It seems the DSM-V might revive (and rename) a contentious old diagnosis: hypersexual disorder is proposed to take up the spot previously occupied by “sexual addiction” and, on occasion, “sexual compulsion.” Over the past century, we have seen this shifting set of symptoms in many other guises, including hyperesthesia sexual, satyriasis, nymphomania, Don Juanism, paraphilia, sexual deviance, hypereroticism, hyperlibido, hyperphilia, and perversion. It has been categorized as a form of obsession, a compulsion, an impulse-control disorder, an addiction, and, in more private conversations, perhaps, bad behavior, tom-foolery, men-being-men, she’s-gotta-have-it, no-good-two-timing, misogyny, macking, swinging, or just dating.
This newest diagnosis describes “recurrent and intense” sexual fantasies, urges, and behaviors that emerge in response to “dysphoric mood states.” People who suffer from this disorder engage in non violent sexual activity “while disregarding the risk for physical or emotional harm to self or others.” The last time we saw a similar diagnosis was in the 1987 DSM IIIR. That entry, on “sexual addiction,” described “distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used.” In the DSM-IV, the entry was removed due to a lack of data. All that remained was an unnamed reference to “[d]istress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual as only things to be used.” It is bookended by distress about inability to conform to gender roles and distress about sexual orientation.
The revision (and renaming) of this set of shifting symptoms marks some significant changes in thinking. The term “addiction,” after all, carries with it notions of powerlessness, consumption, dependence, withdrawal, and escalating need. It also implicitly proposes a mode of self-treatment through a modified twelve-step recovery program, individual therapy, or pharmacological intervention. Hypersexuality (literally: over/above/excessive + sexuality), on the other hand, only amplifies what is normal human activity. When it comes to sexuality, this term might imply, too much is not never enough. The term shifts attention from the more complex emotional qualities of addiction to the biological. Finally, the notion of harm to self and others has replaced the more judgmental assumption that a sexual addict (or player, or swinger, or casual dater) only uses people without actually recognizing their humanity. Being a cold-hearted snake no longer means you’re a sex addict; harmful excess might.
Before “sexual addiction” was removed from the DSM, there was some question about whether it named and described behavior that we might otherwise consider thoughtless, cruel, selfish, or sexist. After all, this diagnosis coincided with the third wave of feminism as well as the so-called sex wars. How could it not be informed by debates about pleasure and danger, porn and sex work, BDSM and other “non-normative” sexual and romantic activities? So, I imagine, people probably wondered: Does a cheating husband really have a mental disorder, or is he just a jerk? Is a man who thinks he’s entitled to look at porn, go to strip clubs, and purchase sex a male chauvinist pig, or is he suffering from a compulsion? Is a woman who sleeps around a slut or a sex addict? Is a serial monogamist just looking for love in all the wrong places, or is that person addicted to love?
In their article, “The Myth of Sexual Compulsivity,” Martin Levine and Richard Troiden argue that the DSM-IIIR inclusion of “sexual addiction” reflected a “pseudoscientific” attempt to reinforce “prevailing erotic values” by stigmatizing sexual values and behaviors that had been de-stigmatized in the 1960s and 1970s (349). Situated historically, the decision to include “sexual addiction” as a mental disorder marked a return to more traditional notions of sexuality and relationships in the wake of HIV/AIDS, a “rise of commitment ethic,” and the increasing influence of the religious Right (354). (Unfortunately, they do not mention feminism). Insofar as it became a diagnosis legitimized by the DSM, however, it worked to stigmatize certain sexual behaviors or identities, potentially violating the civil liberties of people who engage in non-normative sex.
Obviously, the DSM neither invented nor discovered sexual addiction/ hypersexuality. Rather, it reflects the anarchic, bottom up way that disorders enter popular consciousness. So far, it seems, the new term has not caught on enough to override the catchier “sexual addiction.” To do so would require, among other things, changing therapeutic specializations, medical/psychological terms of art and, perhaps, even song titles (“Addicted to Love” comes to mind). There are also all the buttons, t-shirts, and bumper stickers. More significantly, it would require changing the names of not one, but three, twelve-step recovery groups aimed at helping the sexual addict: Sex and Love Addicts Anonymous (SLAA), Sex Addicts Anonymous (SAA), and Sexaholics Anonymous (SA).
