Sex addiction icd 10
Sex Addiction Gets a Diagnosis Code. But Does It Really Exist?/ F. Perry Wilson
A survey study suggests that a surprisingly high number of Americans might suffer from Compulsive Sexual Behavior Disorder.
This week – Sex Addiction. Does it exist and if so, how many people have it?
OK what we’re actually talking about today goes by many names. The latest moniker is Compulsive Sexual Behavior Disorder or CSBD– coming soon to ICD-11!
But let me start by saying that the idea that one can be addicted to sex or have a sexual compulsion is controversial, with psychiatrists on both sides. CSBD doesn’t mean you have a lot of sex – it means you are distressed by sexual urges. The idea is that if these urges are causing distress, they must be pathological. Subtext: if they are pathological, they should be treated.
But first – just how many people have CSBD?
This JAMA Network Open article argues that the condition is surprisingly common.
Researchers from the University of Minnesota used data from the National Survey of Sexual Health and Behavior which is a nationally representative, and, well, really interesting dataset to look at. Have you ever wanted to know if cuddling increases sexual satisfaction? This is the dataset for you.
Spoiler alert: it does.
In any case, the survey includes the Compulsive Sexual Behavior Inventory – which is a validated set of 13 questions which ask about sexual urges. Higher scores are consistent with CSBD.
And a lot of people had high scores. Top line results: 10% of men and 7% of women reported clinically significant levels of distress about their sexual urges or desires.
A number of factors were associated with CSBD. Rates were significantly higher among non-Whites, and dramatically higher among sexual minorities.
But no factor was as strongly associated with distress about sexual urges as income.
But the relationship with income was weird – a U-shaped curve showing higher rates of distress about sexual urges from the poorest, and richest portions of the population. It might be time to re-watch “Eyes Wide Shut”.
But here’s the thing – pathologizing sexual desires can go really wrong really quickly. There may be people who feel distress about their sexual urges because they are totally consuming and intrusive – but much more common is the distress that comes from moralistic or societal pressures to conform to certain sexual norms. The survey can’t capture that crucial difference.
Do I think 10% of American men and 7% of American Women have a sexual pathology like this? No. I think there are plenty of reasons for people to have hang-ups about sex and sexuality. But most of those are cultural. In the end, if you’re not being hurt by a sexual feeling, and no one else is either, it probably doesn’t deserve a diagnostic code.
This commentary first appeared on medscape.com.
Compulsive sexual behavior disorder added to ICD-11 as mental disorder
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WHO has added compulsive sexual behavior disorder as an impulse control disorder to the International Classification of Diseases, Eleventh Revision.
According to the ICD-11, compulsive sexual behavior disorder is characterized by a persistent inability to control intense, repetitive sexual impulses or urges resulting in recurring sexual behavior. This pattern manifests over an extended period (6 months or more), negatively affecting familial, social, educational and/or occupational areas of functioning.
In individuals with symptoms of compulsive sexual behavior disorder, repetitive sexual activities may become an essential focus of their life to the point that they neglect their health and personal care or other interests, activities and responsibilities, according to the ICD-11 classification. Other symptoms may include continued repetitive sexual behavior despite negative consequences or receiving little or no satisfaction from the behavior.
Healio Psychiatry spoke with Judy Silverstein, PhD, American Association of Sexuality Educators, Counselors and Therapists certified sex therapist, supervisor for the American Board of Sexology and clinical psychologist, to learn more about what the addition of compulsive sexual behavior to the ICD-11 will mean to the field of psychiatry. – by Savannah Demko
Why wasn't compulsive sexual behavior disorder considered a mental health disorder before?
The diagnosis of sexual addiction is still somewhat controversial. Some sexologists claim that high sex drive or sexual acting out should not be pathologized. Some addiction specialists view only chemical addictions as true addiction; only recently have scientists recognized the chemicals released during orgasm (eg, oxytocin). However, the withdrawal and tolerance of chemical addictions both occur with sex addiction, and the behavior of sex addicts creates more and more shame and remorse over time.
There is no doubt that sexual behavior can be compulsive, as sexual thoughts and fantasies can be obsessive. Compulsivity may interfere with healthy sexual functioning, even with work, school and social interaction. It can create medical problems, such as STDs, as well.
How prevalent is the condition in the U. S.?
I believe that with the availability of internet pornography, compulsive masturbation — causing interference in life — has become extremely prevalent. The problem with much of the pornography is that it distorts and/or idealizes sexual behavior.
