What is “Hypersexual Disorder”?
The American Psychiatric Association (APA), recognizing the increasing public and clinical acceptance of the concept of sexual addiction, has requested and received extensive Tier 1, peer reviewed research data, along with an exhaustive literature review (Shout out to Dr. Marty Kafka of Harvard!) toward its consideration of a potential DSM-5 Hypsersexuality Disorder diagnosis.
While “Hypersexual Disorder” may not be the ideal term for a problem that more accurately involves the lengthy search and pursuit of sexual and romantic intensity rather than just the sex act itself, the proposed criteria as written do point to problem patterns of excessive fantasy and urges that mirror most aspects of what we have come to know more commonly as “sexual addiction.”
The proposed criteria for Hypersexual Disorder for the DSM-5 read as follows:
- Over a period of at least 6 months, recurrent or intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria:
- Time consumed by sexual fantasies, urges, or behaviors repetitively interferes with other important (non-sexual) goals, activities, and obligations.
- Repetitively engaging in sexual fantasies, urges, or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).
- Repetitively engaging in sexual fantasies, urges, or behaviors in response to stressful life events.
- Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, or behaviors.
- Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.
- 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.
- 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:
- Sexual Behavior with Consenting Adults
- Telephone Sex
- Strip Clubs
- Other: examples, prostitutes, strip clubs/adult bookstores
Thus, hypersexuality is conceptualized as a non-paraphilic sexual desire disorder with an impulsivity component. The proposed behavior specifiers are intended to integrate empirically based contributions from numerous perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.
Will the APA Add Hypersexual Disorder to the DSM-5?
Documented evidence increasingly points toward Hypersexuality Disorder/sexual addiction being a legitimate, serious, and not uncommon clinical condition associated with the related concerns of disease transmission, family and relationship dysfunction, separation, divorce, anxiety, unplanned pregnancy, mood disorders, job loss, and even suicide. Therefore it makes sense that a diagnosis should be imminent and forthcoming.
Yet despite the escalating numbers of men and women now seeking both clinical and self-help support in an effort to alter self-reported patterns of out-of-control sexual behavior, it seems unlikely that the DSM-5 Workgroup of Sexual and Gender Identity Disorders will include Hypersexual Disorder as a distinct diagnostic category in the upcoming DSM-5.
As evidenced by the 2010 reduction of previously available research funding on this topic, the APA currently appears to lack the political will to push forward a definitive diagnosis of addictive sexual behavior. And, to be fair, it must also be acknowledged that the current research literature on hypersexuality/sexual addiction is absent of the standards currently utilized to identify an addictive disorder, as peer reviewed, validated research is still lacking in the areas of tolerance and withdrawal – both of which are required to meet all the necessary criteria toward an addictive disorder diagnosis.
If Not Now, Then What?
A current review of Hypersexual Disorder research, along with documented evidence offered by treatment providers, demonstrates that the number of researched and reported cases of sexual addiction (as outlined above in the suggested DSM-5 definition), now greatly exceeds the number of researched and reported cases of several other sexual disorders already classified as DSM diagnoses, such as fetishism and frotteurism.
These other disorders, placed in the DSM when standards for inclusion were slightly looser, seem to be grandfathered in, for lack of a better term. That is not to say these aren’t legitimate diagnoses, just that hypersexuality as a diagnosis is being held to a higher standard than its sexual disorder predecessors.
Today it seems most likely that the proposed Hypersexual Disorder diagnosis will be placed in the DSM’s appendix under “potential diagnoses requiring further research.” And while this action feels a bit like “too little, too late” to provide guidance for those treatment providers whose clients are seeking help now, it is nevertheless meaningful, as being a documented “potential diagnosis” in the DSM 5 appendix will bring both intensified research and a likely increase in much needed research funding.
Why Do We Need a Formal Diagnosis?
What a DSM diagnosis would do is help clinicians to clearly identify individuals who struggle with compulsive, addictive, and impulsive sexual disorders, diagnose them properly, and direct them toward useful, accurately planned models of treatment. Furthermore, adding Hypersexual Disorder to the DSM-5 would go a long way toward removing the same kinds of moral stigma previously applied to alcoholics, drug addicts, and compulsive gamblers before those concerns were fully recognized as treatable addictions and legitimate disorders.
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.
It should be noted that the proposed Hypersexual Disorder diagnosis, were it included in the DSM-5, 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. Hypersexuality as a diagnostic criteria 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.
Whether we call it Hypersexual Disorder or sexual addiction, the problem itself has never been an excuse for bad behavior, nor is it a fun pastime. Sexual addicts are absolutely responsible for the hurt and loss left in the wake of their sexual acting out, but their addiction does not make them bad or unworthy people. With a diagnosis, we will have a useful retort to those emotionally and psychologically damaging terms such as nympho, slut, and pervert, replacing them with a legitimate, informed diagnostic category from which useful treatment planning and outcome studies can then be drawn.
 Kafka MP, Hypersexual Disorder: a proposed diagnosis for DSM-5. Arch Sex Behav 2010 Apr; 39:377-400.