By Lindsay Abrams
iOct 19 2012, 5:55 PM
A new psychiatric diagnosis for those suffering (yes, suffering) from hypersexuality
josemanuelerre/Flickr
When the
Diagnostic and Statistical Manual (DSM)
--
the definitive guide to diagnostic criteria used by U.S. mental health professionals --
is updated next May (for the first time in 13 years) one of the new conditions in consideration to be among its pages is hypersexual disorder
(HD). Known informally, if not entirely accurately, as "sex addiction,"
HD's inclusion in the manual will mean the diagnosis has finally "made
it."
A patient diagnosed with HD would typically experience "recurrent
and intense sexual fantasies, urges, and behavior" for at least six
consecutive months. Their hypersexuality would be uncontrollable and
distressing, interfering with their normal life and leading to the
possibility of self-harm. The disorder would only be diagnosed in
patients over the age of 18.
The disorder can take the form of masturbation, pornography, sex "with consenting adults,"
cybersex, phone sex, "adult
entertainment venues/clubs," or -- because some things you just can't anticipate -- "other."
Do
claims to "hypersexuality" really make one disordered, and deserve a
place in the same book that defines debilitating afflictions like
depression or schizophrenia?
In order for hypersexual disorder to make it into the book of
diagnoses, the American Psychiatric Association needs to be convinced
that there's a group of people out there whose problems are accurately
defined by the criteria, and who will benefit from a diagnosis. A new
field study published in the
Journal of Sexual Medicine found that this is almost certainly the case.
The research is based on over 150 (overwhelmingly white and male)
patients at outpatient clinics across the U.S. who were seeking help for
unconstrained sexual behavior, along with 50 others who were
being treated for general psychiatric disorders or substance abuse
problems. A team of
psychiatrists, psychologists, social workers, and marriage and
family therapists, specifically chosen for their diverse backgrounds and
varying levels of experience with sexual disorders, attempted to
diagnosis the patients based on re-creations of clinical interviews.
Diagnostic criteria of the type being tested here defines
boundaries, giving doctors a standardized method of distinguishing
between health and illness, and also between specific disorders. A
patient can be diagnosed with multiple disorders, but each is
nonetheless a distinct entity. Basically, the researchers were tasked
with
finding out whether people who sought help for hypersexuality would
be accommodated by the proposed definition. At the same time, they
needed to ensure
that people who suffered from other disorders weren't falsely
diagnosed with HD.
Almost 90 percent of the time, they found that the criteria
accurately classified the hypersexual patients as having HD. Conversely,
93 percent of the
patients who were seeking help for other disorders did not fit into
HD's guidelines.
For example, the people with substance abuse disorders reported
engaging in a fair amount of problematic sexual behavior, but only when
under the influence of
their chosen substance. Substance abuse therefore remained their
primary disorder, and only one such patient was found to have concurrent
HD.
The researchers were able to conclude that the proposed criteria are a reliable diagnostic tool for HD.
But should these criteria even exist in the first place? Do claims
to "hypersexuality" really make one disordered, and deserve a place in
the same book that defines debilitating afflictions like depression or
schizophrenia? Other findings from this study suggest that they should,
because of the profoundly negative
consequences it can have.
The higher the level of hypersexuality reported by patients, the
more problems were associated with their behavior. As a result of what
they certainly saw as a dysfunction, about 28 percent of the patients
interviewed had
contracted an STI at least once. Almost 40 percent had ended a
relationship over their behavior, while most said they had emotionally
hurt a loved one (and for 68
percent, they had done so several times). Over half lost money, and
17 percent had lost at least one job. These are also signs pointing to
disorder, as is the way they tended to understand their actions: 78
percent felt that the
behaviors associated with their hypersexuality had interfered with
healthy sex.
The researchers did find evidence that hypersexual patients who
reported using sex as a way of dealing with depressed moods or stress
were actually more susceptible to mood swings and more vulnerable to
anxiety, perhaps indicating that sex wasn't at the root of their
problems. But they also noted a pattern of escalation: problems with
hypersexuality tended to get worse with time, providing a strong case
for the need for treatment.
How much sex must one have for it to be considered "hyper"? The DSM
doesn't give a number, but the patients in this study reported having an
average of 15 partners over a 12 month period. But less than half of
the patients reported that their hypersexuality manifested itself in
the form of sex
with other people -- excessive consumption of pornography and
masturbation were the most common.
Being really into sex or pornography, having an unusual fetish, or
even engaging in occasional risky behaviors are not, on their own, seen
as
pathological. All can still be seen as normal variants of sexual
expression. If the criteria for HD are accepted into the psychiatric
canon, they will be used to help people who do feel that their behaviors
are interfering with their lives. For them, a diagnosis can be a way of
validating their problem and getting the help they need.
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