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Psychiatrists Still Can’t Decide If Sexual Addiction Is a Mental Disease

Psychiatrists Still Can’t Decide If Sexual Addiction Is a Mental DiseaseTiger Woods, Anthony Wiener, Charlie Sheen, David Duchovny, Michael Douglas, Russell Brand and many other people have all undergone intense treatment for sexual addictions. Yet the American Psychiatric Association does not recognize the condition as a mental disorder.

This year the APA came out with its new version of its “Diagnostic and Statistical Manual of Mental Disorders,” the so-called Bible that all doctors use when they diagnose and treat mental illness. One big question people were asking about the new 2013 DSM-V was whether “sexual addiction” would be added as a mental disorder. As it turned out, the editors decided to sidestep the issue by saying it needs more research.  The decision has implications not just for doctors, but for all Americans.

For example, when the DSM stopped defining homosexuality as a sociopathic personality disturbance, it opened the way for mainstream acceptance for gays and lesbians. When the DSM included drug addiction and alcoholism as mental diseases, it meant that insurance companies had to pay millions for their treatments.

Even though it is not in the DSM, addiction specialists point to the many similarities between sexual addiction and alcoholism or drug addiction.  Just as heroin addicts are always thinking about how to obtain their next fix, people addicted to sex spend a lot of time finding partners and new opportunities to have sex.  Thoughts of sex – like thoughts of drugs and alcohol for other kinds of addicts –  become all-consuming and obsessive. Sex addicts are often preoccupied with sexual fantasies, and many develop rituals, preferring certain kinds of partners and situations, which again drains time and energy from their work and families.

Like drug addicts who ingest drugs in amounts that would kill an ordinary person, sex addicts develop “tolerances.” They have to keep increasing the risks that they take in order to experience the same high levels of pleasure and euphoria.  Seeking out sex just like seeking out drugs or alcohol becomes out of control, and yet they are compelled to engage in self-destructive and repetitious behaviors that ruin their marriages, families, finances, reputations, health, and careers.  Sex addicts feel the same shame and sense of powerlessness over their behaviors that alcoholics and drug addicts experience too. The reaction of their family and friends is often the stereotypical one that alcoholics get, and so sex addicts hear advice like “Just say no” or “Try abstinence.” When their efforts to stop their addictive behaviors fail, their love ones react with contempt at their lack of self-control.

Self-control has little to do with addiction, which many therapists and psychiatrists define as a physical brain disease. Drugs, alcohol and even certain foods can produce chemical changes in the brain’s reward system to the point that a person no longer has control and becomes driven to repeat the self-destructive behaviors.  Sexual activity raises the level of phenylethylamine and other chemicals related to euphoria and excitement so that this system becomes unbalanced. In other words, a sex addict like any other kind of addict might simply unable to control certain chemical reactions in his brain.

In his memoir called “My Booky Wook,” Russell Brand says that at the height of his addiction, he had more than ten regular sexual partners and was also using prostitutes and hooking up with people he met at bars. Yet he was deeply unhappy.  He writes, “Addiction, by definition, is a compulsive behavior that you cannot control or relinquish, despite its destructive consequences. If my life proves nothing else, it demonstrates that this formula can be applied to sex just as easily as it can be to drugs or alcohol.” He was one of the lucky ones who found a way out of his addiction.

References

Brand, Russell. My Booky Wonk: a Memoir of Drugs, Sex, and Standup. London: It Books, 2000.

Friedman, Ann. Too Much or Too Little: DSM-V’s Gray Area on Sex Addiction. New York Magazine, May 23, 2013.

“Love and Sex Addiction.” Diagnosis Dictionary of Psychology Today, see http://www.psychologytoday.com/conditions/sex-and-love-addiction.

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