Many people addicted to porn have difficulty with real intimacy and sexuality. I’ve seen a significant increase in sexual dysfunction in younger men in recent years. Women tend to be far less visual but can also masturbate compulsively to the point of interference in daily life (less often than male compulsive masturbation). What is more common among women is “love addiction” — self destructive relationships which become obsessions.
I don’t know the exact frequency of sexual addiction, but I would guess about 5% to 10% of the population uses sex as a way of attempting to treat or avoid other life problems such as fear of intimacy, depression, social anxiety and other relationship problems.
What behaviors/actions associated with sex addiction should psychiatrists be aware of when dealing with patients?
People who compulsively act out while married or in a committed relationship obviously endanger that relationship. Deception is extremely destructive to both partners. The prevalence of obsessive/compulsive masturbation, with or without the use of pornography, is most likely greater in young men, and a few women. The compulsive use of pornography can lead to desensitization to erotic stimulation in a human (non-screen) relationship, unrealistic expectations with real intimacy, and even sexual dysfunctions.
Will the new ICD-11 classification help more people get help/treatment?
I believe the new diagnosis will increase the number of physicians who recommend treatment, but people with sexual addiction often do not want to give up their “drug of choice” as it is so inherently reinforcing — orgasm is an intense reward. Shame also keeps sex addicts from facing treatment.
What is the take-home message for psychiatrists regarding sex addiction?
Psychiatrists should inquire about whether sexual obsessions and compulsions interfere in people’s lives. They need to be aware of underlying anxiety, depression and intimacy disorders. Sexual acting out may be a way of masking or avoiding deeper emptiness and loneliness. As with other addictions, denial is prevalent.
When I suspect an addiction, inventories can be useful. I often ask people to refrain from their “drug” for a couple of weeks. If they can manage this easily I am less likely to see the acting out as addictive, but if temporary abstinence is too difficult, most likely sexual acting out is compulsive. I use words like obsession or compulsion when discussing with clients, rather than addiction, as people are less likely to be defensive.
Psychiatrists should also be aware of Sexaholics Anonymous and Sex and Love Addicts Anonymous, two of the 12-step programs for sex addiction, and sex and love addiction, which can be frightening initially but very helpful and free to many addicts. There are also therapy groups specifically for sexual addiction.
WHO. ICD-11 for Mortality and Morbidity Statistics. https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1630268048. Accessed on July 16, 2018.
Disclosure: Silverstein reports no relevant financial disclosures.
Is there a sexual addiction - Lifehacker
December 20, 2021 Sex
What does modern medicine think about increased sexual desire and in what cases does it really become harmful.
How the question was historically treated
Science has always looked at human sexuality with apprehension. During the Enlightenment, they still tried to treat her with a naturalistic interest, but by the 19th century, European scientists began to associate open manifestations of desire with promiscuity or illness. nine0003
In those days, getting the status of a sex addict was not so difficult, because even natural needs were viewed with suspicion. Some scientists believed that women "do not have sexual feelings at all." Others denounced clitoral stimulation, considering only vaginal sex to be normal. So women who expressed inappropriate desires could be recognized as nymphomaniacs.
Masturbation has been associated with the development of various diseases, such as ossification of the joints and epilepsy. One of the most implacable fighters against self-satisfaction was the American physician John Harvey Kellogg. As a method of getting rid of a dangerous disease, he advocated circumcision and suturing to prevent erection in men and cauterization of the clitoris with carbolic acid in women. nine0003
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Even today's breakfasts are connected with the struggle against baser instincts: it was Kellogg who invented corn flakes. You can thank him for this, but the doctor sincerely believed that eating cereal reduces libido (unlike meat, which supposedly sets you in a frivolous mood). nine0003
However, over time, scientists came to the conclusion that human sexual needs are evolutionarily determined, and therefore quite natural and do not require draconian measures of suppression. But the level of hormones and the learned strategies of behavior are individual, so questions about how sexually active you need to be still arise.
Is there a normIllustration: Anastasia Pruss / Lifehacker
Everything can change
It is not so easy to say unambiguously what is normal and what is not. After all, even during the life of the same person, the degree of interest in sex varies. nine0003
Allocate pubertal hypersexuality. Teenagers are especially obsessed with sex, which makes perfect sense in a changing, hormone-filled body. People during puberty are characterized by increased excitability and obsessive thoughts about sex. As a rule, with the end of puberty, these manifestations disappear and sex remains an important, but not the main component of impulses and thoughts.
Adolescent hypersexuality is characteristic primarily of men, and in women the attraction is especially strong after 30 years. Although, of course, these are average data, and for specific people everything is different. nine0003
In addition to age, environmental and lifestyle factors can significantly affect libido.
