Congrats, Sex 'Addicts': You're Almost a Diagnosis

The American Psychiatric Association is about to issue, on May 22, the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM-5, and once again, despite the urgings of myriad therapists and religio-conservatives, it won't be listing "sex addiction" as a diagnosis.

But what mental health professionals will see is a newly created catch-all category, first proposed in 2010, called "hypersexual disorder," which will be characterized in part, according to Dr. Martin P. Kafka, by "recurrent and intense sexual fantasies, sexual urges, or sexual behaviors" that occur over a period of at least six months, and which are associated with three or more of the following five criteria:

• Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.

• Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).

• Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events.

• Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.

• Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.

And while many horny folks and avid porn watchers might see themselves as sufferers of two or even three of the above criteria, according to Dr. Kafka, there are still a couple of hurdles to overcome—that is, impairments to be suffered—before a hypersexual disorder diagnosis can be made:

• There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or behaviors.

• These sexual fantasies, urges or behaviors are not due to the direct physiological effect of an exogenous substance (e.g., a drug of abuse or a medication)

In other words, even if you like to fuck or jack off a lot, if that isn't causing you a lot of worry and isn't preventing you from doing your job, relating to your family or interacting with your friends, you don't have it. Or even if you are impaired, and that impairment is due to drugs—meth, coke, opiates or even hallucinogens (acid, shrooms, X, pot)—you still don't have it.

Of course, since psychiatry is as much an art as a science, there are plenty of variables that might enter into whether one has the disorder, which is why Hypersexual Disorder will be listed with other conditions that "require further research." But a group of Ph.D.s—including anti-porn zealot Jill C. Manning—did try to check how well the criteria applied to real people in society, and though they only surveyed 207 individuals, the results they reported seemed to validate the diagnostic methodology.

"The diagnostic criteria for HD [Hypersexuality Disorder] showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency," an abstract of the study said. "Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder."

One thing the DSM-5 doesn't do, however, is validate the claims of the many "sex addiction" therapists that excessive fucking, masturbating and/or use of porn is an "addiction" similar enough to drug addiction to be included in the "addiction disorder" section.

"We couldn't find enough scientific evidence for the existence of sex addiction, but we did feel that gambling merited inclusion and we seriously considered Internet addiction," said Dr. Charles P. O'Brien, chair of the Substance-Related Disorders Work Group and a professor of psychiatry at the University of Pennsylvania School of Medicine. Both sex and internet addictions are included in the appendix "to stimulate research," he explained.

Needless to say, not everyone's happy with that.

"As a therapist who repeatedly sees the devastating results of out-of-control sexual behaviors, I am disappointed with the APA’s verdict that Hypersexual Disorder is not an official psychiatric disorder," wrote therapist Alexandra Katehakis. "The effects of this are both an issue of public health and personal wellbeing, because unmitigated sexual behaviors that have gone out of control cause significant psychological, social, relational and financial distress for individuals and their families. And in their worst scenarios, can lead to sexually transmitted infections, the breaking up of families and a string of legal problems. ... The argument that sex addiction is an agenda put forth by 'sex-negative' clinicians, completely disregards the pain, confusion, trauma, fear and hopelessness experienced by sex addicts and their families."

Spoken like a True Believer in sex addiction, who coincidentally makes at least a portion of her living trying to cure people of a disorder that may not exist!

AVN previously wrote about the upcoming DMS-5 here.