Why “Compulsive Sexual Behavior Disorder” Isn’t the Same as “Sex Addiction”.

The World Health Organisation (WHO ) put out a clarion call ! After 20 years it was time to reevaluate their Bible, namely the International Classification of Diseases (ICD-11). Check every invoice from your health care provider and notice a little ICD-10 code. It is a system used internationally  by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures . When your invoice gets sent to your medical aid they decide whether or not you will be paid out, how much and how often , depending on your code. Voila! Your health status is established and either you are rewarded  with  a money pay back or sent home empty handed. And with a label /code of a disease.  WHO established ICD to create a  common International  language for reporting and monitoring diseases.

For 10+ long years  across the globe many select smart people from recognised World Sexual Health Organisations, put their heads together to think about what to do about sexual health. Should it continue to be viewed as a mental illness if people do not fit into the prescribed norms of what is “normal” sexual response,  “normal” heterosexual orientation. And what to do with those kinky people with paraphilias? Are they mentally ill? ? Most controversially , what to do with people who want sex too much ? Those sex addicts.

Sublimely a new chapter on Conditions Related to Sexual Health was created.  It  includes sexual dysfunctions, sexual pain disorders, paraphilic disorders, gender incongruence, adrenogenital disorders, sexually transmitted infections, changes in female and male genital anatomy, sexual assault and childhood sexual abuse, and contraceptive management. No mention of “sex addiction.”   What is sublime about this chapter is that  it de – stigmatises people who struggle with their sexual health , recognising their is no norm, mainly distress, and most significantly,  that they are not mentally ill,  and have the right to access sexual health services.

And then sneakily, the ICD -11 replaced the existing ICD-10 category of “excessive sexual drive” with compulsive sexual behavior disorder — not “sex addiction” or “hypersexuality.” Compulsive sexual behaviour disorder is  also very purposefully classified as an “impulse control disorder” instead of a disorder related to addiction.

I hear the protestations from the 12 step sex addict treatment centres,  and from people who have been diagnosed with “sex addiction ” or “porn addiction ” . They will convincingly provide evidence that sex is an addiction , like alcohol and drugs, as it shares the same characteristics of  liking and wanting that share neural systems with many other motivated behaviors.

According to Nicole Prause, neuroscientist and sexual psychophysiologist who founded the sexual biotechnology company Liberos LLC,  experimental studies don’t actually demonstrate that excessive sexual behavior can be classified as addiction. In fact she is even opposed to the inclusion of compulsive sexual behavior disorder in the ICD -11, citing insufficient lab data. The sexual science community is divided and this means clients are confused and not receiving consistent counselling nor management. A shame.

 Lets pause to consider what this new diagnosis really is. Impulse disorders are characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.

If you’re reading this and thinking “this is me , Im a sex addict”, consider this:

  • do you engage in repetitive sexual activities?
  • are they a central focus in your life?
  • do you neglect your health , personal care or other interests , activities and responsibilities;
  • have you made numerous unsuccessful efforts to control or significantly reduce repetitive sexual behaviour;
  • do you continue to engage in repetitive sexual behaviour despite adverse consequences
  • do you continue to engage in repetitive sexual behaviour even when you derive little or no satisfaction from it?

If you have answered YES to most of these questions, then you have low impulse control. And will be treated for this mental illness..not sex addiction .  I guess you’re doing this with other behaviours too, like alcohol, smoking, drugs, gambling, work, gym. You have anxiety , maybe even depression or a mixture of both.  Most likely your anxiety has been generated from childhood developmental trauma disorder, like abuse, neglect or abandonment. But you are not a sex addict.

Perhaps you are one of the 1 in 25 USA people who are told that you are way too interested in sex. Yet you’re not distressed by your high sex drive, or high level of interest in sex. And you can control it when ever you want. Or maybe your community or partner or parents have morally judged you as being way too sexual. You suffer from shame and guilt – which does not make you a sex addict. The label and humiliation makes you anxious which in turn will trigger you to act out sexually.

Just in time , exciting research has just been released to back up the decision of WHO , and other sexual scientists , not to create a diagnosis of “sex addiction “.  Nor a diagnosis for “porn addiction ” . A new term has emerged: Pornography Problems due to Moral Incongruence. Josh Grubbs, Samuel Perry and Joshua Wilt are some of the leading researchers on America’s struggles with porn, have conducted a meta-analysis of research on pornography and concluded that porn use does not predict problems with porn, but religiosity does.

Pornography Problems due to Moral Incongruence (PPMI) appear to be the driving force in many of the people who report dysregulated, uncontrollable, or problematic pornography use. Joshua Grubbs says conservative religious attitudes rather than frequency of porn use better predicts self-identification as a ‘porn addict’.

This is where it gets interesting as the WHO ICD-11 specify exclusion of moral conflict over sex from the diagnosis of Compulsive Sexual Behavior Disorder.     This suggest that when diagnosing CSBD, a person’s religiousness is a critically important factor. If you are a religious person you are going to feel morally terrible about using porn. Thus  higher levels of moral conflict over porn use predict higher levels of stress, anxiety, depression, diminished sexual well-being, as well as religious and spiritual struggles.

So lets top focusing on porn and too much sex as being the problem. This research nails down an important imperative: the  more we shame people for their sexual desires, frequencies and behaviours , the more morally conflicted they are. Heightened moral conflict leads to emotional dysregulation and the perfect way to get a little relief from this high anxiety is to impulsively and compulsively place yourself in your own hands, with or without porn, with or without another person present.  And then check yourself into an expensive sex addition treatment centre rather than meeting with a religious minister who will tenderly counsel you about the pleasures of sexuality , including porn.

For more information on Compulsive Sexual Behaviour Disorder, contact me .