Sex addiction, or hypersexual disorder, has recently been considered for including in the diagnostic criteria for a psychiatric disorder. We asked our clinical director Gabrielle Epstein, to shed a some light on this development.
Psychiatric diagnoses are defined and listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). DSM is reviewed at regular intervals with new versions released at intervals ranging from 6 years to as long as 16 years. Each new version of DSM is given a new number, beginning with DSM-1 in 1952 to the current version DSM-IV-TR published in 2000. DSM is used by psychiatrists, psychologists and mental health professionals to determine and help communicate a psychiatric diagnosis. There is often considerable changes between versions. It is worth noting that ‘Homosexuality’ was previously a psychiatric diagnosis in DSM which was removed in DSM-III. Over time more and more mental disorders have been included in DSM.
DSM-5 is currently in consultation, preparation and planning. It is due for publication in May 2013. The American Psychiatric Association (APA) convened a DSM Task Force in 2007 to oversee DSM-5 development with a number of expert working groups convened under the Task Force. The draft version of DSM-5 is available for detailed perusal at http://www.dsm5.org/pages/default.aspx .
A proposed new diagnostic category in DSM-5 is ‘Hypersexual Disorder’ listed under Sexual and Gender Identity Disorders. This is proposed in response to what is identified as is a significant clinical need for mental health providers to recognise and diagnose a distinct group of men and women who have been seeking and are already receiving mental health care such as individual psychotherapy, 12-step group support, pharmacotherapy, and specialized residential treatments. These men and women are presenting to clinicians because of recurrent, “out of control” sexual behaviors.
The proposed diagnostic criteria for ‘Hypersexual Disorder’ include:
(1) Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
(2) Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).
(3) Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events.
(4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior.
(5) Repetitively engaging in sexual behavior 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, and behavior.
C. These sexual fantasies, urges, and behavior are not due to direct physiological effects of exogenous substances (e.g., drugs of abuse or medications) or to Manic Episodes.
Here at Lifeworks we treat a range of people who are experiencing significant difficulties in their lives due to ‘out of control’ sexual urges. Psychiatric diagnoses are one way in which to convey information to clinicians about individual’s presentations and provides a framework for conceptualizing treatment. They are not an end in themselves but rather, a ‘shorthand’ means of conveying information. As such the inclusion of a diagnosis of ‘Hypersexual Disorder’ may be useful. There is public debate as to the utility of psychiatric diagnosis in general, and, ‘Hypersexual Disorder’ has raised considerable debate that arises from any discussion about compulsive behaviour, i.e. is it pathologising a variation of normal behaviour. Overall, behaviours that interfere with an individual’s well-being and their ability to conduct and enjoy their everyday life are an important focus of psychological treatment.