‘Sex Addict’ and Need a Diagnosis? What to Expect Next

photo by Andrew Neel

by Andrea M. Darcy

Are your sexual thoughts and behaviours out of control? And you are wondering if you are a sex addict? 

What is sex addiction?

Sexual addiction is a term used to refer to thoughts and behaviours about sex that negatively affect your life and your ability to cope.

But sexual addiction is not actually an official mental health diagnosis.

A sex addiction diagnosis

The only reference to sex addiction currently on the NHS site is an article that opens with the line, “experts disagree about whether it’s possible to become addicted to sex.”

And it’s an understatement. Sexual addiction has been hotly debated for over a decade in the mental health industry.

In a blow to sex addiction charities and campaigners, recent updates to diagnostic manuals didn’t rule in favour of officially recognising sex as addictive. There is, however, a new diagnosis that recognises sex as potentially compulsive. 

America and the DSM

In the States, the manual psychiatrists use for a diagnosis is called ‘the Diagnostic and Statistical Manual of Mental Disorders’.

In 1987 a diagnosis of “psychosexual disorder not elsewhere classified’ was added to the third version of this manual, the ‘DSM-III”. The disorder was described as “distress about a pattern of repeated sexual conquests with a succession of individuals who exist only as things to be used.” So not quite addiction, but at least something.

But even this diagnosis was taken out of the current version, the DSM-V, and not replaced with any other term. The board behind the publication claimed that they considered putting in ‘hypersexuality’, but felt there wasn’t enough evidence at this time.

The World Health Organisation and the ICD

Outside of America, most countries use a diagnostic manual published by the WHO. It’s called the  International Classification of of Diseases (ICD). The version in use is the ‘ICD-10’, although that is about to change with a transition in 2022 to the ‘ICD-11’.

The ICD-10 doesn’t use the term sex addiction but does refer to ‘excessive sex drive’. As for the ICD-11, it will still not have a diagnosis of sex addiction per se. But the good news is that it will have a new diagnosis of ‘compulsive sexual behaviour disorder’. 

What is compulsive sexual behaviour disorder?

A paper published in “World Psychiatry explains that a diagnosis of compulsive sexual behaviour disorder will require:

“A persistent pattern of failure to control intense, repetitive sexual impulses or urges. Resulting in repetitive sexual behaviour over an extended period (e.g., six months or more). That causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.”

This pattern must also mean that at least one of the following applies: 

• your repetitive sexual activity has become such a focus of your life you are neglecting health, self care, responsibilities, activities, and/or interests
• you have made several attempts to control or reduce your behaviour but were unsuccessful
• you keep engaging in the behaviour even if the consequences are negative
• and you can’t stop even if by now you take little to no pleasure from any of it.

But that sounds like being a sex addict

 The diagnosis will not come under come under the umbrella of addiction but under “impulse control disorders”.

How is an impulse control disorder different than an addiction? If we say addiction, that implies there is a thing that is addictive, like drugs or alcohol. If we say impulse control disorder, that moves the focus from the exterior thing to the way our brain works.

So this new terminology has the benefit of busting through any myth that issues with sex aren’t a choice or about ‘lack of willpower’.  Even if this new term doesn’t prove anything.

A research study analysing all previous research around dysfunctional use of sex, for example, actually concluded that the way people describe their experiences sounds more like an addiction than a compulsion.

Why not just say sex addiction?

photo by: Priscilla du Preez

One argument is that it’s not helpful to demonise what can be normal behaviour. Drug use is not something an average person does, and we can walk away permanently. But things like sex and eating being called ‘addictions’ can mean the person has a very complicated relationship with eating or sex even when they aren’t using it addictively.

Another argument is that a sex addiction diagnosis would mean you were not diagnosed for the underlying disorders that were actually causing your compulsive sexual behaviour. An example given is borderline personality disorder (BPD). Promiscuity is a common symptom, and therapy to help BPD would help this symptom. Just focussing on the sexual acting out wouldn’t stop the impulsivity of BPD that drives that acting out.

Sex addiction and the law

It could also be argued that an official diagnosis as a sex addict would be a legal minefield. Even without being an official diagnosis, sex addiction is already raised in lawsuits.  Research in Canada found it is currently most used in criminal and family law matters. But it has now leaked into professional disciplinary hearings, and things like human rights and immigration hearings.  

On one hand an official diagnosis could protect children in a custody case from being put in the care of a parent with severe addiction issues. On the other hand,  if in a sexual assault case the perpetrator could attain an official diagnosis as a sex addict, they could have legal grounds for diminished responsibility. 

Why does a diagnosis matter?

It matters a lot for those who need help but who also need their health insurance to pay for it.  Or who need to access a certain government mental health service.  In America, this generally entails having an official diagnoses with a ‘code’ from the DSM.

Really feel that addictive thoughts and behaviours around sex are your main issue? It becomes about finding a psychiatrist who understands and can recognise what other diagnosable issues are connected to your sex addiction. They can then diagnose you with a related code that means you get the help you need.

But I know I am a sex addict

It’s understandably very frustrating if you are sure that sex addiction is your main issue but are now being told it’s not officially addictive.

But keep in mind that you are not a diagnosis, you are an individual. And mental health terms are just that, terms. They are created by health professionals to more easily refer to groups of people with similar symptoms. They are not hard science, as evidenced by the fact that things change with each version of the DSM and ICD. 

Getting a diagnosis in the UK

Here in the UK therapists refer to the ICD-10 and the DSM, but the final say tends to come from guidance put out by NICE, the National Institute of Health and Care Excellence. At this time they make no reference to sex addiction or compulsive sexual behaviour disorder. It remains to be seen if this will change with the full transition to the ICD-11.

Find a good therapist who understands that whether you want to to call it addictive or compulsive, you need help with the way you use sex.  If sex addiction is a term you find useful to describe your symptoms, they will understand.

Want to talk to someone who understands what it’s like to be a sex addict? We connect you with welcoming, expert talk therapists in central London. Or use our booking platform to find a UK-wide registered therapist today. 

Can’t stop thinking “I am a sex addict” and still have questions? Use the comment box below. Note we are unable to provide free counselling via comments.