Giving problematic sexual behavior the serious attention it requires.

Few topics in the sexology field have galvanized people into opposing camps as stridently as the topics of sex addiction and sexual compulsivity. They are lightening rods in a 20-year-old controversy about the nature and origin of problematic high-frequency sexual behavior.

Traditionally, sexologists have balked at the notion of sexual addiction. They have dismissed it as a sex-negative paradigm serving the conservative right. Yet, clearly, anyone who has worked with clinical populations encounters men and women who struggle with sexual impulses--often engaging in cycles of behavior that swift further and further out of control.

Take the case of a woman named Charlene, who is 32 years old and has been married for 15 years. She is spending increasing amounts of time in a cyber chat room. It started out of curiosity, but recently she has been going to bed later and later because of her chatting, flirting, and occasional masturbating with an online partner. She feels guilty when she crawls into bed next to her sleeping husband. "No more," she vows each night. But the next day she finds herself marking time until she can log on again.

Does Charlene have a sexual addiction? Depending on your theoretical orientation, you may answer yes or no. Does Charlene have a problem--a problem likely requiring careful assessment and possible intervention? Probably yes.

Do we know much about the incidence, demographics, or co-morbidity of this type of problem? Unfortunately, we do not, because we do not have universally accepted diagnostic criteria or even terminology for describing it. The lack of well-defined diagnostic criteria represents a major barrier to conducting clinical research and developing effective treatment for this problem. The American Psychiatric Association's (APA's) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) virtually ignores problematic hyper-sexuality, offering nothing more than an ineffectual label, Sexual Disorder NOS (Not Otherwise Specified).

In the next few years, the APA will release the DSM-V. Inclusion of this problem in DSM-V can have important implications ranging from insurance coverage for treatment to increased availability of research funding. Inclusion will help to insure that legitimate sexual problems are identified and, equally important, that benign sexual behavior is not pathologized.

But inclusion in DSM-V will not be easy because the APA will only accept diagnostic criteria that are supported by a substantial body of empirical research. And for research to occur, we need generally accepted definitions and criteria.

Toward that end, an historic meeting took place at Vanderbilt University. Fifty invited participants spent two intense days discussing how to develop terminology and diagnostic criteria for problematic hyper-sexuality. The group was able to move beyond the sticking point of whether we were talking about an addiction, a compulsion, or an impulse disorder.

A strong case was made for relying on descriptive language rather than falling back on theoretical positions such as addiction or compulsion. It was evident that people were making a serious commitment to find language and definitions that all parties could accept and work with.

Much remains to be done, but, finally, common ground is being staked out for sexologists and other medical and mental health professionals to share. The days of heated rhetoric appear to be coming to an end. We may finally give problematic sexual behavior the serious attention it requires--unencumbered by politics, personalities, or dogma.

Based on: AASECT, President Column Dr. Dennis Sugrue, Contemporary Sexuality, 2002

Dennis P. Sugrue, Ph.D.

Clinical Psychologist and Associate Professor of Psychiatry

University of Michigan Medical School

Ann Arbor, MI