THE SEXUAL ADDICTION DIAGNOSIS:
CLINICAL CONCERN OR
Why create a hypersexual disorder diagnosis? In the finale of his two-part article, Robert Weiss explains how accurate diagnoses can turn round lives and thus the need for formal guidance in diagnostic manuals.
Download AddictionToday138 – Sex addiction pt2
Pre-internet sexual addiction research in the 1980s suggested that about 3-5% of the US adult population struggled with some form of addictive sexual behaviour. The people studied were a self-selected treatment group, mostly male and heterosexual, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, phone sex and similar behaviours. More rigorous, peer reviewed, tier-one research indicates the incidence of sexual addiction is now spiralling up and becoming more evenly distributed among men and women.
Today, outpatient psychotherapists, family counsellors and addiction professionals are noting a marked escalation in the number of clients seeking treatment for “sex addiction”.
This escalation seems to be directly related to the accessibility and affordability of internet-based pornography and anonymous online sexual partnering. People struggling with addictive and impulse-control problems, early-life trauma and attachment or personality-disordered traits can be vulnerable to sexual arousal as a means of emotional dissociation, self-regulation and mood stabilisation.
A well-written Diagnostic & Statistical Manual diagnosis would offer clear, unbiased, research-based diagnostic criteria in an area of psychological controversy and finger-pointing, allowing clinicians to more accurately identify and diagnose people struggling with compulsive, addictive and impulsive sexual disorders. The resulting diagnostic clarity could also help inform practical and expedient treatment planning, be it outpatient, intensive outpatient or residential.
The diagnosis of sexual addiction is not a de facto label applied solely because someone might prefer fetishistic or paraphilic sexual arousal or behaviour such as cross-dressing, BDSM, etc. Ego-dystonic (unwanted) homosexual or bisexual arousal or behaviour is also not sexual addiction. These issues can lead someone to keep sexual secrets, to feel shame or distress, or feel out of control, all of which are sexual addiction symptoms. But sexual addiction is not defined by what or who a person finds arousing – just as alcoholism is not defined by type of drink. Rather, the disorder is defined by self- and other-objectified repetitive patterns of sexual fantasies, urges and behaviour used to self-medicate and/or stabilise emotional distress and other psychological triggers and conditions.
Misdiagnosis can occur when a clinician or therapist correctly recognises the severity of a patient’s out-of-control sexual behaviour but misperceives the causality and incorrectly diagnoses the patient as being in the manic stage of a bipolar episode or having obsessive compulsive, ADD, generalised anxiety or dissociative identity disorder, all of which can manifest with a characteristic sexual component.
WHAT IS THE TREATMENT?
Sexual addiction treatment programmes typically use strategies similar to those that have proven effective in treating substance addictions – high levels of client accountability to a predetermined plan for (sexual) sobriety, along with cognitive behavioural therapy, group therapy, and 12-step support groups. One significant difference lies in the definition of sobriety.
Whereas complete abstinence from mood altering chemicals is typically the goal of drug and alcohol recovery, sexual sobriety involves a long-term commitment to behaviour change but not sexual abstinence. Recovering sex addicts, like people with an eating disorder, define sobriety by agreeing in writing to eliminate sexual behaviours that might compromise important life-goals and relationships. They abide by the guidelines of a clearly stated set of behaviours defining their individual sexual and relationship health.
Sexual-addiction recovery usually presents demands that cannot be met solely in a therapeutic relationship. Recovering sex addicts usually need more external reinforcement and support if they wish to permanently change deeply rooted patterns.
To this end, addiction-focused group therapy is strongly recommended. This facilitated group setting allows patients to see that their problem is not unique, which helps to reduce the shame, self-hatred and guilt often linked with sexual acting-out. The group treatment format is also ideal for confronting denial and rationalisations common in sex addicts.
Those with profound histories of trauma and abuse can benefit from inpatient residential or intensive outpatient treatment programmes specifically for sexual addicts and their spouses.
MEET THE AUTHOR IN NOVEMBER:
Weiss will fly to London in early November to run specialist workshops on Assessment, Treatment & Diagnosis of Sexual Addiction (hypersexual addiction) in the Digital Age. Elements Behavioral Health is subsidising places at only £60 – or £40 for those who attended UKESAD 2012. To reserve your place, browse or email JBentley@promises.com.
ROBERT WEISS LCSW, CSAT-S has written three books on sexual addiction and is expert on the juxtaposition of human sexuality, intimacy, and technology. He is founding director of The Sexual Recovery Institute (www.sexualrecovery.com) and director of Intimacy and Sexual Disorders Services at The Ranch in Tennessee (www.recoveryranch.com) and Promises Treatment Centers ( www.promises.com). He is a social worker, clinical psychotherapist and educator. A media expert for Time, Newsweek and the New York Times, Weiss has featured on CNN, The Today Show, Oprah and ESPN. He is also the sex and intimacy blogger for Psych-Central, an online psychology site (@RobWeissMSW).