The recovery groups can be placed along a continuum, with the original group (founded in 1976) Sex and Love Addicts Anonymous, on one end, and Sexaholics Anonymous (founded in 1979) on the other. In the middle is Sex Addicts Anonymous (founded in 1977). All three groups modify the twelve-step model to treat their sex/love addiction. They all include the conviction that the problem is progressive, and morally or emotionally devastating; they rely on the twelve steps to recover; and they stress some notion of sexual “sobriety.” It is in this last quality that the groups diverge. While SLAA and SAA advocate a sort of personal bottom line, SA advocates complete sexual sobriety, which is defined as having sex only with a spouse for “reproduction” and relational purposes. (There has recently been some controversy about the decision to define “spouse” as someone of the opposite sex; their welcome newsletter only recognizes opposite sex marriage). A Sexaholic is not even to masturbate because their fight is not against a disease or illness, but against lust itself.
All three groups offer diagnostic questionnaires. In the interest of research, I took one and, after answering 40 yes or no questions, I tried to find the scoring guidelines. Apparently, there are none. A person decides if he or she is a sex addict/sexaholic if he or she feels like one after answering the questions.
My experience answering the questions did not make me think I was a sex addict or a sexaholic, but it did make me wonder about the very nature of this beast. What is a sexual addict? What does it mean to suffer from hypersexual disorder? What does it mean that we have these diagnoses that perch at the shifting intersection between normal and abnormal sexual expression, between not enough and too much, between relational and recreational sexuality? What does it mean that both the terms and the symptoms remain so contested that sobriety can mean dating carefully, not crossing personal bottom line behaviors, or not lusting in one’s body or heart?
Since the term and meaning are still contested, I figured I might as well propose my own. When I think about people who cannot stop looking at porn, or going to prostitutes, or having affairs, or masturbating, “sex addict” does not seem quite right. Nor does “sexual compulsive” or “hypersexual.” If I look past my own knee-jerk reaction to some of these behaviors, I don’t even think, “jerk.” I would say, “emotionally harmful sexual behavior.” By “emotionally harmful,” of course, I mean to self and others, although not to society. As the gay marriage movement has made clear, counter-hetero-mono-normative activity (if I may coin a second term) does no actual harm to society, heterosexuality, traditional marriage, or even Rick Santorum, no matter how much he gripes.
Whatever we call it (and I acknowledge that my term doesn’t roll off the tongue with much elegance) – sexual addiction/compulsion/hypersexuality/ emotionally harmful sexual behavior – something is going on. We can joke about picking up partners at twelve-step meetings, or make up bad puns involving “sexual healing,” or ask snarky questions about what drives powerful men (in particular) to make such stupid choices (getting a blow job in the Oval Office or sending photographs of your bulge to random women come to mind). It is also easy to forget that this diagnosis involves genuine suffering for both the person who realizes that s/he has a problem as well as for the betrayed partner(s) and family of that person.
Indeed, a local sex addiction therapist, Jeremy Frank, offered me another possible explanation. Sex addiction, he said, depends on the perspective of the person seeking therapy. If a person sees a behavior as a problem, then they might say they have an addiction. Most often, a person suffering from sex addiction is trying to avoid pain and suffering.
However we end up naming and describing this phenomenon, I can only conclude that it is like the wheel Lao-tsu imagines in the Tao te Ching. Each term, or symptom, or treatment is a spoke, but “it is the center hole / that makes the wagon move.” That center hole, I propose, is occupied both by the term itself as well as by the disorder (behavior?) it describes. The aporia that structures the disorder-we-can’t-name-or-describe reflects the ways we struggle to interact with others at our most primal, vulnerable, and adventurous. It is the loophole of retreat for the philanderer, but it is also the name that might free a tormented being from the shame and sorrow of seeing something as wonderful as sex become a source of deep suffering.
OK, you know you want to know your score, so I managed to find one site that will tell you, once and for all (or not) if you are a sex addict (based on one person’s definition, for now). You can thank me later.