Thursday, April 1, 2010

Sexual Addiction or It's Not My Fault That My Penis Fell Into Her Vagina

David Duchovny, Tiger Woods, Steve Phillips, and now Jesse James. All men, all self-diagnosed sex addicts, and all victims of their disorder. Well, that's how they want to be betrayed in the media. To most people, sexual addiction appears to be a "get out of jail free" card for sleazy douche bags. So this begs the question, is it a real disorder?

Like any other complex human behavior, it all depends on who you ask.

There appear to be four main camps: those who liken the condition to a chemical dependency disorder, those who view it as a disorder similar to obsessive-compulsive disorder, and those who believe it to be an impulse control disorder. The fourth group believes that the other three groups are full of shit.

Even though many people are diagnosed with, and treated for sexual addiction every year (estimated 3-6% of US population), there is no actual disorder in any of the previous versions of the DSM. A new disorder is being considered for the DSM-V, which is termed "Hypersexual Disorder."

Here of some examples of proposed diagnostic criteria:
1) A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

A) tolerance, as defined by either of the following:
-a need for markedly increased amount or intensity of the behavior to achieve the desired effect
-markedly diminished effect with continued involvement in the behavior at the same level or intensity

B) withdrawal, as manifested by either of the following:
-characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior
-the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
-the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended

C) there is a persistent desire or unsuccessful efforts to cut down or control the behavior
D) a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects
E) important social, occupational, or recreational activities are given up or reduced because of the behavior
F) the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior

I'd argue that these criteria adhere too closely to the substance dependence model and fail the capture the essence of human sexual behavior. Moreover, I don't know think "blue balls" would technically count as a withdrawal symptom.

From the DSM-V
A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria:(1) A great deal of time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
(2) Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).
(3) Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events.
(4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior.
(5) Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others. B. There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behavior.
C. These sexual fantasies, urges, and behavior are not due to the direct physiological effect of an exogenous substance (e.g., a drug of abuse or a medication).

There are some similarities between substance dependence, OCD, and impulse control disorders: impulsivity, obsessions, and compulsions.

Impulsive behaviors are by done without any forethought, spur of the moment.
Obsessions are intrusive thoughts that an individual does not want to have, but has them anyway.
Compulsive behaviors are behaviors that people do, but they do not want to do them.

There is another feature that ties all these disorders together: the addiction, obsession, or compulsion is the central organizing principle of that individual's life. The crack addict lives his life around obtaining and using crack, the patient with OCD is so fearful of contamination that she washes her hands so many times that she has blisters, someone with trichotillomania is completely bald because they cannot stop pulling their hair out. These people do not live happy lives. Their disorder rules their life; they are disabled. These people are doing something that they most certainly do not want to do.

Jesse James had an 11 month affair and Tiger Woods had a 2 year affair (plus other alleged affairs). David Duckovny banged his tennis partner. Steven Phillips is a misogynist. Sounds more like these were guys who got caught cheating and are now doing major damage control.

One more thought. If true addicts cannot use the substance to which they were addicted, are sex addicts not allowed to have sex anymore? If Jesse James porks Sandra again, did he relapse?

Discuss amongst yourselves.


Anonymous said...

JEEZ... you have way too much fucking time on your hands if you post about this crap. Can you at least go back to Taylor and Beyonce blow job pics???

Dr John said...

I like this post. The whole idea of this "disorder" is bullshit. If a compulsive behavior is one you have but you do not want at what point is that true? Having sex with just your wife but not wanting the same sexual act with your mistress but getting some anyway? What defines it as a compulsion, your religious misgivings or society? Or does this happen only after you get caught? I guess that's when you explain to the media its a "compulsion". ahh ahha

Anonymous said...

I have no doubt that sex inspires both compulsions and fantasies - duh! Like anything else in psychiatric field - we're all over the board on this - as most of psychiatry starts out with made up disorders until it gets added to the DSM - then it is a disease! In meantime, we can make fun of "sex addicts" as they do not have an official disease as yet to hang their p$%^er on! Don't forget Wad Boggs and Steve Garvey as two more original thinkers in this area - in this case little head taking over for the big one.

The Shrink said...

Using the WHO's ICD-10 classification system, as we're wont to do in Europe, it's not a disorder.

It's not an illness.

It's a negative life choice.

We shouldn't medicalise this, surely.

therapy4help said...

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