Sexual addiction involves more than considerations of the frequency of sexual encounters or even the social acceptability of the sexual behavior.
Patrick Carnes listed ten specific criteria of sexual addiction in his book "Facing the Shadow":
A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the
same 12-month period;
1. tolerance, as defined by either of the following:
a. a need for markedly increased amount or intensity of the behavior to achieve the desired effect
b. markedly diminished effect with continued involvement in the behavior at the same level or intensity
2. withdrawal, as manifested by either of the following:
a. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior
b. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
3. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended
4. there is a persistent desire or unsuccessful efforts to cut down or control the behavior
5. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects
6. important social, occupational, or recreational activities are given up or reduced because of the behavior
7. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior
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Assessing if and how a person’s behavioral patterns disrupt “healthy” or “normal” social functioning is a difficult task. People’s lives are varied and complex, and individuals have different needs, values, priorities and lifestyles.
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The paraphilic and hypersexual behaviors that characterize sexual addiction also can occur as manifestations of underlying organic pathology. Paraphilic or hypersexual behavior can be a symptom of a brain lesion, a side effect of medication or a symptom of endocrine abnormality.
The differential diagnosis is usually facilitated by the presence of additional symptoms or circumstances that suggest the underlying etiology. Clues that invite an organic evaluation include: onset in middle age or later, regression from previously normal sexuality, excessive aggression, report of auras or seizure-like symptoms prior to or during the sexual behavior, abnormal body habitus and presence of soft neurological signs.
Also of value in determining whether a case of paraphilia or hypersexuality represents sexual addiction are the diagnostic criteria for sexual addiction. Tolerance, psychophysiological withdrawal symptoms on discontinuation of the sexual behavior (usually affective discomfort, irritability or restlessness), and a persistent desire to cut down or control the behavior are generally not observed in patterns of paraphilic or hypersexual behavior that are not part of the sexual addiction syndrome.
The diagnostic criteria for sexual addiction are also useful in distinguishing sexual addiction from nonaddictive patterns of exploitative or aggressive sexual behavior that can occur with antisocial personality disorder.
Obsessions and compulsions with sexual content can occur in obsessive-compulsive disorder (OCD). Sexual obsessions are fairly common in OCD, and were reported in 32% of the patients who were studied by Rasmussen and Tsuang (1986). The content of these obsessions, however, consisted most often not of sexual fantasies, but of fears of acting on sexual impulses or fears of being a pervert. More generally, symptoms of sexual addiction differ from sexual obsessions and compulsions in that the former are associated with sexual arousal and sexual pleasure, while the latter typically are not.
A syndrome that meets the diagnostic criteria for sexual addiction can occur in the context of other psychiatric disorders, including manic-depressive conditions, schizophrenia, personality disorders and substance dependence.
When the diagnostic criteria for both sexual addiction and another psychiatric disorder are met, both diagnoses are warranted, regardless of whether sexual addiction might be secondary to the other psychiatric disorder. The diagnosis of sexual addiction is a descriptive designation of how a pattern of sexual behavior relates to and affects an individual's life. It does not presume a particular etiology, nor is it precluded by the presence of other conditions that may be etiologically relevant.
Ten signs that point to a problem
A pattern of out-of-control behavior
Severe consequences due to sexual behavior
Inability to stop despite adverse consequences
Persistent pursuit of self-destructive or high-risk behavior
Ongoing desire or effort to limit sexual behavior
Sexual obsession and fantasy as a primary coping strategy
Increasing numbers of sexual experiences because the current level of activity is no longer sufficient
Severe mood changes around sexual activity
Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experiences
Neglect of important social, occupational, or recreational activities because of sexual behavior
SOURCE: Don't Call It Love: Recovery From Sexual Addition by Patrick Carnes
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Both characterizations highlight the recurrent nature of the disorder, the intensity of the condition, the fact that it can involve fantasies, urges, or actions, and that this behavior interferes with important areas of functioning.
See also: