Sexual addiction

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Sexual addiction (or sex addiction) is a conceptual model assessing people who report being unable to control their sexual urges, behaviors, or thoughts. Other terms and other models for sexual addiction or aspects of it include hypersexuality, erotomania, nymphomania, satyriasis, Don Juanism (or Don Juanitaism), compulsive sexual behavior, and paraphilia-related disorders.[1][2][3] Medical studies and related opinions vary among professional psychologists, sociologists, clinical sexologists and other specialists on sexual addiction as a medical physiological and psychological addiction, or representative of a psychological/psychiatric condition at all.

Proponents of the sexual addiction model draw analogies between hypersexuality and substance addiction or negative behavioral patterns similar to gambling addiction, recommending 12-step and other addiction-based methods of treatment. Other explanatory models of hypersexuality include sexual compulsivity and sexual impulsivity.

Criticism[edit]

External media
Images
The History and Rise of Sex and Love Addiction (INFOGRAPHIC)
Audio
Robert Weiss & David Ley. Is sex addiction a myth? // KPCC (April 25, 2012, 9:29 am)
Video
Nicole Prause, Ph.D. (sexual physiologist). [1] CBS (July 18, 2013)

The current debate as to the legitimacy of sexual addiction makes this a controversial subject in the scientific and therapeutic communities. The US medical consensus was in 2013 that at that time there was "insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders".[4] There have been little, if any, scientific studies with agreed upon results. A 2014 study showed test subjects with religious upbringings reported distress associated with their religious beliefs, which could represent cultural inconsistencies, not pathology, for this particular population.[5] While a 2013 UCLA study with respect to viewing sexual images found no evidence to support an addiction model,[6] another 2014 University of Cambridge found the exact opposite—that pornography triggers similar brain activity in sex addicts as drug paraphernalia triggers in drug addicts.[7][8]

Earlier debates had not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.[9][10] Some experts regard sexual addiction as a medical form of clinical addiction, directly analogous to alcohol and drug addictions. Other experts believe that sexual addiction is actually a form of obsessive compulsive disorder and refer to it as sexual compulsivity.[11] Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.[12][13] Some who have expressed doubts about the existence of sex addiction argue that the condition is instead a way of projecting social stigma onto patients.[12]

An example of how far this critique sometimes goes is therapist Marty Klein's claim that "The concept of sex addiction provides an excellent example of a model that is both sex-negative and politically disastrous."[14]:8 Klein singles out a number of features that he considers crucial limitations of the sex addiction model.[14]:8

Klein states that the diagnostic criteria for sexual addiction are easy to find on the Internet.[14]:9 Drawing on the Sexual Addiction Screening Test, he states that "The sexual addiction diagnostic criteria make problems of nonproblematic experiences, and as a result pathologize a majority of people."[14]:10

Origin[edit]

Sex addiction as a term first emerged in the mid-1970s when various members of Alcoholics Anonymous sought to apply the principles of 12-Steps toward sexual recovery from serial infidelity and other unmanageable compulsive sex behaviors that were similar to the powerlessness and un-manageability they experienced with alcoholism.[15] Multiple 12-step style self-help groups now exist for people who identify as sex addicts, including Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous.

Models[edit]

Diagnostic models[edit]

DSM[edit]

The American Psychiatric Association publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely recognized compendium of acknowledged mental disorders and their diagnostic criteria.[citation needed]

The version published in 1987 (DSM-III-R), referred to "distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used."[16] The reference to sexual addiction was subsequently removed.[17] The DSM-IV-TR, published in 2000 (DSM-IV-TR), did not include sexual addiction as a mental disorder.[18] The DSM-IV-TR included a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified,stating : "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used." (Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.)[18]

Some authors suggested that sexual addiction should be re-introduced into the DSM system;[19] however, sexual addiction was rejected for inclusion in the DSM-5, which was published in 2013.[20] Darrel Regier, vice-chair of the DSM-5 task force, said that "[A]lthough 'hypersexuality' is a proposed new addition...[the phenomenon] was not at the point where we were ready to call it an addiction." The proposed diagnosis does not make the cut as an official psychiatric diagnosis due to a lack of substantial empirical evidence, according to the American Psychiatric Association.[4][21]

