Diagnosing Sexual Addiction or Unwanted Sexual Behavior

The Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) is the book through which the American Psychiatric Association regulates everything from Schizophrenia to Generalized Anxiety disorder. It is the manual that Psychologists, Psychiatrists, and Therapists live by and the criteria they use to assess whether or not someone has enough symptoms to elicit a diagnosis. The DSM-V has a section related to Sexual Dysfunction, but not addiction.

This is due to the debate regarding whether sexual behaviors can be addictive. However, they do outline Substance Use Disorders and I think we can find it helpful to look at that criteria in comparison to sexual behaviors. It’s important to note that we are no longer just discussing pornography. This can be applied to sex with a spouse/partner, strip clubs/brothels, purchasing sex online, risky behavior on dating apps, video chats, sexting, pornography, and so much more.

If you’re like the average person in this situation, I bet you’ve thought to yourself something along the lines of “at least it’s not drugs.” Even though all addiction is addiction, there seems to be different stigma’s around each of them. It was important to me to write this specific article. I’ve found that when I work with clients and have this conversation, it creates a dialogue which is often missed. It gives you a set of standards to look at and use to reflect on your own behaviors. It helps ask difficult questions and shed light on present situations.

This isn’t meant to be academic or condemning, so as you read this, imagine it’s a conversation. Imagine you’re in a room talking with someone about these concerns and see how the conversation changes. The DSM-V lists eleven points of diagnostic criteria for Alcohol Use Disorder. The interesting piece is that only two of the eleven markers must be present in a person’s life. The two markers must occur during a 12-month period and they must lead to distress or clinically significant impairment. I’ll list a few of the criterion below:

1. Alcohol is often taken in larger amounts or over a longer period than was intended (p. 490).

2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use (p. 490).

3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects (p. 491).

4. Craving, or a strong desire to use alcohol (p. 491).

5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home (p. 491).

6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems cause or exacerbated by the effects of alcohol (p. 491).

   Now, take a deep breath. Okay, now take what you just read and substitute the word “alcohol” for “porn,” “sex,” or whatever vice fits your modus operandi. How does that change the perspective? Is it hitting close to home? Remember, those are only six of the eleven options. And only two are required. That is a pretty sobering thought if you let it sink in. If you’re debating closing out this article and pushing this to the back of your mind, I urge you to stick with this. Continue reading by clicking through to another article.

   References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: Dsm-5. Arlington, VA., 490-491