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Sex Addicts Anonymous

Is Sex Addiction a Mental Health Disorder?

Hypersexuality, sexual compulsivity, sex addiction, compulsive sexual behavior are all interchangeable ways to describe someone who is having problematic sexual issues. For nearly ten years, many mental health professionals have advocated for an official diagnosis to describe a disorder that has been treated for close to two decades. (NCBI) No longer do people have to hide behind the stigmas of this subject, as the once-taboo thought process behind such a disease is being lifted through clinical awareness. Fortunately, as a mental health illness, this is a treatable disorder that centers around impulse, distress, and impairment.

What is Compulsive Sexual Behavior?

“Compulsive sexual behavior (CSB) is characterized by craving, impulsivity, social/occupational impairment, and psychiatric comorbidity. Prevalence of CSB is estimated around 3–6%, with a male predominance.” (Kraus) As with most preocupacional issues, pleasure sensors are involved with CSB. Humans have a reward system that is sensitive to dopamine receptors. Survival is the main purpose for this internal reward system that allows for; satisfaction after a job well done or motivation during an intense workout. Naturally the brain releases dopamine at a consistent level to maintain a level of joy. Adversely when this system is artificially stimulated, dopamine levels are increased, delivering a high feeling, which then leads to an inevitable emptiness. Here is where addiction is developed. When this reward system is given unnatural accolades in response to meritless tasks, the brain now is chasing this proverbial dragon. Addicts are known to relieve trauma, pain or guilt utilizing these methods.

As a stand-alone diagnosis, those claiming to have sex addiction generally don’t fit the criteria. Many cases point to other more common mental health disorders such as depression or anxiety that are causing these issues. Impulse is the nature of compulsive sexual behavior and has been classified in the International Statistical Classification of Diseases’ 10th revision under F52.8 as, “other sexual dysfunction, not caused by organic disorders or disease” and under F52.9 as, “Unspecified sexual dysfunction, not caused by organic disorder or disease”. (ICD) Broad terminology allows for clinical interpretation of individuals who have a preoccupation to sexual type acts. Distress from these repeated behaviors has researchers vying for a more classified description of compulsive sexual behavior as a mental health disorder in the ICD-11, “Compulsive sexual behaviour disorder has been proposed for inclusion as an impulse control disorder in the ICD‐11. It is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.” (Kraus)
Powerlessness, unmanageability, and the preoccupation around sex is what makes this subject a strong case for mental health disorder classification.

Shame and Isolation Consistent with Addiction

Everyday life with family, friends, work, and duty can become secondary responsibilities that are often neglected when sex addiction takes control. Over time this isolation and excess desire leads to distress, guilt, and embarrassment. Shame further causes these acts to become uncontrollable as the “high” is now the only pleasure known, making a direct case for compulsive sexual behavior as an addiction.

Sexual Impulse is not always Sex Addiction

Predisposition to sexual impulses does not mean that all “sex addicts” are obsessive of deviant behaviors, some are addicted to love and relationships. “Being in love” is intimately tied to characteristic biochemical reactions occurring within the brain. These reactions involve such compounds as dopamine, oxytocin, vasopressin, and serotonin and recruit brain regions known to play a role in the development of trust, the creation of feelings of pleasure, and the signalling of reward.” (Earp) Establishing new relationships and seeking intimate approval in others can be just as destructive due to a cycle of compulsion around the dedicated attention it requires to establish these connections. Severe attachment, relationship fallout and toxic environments are all negative outcomes of those who continually chase the thrill of new love, usually stemming from childhood abandonment. PsychAlive elaborates on attachment with:

Attachment patterns develop during the first 18 months of life as a result of
how the primary caregiver (usually the mother) interacts with the
infant….Insecure attachment develops when a parent is unable to consistently sooth their child. In this scenario, the upset child turns to their parent for comfort and connection, but they get ignored, or their parent is too anxious or distracted to properly sooth them, or they are scolded or even abused for crying and having needs. How attuned the parent is to their child at times of distress over time forms an attachment pattern that follows the child into their adult Relationships.

