The idea that someone can have a sex addiction has been controversial, but a new study suggests that it is a real disorder, and lays out rules that could be used in deciding who has it.
Hypersexual disorder, as sex addiction is formally known, is under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM)
— the bible of mental conditions.
— the bible of mental conditions.
But first, researchers need to agree on how to define this disorder. For example, under one proposed definition, a person who simply has frequent sex would not be diagnosed with hypersexual disorder, said study researcher Rory Reid, an assistant professor and research psychologist at the University of California, Los Angeles.
But a person whose sexual activities are excessive, frequently used to cope with stress and interfere with their ability to function in daily life may meet the criteria for the disorder, Reid said.
The definition also needs to hold up in the real world, so that health care professionals can consistently apply it when diagnosing patients.
In the new study, researchers found that professionals could use the proposed symptoms of hypersexual disorder to separate people into two groups — those who have a disorder, and others who don't. In addition, health professionals with varied backgrounds, including psychiatrists, psychologists and social workers, generally agreed about how to interpret the definition.
The researchers emphasized that they are not trying to turn common behaviors — such as having a lot of sex, or watching pornography — into disorders.
— into disorders.
Rather, people with hypersexual disorder report feeling out of control, and act on their sexual urges while disregarding the repercussions. "They might consider the consequences momentarily, but somehow feel their need for sex is more important, and choose sex even in situations where such choices might cause significant problems or harm," such as job loss, relationship problems or financial difficulties, Reid said.
or financial difficulties, Reid said.
The results of the study will be sent to the American Psychiatric Association — the organization in charge of putting together the DSM. APA reviewers will then determine whether hypersexual disorder will be included in the next edition of the manual, to be released next summer.
In the study, hypersexual disorder was defined as "recurrent and intense sexual fantasies, sexual urges, and sexual behavior," that had lasted at least six months. Diagnosis requires that these sexual fantasies, urges and behaviors cause the patient distress, or interfere with some aspect of the patient's life, such as the patient's job or social life. To be classified under the disorder, these behaviors must not be brought on by drugs or alcohol, or another mental disorder.
The researchers interviewed 207 people who had been referred to a mental health clinic, without knowing the reasons for their referral. One hundred fifty-two people had been referred for sexual behavior problems, while 20 were referred for substance abuse, and 35 for another psychiatric condition.
Using the criteria for hypersexual disorder, 134 of the patients referred for sexual problems were diagnosed with hypersexual disorder and 18 were diagnosed as having another psychiatric condition or no condition at all. Having a diagnosis of hypersexual disorder was closely linked to patients' scores on separate questionnaires designed to assess sexual behavior, impulsively and susceptibility to stress.
In 92 percent of cases, the professionals agreed on who should be diagnosed with the condition.
The vast majority of patients who were referred for substance abuse problems (19 out of 20) or another psychiatric condition (32 out of 35) were diagnosed with their respective conditions, and not with hypersexual disorder.
To answer critics who argue hypersexual disorder could be used as an excuse to be unfaithful, Reid said the disorder would not absolve people from the consequences of their behavior.
"Having a disorder didn't help them avoid consequences, such as divorce, but it is advantageous for them when they want to get help and change," Reid said.
Future research is needed to determine whether people with hypersexual disorder have changes in their brain that are similar to the changes seen in people with addictions, Reid said. In addition, studies should determine the prevalence of the condition in the general population, he said.
, Reid said. In addition, studies should determine the prevalence of the condition in the general population, he said.
If hypersexual disorder is added to the DSM, it will be included in the appendix, Reid said. The inclusion of disorders in the appendix is provisional, and requires further research, Reid said.
You've probably heard of sex addiction, but you might be surprised to know that there's debate about whether it's truly an addiction, and that it's not even all about sex.
"That's a common misconception," says Rory Reid, PhD, LCSW, a research psychologist at UCLA's Semel Institute for Neuroscience and Human Behavior. "It is no more about sex than an eating disorder is about food or pathological gambling is about money."
Sex addicts, in other words, are not simply people who crave lots of sex. Instead, they have underlying problems -- stress, anxiety, depression, shame -- that drive their often risky sexual behavior.
"Those are some of the core issues that you start to see when you treat someone with sex addiction," says John O'Neill, LCSW, LCDC, CAS, CART, a certified addiction counselor at the Menninger Clinic in Houston. "You can't miss those pieces."
What Is Sex Addiction?
Sex addiction won't be in the upcoming edition of the DSM-5, which is used to diagnose mental disorders.
That doesn't mean that it's not a very real problem.
"People are going to seek help, and there doesn't need to be diagnosable condition for them to get help," Reid says. "If they are suffering, we want to help them."
Reid and many other experts prefer the term "hypersexual disorder," rather than "sex addiction."
By either name, it's about people who keep engaging in sexual behaviors that are damaging them and/or their families.
As examples, Reid cites men who spend half their income on prostitutes, and office workers who surf the web for porn despite warnings that they'll lose their job if they keep it up.
"Who does that? Somebody with a problem," Reid says.
That problem puts so much at risk: their personal lives, their social lives, their jobs, and, with the threat of HIV/AIDS and other sexually transmitted diseases, their health.
Despite the danger, they return to the same behaviors over and over, whether it's Internet porn, soliciting sex workers, ceaselessly seeking affairs, masturbating or exposing themselves in public, or any number of other acts.
"I see in them an inability to stop what they're doing," O'Neill says. "They're preoccupied; their brain just keeps going back to it. It often leads to loneliness and isolation. There's such intense shame and pain."
Frequently, a crisis convinces them to seek treatment, Reid says. They're caught in the act by a spouse, fired from their job, or arrested for soliciting sex from prostitutes. For some people, the crisis brings relief from distress caused by their behavior and constant fear of being discovered. "The world comes crashing down," says Reid, "and some say, 'I'm glad that I got caught.'"
Addiction or Not?
There are no reliable estimates of how many people have the disorder. Some studies suggest that it's more common in men, and gay men in particular, than women.Addiction or Not? continued...
The causes are also unknown, or how similar it is to other addictions. That's one reason that Reid prefers the term hypersexual disorder (HD).
"We don't know if the [brain] mechanisms associated with HD behavior operate the same ways as a substance disorder or pathological gambling," Reid says.
Reid says HD behavior can appear similar to those associated with obsessive compulsive disorder. It also could be tied to abnormal levels of the brain chemical dopamine or serotonin. Or, problems related to attention, impulse control, or emotional regulation could also be involved.
"There are so many models or theories that we can look at to help us understand HD," Reid says. "An addiction model is just one of them."
Treating Hypersexual Disorder
There isn't much research on what treatments work best. Reid encourages his patients to challenge the thoughts that lead to their risky behavior.
"If a patient says he has a craving and he can't control it, I confront the 'can't,'" Reid says. "I ask, 'What's going to happen if you don't satisfy that craving? Is your penis going to fall off? No.' I try to get the patient to see things more realistically."
One-on-one counseling, support groups, and having a plan are key.
"You want to make connections with other people who are also struggling, and you have to know who you are going to call, what you are going to do, and how you are going to attend to your feelings," O'Neill says. "If they're willing to really follow through, work with their families and their support networks, in my experience, people can get significantly better and stay in recovery."
In some cases, medications used to treat obsessive-compulsive disorder or impulse control disorders may be used to curb the compulsive nature of the sex addiction.
