Health Organization and American Psychiatric Association, this does not seem very likely in the future.