Stigma and shame are part of the same process. In a way stigma is shame. It is attributing something shameful to the sex addict. And the sex addict obliges by feeling ashamed and keeping their addiction a secret.
“Stigma erodes confidence that mental disorders are real, treatable health conditions” (National Alliance on Mental Illness).
By the same token affirming that something is a real, treatable disorder begins to break down the tendency of people to stigmatize the condition and empowers people to seek help.
The psychiatric community which effectively legislates what is and isn’t a real, treatable disorder has been hesitant to designate sex addiction as a real mental disorder, even though other similar behavioral compulsions are included.
The new findings
The recent report of the findings of the DSM-5 (Diagnostic and Statistical manual) field trial for Hypersexual Disorder showed that
“…the criteria for HD [hypersexual disorder] accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness as well as good internal consistency.”
What this means is that the proposed criteria for a new diagnosis of “hypersexual disorder” accurately differentiated a group of people being treated for sex addiction from everyone else. It described what these sex addicts were exhibiting and it did so in a way that was reliable (consistent) and valid (distinct from other kinds of related problems.)
Whether this new diagnosis of Hypersexual Disorder will be included in the upcoming DSM-5 is still uncertain. But allowing “Hypersexual Disorder” to take its place next to “Eating Disorders” and “Pathological Gambling” (both already included in the DSM-IV) would be a big step.
Stigma and fear
I have argued previously that overcoming the stigma associated with sex addiction is a familiar developmental process of confronting diseases like alcoholism, and that it begins with demonization, proceeds to criminalization and then to medicalization.
People who are uncomfortable with sexuality in some way may be unconsciously acting to ridicule or blame sex addicts, to push them away and above all to not “let them off the hook.” Other people who carry some shame themselves or are afraid of being shamed for their sexuality may want to deny the disorder so as to see it as “normal.”
But some professionals such as David Ley have taken very strong stands on the issue. They argue that there is no evidence for sex addiction as a real mental disorder and that we are in danger of making everything into an addiction. Often the arguments attack (i.e. shame) fellow professionals as creating an illness so that they can profit from treating it.
The comparison with homosexuality as a “disease”
Homosexuality used to be classified as a mental disorder in the DSM until it was removed in 1973. Now “treating,” or attempting to “cure” homosexuality is under attack. “Conversion therapy” or “reparative therapy” as it is sometimes called is illegal with teens in California and a similar bill has been introduced in Pennsylvania.
The difference is this: as awareness grew and stigma diminished around gayness, people felt less and less interested in getting themselves or their loved ones “cured” of being gay.
With sex addiction the opposite is likely to be the case. The people who actually experience sex addiction are in distress. They are suffering adverse consequences such as losing their spouse, neglecting their work, contracting STDs or going broke. These are not the result of stigma, stigma just adds insult to injury, much as it used to do with alcoholism or mental illness generally.
To the extent that the disorder begins to be accepted as real, stigma will be reduced the shame around compulsive sexual behavior will be diminished. This will make it possible for more people to open up about their problem and go for help.