Sexual Addiction – Excuse or Affliction?


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Normal or Pathological? Photo Credit: B. Schwabe

Soon, mental health professionals will be familiarizing themselves with a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V).

For several years, groups of psychiatrists and psychologists have been attempting to agree on new parameters of pathology that will determine who is mentally ill and to what degree.

One section that leads to the most disagreement is the section that describes sexual arousal, aversion, desire, and dysfunction.

Sexuality: What is Normal?

Is there any form of behavior more thoroughly studied than sexuality?  Societal or cultural norms determine what is acceptable, so they vary by time and place, and laws protecting vulnerable persons determine legal vs illegal sexual behavior.

For example, according to Stephanie Paul, writing about outdated laws for Legal Zoom, women who dare to publicly adjust their stockings in either Dennison, Texas, or Bristol, Tennessee could be jailed for up to twelve months.

Although this law is still on the books, hopefully this behavior would not actually lead to arrest today.  Cultural norms have changed considerably since the nineteenth century, but determining sexual normalcy or pathology is still fraught with passionate disagreement.

 Sexual Addiction or Compulsion?

What about infidelity, monogamy vs “open” relationships, and the emotional conflict that results when individuals in a relationship disagree on these standards?  Infidelity is not considered illegal in North America, except in the U.S. military, but when does sexual behavior become dysfunctional, or an addiction?  Is there really such a thing as a sex addict? Sexologists David Hersh and David McKenzie don’t think so – they contend that relational differences in sexual preferences, including frequency, are not necessarily pathological and that there is no real scientifically derived data that concludes sexual addiction exists.

Is “Swinging” Compulsive Sexual Behavior?

Traditions of monogamy or polygamy are rooted in religious doctrine, leading to disagreement in multi-ethnic societies such as North America. Perhaps surprisingly, Bergstrand and Blevins’ research into who chooses a “swinging” lifestyle in the U.S. reveals that:

” … swingers surveyed are the white, middle-class, middle-aged, church-going segment of the population reported in earlier studies, but when it comes to attitudes about sex and marriage they are less racist, less sexist, and less heterosexist than the general population. Swinging appears to make the vast majority of swingers’ marriages happier, and swingers rate the happiness of their marriages and life satisfaction generally as higher than the non-swinging population.”

So, in this context, infidelity or sex outside of the primary relationship is not considered a mental disorder or an addiction, but a choice that is made between adults, consensually.

When is Sexual Behavior Pathological?

Sexual behavior becomes pathological when it causes distress for the perpetrator, and/or is imposed without informed consent, thus victimizing someone.  These are the behaviors being considered for inclusion in DSM-V.

Currently the DSM-IV describes several Obsessive-Compulsive disorders, included within the section on Anxiety Disorders.  These involve unreasonable and obsessive thoughts, impulses, or images that are very difficult or impossible to ignore and result in compulsive behaviors or mental acts that are an attempt to reduce anxiety.  These thoughts and urges are not related to substance use or a medical condition.

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