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What is Hypersexual Disorder

So far it’s just a dream, a glint in the eyes of the Sexual and Gender Identity Disorders Work Group that is working on the revision to the DSM, the manual that mental health professionals use to diagnose and bill for their services. 

The Sexual and Gender Identity Disorders Work Group recently put up a web page that lists all the proposed additions, deletions, and revisions in the area of sex and gender.

As you’d expect from a process where more than half of those who are involved have ties to the drug industry, the proposals are good for Big Pharma and also for researchers, not so good for the rest of us (and honestly, not so good for the individuals who work in research and pharma, since they have sex too, and they will be as badly damaged by the DSM-5 as any of us...only they'll have more money for lawyers and press agents).

Come As You Are is getting involved in setting up some public discussions about the DSM revisions and what they mean to the construction of sexuality and gender, but for now I just want to share one of the proposed new diagnoses, Hypersexual Disorder. Here’s the proposed definition:

Hypersexual Disorder

A.    Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria:

(1)   A great deal of time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior. [15]

(2)   Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). [16]

(3)   Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events. [17]

(4)   Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior. [18]

(5)   Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others. [19]

B.    There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behavior. [20]

C.     These sexual fantasies, urges, and behavior are not due to the direct physiological effect of an exogenous substance (e.g., a drug of abuse or a medication). [21]

This is really ghastly. What they have described can easily be categorized as common and reasonable sexual experience. 

How many of us think about having sex "a great deal of the time"?

How many of us have sex in response to stress or anxiety? 

And how many of us would say that after having sex we feel less anxious, more relaxed? 

Are these signs of a disorder?

Let’s consider an example, one of hundreds I could offer from my personal and professional life as a sex educator and, maybe more importantly, someone who is willing to talk to anyone about sexuality.

Doug grew up always feeling a bit different from his friends. He never knew exactly why but by the time he was 10 or 11 he realized that he felt about boys the way most of the boys felt about girls. He also was interested in girls, and they seemed interested in him. So he became a teenager and started being sexual with girls and then women.  He really loves sex, he thinks about it a fair bit, and when he wasn’t attached to one person would have sex, often after only a few dates. He always felt tension, stress, about this other thing he was interested in, but he knew that wanting to have sex with guys was weird and wrong  (he “knew” this not because he felt it instinctually, but because he was told this by everyone in his life and 95% of all media he consumed). Now he’s in his 30s and in a good relationship with a woman and they are talking about marriage. He decides he has to tell his partner about this. What he says is that he’s always had feelings and desires; they have always stressed him out, and made him question aspects of who he is. 

Doug would absolutely qualify for a diagnosis of hypersexual disorder. Is Doug sick? Does he need medical treatment? Is Doug’s situation abnormal? What would happen today if Doug sought counseling or psychiatry? What would happen three years from now if Hypersexual Disorder makes it into the DSM-5?

The second requirement of “personal distress” is often offered as a bone to those of us who cringe at the thought of medicalizing sexuality. The problem is that the way we are sexually socialized and the popular discourse around sexuality leads a path to personal distress. Our sexual options are so narrow that most of us have something, in the eyes of Dr. Phil and the DSM, to be stressed about.

As a sex educator I encounter people all the time who are distressed by their perfectly healthy desires for sex. There is simply no argument I have heard thus far that would lead me to think that a medical diagnosis would serve anyone in this situation any good.

Read more - New York Times: Revising Book on Disorders of the Mind