ICD[edit]

The World Health Organization produces the International Classification of Diseases (ICD), which is not limited to mental disorders. The most recent version of that document, ICD-10, includes "Excessive sexual drive" as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).[22]

CCMD[edit]

The Chinese Society of Psychiatry produces the Chinese Classification of Mental Disorders (CCMD), which is currently in its third edition - the CCMD-3 and Chapter 5 of the document lists Physiological disorders related to psychological factors and under code 52 are disorders that are "Nonorganic sexual dysfuction," and within that category are listed a number of disorders, one of which is "Other or unspecified sexual dysfunction" (numerical code 52.9).[23] This is roughly equivalent to the ICD-10 diagnosis of "Excessive sexual drive" (F52.7), "Other sexual dysfunction, not caused by organic disorder or disease" (F52.8) and "Unspecified sexual dysfunction, not caused by organic disorder or disease" (F52.9).[24]

Borderline personality disorder[edit]

The American Psychiatric Association uses the Diagnostic and Statistical Manual of Mental Disorders (DSM) to define and classify mental illnesses and in the DSM-IV version of the document, it lists borderline personality disorder (BPD) as an Axis II - Cluster B personality disorder with the code 301.83. The DSM-5 dropped the multiaxial system, but BPD still retains the same numerical code of 301.83.[4] The World Health Organization's produces the International Classification of Diseases (ICD) and lists BPD under the name "Emotionally unstable personality disorder". The latest version of the document (ICD-10) lists the disorder in Chapter X which is reserved for "Disorders of adult personality and behaviour" and has the code F60.3.[25] The Chinese Society of Psychiatry uses the Chinese Classification of Mental Disorders (CCMD), which is in its third edition (CCMD-3) and has a diagnosis of "Nonorganic sexual dysfunction" (numerical code 52.9), of which sexual promiscuity may be a symptom. Personality disorders, Habit and impulse disorders, Psychosexual disorders in the CCMD-3 fall in Chapter 6 and under code 6.60 are listed the personality disorders. The CCMD-3 lists "impulsive personality disorder" (numerical code 60.4),[26] which is equivalent to what the DSM refers to as "borderline personality disorder" and what the ICD-10 refers to as "emotionally unstable personality disorder". All three classification manuals and documents list sexual promiscuity as a prevalent and problematic symptom for patients with this particular pathology. Hypersexuality along with high-risk sexual behaviour, seductive behaviour, and promiscuity are an often due to the marked impulsivity common to this group of patients. Individuals with borderline personality disorder (emotionally unstable personality disorder or impulsive personality disorder) not only are prone to promiscuity, but in many cases, co-morbid paraphilias and fetishistic behaviour are commonly associated with their sexual behaviours. Common paraphilic compulsions among individuals with this diagnosis include urolagnia ("golden showers"), sadomasochism, voyeurism autassassinophilia, partialism, biastophilia, and in some cases paraphilic drives may be more extreme and dangerous - such as erotophonophilia, necrophilia, pedophilia, and even anthropophagy. Both males and females with this personality disorder often have a strong desire and compulsion to get involved in illicit sex, affairs, and relationships with married or otherwise pre-attached individuals. Consequently individuals with borderline personality disorder often experience love and sexuality in perverse and violent qualities which they cannot integrate with the tender, intimate side of relationships.[27][28]

Symptoms and diagnostic criteria[edit]

Several mental health providers have proposed various, but similar, criteria for diagnosing sexual addiction, including Patrick Carnes,[29] and Aviel Goodman,[30] None of these proposals has been adopted into any official diagnostic manual, however.

