There will always be controversy when any form of inherently ‘‘normal’’ human behaviors such as eating, exercise or sexual behavior, become medically ‘‘pathologized’’[1]. To this point, the past 25 years has wrought a troubled and inconsistent history in the attempts of the psychiatric and mental health communities to accurately label and diagnose the problem of “excessive sexual behavior.”

In 1987, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders or DSM-III added the concept of sexual addiction for the first time as, “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.”

Subsequent versions of this same diagnostic manual (DSM IV & DSM IV-TR) first discontinued this terminology primarily due to “insufficient research” and “lack of expert consensus” only to again reintroduce it as a vague and general term called “Sexual Disorders Not Otherwise Specified.” Rather than giving psychotherapists a much needed tool toward diagnosing these types of sexual disorders, the adoption of this (NOS) term actually added to the confusion by being both non-specific and lacking the kinds of concrete symptom descriptors from which all accurate diagnosis are made. This diagnosis was and is a best a half-measure

Interestingly, during this same period of clinical disagreement and disorganization, the concepts of sexual addiction, porn addict, sexual compulsivity etc. all have become part of the popular lexicon, gaining widespread acceptance and even partial therapeutic legitimacy. Among the chief contributors to this change is the work of those professionals who have continued the research and treatment of problem sexual disorders, a technological, Internet-related rise in addictive, compulsive and impulsive sexual problems, along with multiple highly publicized portrayals of famous individuals whose problem patterns of sexual behavior have been heavily exposed by the media.

In addition, thousands of people on a daily basis today attend international 12-step support groups like Sex Addicts Anonymous, Sexaholics Anonymous and Sex and Love Addicts Anonymous, voluntarily working to alleviate their self-diagnosed struggles with problem patterns of addictive non-offending sexual behavior.

An overview of “Hypersexual Disorders” research along with documented evidence of sexual disorders, professionals today indicate that the number of researched and reported ‘‘cases’’ of this problem now greatly exceeds past research and reporting of several sexual disorders already definitively classified in the DSM IV such as Fetishism and Frotteurism[2]. And while the name “Hypersexual Disorder” is not an ideal description of a problem that more accurately involves the lengthy search and pursuit of sex, rather than the act itself, today there seems little doubt that hypersexuality is a legitimate, serious and common clinical condition associated with the related concerns of unplanned pregnancy, relationship dysfunction, separation, divorce, anxiety, depression and sexually transmitted disease.

And yet the question remains whether this upsurge in human hypersexualty research combined with escalating numbers of men and women seeking therapeutic and self-help for these same concerns, will encourage the DSM-V Workgroup on Sexual and Gender Identity Disorders and its chair Dr. Kenneth J. Zucker to include Hypersexual Disorder as a distinct diagnostic category in the upcoming DSM 5.

Details of the proposed Hypersexual Disorder diagnosis for the DSM 5 can be found below.[3] If included in the DSM 5, the diagnosis will not add to our tax burden nor raise our health insurance rates – as mental health coverage today rarely includes the treatment of any sexual disorder. However, if and when a legitimate clinical name and description is provided for those who struggle with compulsive, addictive and impulsive sexual disorders, it will go a long way toward removing the same kinds of shameful ethical and moral stigma previously applied to alcoholics, drug addicts and compulsive gamblers before those concerns were fully recognized as treatable mental health disorders.

Let us not forget that prior to proper diagnosis and treatment planning- Alcoholics were simply bums, and compulsive gamblers considered as men and women too sociopathic to not gamble away the family rent money. Perhaps by placing Hypersexuailty into the DSM V, we can begin to replace words like nympho and pervert with a diagnostic category, which is today both well-understood and highly amenable to proper treatment.

Proposed diagnostic criteria for Hypersexual Disorder[4]

A. Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria:

A1. Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.

A2. Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).

A3. Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events.

A4. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.

A5. Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.

B. There is 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.

C. These sexual fantasies, urges or behaviors are not due to the direct physiological effect of an exogenous substance (e.g., a drug of abuse or a medication).

Specify if: Masturbation, Pornography, Sexual Behavior with Consenting Adults, Cybersex, Telephone Sex, Strip Clubs, Other

[1] Much of the detail of this blog was made possible through the use of Dr. Martin P. Kafka’s excellent paper: Hypersexual Disorder: A Proposed Diagnosis for DSM-V Archives of Sexual Behavior: 2009

[2] Ibid

[3] Reprinted from the Diagnostic and Statistical Manual of Mental Disorders V Workgroup Reports (Copyright 2009), American Psychiatric Association.

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Photo by Valerie Everett, available under a Creative Commons attribution license.