THE SEXUAL ADDICTION DIAGNOSIS:
CLINICAL CONCERN OR PATHOLOGISING DIVERSITY?
Sexual addiction, or hypersexual disorder, looks set to be formally recognised in the 2013 Diagnostic & Statistical Manual of psychiatric disorders. Robert Weiss gives an introduction in July issue of Addiction Today journal – to be followed by a more indepth explanation in the next issue and a workshop in London in November.
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Is sex addiction real? There will always be controversy – as there should be – when any forms of inherently healthy human behaviour such as eating, sleeping or sex are clinically designated as pathological. The power to “label” should avoid turning social, religious or moral judgments into diagnoses – as was homosexuality in the DSM-I and DSM-II Diagnostic & Statistical Manuals.
But equal care must be taken to consider, research and even create diagnostic criteria to address situations where otherwise-healthy behaviours have gone awry, due to underlying psychological deficits and past trauma.
Let us briefly counter popular myth. A sexual addiction diagnosis is not determined by what turns someone on (such as fetish behaviour or polyamory), nor is it defined by who turns someone on (man or woman, transgender, younger, older, etc). It is also not derived from any specific moral, cultural or religious compass. And it is not solely a men’s issue, gay or straight.
Sexual addiction is diagnosed by repetitive patterns of problematic sexual behaviour in both men and women, over which s/he appears to have lost control. These sexual behaviour patterns cause deeply negative consequences in the lives of those acting them out and loved ones, but they disregard these risks as sexual acting out becomes an increasing priority. These problem sexual behaviour patterns continue despite attempts to stop or change them, regardless of related life consequences of broken relationships, disease transmission or arrest.
Sex addicts live with the constant threat of health, career and life goals lost to consistent, secretive sexual acting-out. Like drug addicts, compulsive overeaters or gamblers, sex addicts will lose choice over their sexual decision-making.
WHY ACT OUT WITH SEX?
For reasons as varied as individuals, addictive sexual behaviour is a neurobiologically-based drug of choice for emotionally-challenged people who abuse sexual intensity and fantasy-based dissociation as a means of emotional regulation.
These intellectually intact, but often emotionally bereft, people use planning and sexual ritual to experience what might be termed “controllable intimacy” (prostitutes, abusing porn, seeing prostitutes, having multiple affairs), situations offering a temporary illusion of meeting emotional needs without risking rejection, criticism or abandonment – implicit to all truly intimate social and intimate partnerships.
Some sex addicts also use sexual fantasy and the sex itself as a means to self-regulate – gain control over – unconscious triggers to early abuse, violation and neglect.
WHAT DOES THE FUTURE HOLD?
Over the past 20 years the concept of “sex addiction” has gained widespread media and public acceptance as well as grudging therapeutic legitimacy. Driven by a combination of media attention, the international rise of 12-step sexual recovery groups, film depictions (Shame, I am a Sex Addict, etc), along with much-publicised problem sexual behaviours of major international political and sports figures, the public appears to have tentatively embraced the concept.
Recognising the need to address this issue, the American Psychiatric Association compiled an exhaustive literature review – shout out to Dr Marty Kafka of Harvard for his dedicated efforts – toward a potential DSM-5 Hypersexual Disorder diagnosis (2013). It might surprise some reading the diagnosis to find the focus of the problem relating as much to sexual urges and fantasy as to the sexual act itself. The proposed behaviour specifiers are intended to integrate empirically based contributions from many perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.
Part two of this article will review the need for a formal Hypersexual Disorder diagnosis, address related diagnostic myths and misunderstandings and discuss sexual addiction treatment.
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).