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Finally, an Official Diagnosis for Compulsive Sexual Behavior Disorder (Sex Addiction)

It’s been a long time coming, but the World Health Organization has formally adopted the ICD-11, the latest revision of its diagnostic manual. The manual does not officially take effect until January of 2022, but the announcement of its forthcoming implementation, including a number of significant revisions, is already impacting the mental health field.

One of the more noteworthy changes is the long-overdue addition of a Compulsive Sexual Behavior Disorder diagnosis. Though the diagnosis does not officially go into effect until 2022, and though most mental health providers in the U.S. utilize the American Psychological Association’s DSM-5 more often than the World Health Organization’s ICD, the development is nonetheless significant, especially in light of the APA’s relatively recent decision to willfully ignore the current sex/porn addiction epidemic.

In case you’re wondering, the ICD-11 Compulsive Sexual Behavior Disorder diagnosis (6C72) reads as follows:

Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. 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 behavior; and continued repetitive sexual behavior 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 behavior 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 behaviors is not sufficient to meet this requirement.

This description meshes nicely with the criteria Certified Sex Addiction Therapists (CSATs) have been using for many years to identify and diagnose sex/porn addiction. The short version of those criteria reads as follows:

  1. Preoccupation to the point of obsession with sex/porn
  2. Loss of control over sex/porn behavior, best evidenced by multiple failed attempts to quit or cut back
  3. Directly related negative life consequences

So, why is the ICD-11 diagnosis so important? It’s important because, as stated above, the American Psychiatric Association chose to completely and rather willfully ignore 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 confused about diagnosing and treating the disorder, and countless recovering sex/porn addicts struggling to get insurance reimbursement.

The only explanation given by the APA regarding this decision appears in their introduction to the Addictive Disorders Section of the DSM-5, where 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, they 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 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 even 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 male 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. Hopefully, the APA will soon follow suit.

With adoption and implementation of the ICD-11 in January of 2022, there may still be a small amount of debate in the clinical community about whether the issue should be referred to as a compulsive/impulsive behavior or an addiction, but otherwise the decades-long debate about sexual compulsivity/addiction seems pretty well over. 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 issue. And finally, with the ICD-11, we can.

For more information about sex and porn addiction (and paired sexual behaviors with substance abuse) visit SexandRelationshipHealing.com. Information about treatment for these issues can be found at SeekingIntegrity.com.

Finally, an Official Diagnosis for Compulsive Sexual Behavior Disorder (Sex Addiction)


Robert Weiss PhD, MSW

Robert Weiss PhD, MSW is an expert in the treatment of adult intimacy disorders and related addictions, most notably sex/porn/relationship addictions along with co-occurring drug/sex addiction. A clinical sexologist and practicing psychotherapist, Dr. Rob frequently serves as a subject matter expert for major media outlets including CNN, HLN, MSNBC, OWN, The New York Times, The Los Angeles Times, and NPR, among others. Dr. Rob is the author of Prodependence: Moving Beyond Codependency, Out of the Doghouse, Sex Addiction 101, and Cruise Control, among other books. He blogs regularly for Psychology Today and Psych Central. His podcast, Sex, Love, & Addiction, is rated as a Top 10 Addiction Podcast for 2019. He also hosts a weekly live no cost Webinar with Q&A on SexandRelationshipHealing.com. A skilled clinical educator, Dr. Rob routinely provides training to therapists, hospitals, psychiatric organizations, and even the US military. Over the years, he has created and overseen nearly a dozen high-end addiction and mental health treatment facilities across the globe. For more information or to reach Dr. Rob, visit SeekingIntegrity.com. You can also follow him on Twitter (@RobWeissMSW), LinkedIn (Robert Weiss LCSW), and Facebook (Rob Weiss MSW).


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APA Reference
Weiss PhD, R. (2019). Finally, an Official Diagnosis for Compulsive Sexual Behavior Disorder (Sex Addiction). Psych Central. Retrieved on July 22, 2019, from https://blogs.psychcentral.com/sex/2019/07/finally-an-official-diagnosis-for-compulsive-sexual-behavior-disorder-sex-addiction/

 

Last updated: 3 Jul 2019
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