As reported by CNN,  For the first time, compulsive sexual behavior — commonly called sex addiction — is classified as a mental health disorder on the World Health Organization’s International Classification of Diseases (ICD) list — a decision not without controversy.”

Sex-Addiction is on the Nomenclature Map!

On the recent heels of much media publicity regarding the “Bad Men” (see . . . “Can bad men change”in a May issue of Time) comes a final decision regarding the diagnosis of sex-addiction or out-of-control sexual behavior (OOSB). That is not to imply that Kevin Bacon and Harvey Weinstein are or are not sex addicts. In fact, like many pieces of our diagnostic nomenclature, any diagnosis can come in various shapes and sizes, sex addiction certainly being no exception. That said, Bacon and Weinstein fit the criteria, plus some.

Updated in June, the list (called the International Classification of Diseases and Related Health Problems-11 (ICD-11)) is the foundational document that clinicians and scientists around the world use to identify and study health problems, injuries, and causes of death. The ICD-11 defines compulsive sexual behavior disorder as a “persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.”

It has been classified as a disorder because the behaviors involved can be destructive. That is, people, continue to engage in them, despite pleasure or lack thereof, for some alleged benefit despite negative consequences (i.e.-marital/family disharmony, financial consequences, health problems, job loss).

The Diagnosis of Sex-Addiction Has Been Disputed

This development follows an entrenched debate in the mental health community, particularly highlighting the well-known skirmish and backlash from the American Association of Sexuality, Counselors and Therapists (AASECT) community (see their November 2016 position paper), where they gallantly emphasize that anyone who uses the label sex-addict is not ‘sex-positive’ and has the potential to pathologize the behavior/individual. That, IMO, is preposterous. That is a broad generalization, perhaps addressed to a large number of Certified Sex-Addiction Therapists (CSATS, of which I am one) who are trained in an addiction model. There are many who do; there are many who don’t.

That AASECT has also asserted that those untrained or sparsely trained in sex and sexuality are not sufficiently informed has been a long-standing criticism. (#2 in their position paper) And yes, also a strong criticism of Dr. Marty Klein, that is perhaps the majority, but not all CSATS infiltrate that category.  AASECT challenges the training via IITAP, for which I don’t disagree given the lack or absence of training in sex and sexuality for a group primarily comprised of master’s level individuals, many of whom are starting out in an attempt to establish a specialty. Of recent IITAP has made some advances, amongst them making provisional sexuality training, albeit optional and limited, as well as acknowledging the relational trauma model for partners rather than being stuck in the co-dependence/co-addict frame.

Their first position cites a lack of evidence for sex-addiction as a mental health disorder. We have empirical evidence in the field of neurobiology that has examined brain chemicals in some pattern as similar to addiction. With the advent of sex-addiction on the nomenclature map will now come monies for further research, research that is continually needed.

When one is trained in a rigid model of anything their view of the world is limited. As such, there are many in the field who view sexual behaviors from various models. It’s beneficial to have optional lenses with which to understand and make meaning of behaviors; not all individuals with out-of-control sexual behaviors are alike nor are they, addicts.  That said, the addiction, trauma or conventional models of human behavior can all be applicable to their healing.

Dissention comes from many places, but objectively from the notion that little research exists. Regardless, these symptoms, as are the symptoms of other process addictions, are real. They are experienced by real people, couples and families, with an impact that often trickles down not just to the marriage but the families and community at large.  With a diagnosis and more research and development, available models will continuously change and improve.

Read the CNN piece here.

Updated June 1, 2019:

In its adaptation of the new nomenclature, ICD-11 (official 2022) made inclusive Compulsive Sexual Behavior Disorder (CSBD) within the Impulse Control Disorder category. The label is meant to normalize the many terms previously applied including but not limited to, sex addiction, sexual compulsivity, hypersexuality, and out-of-control sexual behavior,