Is Sex Addiction an Official Mental Health Diagnosis?

At this time, “sex addiction” is among the more hotly debated topics in the mental health community. This controversy is not without merit – there should always be a significant debate before any form of inherently healthy human behavior (such as sex) is clinically designated as pathological (unhealthy). The power to label must always be wielded carefully to avoid turning social, religious, or moral judgments into “legitimate” diagnoses (as once happened with homosexuality). The question being bandied about these days is whether sexual addiction should be included as an official diagnosis in the next version of the DSM (the Statistical Manual of Mental Health Disorders), generally regarded as the “diagnostic bible” of the American Psychiatric Association (APA). The concept of sexual addiction first appeared in the 1987 version of the DSM as a “descriptor” that could be applied under the more general diagnosis of “Sexual Disorders NOS (not otherwise specified).” That version of the DSM stated the sexual addiction descriptor could be used if the individual in question displayed “distress about a pattern of repeated sexual conquests or other forms of non-paraphilic sexual addiction, involving a succession of people who exist only as things to be used.” Unfortunately, subsequent versions of the DSM retracted this descriptor due to “insufficient research” and a “lack of expert consensus.” This decision has left many in the clinical community scratching their heads as they attempt to properly assess, diagnose, and treat individuals with problematic patterns of consensual adult sexual behavior. And the timing of the APA’s retraction could not have been worse. During this very same period the “digital technology explosion” dramatically increased the average person’s ability to affordably and anonymously access a seemingly endless array of highly graphic pornography, prostitutes, and casual sex partners. This proliferation of access has caused tremendous problems, particularly for individuals with pre-existing addictive disorders and/or the various emotional trauma and psychological conditions that typically underlie addictive disorders. Many of these individuals are using online pornography and/or casual sex to self-medicate uncomfortable feelings and dissociate from stress. In other words, these people are using sexual fantasy and behavior in the same way and for the same purpose as drug addicts use drugs. Ironically, at the same time the APA backed away from officially defining sex addiction, the concept has gained widespread media and public acceptance, along with a significant degree of therapeutic legitimacy. Thanks in large part to a films and television shows focused on sexual addiction (Shame, Californication, etc.), coupled with the much-publicized problematic sexual behaviors of numerous political figures and sports stars, the general public and therapeutic communities appear to have (at least tentatively) embraced the concepts of sex and love addiction. Recognizing this, the APA has undertaken a review of the topic. They are currently considering a potential DSM diagnosis of Hypersexual Disorder. While “hypersexuality” is not an ideal term for a problem that more accurately involves the lengthy fantasy about and search for sex rather than the sex act itself, there is little doubt that, whatever it is called, sexual addiction is a legitimate, serious, and relatively common clinical condition that results in serious negative consequences when left untreated. As of now, it appears Hypersexual Disorder will end up in the DSM’s appendix under “Potential Diagnoses Requiring Further Research.” And while this action is in many ways “too little, too late,” especially for those individuals seeking help now, it is nevertheless meaningful, as being a documented “potential diagnosis” in the DSM’s appendix will bring both intensified research and a likely increase in much needed research funding. It is important to note that in no way does this diagnostic setback prevent informed, forward-thinking clinicians from recognizing and treating sexual addiction in their clients.

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