The benchmarks typically used by certified sex addiction therapists (CSATs) when identifying sexual addiction are as follows:
- Sexual preoccupation to the point of obsession
- Loss of control over sexual urges, fantasies, and behaviors (typically evidenced by failed attempts to quit or cut back)
- Negative life consequences related to compulsive sexual behaviors, such as ruined relationships, trouble at work or in school, loss of interest in nonsexual activities, financial problems, loss of community standing, shame, depression, anxiety, legal issues, and more
Unfortunately, the DSM-5 does not acknowledge sexual addiction. This makes it more difficult for therapists to identify and treat compulsive sexual behaviors, and for clients to seek insurance-funded treatment. That said, Compulsive Sexual Behaviour Disorder is scheduled for inclusion in the forthcoming ICD-11 (the international equivalent of the DSM). The ICD-11 diagnosis reads as follows:
Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.
The DSM will likely implement a similar diagnosis within a few years. For now, however, we do not have an “official” sex addiction diagnosis in the US.
In the interim, for those seeking insurance funding, the DSM offers a pair of very unwieldy (though useful when necessary) options. First there is “Unspecified Sexual Dysfunction,” then there is “Other Specified Sexual Dysfunction.”
Unspecified Sexual Dysfunction, diagnostic code 302.70, reads:
This category applies to presentations in which symptoms characteristic of a sexual dysfunction that cause clinically significant distress in the individual predominate but do not meet the full criteria for any of the disorders in the sexual dysfunctions diagnostic class. The unspecified sexual dysfunction category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific sexual dysfunction, and include presentations for which there is insufficient information to make a more specific diagnosis.
Other Specified Sexual Dysfunction, diagnostic code 302.79, is defined as follows:
This category applies to presentations in which symptoms characteristic of a sexual dysfunction that cause clinically significant distress in the individual predominate but do not meet the full criteria for any of the disorders in the sexual dysfunctions diagnostic class. The other specified sexual dysfunction category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific sexual dysfunction. This is done by recording “other specified sexual dysfunction” followed by the specific reason (e.g. “sexual aversion”).
Admittedly, these diagnoses are largely unrelated to the criteria used by CSATS when identifying sexual addiction, but for insurance purposes they may work.
That said, it would be nice to work with an official diagnosis that reflects the reality of sexual addiction as it is now commonly understood: preoccupation to the point of obsession, loss of control, and directly related negative consequences. For the time being, 302.79 and 302.70, especially when coupled with concurrent diagnoses for issues like depression and severe anxiety, are useful.