'Sex Addiction' Redefined

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A new psychiatric diagnosis for those suffering (yes, suffering) from hypersexuality

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When the Diagnostic and Statistical Manual (DSM) -- the definitive guide to diagnostic criteria used by U.S. mental health professionals -- is updated next May (for the first time in 13 years) one of the new conditions in consideration to be among its pages is hypersexual disorder (HD). Known informally, if not entirely accurately, as "sex addiction," HD's inclusion in the manual will mean the diagnosis has finally "made it." 

A patient diagnosed with HD would typically experience "recurrent and intense sexual fantasies, urges, and behavior" for at least six consecutive months. Their hypersexuality would be uncontrollable and distressing, interfering with their normal life and leading to the possibility of self-harm. The disorder would only be diagnosed in patients over the age of 18. The disorder can take the form of masturbation, pornography, sex "with consenting adults," cybersex, phone sex, "adult entertainment venues/clubs," or -- because some things you just can't anticipate -- "other."

Do claims to "hypersexuality" really make one disordered, and deserve a place in the same book that defines debilitating afflictions like depression or schizophrenia?

In order for hypersexual disorder to make it into the book of diagnoses, the American Psychiatric Association needs to be convinced that there's a group of people out there whose problems are accurately defined by the criteria, and who will benefit from a diagnosis. A new field study published in the Journal of Sexual Medicine found that this is almost certainly the case.

The research is based on over 150 (overwhelmingly white and male) patients at outpatient clinics across the U.S. who were seeking help for unconstrained sexual behavior, along with 50 others who were being treated for general psychiatric disorders or substance abuse problems. A team of psychiatrists, psychologists, social workers, and marriage and family therapists, specifically chosen for their diverse backgrounds and varying levels of experience with sexual disorders, attempted to diagnosis the patients based on re-creations of clinical interviews. 

Diagnostic criteria of the type being tested here defines boundaries, giving doctors a standardized method of distinguishing between health and illness, and also between specific disorders. A patient can be diagnosed with multiple disorders, but each is nonetheless a distinct entity. Basically, the researchers were tasked with finding out whether people who sought help for hypersexuality would be accommodated by the proposed definition. At the same time, they needed to ensure that people who suffered from other disorders weren't falsely diagnosed with HD.

Almost 90 percent of the time, they found that the criteria accurately classified the hypersexual patients as having HD. Conversely, 93 percent of the patients who were seeking help for other disorders did not fit into HD's guidelines.

For example, the people with substance abuse disorders reported engaging in a fair amount of problematic sexual behavior, but only when under the influence of their chosen substance. Substance abuse therefore remained their primary disorder, and only one such patient was found to have concurrent HD.

The researchers were able to conclude that the proposed criteria are a reliable diagnostic tool for HD.

But should these criteria even exist in the first place? Do claims to "hypersexuality" really make one disordered, and deserve a place in the same book that defines debilitating afflictions like depression or schizophrenia? Other findings from this study suggest that they should, because of the profoundly negative consequences it can have.

The higher the level of hypersexuality reported by patients, the more problems were associated with their behavior. As a result of what they certainly saw as a dysfunction, about 28 percent of the patients interviewed had contracted an STI at least once. Almost 40 percent had ended a relationship over their behavior, while most said they had emotionally hurt a loved one (and for 68 percent, they had done so several times). Over half lost money, and 17 percent had lost at least one job. These are also signs pointing to disorder, as is the way they tended to understand their actions: 78 percent felt that the behaviors associated with their hypersexuality had interfered with healthy sex.

The researchers did find evidence that hypersexual patients who reported using sex as a way of dealing with depressed moods or stress were actually more susceptible to mood swings and more vulnerable to anxiety, perhaps indicating that sex wasn't at the root of their problems. But they also noted a pattern of escalation: problems with hypersexuality tended to get worse with time, providing a strong case for the need for treatment.

How much sex must one have for it to be considered "hyper"? The DSM doesn't give a number, but the patients in this study reported having an average of 15 partners over a 12 month period. But less than half of the patients reported that their hypersexuality manifested itself in the form of sex with other people -- excessive consumption of pornography and masturbation were the most common.

Being really into sex or pornography, having an unusual fetish, or even engaging in occasional risky behaviors are not, on their own, seen as pathological. All can still be seen as normal variants of sexual expression. If the criteria for HD are accepted into the psychiatric canon, they will be used to help people who do feel that their behaviors are interfering with their lives. For them, a diagnosis can be a way of validating their problem and getting the help they need.

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Lindsay Abrams is an assistant editor at Salon and a former writer and producer for The Atlantic's Health Channel.

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