Sexual addiction is among the most hotly debated topics in the psychiatric community. Does it exist? If so, how do we define it? What should we call it? And does it belong in the Diagnostic and Statistical Manual of Mental Disorders (DSM) -- the "diagnostic bible" for psychological disorders?
Needless to say, there is always controversy if and when any form of inherently-healthy human behavior (eating, sleeping, sex, etc.) is clinically designated as pathological, and rightfully so. The power to "label" must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as happened with homosexuality in early versions of the DSM). However, equal care must be taken to not avoid researching and creating diagnostic criteria for such behaviors when they do go awry.
Having spent 20-plus years treating, writing about, and coming to understand individuals with self-reported addictive and compulsive sexual fantasies and behaviors, I can assure you the time has come -- in fact, is overdue -- for the American Psychiatric Association to recognize this problem as a legitimate disorder by including it in the DSM.
We're getting closer to a diagnosis. Dr. Marty Kafka of Harvard has proposed to the DSM Workgroup of Sexual and Gender Identity Disorders a "Hypersexual Disorder" (aka sexual addiction) definition based on decades of tier one, peer-reviewed clinical research.
Furthermore, a recent nationwide study ("Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder," Journal of Sexual Medicine) indicates Dr. Kafka's proposed criteria are well thought out and effective in terms of diagnosing and potentially treating this affliction.
The simple fact is we now have criteria that can be used to accurately identify and treat those with hypersexual disorder -- provided the APA is willing to adopt the definition.
Despite the results of the recent study, a number of quite valid questions continue to be asked by both clinicians and the lay population. Chief among these is: How much sex must one have for it to be considered sexual addiction?
Of course, in the addiction field this is like asking how many drinks it takes to become an alcoholic or how many card games makes a compulsive gambler. There simply isn't a set amount.
Hypersexual Disorder -- like alcoholism and other addictions -- is not defined by the degree of consumption; instead, it is defined by how that consumption is affecting the person's life and functionality. Questions that more accurately identify addiction (both substance and behavioral) center on concepts such as: loss of control over the substance or behavior, repeated failed attempts to stop using the substance or behavior, and negative life consequences brought on by the substance or behavior. As such, X amount of much drug use or Y amount of behavioral "acting out" may qualify one individual for an addiction diagnosis, while another person might simply be engaged in "recreation."
Wisely, Dr. Kafka's proposed DSM-5 Hypersexual Disorder definition takes this into account, requiring, among other things, "clinically significant personal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, or behaviors."
Another commonly-posed question is: Does hypersexuality deserve a place in the same book that defines debilitating afflictions like depression or schizophrenia?
My answer is an unqualified yes.
As the UCLA-led study shows (among many other such studies), Hypersexual Disorder is a serious issue. How many people who "knew better" nonetheless became HIV-positive related to their addictive sexual behavior patterns? How many people have relapsed into stimulant and other drug addictions related to their hypersexual activity? How many sex addiction-related divorces, career losses, arrests, and emotional and physical health challenges does one need to validate a diagnosis? And are these not the same basic consequences that arise with mood disorders, delusional disorders, and other addictions? The fact that sex is involved doesn't make the affliction any less valid.
In my work at treatment facilities like The Ranch in Tennessee and the Sexual Recovery Institute in Los Angeles (which served as the primary research site for the UCLA-led study), I have worked with thousands of men and women whose early trauma experiences and social, emotional, and intimacy deficits have left them repeatedly seeking sexual intensity as a substitute for emotional self-regulation and the comfort of genuine human connection, and I have seen the devastating damage their compulsive sexual fantasy/behavior has wrought.
It should be noted that the proposed Hypersexual Disorder diagnosis, if it is included in the forthcoming DSM-5 (to be published in the spring of 2013), would neither add to our nation's tax burden nor raise health insurance rates, as most mental health coverage already excludes psychological treatment for sexual issues. Nor would the diagnosis "take off the hook" or give "excuses for bad behavior" to those men and women whose sexual activities have caused harm to self, loved ones, and family. Hypersexual Disorder also will not and was never intended to provide sexual offenders an easy way out of the consequences (legal and otherwise) for their non-consensual, violating sexual patterns. What a DSM-5 diagnosis would do is help clinicians to clearly identify individuals who struggle with addictive sexual behaviors, diagnose them properly, and direct them toward useful, effective, accurately planned models of treatment.
Let us not forget that prior to proper diagnosis and treatment planning, alcoholics were simply bums, overeaters were fat and lazy, and compulsive gamblers were too sociopathic to not gamble away the family rent. With a proper sex addiction diagnosis, we will finally have a useful retort to emotionally and psychologically damaging terms such as nympho, slut, and pervert -- replacing them with a legitimate, informed diagnostic category from which useful treatment planning can be drawn.
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Robert Weiss LCSW, CSAT-S is the author of three books on sexual addiction and an expert on the juxtaposition of human sexuality, intimacy, and technology. He is founding director of The Sexual Recovery Institute and Director of Intimacy and Sexual Disorders Services at The Ranch and Promises Treatment Centers. Mr. Weiss is a clinical psychotherapist and educator. He has provided sexual addiction treatment training internationally for psychology professionals, addiction treatment centers, and the U.S. military. A media expert for Time, Newsweek, and the New York Times, Mr. Weiss has been featured on CNN, The Today Show, Oprah, and ESPN among many others. Rob can also be found on Twitter at @RobWeissMSW.
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