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New study suggests that sex addiction is a genuine disorder

Robin Wulffson MD's picture
hypersexual disorder, sex addiction, sexuality, abnormal sexual behavior

The concept that an individual can have a sex addiction has been controversial; however a new study suggests that it is a genuine disorder, and defines rules that could be used in deciding who has it. The UCLA-led study was published online on October 4 in the Journal of Sexual Medicine.

Sex addiction is formally known as hypersexual disorder. The researchers set out to determine whether hypersexual disorder qualified as a genuine disorder and warranted inclusion in the Fifth Edition (DSM-5) Work Group on Sexual and Gender Identity Disorders, which is the authoritative work on mental conditions. The investigators first needed to agree on how to define the disorder. For example, under one proposed definition, a person who simply has frequent sex would not be diagnosed with hypersexual disorder; however, an individual whose sexual activities are excessive, frequently used to cope with stress, and interfere with their ability to function in daily life may meet the criteria for the disorder. They noted that the definition also needs to hold up in the real world, so that healthcare professionals can consistently apply it when diagnosing patients.

The study group comprised 207 patients who were assessed for psychopathology and hypersexual disorder by blinded raters to determine inter-rater reliability of the hypersexual disorder criteria; in addition, the subjects were followed up two weeks later by a third rater to evaluate the stability of the hypersexual disorder criteria over time. The patients also completed a number of self-report measures to assess the validity of the criteria.

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The main outcome measures were the assessment of hypersexual disorder and psychopathology by structured diagnostic interviews, the Hypersexual Behavior Inventory, Sexual Compulsivity Scale, and Hypersexual Behavior Consequences Scale. Emotional dysregulation and stress proneness were measured by facets on the NEO Personality Inventory—Revised.

Using the criteria for hypersexual disorder, 134 of the patients referred for sexual problems were diagnosed with hypersexual disorder and 18 were diagnosed as having another psychiatric condition or no condition at all. They found that having a diagnosis of hypersexual disorder was closely linked to patients’ scores on separate questionnaires designed to assess sexual behavior, impulsively, and susceptibility to stress. In 92% of cases, the professionals agreed on who should be diagnosed with the condition.

The researchers found that inter-rater reliability was high and the hypersexual disorder criteria showed good stability over time. Sensitivity and specificity indices showed that the criteria for HD accurately reflected the presenting problem among patients. The diagnostic criteria for HD showed good validity with theoretically related measures of hypersexuality, impulsivity, emotional dysregulation, and stress proneness, as well as good internal consistency. Patients assessed for HD also reported a vast array of consequences for hypersexual behavior that were significantly greater than those diagnosed with a general psychiatric condition or substance-related disorder. The vast majority of patients who were referred for substance abuse problems (19 out of 20) or another psychiatric condition (32 out of 35) were correctly diagnosed with their respective conditions, and not with hypersexual disorder.

The authors concluded that the hypersexual disorder criteria proposed by the DSM-5 Work Group on Sexual and Gender Identity Disorders appear to demonstrate high reliability and validity when applied to patients in a clinical setting among a group of raters with modest training on assessing hypersexual disorder. The study authors noted that future research is needed to determine whether individuals with hypersexual disorder have changes in their brain that are similar to the changes seen in individuals with addictions. Furthermore, these studies should determine the prevalence of the condition in the general population.

Reference: Journal of Sexual Medicine