Over the past 18 months, a debate has raged, but the victors appear to have emerged from the smoke. The American Psychiatric Association is updating their “Bible” of diagnostic categories of mental health. Yet again, the sex addiction industry has been clamoring for creation of a disorder to support their work. And yet again, the APA has turned them down flat.
This is not a new debate. My book, The Myth of Sex Addiction, details the history of this controversy, from the days of the first DSM, when nymphomania was included, through the last several revisions, as sex addiction has been rejected, again and again. Every time the book is revised, the sex addiction industry tries and tries to get their pet concept termed a mental disorder. Legitimacy would allow them to bill insurance companies, would allow the pharmaceutical companies to market libido-suppressing drugs as treatment for sex addiction, and would give some appearance of credibility to those folks who get in trouble for sexual behaviors, and either cry “I’m a sex addict,” or get labeled as one by the media.
In the most recent revision process, two proposals were advanced to the DSM5 committees. A proposal of sex addiction was submitted to the Addictive Disorder workgroup, where it was rejected, on the grounds of having no scientific basis. But, an interesting second proposal was put forth to the Sex Disorders workgroup, for a concept called hypersexual disorder. Basically, this was a bare-bones, stripped down syndrome, that excluded all the addiction language, and tried to target merely a cluster of sex-related behavior problems.
Hypersexual disorder had some interesting research potentially supporting the concept, and looked like it was headed for inclusion in the DSM5, at least in an appendix, where it was regarded as something worthy of further research. The majority of alleged hypersexuals appeared to be men masturbating to online porn, and the porn addiction hysterics tried to use pop brain science to spice up their claims that hypersexual disorder, in the form of addiction to online porn, was dangerous, causing erectile dysfunction and CHANGING YOUR BRAIN!
But hypersexual disorder as a concept was problematic as well. It pathologized gay and bi males, calling their sexuality unhealthy. It offered an excuse to avoid responsibility by wealthy men acting out sexual privileges. The science used to justify this concept was, for the most part, bad science, with poor design, poor methodology and theory, and no validity to be applied to the general pouplation. Finally, hypersexual disorder was clearly just a synonym for sex addiction, which the industry of sex addiction treatment providers planned to use to legitimize their work.
But, the proclamation has come down from Mt. Sinai, and the forthcoming tablets of psychiatric commandments don’t bode well for the sex addiction industry. According to the DSM5 committee of the APA, hypersexual disorder has now been rejected entirely, even from “Section 3,” the section designated as “requiring further research.”
So, yet again, the APA has acted wisely, on the basis of scientific merit, and declined to endorse the concept of sex addiction, in any way, shape or form. Pop science, grossly exaggerated claims that your brain is being changed by sex and porn might play well in the popular media, but don't have any place in good science, or careful medicine. Sex addiction is a popular concept, that the media has embraced, and is one that an entire industry has grown up around.
Over the past year, I've done hundreds of interviews with media around the world, on why I don't believe in sex addiction, and think you shouldn't either. The APA's decision is a wake-up call, to the popular media and to their incestuous partners, the sex addiction industry. Sex addiction is NOT a real disorder. It’s a morally-based concept that reflects our society’s conflicted feelings about sex. It is NOT a mental disorder, and never will be. (At least, until the debate renews again, with DSM6.)