Is sex addiction a real disorder— or just an excuse for bad behavior?
The condition—now labeled “hypersexual disorder”— is up for consideration as a diagnosis to be included as a research topic in the next edition of psychiatry’s diagnostic manual, the DSM-5. A new study provides support for its inclusion.
In a paper published in the Journal of Sexual Medicine researchers studied 207 people who had visited outpatient clinics and reported problematic sexual behavior. The clinics offered either specific counseling and treatment for sexual addiction or more general treatment for drug addiction or psychiatric problems. The participants were randomly selected among those seeking admission whose problems included at least some compulsive sexual behavior.
The authors used the criteria proposed for DSM-5 to make the diagnosis. So for at least six months, a person must suffer from a preoccupation with sex or sexual fantasies and repeatedly engage in related behaviors to the point where it risks causing harm and significantly impairs normal functioning in work and relationships. In addition, the behavior must occur not just while the person is drunk or high, and the potentially addicted person should have tried and failed repeatedly to change their behavior without success. The compulsive behavior must also occur either in response to stress or negative emotional experiences or both.
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That rules out the average case of cheating, primarily because it isn’t associated with such repetitive, compulsive behavior. “[C]ommon behaviors such as brief sexual encounters with unfamiliar partners, multiple [adulterous] affairs or frequent pornography consumption do not satisfy the symptom criteria unless they are concurrently associated with a broader spectrum of pathological expression for a period of at least 6 months,” the authors write.
In fact, only one of the 20 people who sought help primarily for drug addiction also turned out to have hypersexual disorder — and only three of those who sought psychiatric care for disorders like anxiety or depression were also diagnosed with the condition. Of those who sought treatment specifically for compulsive sexual behavior, 88% qualified for the diagnosis. The study suggests that 93% of the time, the diagnostic criteria will exclude those who are not sex addicts.
“The results lead us to believe that the proposed criteria tend not to identify patients who don’t have problems with their sexual behavior,” lead author Rory Reid of the University of California in Los Angeles said in a statement, “This is a significant finding, since many had expressed concerns that the proposal would falsely classify individuals.”
The study also suggests that sex addiction may threaten health and social relationships: 28% of those diagnosed contracted an STD at least once, 39% had lost relationships and 17% had lost jobs because of their condition.
The findings also highlighted intriguing gender divides among sufferers: 95% of those seeking help for sexual compulsion at one of the study treatment centers were male but 40% of those diagnosed at psychiatric and addiction centers were women, suggesting that although the disorder may genuinely be more common in men, women may be less likely to seek help for it.
And contrary to popular portrayals of sex addicts as spending their nights having intercourse with multiple partners, the vast majority of the compulsive sexual behavior among those diagnosed with disorder in the study involved masturbation and pornography. Over three quarters of participants reported problems with pornography, but only 45% engaged in compulsive sex with other consenting adults and 45% cheated on their primary partners. Those who did have partnered sex averaged 15 sexual partners in the past year. Most sex addiction, it seems, occurs solo.
The DSM-5 criteria require that patients are at least 18 before being diagnosed, primarily because normal sexual development can make diagnosing a sexual disorder challenging: simply consider the amount of turmoil sexual desire causes in the average adolescent experience. There is also a void in the research on what is “normal” for teens, which could lead to normal teens being wrong diagnosed as sex addicts if this data is not obtained and utilized. Still, just over half of the participants reported that their sexual problems began before they turned 18.
As with other DSM diagnoses, the new criteria for hypersexual disorder shouldn’t be considered objective nor the final word. Some people do engage compulsively in sexual behavior that causes serious distress to themselves and others, so creating careful diagnostic criteria makes sense. And without such criteria, it’s impossible to judge the effectiveness of treatment.