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It’s Official: Compulsive Sexual Behavior (Sex Addiction) Gets a Diagnosis

At some point in 2018, the World Health Organization will release the latest version of its International Classification of Diseases (the ICD-11). Rumors suggest the book will publish over the summer, but the WHO’s official statement only says, “the final ICD-11 will be released in 2018.” Thus, it could be any time between now and the end of the year.

If you’re unfamiliar with the ICD and its importance, I’ll simply say that it’s the primary diagnostic manual for medical and psychological disorders in every nation other than the United States. Here, we tend to rely on the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (the DSM) for mental health and addiction focused diagnoses. But pretty much everyone else on the planet uses the ICD.

More importantly, it’s usually the ICD rather than the DSM that leads the way in terms of recognizing current issues in society and mental health treatment. The WHO and the APA do, however, try to remain in sync. If one organization (usually the WHO) makes a change, the other (usually the APA) follows suit. Moreover, the ICD rather than the DSM is the maker and keeper of diagnostic codes. The DSM piggy-backs the ICD in this and most other respects.

So, why is this so important? It’s important because the APA completely ignored compulsive/addictive sexual behavior in its most recent update to the DSM (the DSM-5), despite an APA commissioned position paper by Harvard’s Dr. Martin Kafka recommending inclusion. This left many clinicians in the United States confused about diagnosing and treating this very real disorder, with countless thousands of clients struggling to get insurance reimbursement. (Yes, there are viable “work-around” options, but the criteria for those options are largely unrelated to the benchmarks used by Certified Sex Addiction Therapists (CSATs) when identifying and treating compulsive/addictive sexual behaviors.

The only explanation given by the APA regarding their decision is “lack of supportive research.” In their introduction to the Addictive Disorders Section of the DSM-5 they write:

[Groups] of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction,” “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.

With this, the APA completely ignored Kafka’s position paper, in which he wrote, “The number of cases of hypersexual disorder reported in the peer-reviewed journals greatly exceeds the number of cases of some of the codified paraphilic disorders, such as fetishism and frotteurism.” Moreover, since the APA’s decision was made, we’ve seen a significant amount of new research focused on and supporting the concept of compulsive sexual behavior as an identifiable and treatable psychological disorder. So the APA’s “lack of supportive” research statement holds less water now than before. Consider, for instance, the following:

  • A study testing the efficacy of Dr. Kafka’s proposed diagnostic criteria, as delineated in his position paper, found the criteria to be accurate and well thought out, more so in fact that most other DSM diagnostic criteria.
  • A study identified both classic and contemporary forms of sexual addiction, especially in regard to porn addiction.
  • A brain activation study looking at neurobiological responses to sexually explicit materials found that in self-identified sex addicts (but not in a control group) this activation mirrored that of drug addicts who are exposed to drug-related stimuli.
  • An attentional bias study focused on sexually explicit cues found significant parallels among self-identified sex addicts and drug addicts.
  • A study looking at risk factors for problematic online sexual activity found that the characteristics and motives of sex addicts tend to parallel the characteristics and motives of substance abusers and other addicts.
  • A study of male porn users found that men who are clinically and/or self-identified as porn addicts tend to be preoccupied to the point of obsession, to be out of control (typically evidenced by failed attempts to quit or cut back), and to experience directly related consequences—the same issues that we see with other addictions.
  • A study looking at porn usage found that negative life consequences are far more predictive of treatment-seeking than the amount of porn being looked at—yet another parallel with other addictions.

Unlike the APA, the WHO has examined the existing research and decided that compulsive sexual behavior (or sex addiction, or sexual compulsivity, or out of control sexual behavior, or hypersexuality, or whatever else you choose to call it) is of genuine concern and thus deserving of a formal, criteria-based diagnosis. The WHO is choosing to call the issue Compulsive Sexual Behaviour Disorder, with an ICD code of 6C72. The ICD-11 description reads:

Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.

With publication of the ICD-11, there may be a small amount of debate about whether the issue should be referred to as a compulsive behavior or an addiction, but otherwise the matter finally seems pretty well settled. And, as I and other advocates of an official diagnosis have stated for several years, who cares what we call it? Pick any label you like, as long as we, as clinicians, can effectively diagnose and treat the people who are dealing with this debilitating disorder.

So, will the wall of ignorance and political infighting that currently splits the sexual health field crumble anytime soon? Probably not. Sex addiction deniers have been digging their heels in for decades, more deeply than ever in the past few years, and they’re not likely to willingly relent—even in the face of mounting scientific and clinical evidence and a forthcoming diagnosis in the ICD-11. That said, the WHO’s forward-thinking stance will eventually take root with the APA and in the DSM, as it inevitably does when the WHO makes a change to the ICD. In the interim, those of us who regularly treat sex and intimacy disorders have another very useful tool in the arsenal.

 

It’s Official: Compulsive Sexual Behavior (Sex Addiction) Gets a Diagnosis

Robert Weiss LCSW, CSAT-S

Robert Weiss LCSW, CSAT-S is a digital-age intimacy and relationships expert specializing in infidelity and addictions—most notably sex, porn, and love addiction. An internationally acknowledged clinician, he frequently serves as a subject expert on human sexuality for multiple media outlets including CNN, HLN, MSNBC, The Oprah Winfrey Network, The New York Times, The Los Angeles Times, and NPR, among others. He is the author of several highly regarded books, including “Out of the Doghouse: A Step-by-Step Relationship-Saving Guide for Men Caught Cheating,” “Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction,” “Sex Addiction 101: The Workbook,” and “Cruise Control: Understanding Sex Addiction in Gay Men.” He blogs regularly for Psychology Today, Huffington Post, and Psych Central. A skilled clinical educator, he routinely provides training to therapists, the US military, hospitals, and psychiatric centers in the US and abroad. Over the years, he has created and overseen more than a dozen high-end addiction and mental health treatment facilities. Currently, he is CEO of Seeking Integrity, LLC, being developed as an online resource for recovery from infidelity and sexual addiction. For more information or to reach Mr. Weiss, please visit his website, robertweissmsw.com, or follow him on Twitter, @RobWeissMSW.


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APA Reference
Weiss LCSW, R. (2018). It’s Official: Compulsive Sexual Behavior (Sex Addiction) Gets a Diagnosis. Psych Central. Retrieved on October 21, 2018, from https://blogs.psychcentral.com/sex/2018/05/its-official-compulsive-sexual-behavior-sex-addiction-gets-a-diagnosis/

 

Last updated: 21 May 2018
Last reviewed: By John M. Grohol, Psy.D. on 21 May 2018
Published on PsychCentral.com. All rights reserved.