Sexual Addiction or Sexual Compulsivity: What to Call It?

Should sexually compulsive behavior be designated a disorder or an addiction?

by · Psychology Today
Reviewed by Hara Estroff Marano
Source: Shutterstock, Bakhtiar Zein

Relatively recently, the World Health Organization (WHO) added compulsive sexual behavior disorder (CSBD) as an official diagnosis. Although most mental health providers in the United States utilize the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM) rather than the World Health Organization’s International Classification of Diseases (which is the primary manual for most of the rest of the world), the development is nonetheless significant.

Clinicians have long required clear criteria to establish a diagnosis and engage in a treatment protocol. Both the DSM and the ICD establish those criteria.

The criteria for diagnosing CSBD, as outlined in the eleventh edition of the ICD (ICD-11) are as follows:

  • A persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.
  • Repetitive sexual activities become a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities.
  • Numerous unsuccessful efforts to significantly reduce repetitive sexual behavior.
  • Continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it.
  • The pattern of failure to control intense sexual impulses or urges that results in repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more).
  • The pattern of failure to control intense sexual impulses or urges that results in repetitive sexual behavior causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. (Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.)

This description mirrors the criteria therapists typically use when evaluating for an addiction of any type (both substance and behavioral). The short version of those criteria is as follows:

  • Preoccupation to the point of obsession with a substance or behavior.
  • Loss of control over the use of a substance or behavior, best evidenced by multiple failed attempts to quit or cut back.
  • Directly related negative life consequences.

These benchmarks comprise a shorthand version of the eleven criteria the DSM uses to identify addictions, any two of which are enough for an official diagnosis. Of note: The APA officially refers to addictions as “use disorders,” although the terms "addiction" and "compulsivity" are commonly used colloquially by both clinicians and clients who deal with the problems.

Groups providing support to individuals struggling with sexually compulsive/addictive behaviors use varied terminology.

Individuals who struggle with compulsive sexual behavior routinely self-refer to and participate in these groups as part of their healing process. They and their fellow group members most often self-identify as sex addicts, porn addicts, love addicts, or some combination thereof. While a few such individuals don’t like using the word "addict" and instead identify as "compulsive," hardly any of them ever refer to their issue as a "use disorder".

That said, clinicians need clear clinical language and criteria to diagnose any disorder and to effectively share information from a professional standpoint. As such, it is essential for therapists to use the official diagnostic language (such as "substance use disorder" and "compulsive sexual behavior disorder").

THE BASICS

In the real world, however, people don’t walk into a support group and say, “Hi, I’m Joe, and I have a substance use disorder.” Instead, they nearly always use some colloquial phrase referring to their problem, such as, “Hi. I’m Joe, and I’m an alcoholic.” The same is true for language surrounding CSBD. No one in sexual recovery self-identifies as suffering from compulsive sexual behavior disorder. Instead, they say they are sexually addicted or sexually compulsive.

At the end of the day, what clients ultimately choose to call their sexual compulsivity/addiction problem does not matter. What matters is that the individual is healing. So, let’s move away from discussions about what to call this issue. Our clients have a problem, let’s just help them.