The idea that someone can have a sex addiction has been controversial, but a new study suggests that it is a real disorder, and lays out rules that could be used in deciding who has it.
Hypersexual disorder, as sex addiction is formally known, is under consideration for inclusion in the Diagnostic and Statistical Manual of Mental Disorders (DSM) — the bible of mental conditions.
But first, researchers need to agree on how to define this disorder. For example, under one proposed definition, a person who simply has frequent sex would not be diagnosed with hypersexual disorder, said study researcher Rory Reid, an assistant professor and research psychologist at the University of California, Los Angeles.
But a person whose sexual activities are excessive, frequently used to cope with stress and interfere with their ability to function in daily life may meet the criteria for the disorder, Reid said.
The definition also needs to hold up in the real world, so that health care professionals can consistently apply it when diagnosing patients.
In the new study, researchers found that professionals could use the proposed symptoms of hypersexual disorder to separate people into two groups — those who have a disorder, and others who don't. In addition, health professionals with varied backgrounds, including psychiatrists, psychologists and social workers, generally agreed about how to interpret the definition.
The researchers emphasized that they are not trying to turn common behaviors — such as having a lot of sex, or watching pornography — into disorders.
Rather, people with hypersexual disorder report feeling out of control, and act on their sexual urges while disregarding the repercussions. "They might consider the consequences momentarily, but somehow feel their need for sex is more important, and choose sex even in situations where such choices might cause significant problems or harm," such as job loss, relationship problems or financial difficulties, Reid said.
The results of the study will be sent to the American Psychiatric Association — the organization in charge of putting together the DSM. APA reviewers will then determine whether hypersexual disorder will be included in the next edition of the manual, to be released next summer.
In the study, hypersexual disorder was defined as "recurrent and intense sexual fantasies, sexual urges, and sexual behavior," that had lasted at least six months. Diagnosis requires that these sexual fantasies, urges and behaviors cause the patient distress, or interfere with some aspect of the patient's life, such as the patient's job or social life. To be classified under the disorder, these behaviors must not be brought on by drugs or alcohol, or another mental disorder.
The researchers interviewed 207 people who had been referred to a mental health clinic, without knowing the reasons for their referral. One hundred fifty-two people had been referred for sexual behavior problems, while 20 were referred for substance abuse, and 35 for another psychiatric condition.
Using the criteria for hypersexual disorder, 134 of the patients referred for sexual problems were diagnosed with hypersexual disorder and 18 were diagnosed as having another psychiatric condition or no condition at all. Having a diagnosis of hypersexual disorder was closely linked to patients' scores on separate questionnaires designed to assess sexual behavior, impulsively and susceptibility to stress.
In 92 percent of cases, the professionals agreed on who should be diagnosed with the condition.
The vast majority of patients who were referred for substance abuse problems (19 out of 20) or another psychiatric condition (32 out of 35) were diagnosed with their respective conditions, and not with hypersexual disorder.
Doctors also asked patients to report which behaviors were most problematic for them, including masturbation, pornography viewing, sex with consenting adults, cybersex, telephone sex and frequenting strip clubs.
The majority who were diagnosed with hypersexual disorder said masturbation and pornography viewing were problematic. Some patients reported losing jobs because they could not refrain from these behaviors at work, Reid said.
Patients are likely to say that they engaged in these behaviors despite efforts to try to control them, and with disregard for the physical or emotional harm to themselves or others, the researchers said.
To answer critics who argue hypersexual disorder could be used as an excuse to be unfaithful, Reid said the disorder would not absolve people from the consequences of their behavior.
"Having a disorder didn't help them avoid consequences, such as divorce, but it is advantageous for them when they want to get help and change," Reid said.
Future research is needed to determine whether people with hypersexual disorder have changes in their brain that are similar to the changes seen in people with addictions, Reid said. In addition, studies should determine the prevalence of the condition in the general population, he said.
If hypersexual disorder is added to the DSM, it will be included in the appendix, Reid said. The inclusion of disorders in the appendix is provisional, and requires further research, Reid said.
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