http://www.latimes.com/news/nationworld/nation/la-sci-sex-addiction1-2010mar01,0,1660444.storyMarch 1, 2010
Sex addiction divides mental health experts
Is extreme sexual acting out an obsessive-compulsive disorder, a sign of depression or just bad behavior? 'If we are looking at a disorder, it's not clear what that disorder is,' one expert says.
By Shari Roan
Tiger Woods, who recently admitted to multiple extramarital affairs, said he is receiving treatment. David Duchovny, who plays a sex-obsessed professor on the TV show "Californication," underwent rehab in 2008. Dr. Drew Pinsky has launched a reality series dealing with the subject. Sex addiction talk seems to be everywhere. But mental health experts are split on what underlies such behavior. The American Psychiatric Assn. has proposed that out-of-control sexual appetites be included as a diagnosis in the next edition of the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders, to be published in 2013. Unlike compulsive gambling, which also is proposed for addition to the new DSM (to be called DSM-5), the proposed diagnosis -- hypersexual disorder -- stops short of categorizing the problem as an addiction, and for a reason.
"If we are looking at a disorder, it's not clear what that disorder is," said Michael Miner, a professor of family medicine and community health at the University of Minnesota who advised the DSM-5 committee on sexual disorders. "There is not an agreed-upon name. The research is in its infancy." Patterns of extreme sexual acting out are described variously by therapists as an addiction, as a type of obsessive-compulsive disorder or as a symptom of another psychiatric illness, such as depression. The lines specialists draw between what is sexually normal or abnormal have long been in flux. Some behaviors, such as pedophilia, are almost universally considered abnormal and have been described in the DSM for decades. Homosexuality was once considered deviant, but that reference was dropped from the DSM decades ago.
Therapists who see patients -- mostly men -- with problems caused by repetitive sexual behaviors, whether sex with consenting adults, pornography or cyber-sex, said the addition of a hypersexual behavior category was long overdue. "There is no doubt in my mind that this condition exists and that it's serious," said Dr. Martin P. Kafka, an associate clinical professor of psychiatry at Harvard University who was a member of the DSM-5 work group on sexual disorders... Some studies suggest that hypersexual behavior is indeed similar to an addiction, akin to the loss of control that seizes compulsive gamblers or shoppers... Attempting to understand what causes hypersexual behavior goes beyond curiosity: It lies at the heart of crafting effective treatments. But there are few studies on what works, Kafka said.
Meanwhile, some outspoken critics doubt that hypersexual behavior is a disorder at all. They argue against creating a label that can stigmatize people or provide excuses for what is plain poor conduct. It's alarming "for a group of psychiatrists to try to legislate how much sex we can enjoy before we're labeled mentally ill," said Christopher Lane, a Northwestern University literature professor and author of a 2007 book criticizing mental health professionals for ever-expanding ideas of what constitutes abnormal behavior. Lane suggested that the rush to reclassify some behaviors as treatable conditions was driven in part by business interests: Treatment centers pop up. The pharmaceutical industry offers pills as remedies. What is out-of-bounds sexual activity varies by culture, Miner said. "Sex in the United States is a very odd phenomenon. We are probably one of the more sexualized societies in the world and also one of the most puritanical," he said. "You wonder, if Tiger Woods was a French golfer, whether this . . . would have been such a big deal."
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