During the update of the Diagnostic and Statistical Manual to version 5 (DSM-5), the American Psychiatric Association rejected two independent proposals for inclusion.[citation needed]

The International Classification of Diseases (ICD-10) of the World Health Organization, however, does include an entry for "Excessive Masturbation"[31] and another for "Excessive Sexual Drive."[25]

In 2011, the American Society of Addiction Medicine (ASAM), the largest medical consensus of physicians dedicated to treating and preventing addiction,[32] redefined addiction as a chronic brain disorder[33] which for the first time broadened the definition of addiction from substances to include addictive behaviors and reward-seeking, such as gambling and sex.[34]

Biomolecular models[edit]

Treatment approaches[edit]

There are many options for counselors to obtain licensure in specialized sexual addiction training; CSAT certification may be the best-known.[35] Certified Sex Addiction Therapists (CSAT) are licensed therapists with graduate degrees who demonstrate their competence in sex addiction therapy by becoming credentialed by the International Institute for Trauma and Addiction Professionals.[36][37]

On a different track, SSRIs have been used in research studies and off-label to treat symptoms of overly frequent sexual urges, but their effects are not always robust. Targeted to treat addictions by interrupting neurotransmitters, these synthetic chemical hormones attempt to adjust behavior through the effect of reducing libido, but medications are rarely prescribed in conventional sex addiction treatments.[citation needed]

See also[edit]

References[edit]

  1. ^ Coleman, Eli (June–July 2003). "Compulsive Sexual Behavior: What to Call It, How to Treat It?". SIECUS Report. The Debate: Sexual Addiction and Compulsion (ProQuest Academic Research Library) 31 (5): 12–16. Retrieved 2012-10-15. 
  2. ^ Coleman, E. (2011). "Chapter 28. Impulsive/compulsive sexual behavior: Assessment and treatment". In Grant, Jon E.; Potenza, Marc N. The Oxford Handbook of Impulse Control Disorders. New York: Oxford University Press. p. 375. ISBN 9780195389715. 
  3. ^ Carnes, Patrick (1994). Contrary to Love: Helping the Sexual Addict. Hazelden Publishing. p. 28. ISBN 1568380593. 
  4. ^ a b c American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 481, 797–798. ISBN 978-0-89042-555-8. "Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as "sex addiction," "exercise addiction," or "shopping addiction," are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders." 
  5. ^ Grubbs, J., Exline, J., Pargament, K., Hook, J., & Carlisle, R. (2014). "Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography". Archives of Sexual Behavior. online first. doi:10.1007/s10508-013-0257-z. 
  6. ^ Ley, D ., Prause, N., and Finn, P. (2014). "The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model". Current Sexual Health Reports 1 (1). doi:10.1007/s11930-014-0016-8. 
  7. ^ Medical Xpress article: "Brain activity in sex addiction mirrors that of drug addiction"
  8. ^ Independent UK article: "Sex and drug addicts' behaviour is ‘triggered by the same type of brain activity’, say Cambridge scientists"
  9. ^ Francoeur, R. T. (1994). Taking sides: Clashing views on controversial issues in human sexuality, p. 25. Dushkin Pub. Group.
  10. ^ Kingston, D. A.; Firestone, P. (2008). "Problematic hypersexuality: A review of conceptualization and diagnosis". Sexual Addiction and Compulsivity 15 (4): 284–310. doi:10.1080/10720160802289249. 
  11. ^ Mayo Clinic Website
  12. ^ a b Levine, M. P.; Troiden, R. R. (1988). "The myth of sexual compulsivity". Journal of Sex Research 25 (3): 347–363. doi:10.1080/00224498809551467. 
  13. ^ Giles, J. (2006). "No such thing as excessive levels of sexual behavior". Archives of Sexual Behavior 35 (6): 641–642. doi:10.1007/s10508-006-9098-3. PMID 17109229. 
  14. ^ a b c d Klein, Marty (June–July 2003). "Sex Addiction: A Dangerous Clinical Concept". SIECUS Report (ProQuest Academic Research Library) 31 (5): 8–11. Retrieved 2012-10-15. 
  15. ^ Augustine Fellowship (June 1986). Sex and Love Addicts Anonymous. Augustine Fellowship. ISBN 0-9615701-1-3. OCLC 13004050. 
  16. ^ American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
  17. ^ Kafka, M. P. (2010). "Hypersexual Disorder: A proposed diagnosis for DSM-V" (PDF). Archives of Sexual Behavior 39 (2): 377–400. doi:10.1007/s10508-009-9574-7. PMID 19937105. 
  18. ^ a b American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author.
  19. ^ Irons, R.; Irons, J. P. (1996). "Differential diagnosis of addictive sexual disorders using the DSM-IV". Sexual Addiction & Compulsivity 3: 7–21. doi:10.1080/10720169608400096. 
  20. ^ Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' USA Today.
  21. ^ Rachael Rettner (Dec 6, 2012). "'Sex Addiction' Still Not Official Disorder". LiveScience. Retrieved 2013-01-02. 
  22. ^ International Classification of Diseases, version 2007.
  23. ^ "Chinese Society of Psychiatry". Chinese Classification of Mental Disorders (CCMD). Ministry of Health. Retrieved 3 July 2014. 
  24. ^ "ICD-10 - Chapter V Mental and behavioural disorders (F00-F99)". World Health Organization. Retrieved 3 July 2014. 
  25. ^ a b "International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) Version for 2010". International Statistical Classification of Diseases and Related Health Problems. World Health Organization. Retrieved 3 July 2014. 
  26. ^ "CCMD-3". Chinese Society of Psychiatry. Chinese Classification of Mental Disorders (third edition). Retrieved 3 July 2014. 
  27. ^ Mitchell, Stephen (1995). Freud and Beyond: A History of Modern Psychoanalytic Thought. New York: Basic Books. ISBN 978-0-465-01405-7. 
  28. ^ Hull, J. W., Clarkin, J. F., & Yeomans, F. (1993). Borderline personality disorder and impulsive sexual behavior. Psychiatric Services, 44(10), 1000-1001.
  29. ^ Patrick Carnes; David Delmonico; Elizabeth Griffin (2001). In the Shadows of the Net. p. 31. ISBN 1-59285-149-5. 
  30. ^ Goodman, Aviel (1998). Sexual Addiction: An Integrated Approach. Madison, Connecticut: International Universities Press. pp. 233–234. ISBN 978-0-8236-6063-6 
  31. ^ "2012 ICD-10-CM Diagnosis Code F98.8 : Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence". Icd10data.com. Retrieved 2012-06-22. 
  32. ^ "2011 New definition of addiction: Addiction is a chronic brain disease, not just bad behavior or bad choices". Retrieved 2011-08-15. 
  33. ^ "2011 Addiction Now Defined As Brain Disorder, Not Behavior Issue". Retrieved 2011-08-15. 
  34. ^ "2011 ASAM: The Definition of Addiction". Retrieved 2011-04-12. 
  35. ^ Stacy Notaras Murphy. It’s not about sex. Counseling Today. An American Counseling Association Publication. (December 2011.)
  36. ^ IITAP Official Website
  37. ^ Stefanie Carnes. Mending a Shattered Heart: A Guide for Partners of Sex Addicts. Gentle Path Press; Second Edition. (October 4, 2011) page 139 ISBN 978-0-9826505-9-2

