PART ONE: Should Sexual Addiction Become A Legitimate Mental Health Diagnosis?
There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma.
Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors.
More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering.
Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.
Lamentably, at the very same time that sexual addiction disorder began its technology generated escalation, the American Psychiatric Association (APA) backed away from the provision of either a diagnostic indicator or a workable diagnosis. Consequently, the past 25 years have wrought a somewhat anguished and inconsistent history in the attempts of the psychiatric, addiction, and mental health communities to accurately label and distinguish the problem of excessive adult consensual sexual behavior.
Today, American outpatient psychotherapists and addiction counselors are reporting a marked increase in the number of clients seeking help with self-reported crises related to problems like “I find myself disappearing for multiple hours daily into online porn” or “I feel lost on a never-ending treadmill of anonymous sexual hook-ups and affairs,” not to mention the tens of thousands who daily struggle with the dopamine-fueled nightmare combination of stimulant (meth/cocaine) abuse fused with intensely problematic sexual behavior patterns.
It would seem that these clinicians and clients would benefit greatly from the guidance the APA and DSM might offer them, but does not currently provide.
Sex Addiction and the DSM: A Brief History
In 1987 the APA’s Statistical Manual of Mental Health Disorders (DSM-III-R) added for the first time the concept of sexual addiction as a specific descriptor that might be applied under the more general diagnosis of “Sexual Disorders NOS (Not Otherwise Specified).” The DSM-III-R then stated this descriptor could be applied if the individual being assessed displayed “distress about a pattern of repeated sexual conquests or other forms of non-paraphillic sexual addiction, involving a succession of people who exist only as things to be used.”
This early DSM descriptor is not inconsistent with language commonly used by clinicians currently treating sex addicts and their spouses, who typically define sexual addiction much as Dr. Patrick Carnes did in the early 1980s: repetitive and problematic compulsive or impulsive sexual behavior patterns involving excessive shame, secrecy and/or abuse to self and/or others. Ruling Out: ego dystonic sexual arousal or behavior patterns directly related to sexual orientation, active fetishes, sexual offending, or major mental health disorders such as the manic stage of a bipolar episode or Obsessive Compulsive Disorder.
Active sex addiction causes relationship, career, legal, emotional and physical health problems, and untreated sex addicts will continue their sexual behaviors despite repeated attempts to limit or eliminate them, even when facing the negative life consequences that inevitably result.
Unfortunately, subsequent and current versions of the DSM (DSM-IV and DSM-IV-TR) retracted the DSM-III-R descriptor due to “insufficient research” and “a lack of expert consensus.” In hindsight, this decision has left the clinical community without adequate criteria for the assessment, diagnosis, and treatment of individuals with problematic consensual adult sexual behavior patterns. And the timing couldn’t be worse.
During this same period the tech-connect boom has dramatically increased the average person’s ability to affordably and anonymously access endless amounts of highly graphic pornography, casual sexual experiences, and online prostitution.
This proliferation of access is causing tremendous problems for many individuals with pre-existing addictive disorders, social inhibition, early trauma, and attachment and mood disorders, along with those who are more profoundly mentally ill – all of which can contribute to long term, profoundly problematic, and repetitive patterns of sexual acting out.
How Does Sex Become an Addiction?
In essence, whenever intensely pleasurable and arousing substances, like cocaine and crystal meth, or experiences, like gambling and sex, become more readily affordable and accessible, the potential for addiction rears its ugly head. This is especially true when these substances or experiences are highly refined and amplified as in the case of newer pharmaceutical drugs and Internet porn.
As our increasing technological interconnectivity has brought with it affordable, easy links to intensely pleasurable sexual content and anonymous sex, addiction and mental health professionals are seeing a corresponding increase in the number of people struggling with sexual and romantic addictions. It’s just that simple.
For reasons as varied as the individual, the increasing availability of intensely absorbing sexual content and experience has become a “drug of choice” for those who abuse sexual intensity and fantasy-based dissociation as a replication of intimacy, and those who use the search for romance and sex to self-regulate challenging emotions as well as tolerate stressors that unconsciously evoke past trauma or abuse. Despite this, The DSM currently provides no guidelines for assessing, diagnosing, and treating those individuals for whom sex has become an obsession.
What Does the Future Hold?
Ironically, at the same time the APA backed away from both defining and providing the research dollars needed to help define addictive sexual behavior, the concept of “sex addiction” has gained widespread media and public acceptance as well as grudging therapeutic legitimacy.
Driven by a combination of media attention, the international rise of 12-Step sexual recovery groups, films and television shows focused on sexual addiction (Shame, Californication, etc.), and the much-publicized problem sexual behaviors of multiple major political and sports figures, the general public appears to have tentatively embraced the concepts of sex addict, porn addict, and romantic and sexual addiction.
Recognizing the need to readdress this issue, the APA has undertaken a review of the topic and is currently considering a potential DSM-5 diagnosis called “Hypersexual Disorder.” While “hypersexual disorder” is not an ideal term for a problem that more accurately involves the lengthy search and pursuit of love and sex rather than the sex act itself, today there seems little doubt that hypersexuality is a legitimate, serious, and not uncommon clinical condition associated with the related concerns of disease transmission, drug and alcohol relapse, family and relationship dysfunction, divorce, mood disorders, unplanned pregnancy, job loss, and even suicide.
Click here for PART TWO on the APA’s current stance on the proposed DSM-5 “Hypersexual Disorder” diagnosis, and how it is likely to be received.
Robert Weiss is the author of three books on sexual addiction and Founding Director of the premiere sex addiction treatment program, The Sexual Recovery Institute. He is Director of Sexual Disorders Services at The Ranch and Promises Treatment Centers. These centers serve individuals seeking sexual addiction treatment, love addiction treatment, and porn addiction help. Specifically, the Centers for Relationship and Sexual Recovery at The Ranch (CRSR) offer specialized intimacy, sex and relationship addiction treatment for both men and women in gender-specific, gender-separate treatment and living environments.
Follow Robert on Twitter @RobWeissMSW
Sexy brunette photo available from Shutterstock.
Weiss LCSW, R. (2012). PART ONE: Should Sexual Addiction Become A Legitimate Mental Health Diagnosis?. Psych Central. Retrieved on October 6, 2015, from http://blogs.psychcentral.com/sex/2012/04/hypersexualitydisorder/