With the new language, Baldwin says, he quickly realized that laws regarding alternative sexual behavior would continue to be problematic “as long as the psychiatric community defines these behaviors as pathological.”

“I knew there were therapists around the world diagnosing practicing consensual sadomasochists with mental illness,” he says.

At the time that the new DSM was published, Baldwin and Bannon were planning to attend the 1987 march on Washington, D.C., in support of gay rights; after the new criteria came out, they decided to host a panel discussion for mental-health professionals in the State Department auditorium, where they announced the launch of what would come to be known as “The DSM Revision Project.”

“We asked how many people in the room were mental-health professionals,” Baldwin says, and “two-thirds of the people in the room raised their hands. And we said, ‘The way this needs to happen is, licensed mental-health practitioners need to write the DSM committee that reviews the language of the DSM concerned with paraphilias.’”

Around 40 or 50 people left the session with the information needed to write the letters. “We did not know exactly what would result,” Bannon recalls. “We did not think we would see dramatic changes suddenly.”

They didn’t—but the changes they did see were positive. The next edition of the DSM, published in 1994, added that to be considered part of a mental illness, "fantasies, sexual urges, or behaviors" must "cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.”

“This was a definite improvement from the DSM-III-R,” says Wright, who later took over leadership of the DSM Revision Project from Bannon and Baldwin.

“These criteria gave [health professionals] wiggle room to say, ‘They have issues, but it is not about their kink. For the vast majority, it is just the way they have sex,’” Bannon explains. “Rather than saying, ‘Because you are into this method of sexuality, you are sick,’ [they could say], ‘Pathologically, if this impacts your life negatively, then you have a problem.’”

But the new language in the 1994 DSM also allowed for wiggle room of a different kind: The threshold of “significant distress” was often loosely interpreted, with the social stigma of kink, rather than kink itself, causing the negative impact on people’s lives. Workplace discrimination and violence were on the rise, according to a 2008 NCSF survey, and people were still being declared unfit parents as a result of their sexual preferences: Eighty of the 100 people who turned to the NCSF for legal assistance in custody battles from 1997-2010 lost their cases.

A few years after the 1994 DSM was published, Wright decided it was time to fight for another revision. When she founded the organization in 1997, the NCSF’s goal was a change to the APA’s diagnostic codes that separated the behavior (e.g., “he likes to restrict his breathing during sex”) from the diagnosis (e.g., “his desire to restrict his breath means that he must be mentally ill”). The next DSM, the group argued, should split the paraphilias from the paraphilic disorders, so that simply enjoying consensual BDSM would not be considered indicative of an illness.