In recent years, media reports of celebrities - usually men - citing "sex addiction" as the reason they've been unfaithful have made headlines.
But is what's known to psychologists as "hypersexual disorder" a real pathology or just a lame excuse for bad behaviour?
The issue is a real one, since there's been talk of including hypersexual disorder in the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), considered the "bible" for psychologists and psychiatrists.
Now, a team of experts has formulated criteria that could help therapists correctly identify the disorder, with an eye to treatment.
How the research was done
To test the criteria, the researchers interviewed and conducted psychological testing on 207 patients treated at several U.S. mental health clinics. All of the participants were seeking help for out-of-control sexual behaviour, a substance abuse disorder or another psychiatric condition such as depression or anxiety.
Applying their proposed criteria to the data they gathered from the participants, the researchers said the criteria accurately spotted 93% of people with hypersexual disorder.
According to one of the researchers, the critical issue is whether the out-of-control sexual behaviour is interfering with a person's life and they feel powerless to change it.
"It's about having sex that's causing problems, out of control, risking infection," said guidelines co-author Rory Reid, an assistant professor of psychiatry at the University of California, Los Angeles. "It's usually the consequences [of the hypersexual behavior] that bring people through the door."
More a compulsion than an addiction
Reid added that he believes the lay term "sex addiction" is a misnomer. "I wouldn't call it sex addiction because we're lacking information about whether it is indeed a compulsion," he explained.
To meet the criteria for hypersexual disorder, the behaviour must be causing harm. "If a patient is engaging in a particular sexual behaviour and it's not hurting them or others, it's not a problem," he explained.
So what do they mean by "causing harm"? For one particularly disturbing example, Reid described one patient, an air cargo pilot, who engaged in auto-erotic asphyxiation about once a month - masturbating at high altitude to the point of passing out.
The study findings, published in the Journal of Sexual Medicine, support a set of criteria that show what should be considered a hypersexual disorder.
The criteria include:
Sexual behaviour that's been occurring over a period of at least six months.
Recurrent, intense sexual fantasies, often in response to anxiety, depression and other mood states or stressful life events.
Attempts by the person to control or reduce the behaviours.
Behaviours that risk harm to themselves or others, or cause clinically significant personal distress or impairment in people's lives.
Certain things that would rule out a diagnosis of hypersexual disorder would include drug abuse (the sexual fantasies or behaviours typically occur while under the influence), underlying medical conditions, or youth (diagnosis typically isn't made for anyone under the age of 18).
'Sex addiction' may start as a teenager
However, Reid added that the study did find the disorder most often has its roots in adolescence or early adulthood. The most common sexual behaviours associated with the problem included masturbation and excessive use of pornography, sex with a consenting adult, and cybersex ("virtual" sex conducted online). Other risk factors included sex with prostitutes, repeated affairs, or having an average of 15 different sex partners in a year.
The good news is that hypersexual disorder can be treated. According to Reid, treatment typically includes cognitive behavioural therapy or experiential therapy to help people process their emotions and develop coping skills, mindfulness meditation to help patients increase their tolerance for cravings and 12-step groups.
Still, some may wonder if labelling out-of-control sexual behaviour a pathology is simply turning normal adult behaviour into an illness. But James Maddux, professor emeritus of psychology at George Mason University in Fairfax, Va., says that in this case, that's probably not what's happening.
"I'm always sceptical of a new so-called disorder but in this case I think it's probably justified," he said. The key, he said, is that "the research is based on people who actually sought help and are disturbed about it."
Reid said that getting the new criteria into the DSM-5 would "put everyone on the same page" when it comes to diagnosing these sexual problems. He added that it would also provide well-structured criteria on which outcome studies could be based.
However, Reid doesn't believe the criteria will make it into the main section of the next edition of the DSM. "They've already made a decision that if this disorder is included in the DSM-5, it will not be in the front pages but as an appendix item -- which means more research is needed. It won't show up as a full-blown psychiatric dysfunction [in the new edition]," he said.
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The sex addiction cycle
There's more on sexual health at the U.S. National Library of Medicine.
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