Sex Addiction

Diagnostic Criteria

Although the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) does not have a distinct code for all forms of excessive sexual activities, three classifications are typically used. When the compulsion is considered more culturally common (i.e., masturbation, serial sex partners, viewing pornography, paying consenting adults for liaisons), the disorder is typically diagnosed as either an impulse control disorder, not otherwise specified or a sexual disorder, not otherwise specified. More unconventional sexual obsessions are defined under the title of paraphilias (i.e., fetishism, voyeurism, sexual sadism or masochism). It is anticipated that the fifth edition of the DSM may create a new category of disorders under the heading of behavioral and substance addictions. If that were to occur, it is expected that many sexual compulsions would be determined as sexual addictions and, thus, would be included with such impulse control disorders as pathological gambling, compulsive buying or spending, and Internet addiction.

Despite the endless debates as to whether behavioral compulsions are truly addictions, the addiction model is clearly a useful viewpoint for understanding, assessing, and treating compulsive sexual behaviors. Consistent with other behavioral compulsions, sexual addiction is defined as an excessive involvement in specific or various practices that disrupt normal daily living and impede healthy functioning. A loss of time and perspective emerges from the preoccupation to satisfy cravings, rituals develop which reinforce the behavior, cravings intensify, and the ability to control thoughts and behaviors progressively decreases as pleasure-seeking behaviors become primary.

As with other addictions, a person's mood is altered by the planning, pursuit, and attainment of sexual gratification. Tolerance and withdrawal experiences develop as the person chases the original excitement; yet, the person only finds temporary relief and soon is seeking additional sexual pleasure. As the addictive cycle progresses, the compulsive sexual behavior becomes a coping mechanism for anxiety, stress, loneliness, and other negative experiences, until finally, the individual is "addicted" to the pleasure-giving neurotransmitters released during the sexual activity. The obsessive pursuit of sexual satisfaction begins to dominate while leaving the person's home and work life neglected and at risk.

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