- The Washington Times - Friday, June 17, 2011

ANALYSIS/OPINION:

Over the past few weeks, we’ve heard several variations on a theme - a powerful man who can’t keep his pants buttoned. Spouses are hurt, jobs lost. It really is quite tragic. But the new kid on the block is the defense we now are all waiting for: “I am a sex addict.” Eyes roll.

The timing for these stories couldn’t be more perfect. In recent months, the American Psychiatric Association’s task force met in an ongoing discussion on whether to include hypersexual disorder (aka sex addiction) in its big book, the Diagnostical and Statistical Manual of Mental Disorders (DSM). The fifth edition is due out within the next few years. Even among professionals, there is great debate on whether this condition exists. Are these individuals perpetrators? Men being men? Victims of societal craze? Stupid? Or perhaps they suffer from a legitimate mental disorder?

The proposed diagnostic criteria, which have yet to be accepted, include a list of symptoms that the hypersexual person has. These include failing to control sexual behaviors, turning to sex as a means of dealing with unpleasant feelings, and continuing to engage in sexual behaviors despite bad things happening, to name a few. These behaviors must be persistent and contribute to distress or dysfunction in a person’s life. It is not about liking a lot of sex or engaging in diverse or exotic sexual practices. It’s also not about abusing authority, violating others or being just plain stupid. Rather, it’s about the quality and role that sex plays in one’s life.

In essence, this is alcoholism or drug addiction but without the tolerance or withdrawal, although even that is debated. It is labeled hypersexual disorder because, unlike classic “addictions” (a term not even recognized by the DSM), this disorder assumes no specific root causes and is based on empirical scientific data. It’s not just the “I am addicted to everything” fad.

The main arguments against inclusion of this disorder are that the underlying brain dysfunction has yet to be discovered and that other disorders in the DSM might better account for these behaviors. Hence, is this something that is real? Not all bad choices in life merit labeling as a mental disorder.

Hypersexual disorder, sex addiction, compulsive sexual behavior is real - no matter what you call it. It affects men and women of all ages, races, genders and ethnicities. Its original terms, Don Juanism and satyriasis, point to its existence over time. And although we don’t yet know its full origins, the complex biological, psychological and social influences that impact the neural pathways of the mind are no less real than the HIV virus, a cancer cell or the inflammatory response. And the damage it causes individuals and their relationships is no less real than the damage to the liver, kidneys, heart, etc. that more classic “diseases” cause. Many “real” mental disorders and even physical disorders have yet to be fully explained or understood.

I don’t know if any of the individuals involved in the recent sex scandals meet the proposed criteria for hypersexual disorder. Nor, without having evaluated them or knowing the context of their problems, is it ethical for me to say so. However, I cringe just as much when I hear people hide behind diagnoses as a means to justify irresponsible behavior. Yet simply because people abuse a diagnosis doesn’t mean that diagnosis doesn’t exist.

As a clinician who sees many individuals whose sexual behaviors have gotten them into trouble and harmed them and those around them, offering a diagnosis provides my clients with understanding and hope. It enables them to understand they are not alone and that there is treatment out there to help them. Explanations of behavior are different from excuses. Ultimately, it is more important how one uses a label than is the label itself.

“I suffer from hypersexual disorder” may not quite have the same ring as “I am a sex addict.” But the ability to say that opens the door to hope for many individuals who are suffering - suffering not from the humiliation of being in the front pages, but rather from a true dysregulation in their sexual behaviors.

As a physician, researcher and, most important, patient advocate, I hope the convergence of sex and politics we are seeing in the news doesn’t let politics win out in how the scientific community addresses sex and the human condition.

Dr. Charles P. Samenow is an assistant professor of psychiatry and behavioral sciences at George Washington University and editor of Sexual Addiction and Compulsivity: The Journal of Prevention and Treatment.

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