Sex Addiction Part II

Nymph and Satyr Carousing: The Metropolitan Museum of Art

Our last post on the subject of sex addiction ended with “not yet” as the answer to the question “Is sex addiction a real psychiatric diagnosis?” We also reported that other media stories raised the issue of whether people (including celebrities) be forgiven for certain sexual behaviors if these behaviors are part of a recognized medical or psychological disorder?

As we pointed out in our last post on sex addiction, the “bible” of recognized mental health conditions is the Diagnostic and Statistical Manual of Mental Disorders. First published in 1951 (DSM-I), this manual is updated about every 15 years by the American Psychiatric Association. The current edition, DSM-IV-TR, was published in 1994 and the fifth edition, DSM-IV is due for release in 2012. [Outside of the U.S., medical and psychiatric diseases are described in the International Classification of Diseases (ICD) published by the World Health Organization (WHO). ICD-10 is the current version and corresponds to DSM-IV-TR.]

Neither the Diagnostic and Statistical Manual of Mental Disorders or the International Classification of Diseases contains a disease called “sex addiction,” although this “diagnosis” can be lumped under the existing categories “Sexual Disorders Not Otherwise Specified” (DSM-IV-TR) and “excessive sexual drive – (nymphomania for women) and satyriasis (for men)” (ICD-10). In medical journals, the term “Don Juanism” is sometimes used instead of satyriasis.

In a very recent article in the medical journal, Archives of Sexual Behavior published by the International Academy of Sex Research, Dr. Martin P. Kafka of McLean Hospital (affiliated with Harvard Medical School) has proposed that what is commonly known as “sex addiction” be included as an official diagnosis, Hypersexual Disorder, in DSM-V in 2012.

Is there a blood test or some type of brain scan that can be used to diagnose Hypersexual Disorder? No, and the answer is also negative for most psychological diseases. Most mental health conditions are diagnosed by experienced psychiatrists or psychologists using what are called “clinical” criteria, in other words a collection of signs and symptoms that are commonly found in patients suffering from the condition. Dr. Kafka’s proposed criteria for the diagnosis of Hypersexual Disorder are very similar, in form and style, to many others in the DSM. These criteria are:

A. Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria:

A1. Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.
A2. Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g. anxiety, depressions, boredom, irritability).
A3. Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events.
A4. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.
A5. Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.

B. 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.

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

Specify if:

  • Masturbation
  • Pornography
  • Sexual Behavior with Consenting Adults
  • Cybersex
  • Telephone Sex
  • Strip Clubs
  • Other

Dr. Kafka makes many other interesting points in his article (full citation included in the CaseBook below) such as the fact that “sex addiction” does not really fit the definition of “addiction,” as in substance abuse or substance dependence. Also, even though there is a compulsive aspect to hypersexual disorder, it is not really similar to or associated with obsessive-compulsive disorder or OCD.

More information

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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