Trends in the Diagnosis and Treatment of Sexual Addiction
Over the past several decades the issue of sexual addiction has been hotly debated in the mental health field. Professionals have long debated the issue as to whether or not sexual addiction actually exists or if only sexually compulsive behaviors exist. In the 1980s sexual addiction was classified as a disorder in the DSM. However, sexual addiction was removed from the manual in 1994 (Beck, 2008). Since this time a couple of trends have been prevalent on the topic of sexual addiction. Many have fought, and are still fighting, to have sexual addiction reincorporated into the DSM. These individuals hold to the view that sexual addiction is a real and devastating problem. Others, however, argue that sexual addiction is a behavioral issue and not a true disorder. This view questions the extent to which sexual activity can be called addictive, whether or not the DSM can take a moral stance on sexuality, and argue that there is too much subjectivity regarding diagnosis of sexual addiction. In addition, this trend is careful to not lay blanket morality over different cultures. Ethically this argument holds to a more neutral stance, attempting to not impose on specific belief systems and ethics of others. Another trend found in the sexual addiction arena is internet sexuality. Significant research has supported the theory that internet addiction should also be added to the DSM as a disorder, moreover, that sexual addiction (in relation to pornography) is a clinical disorder (Murero, 2001).
Sexual addiction was removed from the DSM for many reasons. The trend to remove this disorder from the DSM gained much support in the 1990s. This trend has carried on for at least a decade, and still is the ideal that is accepted by the DSM. Many professionals argued that sexual addiction should not be classified as an “addiction” due many reasons. Giving the compulsions the term “addiction” may cause some to justify their behaviors, creating additional problems. Many argue that sexual compulsions are simply a behavioral problem, and that the individuals struggling with this issue are not in need of clinical diagnosis (Klein, 2003). Clinicians do not classify certain disorders as addictions because of the lack of particular symptoms and signs, such as withdrawal. However, some disorders in the DSM are classified by their compulsions and inability to prevent relapse (Hagedorn & Juhnke, 2005). This is a weakness in this argument because sexual addicts have been found as having difficulty stopping the behavior and have psychological signs of withdrawal (Hyatt, 1997). The trend that argues against sexual addiction also holds that it is against ethical guidelines to place a moral judgment of appropriate and inappropriate sexuality on individuals (Klein, 2003).
The trend that is calling for sexual addiction to be included in the DSM holds that sexual addiction has long been a huge issue, especially with the ease of internet use and availability (Bird, 2006). Advantages to classifying sexual compulsions as an addiction are clinical in nature, adding to treatment modalities and care of clients. Although some differences exist, some argue the patterns of a sexual addict closely mirror those of a drug addict (Inaba & Cohen, 2007). When sexual addicts act on their impulse, chemicals are released in their brain, causing a particular “high.” Bostwick and Bucci (2008) point out that dopamine is a primary chemical released in the brain that regulates both typical and addictive functioning. Dopamine is released in greater amounts when the addictive behavior is being acted out. Bostwick and Bucci (2008) argue that sexual addiction, as with other addictions, are due in part to a malfunction in the brain’s rearward center. Other similarities between drug addicts and sexual addicts include that sexual addicts cannot stop acting on their impulse, even due to negative consequences, and the addict is typically preoccupied with the next high (Bhugra, 1998). This trend also points out that many sexual addicts even act out when they know their family, marriage, or job is in jeopardy (Bird, 2006). Hyatt (1997) firmly believes that sexual addiction exhibits all of the signs of a “psychoactive substance dependence.” He argues that sexual addiction even carries with it certain withdrawal symptoms, such as psychological stress (Hyatt, 1997). A major reason this side of the debate is very concerned about the issue of sexual addiction is due to the fact that individuals exhibiting sexually addictive behaviors are not deterred by negative consequences. This greatly supports their argument (Breaux, 2004; O’Donohue, 2004; Birchard, 2006). This trend holds to the argument that classifying sexual addiction similarly to drug addiction has great advantages in treatment; focusing on their addictive behaviors and the prevention of relapse. Those supporting this argument have great concern for the moral deterioration of sexuality in contemporary culture, especially as seen in internet pornography. This, however, is a weakness of the argument. Those opposing the addition of sexual addiction into the DSM argue that applying specific sexual morals to everyone is a violation of ethical codes and professional guidelines.
A final trend that the sexual addiction argument has taken is that of internet sexuality (Griffiths, 2001). Sexual addiction has become more and more rampant with the widespread availability of the internet. Sexual addiction significantly impacts chemicals in the brain, causing both an emotional and physical addiction and leading to inability to function properly in society, especially in relation to internet sexual addiction (Inaba & Cohen, 2007). Internet pornography is one of the largest industries in the United States (Abell, Steenbergh & Biovin, 2006). Some argue strongly that internet pornography has been one of the biggest contributors to sexual addiction (Abell, Steenbergh & Biovin, 2006). Some individuals with online sexual compulsivity have had extreme difficulty quitting their negative behaviors, even when significant negative consequences are present (Cooper, Galbreath & Becker, 2004). Much debate has occurred due to the significant issues with sexual addiction and internet sexuality. Some hold to the argument that these behaviors are pathological in nature, while others simply say that internet sexuality is just an extension of human relationships (Cooper, Scherer, Boies, & Gordon, 1999).
This trend, as well as the aforementioned trends, is limited fundamentally by its explicit nature. This can only be applied to individuals that are legal adults, especially as research is conducted. In addition, some important ethical questions are to be considered. If adding sexual addiction to the DSM means that a particular moral stance must be taken then some argue that ethical guidelines are significantly breached. However, the other side of the argument may suggest that other disorders, and even not taking a stance on the issue, are both moral judgments. These trends will continue to be large debates within the mental health community as professionals seek to best serve humanity.
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