Further reading[edit]

There are several books which offer overview history and treatment techniques for sexual addiction, including the following
There are also books focusing on partners of sex addicts
  • My Secret Life with a Sex Addict - from discovery to recovery by Emma Dawson. (Thornton Publishing, 2004) ISBN 978-1-932344-70-7
  • Hope After Betrayal: Healing When Sexual Addiction Invades Your Marriage by Meg Wilson. (Kregel Publications, 2007) ISBN 978-0-8254-3935-3
  • Deceived: Facing Sexual Betrayal Lies and Secrets by Claudia Black. (Hazelden, 2009) ISBN 978-1-59285-698-5
  • Your Sexually Addicted Spouse: How Partners Can Cope and Heal by Barbara Steffens and Marsha Means. (New Horizon Press, 2009) ISBN 978-0-88282-309-6
  • Mending a Shattered Heart: A Guide for Partners of Sex Addicts by Stefanie Carnes. (Gentle Path Press, 2011) ISBN 978-0-9774400-6-1
  • A Couple's Guide to Sexual Addiction: A Step-by-Step Plan to Rebuild Trust and Restore Intimacy by Paldrom Collins and George Collins. (Adams Media, 2011) ISBN 978-1-4405-1221-6
The interested reader can find discussions of the concept of sexual addiction in

External links[edit]