Hypersexuality and the DSM

Many people are becoming accustomed to hearing about sex addiction or seeing something about sex addiction in the news. Political scandals and movies such as Shame can make it seem like sex addiction is something new. The truth is those who work in the field have been battling to create legitimacy for sex addiction in the medical field for years.

Anyone who tries to seek treatment for sexual addiction quickly comes to find that most Certified Sex Addiction Therapists do not accept insurance. While there may be multiple reasons for this, one reason is that insurance does not cover the treatment of sexual addiction or sexual compulsivity. While this may be confusing to someone who is not in the mental health field, there is actually a reason for the lack of coverage. Insurance companies will cover treatment for mental health issues that have made it into the DSM. The current version of the DSM is the DSM-IV-TR. Sexual Compulsivity is not in the DSM.

There is a new version of the DSM, the DSM-V, which is slated for publication in spring of 2013. There has been a solid flight by those in the field of sexual addiction treatment to have sexual addiction; termed Hypersexual Disorder, included in the next DSM. This debate was placed in the hands of the Work Group on Sexual and Gender Identity Disorders. The call for research on this subject was taken up by several researchers including Dr. Rory Reid, a prominent researcher in the field of Hypersexual Disorder. Recently, Dr. Reid and his fellow researchers published the findings in a field trial for the DSM-V in the Journal of Sexual Medicine.

The term sex addict has been bandied about in popular culture in the same way the term bi-polar is sometimes been used to describe a moody person. To clarify what the DSM-V committee is talking about it helps to share the criteria for Hypersexual Disorder:
A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, with four or more of the following criteria:
a. Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
b. Repetitively engaging in these sexual fantasies urges and behavior in response to dysphonic mood states (e.g. anxiety, depression, boredom, and irritability).
c. Repetitively engaging in these sexual fantasies urges and behavior in response to stressful events.
d. Repetitive and unsuccessful efforts to control or significantly reduce these sexual fantasies, urges and behavior,
e. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.
B. There is clinically significant impersonal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or 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), a co-occurring general medical condition or to manic episodes.
D. The person is at least 18 years of age.
Specify if masturbation, pornography, sexual behavior with consenting adults, cybersex, telephone sex and strip clubs.

Now that we know what we are looking for, let’s look at Reid et. als study. First, why do we need studies like this? Before the APA can include a mental health disorder they need to know that it is not only valid but that there are reliable diagnostic criteria that can be used to assess the presence of the disorder. The recent study published by Reid et. al. aimed to assess the reliability and validity of the proposed diagnostic criteria for Hypersexual Disorder.

The study was conducted at out-patient treatment sites in four states. The clinicians used nine measures to gather information about the clients coming into treatment for Hypersexual Disorder. As this is an academic article, I am not going to discuss the details of the study measures or statistics. The main finding of importance is that the proposed criteria for Hypersexual Disorder can be applied in a reliable fashion as well as are stable over short periods of time.

The question for someone not in the academic community might be, so what? What does this mean? Honestly, for the person suffering from sexual compulsivity, this study really doesn’t help! What this study is, is a first step towards legitimizing Hypersexual Disorder as an accepted mental health issue. That acceptance can help reduce the societal stigma of being a sex addict and could, hopefully, eventually increase access to treatment for those unable to pay for treatment out of pocket.

Reid et. al (2012). Report of Findings in a DSM-5 Field Trial for Hyperseuxal Disorder. Journal of Sexual Medicine, VOl 9, Issue 11, 2868-2877.