According to the Asexual Visibility & Education Network (AVEN), one of the most popular and influential advocacy and educational online networks of the asexual community, asexuality is defined as a sexual orientation, where the individual "does not experience sexual attraction or an intrinsic desire to have sexual relationships". In contrast, according to the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5), people with Female Sexual Interest/Arousal Disorder experience "lack of, or significantly reduced, sexual interest/arousal", while those with Male Hypoactive Sexual Desire Disorder experience "persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity", and the condition causes "clinical significant distress in the individual".
Hinderliter (2013) gave a detailed review on how the concept "Asexuality" evolved and contrasted it with Hypoactive Sexual Desire Disorder (HSDD), a diagnostic category in previous versions of DSM. I'd like to highlight a few points raised by Hinderliter:
HSDD is a concept originated from "medicine, sex therapy and various traditions of psychotherapy", whereas Asexuality was largely constructed in online forums and discussion groups by those identifying themselves as asexuals .
HSDD is a condition diagnosed by a clinician, whereas asexuality community has "a built-in suspicion of 'expert' knowledge being used in ways seen as invalidating the experiences of asexuals, especially ones doing so with medicalisation / pathologisation". AVEN strongly insists that only one can decide for oneself if one is asexual or not.
HSDD is a pathological condition, whereas asexuality is positioned as a sexual orientation so that people are encouraged "to think about asexuality with terms similar to other non-heterosexual sexual orientations ... such as the importance of acceptance, understanding, respect, not assuming pathology, not trying to change sexual orientations, etc.". In addition, asexuality was constructed as an identity so that asexual people find it helpful in "making sense of their lives and navigating relationships".
Asexuality includes people who do or feel things often considered 'sexual' by non-asexuals, such as masturbation. They do experience arousal (or "libido"), but they believe that "it is not associated with a desire to find a sexual partner or partners... Some may occasionally masturbate, but feel no desire for partnered sex" (quoted from AVEN website).
AVEN believes that romantic attraction and sexual attraction are two different things, and can be separated. Asexual people may experience attraction that can be "romantic, aesthetic, or sensual in nature (such as cuddling, hugging, or kissing) but do not lead to a need to act out on that attraction sexually" (quoted from AVEN website). In other words, they consider that behaviour, such as cuddling, hugging, or kissing, can be non-sexual in nature.
In other words, while HSDD is concerned about sexual interest / desire / arousal, Asexuality is defined by the subjective experience of sexual attraction towards other people, but not arousal or behaviour.
It is not uncommon for a client to seek Clinical Psychology opinion if he/she is asexual. It follows from the AVEN's viewpoint that it may be "politically incorrect" to tell the person if he/she is asexual. I think "asexuality" is an identity, and the client should be educated about the fact that it is NOT a psychiatric / psychological construct. Nevertheless, a person who experiences reduced or lack of sexual interest or desire may be torn between if it is "normal" as how asexual people view their experience, and if it is a condition that the person can do something to change it. The DSM criterion regarding significant distress may provide a way out, but it is again very subjective in judging what level of distress is significant in many cases. After all, who does not experience distress before accepting who he/she is? In addition, it is intriguing to conceptualize a condition as pathological when it is significantly stressful, and it becomes normal when the person does not find it stressful. It is hence not unreasonable to deal with the problem with relation therapy if the distress is caused by the non-acceptance or complaints of the individual's partner(s), or with social advocacy if the distress is caused by the non-acceptance of the community as a whole.
Whether asexality is a sexual orientation is another highly controversial issue, which involves issues such as, what sexual orientation is (or if it exists at all), and the lack of empirical studies in asexuality. I try to avoid dwelling on this at the moment. I'd take asexuality as an identity, so as to make working with these clients easier. Perhaps, the challenge to a Clinical Psychologist is to work with the clients to go through their experiences and to find out whether they want to change it or not. I must say that there is no simple answer. I think the most difficult part is to discuss the meaning of sexual arousal and behaviour, particularly whether they mean "sexual" to the individual. Moreover, even a person who takes up the identity of an asexual does not mean zero distress and no difficulty in their experiences as an asexual. An individual may take up an identity of a "vegetarian", "ovo-vegetarians", or "vegans". There is no problem in these identities but it does not necessarily preclude other problems, such as, nutritional balance, weight management or eating disorders (I do not mean that vegetarians are prone to these problems; these issues just exist in every population).
It's pride month in June. While everyone is talking about LGBTIQ, maybe it is worth thinking if we could talk about LGBTIQA as well?
Reference:
Hinderliter, A. (2013). How is asexuality different from hypoactive sexual desire disorder. Psychology & Sexuality, 4(2), 167-178.