Sexual addiction, or hypersexual disorder, is a form of behavioral addiction that belongs to a larger group of conditions known as process addictions. Until recently, these addictions received no official recognition from the American Psychiatric Association (APA), an organization that defines and categorizes mental health disorders in the U.S. However, this organization has now started to reassess its position on various process addictions, including hypersexual disorder. As part of this reassessment, an APA committee recently proposed a set of guidelines for making a meaningful hypersexual disorder diagnosis. A 2012 study at UCLA supports the validity of the APA’s proposed guidelines.
Understanding Process Addictions
Process addictions get their name because they form around activities or behaviors (i.e., processes) that most people engage in without suffering significant harm or life disruption. In addition to having sex, examples of potentially addictive processes include eating, shopping, surfing the Internet, gambling, playing video games and reading or watching pornography. At one time, scientists thought that process addictions differed fundamentally from drug or alcohol addictions, which develop from long-term changes in basic brain chemistry. However, accumulating evidence now shows that people with process addictions also undergo similar alterations in brain function, and therefore have more in common with substance addictions than previously believed.
Defining Hypersexual Disorder
The American Psychiatric Association maintains and periodically updates a guidebook called the Diagnostic and Statistical Manual of Mental Disorders (DSM), which mental health professionals refer to when diagnosing their patients. Technically speaking, a mental health disorder that doesn’t appear in the DSM does not officially exist; in real-world terms, this means that unofficial disorders don’t get diagnosed, and also don’t receive the same types of research efforts that are commonly dedicated to officially recognized disorders. In 2013, the American Psychiatric Association will officially include pathological gambling in the next DSM under a new category called behavioral addiction. It will also include hypersexual disorder (and Internet addiction) on a list for further study. As part of the process of studying hypersexual disorder, an APA committee proposed a detailed definition for the condition. To meet this proposed definition, a person with a possible case of sexual addiction must have intense, recurring sexual urges, behaviors or fantasies that last for six months or longer. The individual must also meet at least four of five additional criteria; these include repeatedly using sexual behaviors, fantasies, or urges to offset unpleasant or unwanted emotional states; repeatedly using sexual behaviors, fantasies or urges to offset stressful external events; committing excessive amounts of time to sexual urges or fantasies, or to actual sexual conduct; repeatedly performing sexual acts despite clear risks for negative emotional or physical consequences; and a repeated inability to control the frequency of sexual urges, fantasies or behaviors. In addition, the individual must be 18 or older; experience significant sex addiction-related disruptions to his or her social, personal or work life; and show no signs of other potential problems that could explain his or her behavior, such as substance abuse issues or the presence of manic-depressive illness.
Recent Supporting Findings
In October 2012, researchers at UCLA released the results of a study that examined symptoms in groups of people who reported struggles with sexual self-control, substance abuse or other significant psychiatric problems. They found that the APA’s proposed definition for hypersexual disorder correctly identified study participants with self-reported sex addictions in 88 percent of all cases. Just as importantly, they found that the APA’s definition properly excluded participants without self-reported sex addictions in fully 93 percent of all cases. In addition to their main findings, the UCLA researchers noted several other key points. First, roughly 85 percent of all cases, people who qualified for a hypersexual disorder diagnosis reported an onset of symptoms before they reached the age of 25. The most common activities of hypersexual individuals in the study were excessive masturbation and excessive involvement with pornographic material; consensual sexual activity ranked third on the list.
In order to define a true medical disorder, doctors and scientists must identify symptoms that are common to people with the disorder, as well as factors that accurately exclude people without appropriate symptoms. By fulfilling both of these criteria, the APA’s proposed definition for hypersexual disorder gains considerable validity as separate, distinct medical condition. In fact, findings from the UCLA study show that the accuracy of diagnosis for hypersexual disorder is roughly equal to the accuracy of diagnoses for other long-recognized mental health disorders.