Sex Addiction Fails to Make it Into the DSM5

The American Psychological Association has announced the changes to the Diagnostical and Statistical Manual that will be coming out with its fifth edition, and the addition of sex addiction is not one of them.

I, for one, am relieved. If you've read my blog before, you'll know that I don't believe in the concept of sex addiction (Sex Addiction is a Myth). I believe that people can have all manner of anxiety issues and troubles coping in life and that although those may express themselves in a number of ways, included compulsive sexual behaviors, it's the underlying issues that are the real problem, not the behavior.

Many others vehemently disagree with me. A number of psychologists, psychiatrists and, lets be honest about this, conservative religious groups, have been lobbying hard for the acceptance of the idea that sex addiction is a real thing. In fact, what was presented to the APA for consideration was not sex addiction, but rather 'hypersexual disorder'. Rory Reid, a research psychologist who studies this 'condition' described it this way for My Health News "recurrent and intense sexual fantasies, sexual urges, and sexual behavior," that lasted at least six months." That seems just a little vague, doesn't it? Doesn't that describe about 85% of the human population? We are sexual beings and intense sexual urges and fantasies are a normal part of us. If we use this definition, I have this disorder.

However Reid also says that, "Diagnosis requires that these urges cause the patient distress, and aren't brought on by drugs or another mental disorder. The behavior must also interfere with their life, for instance, some patients in (Reid's) study lost jobs because they could not refrain from watching pornography and masturbating at work." This is what the proponents of sex addiction as a mental illness always throw in there. It's not just that someone likes sex or masturbates a lot, it's that they have no control over it and it's having a negative impact on their life. When you add that to it, it sounds completely reasonable. Of course if you masturbate at work all the time, you have a serious problem.

My question is though, is the problem hypersexual disorder or is it obsessive compulsive disorder and/or difficulty dealing with stress and anxiety? Are we diagnosing the illness or just the symptom? My personal belief is that considering anything that is actually a biological need like food, sleep, or sex to be addictive is dangerous. How do you determine what's a normal amount of eating or moderate over-eating and what is addictive behavior? How do you determine what is a normal amount of masturbating and what is addictive behavior? When we look at addictions to substances or things that we do not need to survive like alchohol or cocaine, the prescribed solution is almost always complete abstinence. That's how we know how to deal with addictions. Where does this leave someone who is diagnosed as having a sex addiction? They can never have sex again? Is that healthy? If that's not the case, then how do you determine what's healthy sex and what's not?

I have no doubt that many of the professionals who do believe this is a real disorder are honestly trying to help their patients. They see what is happening for them and they are looking for information, recognition, and resources that will help treat them.

However, I do believe that there are some professionals, and some people and groups that support this idea who are doing so because they have an agenda. When you hear people talk about cases of sex addiction, the person is almost always addicted to internet porn. The focus of this conversation is internet porn about 90% of the time. I believe that many of the people who support this being added to the DSM5 are sex-negative conservatives who want to use this as leverage to push the enforcement of obscenity laws or the creation of new censorship around pornography. If they can show that it is actually addictive, and there are some people already who are trying to say they have scientific evidence that watching internet porn creates neural pathways in the brain that foster addiction, they will have a lot of ammunition in that endeavor.

Sex addiction has also been used by a lot of people as an excuse for infidelity and other inappropriate behavior. Celebrities love to do this. They get caught doing something they absolutely should not have been doing and they claim they are sex addicts and could not help themselves. They are not sex addicts. They did something really stupid, inconsiderate and reckless and they got caught. And even if they actually were sex addicts (if that was a real thing) it still doesn't excuse the behavior.

I think it is very useful to understand how substance addictions work on the brain so that we can provide the best possible help to people who are dealing with them. But underlying even a substance addiction is life problems that must be dealt with so that the person has less of a need to turn to the substance to cope. So, I think, it is with these supposedly out of control sexual behaviors. The questions is not so much 'how can we stop you from masturbating at work' as it is, 'how can we help you to determine the triggers that make you want to engage in compulsive behaviors and make changes to those conditions in your life'.