The Competing Models of Out-of-Control Sexual Behaviors
Whenever a new phenomena or illness is discovered, whether it be a medical or mental health problem, the waters are initially often muddy. Substantial research and experimental treatments are needed to clarify the precise nature of the disorder or disease.
In the case of out-of-control sexual behaviors, researchers have largely fallen into one of four camps:
- The out-of-control sexual behaviors are indicative of an addictive disorder (like substance abuse addictions),
- The behaviors are indicative of a hypersexual disorder (excessive sexual behaviors/output in a given time period),
- The behaviors are indicative of an impulse-control disorder (impulsivity-driven sexual behaviors), or
- The behaviors are indicative of a compulsive disorder (compulsive sexual behaviors, perhaps a symptom of obsessive-compulsive disorder or OCD).
Similar to many other mental disorders and addictions preceding it, when first presented to the medical and mental health communities, sex addiction as a concept was greeted with a great deal of skepticism. The existence of four competing models has made it difficult to present a unified, cohesive body of evidence supporting the existence of an out-of-control sexual behavior disorder. Recently, hypersexual disorder was proposed for inclusion in the American Psychiatric Association’s new Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is used by mental health providers to diagnose patients.
Sexual Disorders and the DSM-5
While hypersexual disorder was not included in the first publication of the DSM-5, the substance disorders section of the manual was significantly restructured, so now, substance use and pathological gambling disorders are included under the new heading of Addiction and Related Disorders. Also, Internet Gaming Disorder was identified for future research.
These structural changes in the DSM-5 suggest a growing recognition of the many parallels between behavioral addictions and chemical addictions. Additionally, sexual addiction was recently officially recognized by the American Society of Addiction Medicine (ASAM) as a legitimate addiction. Now, agreement on a set of diagnostic criteria may continue to legitimize sexual addiction as a valid mental health issue with serious personal and societal consequences.
Consistencies Emerge Among Four Diagnostic Models
A seminal article was recently published in the Journal of Addiction Medicine called “Clinical Relevance of the Proposed Sexual Addiction Diagnostic Criteria: Relation to the Sexual Addiction Screening Test-Revised” (Carnes, Hopkins & Green, 2014). This article compared various diagnostic models that have been proposed over the years by researchers from the sex addiction, hypersexuality, and sexual compulsivity perspectives. Interestingly, despite controversy over what to call the disorder, several key consistencies emerged when comparing the existing sets of diagnostic criteria.
The most common consistencies relate to continuation of sexual behavior despite problems or adverse consequences, engagement in sexual behaviors during time allotted for other obligations, and ineffective attempts to limit or control certain sexual behaviors The authors conclude that the following diagnostic criteria, first proposed by Carnes (2005), have considerable overlap with criteria proposed by researchers from the hypersexual and sexual compulsivity perspectives:
- Recurrent failure (pattern) to resist sexual impulses to engage in specific sexual behaviors
- Engaged in sexual behaviors to a greater extent or over a longer period than intended
- Long-standing desire, or a history of unsuccessful efforts to stop, reduce, or control sexual behaviors.
- Spent excessive time obtaining sex, being sexual, or recovering from sexual experiences
- Obsessed with preparing for sexual activities
- Frequently engaged in sexual behavior when expected to be fulfilling occupational, academic, domestic, or social obligations
- Continued sexual behavior despite knowing it has caused or exacerbated social, financial, psychological, or physical problems
- Increased the intensity, frequency, number, or risk of sexual behaviors to achieve the desired effect, or experience diminished effect when continuing behaviors at the same level of intensity, frequency, number or risk.
- Given up or limited social, occupational, or recreational activities because of sexual behavior
- Become upset, anxious, restless, or irritable if unable to engage in sexual behavior.
Like most mental health diagnoses, they recommend that diagnosis not be given if the out of control sexual behavior symptoms are primarily related to a medical condition, a psychological condition, a medication/substance of abuse, or a manic episode.
Sex Addiction as a Diagnosable Disorder
What do these findings mean for the future of sex addiction as a diagnosable disorder? These authors suggest that there is more agreement than disagreement in the field concerning what criteria constitute problematic sexual behaviors or sexual addiction. The proposed criteria are highly endorsed by people seeking treatment for sexual addiction and, thus, appear to be relevant indicators of a serious and destructive pattern of sexual behavior, whether it is called sexual addiction, hypersexuality, or sexual compulsivity.
The empirical evidence is slowly building to support sexual addiction as a mental disorder. If it is recognized as a mental disorder, treatment for sexual addiction would likely become more affordable and accessible to greater numbers of people who are currently experiencing debilitating consequences related to their out-of-control sexual behaviors.
Gentle Path at the Meadows is committed to continue pioneering research in this area to maintain our cutting-edge, scientifically-supported, world-class treatment for sexual addiction.