-Firestone, Love Addictions: Do You Have an Unhealthy Addiction to Love?

Opposite to common sexual impulses such as; promiscuity, adult films, pornography, serial dating, and excessive masturbation, there is an area of sexual addiction characterized as paraphilia. It’s these designations that cause sex addiction difficult to ascertain between sexual preference, illegal acts, and mental health disorders. Due to this complicated subject matter, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has attempted to separate paraphilia apart from paraphilia disorders. Paraphilia can be of personal sexual preference or interest, whereas a paraphilia disorder diagnosis would require one to “feel personal distress about their interest, not merely distress resulting from society’s disapproval”; or “have a sexual desire or behavior that involves another person‘s psychological distress, injury, or death, or a desire for sexual behaviors involving unwilling persons or persons unable to give legal consent.” (McManus) Depending on local laws, paraphilia acts such as; frotteurism, zoophilia, pedophilia, voyeurism, and exhibitionism are illegal.

Within the legal system is where difficulties lie. Diagnosing rapists and sexual predators to have a paraphilic disorder has unraveled a loophole in the judicial process. Fixed, shorter-term sentences to convicted rapists have been a consequence that derived from DSM-5’s terminology being incorrectly applied to many cases. William L. Fitch, of Maryland Forensic Services, also found improper hospitalization for convicted sexual offenders, scheduled for release, across sixteen states.” (Fitch) Difficult lines between clinical designation and law have created a concern for the future inclusion of paraphilia within the DSM.

Preference also has its place when discussing paraphilia. Many consensual and non-criminal behaviors are also discretionary. Certain sects may be morally against specific activities, however, cultural bias does not construe these sexual preferences between consensual adults to be illegal. International Commission of Jurists discusses religion and morality, regarding sexual preference:

Societies’ values and notions of propriety have often been based on
religious ideologies of morality. Religious and moral discourses have
shaped attitudes and laws in respect of sex and gender…Among all the
Abrahamic religions, there has been a variety of oppression and tolerance
of same-sex eroicism at different times, places and among different
branches of these religions.

-ICJ, Sexual orientation, gender identity and international human rights law – Practitioners’ guide, no. 4

Examples of common preference-based paraphilias are; fetishism, partialism, masochism, sadism, and transvestism. Preference does not mean that these acts cannot become addictive.

Understanding that not all sex addicts are predators allows for treating these compulsive tendencies as a mental addiction. Opposite to that, realizing the attempted abuse of legal loopholes in regards to sexual criminal activities can allow for the American Psychiatric Association, creators of the DSM-5, to develop changes that exclude vague terminology. Developing a distinction between treatable compulsive sexual behaviors and harmful lewd criminal acts to future editions of the DSM would remit crafty lawyers from pointing to the disorder for recourse of lighter punishment. As preoccupation with problematic sexual behaviors becomes a priority, it again goes back to making the case of sex addiction as a mental health disorder. Deciding factors to establishing an acumen suitable for sex addiction treatment as a mental health disorder, lie within the boundaries of socially accepted behaviors and criminal acts.

References & Citations

Earp, Brian D, et al. “Addicted to Love: What Is Love Addiction and When Should It Be
Treated?” Philosophy, Psychiatry, & Psychology : PPP.

Firestone, Lena “Love Addictions: Do You Have an Unhealthy Addiction to Love?”

ICD “ICD-10 Version.” World Health Organization.

ICJ “Sexual Orientation, Gender Identity and International Human Rights Law –
Practitioners’ Guide, No. 4.” International Commission of Jurists.

Kraus, Shane W, et al. “Neurobiology of Compulsive Sexual Behavior: Emerging
Science.” Neuropsychopharmacology.

McManus, Michelle A, et al. “Paraphilias: Definition, Diagnosis and Treatment.”
F1000prime Reports.

WL, Fitch. “Sexual Offender Commitment in the United States: Legislative and Policy
Concerns.” Annals of the New York Academy of Sciences.