Corn flakes are unlikely to prevent you from experiencing attraction, but alcohol abuse is very much so. Sometimes desire decreases against the background of taking antidepressants, as well as due to internal hormonal disorders. Also, sexual temperament is harmed by a systematic lack of sleep.
On the other hand, playing sports helps to increase the desire. So if you want your hormones to work more actively, add moderate exercise to your schedule. nine0003
People have different libidos
It's hard to say how much sex and masturbation you need to have for this to be considered normal. Often our ideas about what indicators to equal are imposed from the outside. However, in personal life, everyone can set their own rules. The temperament of all people is different. For someone, several times a month or even a year are enough, while someone needs a discharge much more often. The main criterion here is subjective comfort and agreement with a partner or partners. nine0003
In addition, there are asexuals who do not need sexual relations at all. But they can also be very different. Some, in principle, do not experience attraction and excitement, others simply do not want sex with other people, but practice masturbation.
Nor is it possible to set a standard for the number of sexual partners.
According to statistics for 2005, the average number of partners during the life of respondents around the world turned out to be 9. At the same time, in the United States, each person had an average of 10.7 sexual partners, and, say, in Indonesia - 5.1. Of course, we are talking about averages per capita. Someone keeps celibacy, and someone has dozens of partners. It is also important to consider that in such surveys, people often report incorrect data, trying to impress others with sexual victories or, conversely, not wanting to appear licentious. nine0003
When sexual activity is harmfulIllustration: Anastasia Pruss / Lifehacker
Only a person can determine what is normal for him and what is not. At the same time, behavior should not become destructive and lead to obvious bad consequences. There are several signs that indicate that a problem exists and needs attention.
A person tries to quit, but can't
The principle "no complaints - no diagnosis" works here in many respects. If your own body does not cause discomfort to a person and does not prevent him from building mutually satisfying relationships with other people, he will have no reason to go to doctors. But several attempts to control their sexual behavior, which ended in failure, are a wake-up call. It can signal that outside help is really needed. nine0003
Obsessive-compulsive behavior occurs
A person develops obsessive thoughts and desires, which he tries to cope with with the help of special actions (compulsions) - often exhausting, unpleasant or humiliating. For a while they help, but then everything starts all over again.
Some people with obsessive-compulsive disorder feel the need to wash their hands dozens of times a day, others touch stationary objects or perform other rituals that drown out anxiety. For people with sexual compulsions, sex plays the role of a sedative, and its quality and generally pleasant sensations are far from in the first place. nine0003
There is no adequate cycle of sexual response
Not all sex has to end in orgasm, but the standard cycle of human sexual response includes a path from excitement to discharge. People with sexual disorders may experience compulsions beyond their capacity. That is, desire persists even in the absence of physical arousal, and sexual activities do not lead to orgasm. Nevertheless, the person insistently continues to try (this, by the way, is fraught with injuries to the genital organs). nine0003
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There is a threat to health and safety
Sexual activity should not lead to distress. This is the name of a negative type of stress that disrupts the functioning of the immune system and other body systems. If sex becomes so important that it prevents a person from taking care of himself or makes him forget about protection and possible negative consequences, something has gone wrong. nine0003
Other people's rights are violated
Whatever we want, the free will and health of others should never be endangered. A person who commits sexual harassment or violence is dangerous to others and breaks the law.
If you find one or more of the listed symptoms, you should contact a specialist - a psychotherapist or a sexologist. There are also support groups for sex addicts.
Is it a disease or notIllustration: Anastasia Pruss / Lifehacker
What medical classifications say
The World Health Organization's International Classification of Diseases (ICD) does not diagnose sex addiction. Nevertheless, in the ICD-10 edition there is a diagnosis of "excessive sexual desire" F52. 7. It includes nymphomania and satyriasis, which denote an unhealthy, pathological form of sexual desire in women and men, respectively. However, in modern sexological practice, these terms are rarely used. We are talking about an obsessive, painful craving for the person himself, which leads to potentially traumatic actions. nine0003
In 2019, for the new version of the handbook, ICD-11, the item “compulsive sexual behavior disorder” was prepared. It talks about the impossibility of a person to control his attraction. At the same time, the craving for sex leads to recurring episodes that are harmful in social, work and family life.
Separately (although not mentioned in the ICD) is porn addiction - obsessive sexual activity using pornographic materials. It becomes a problem when it takes up so much space in life that it calls into question physical, mental, social well-being. The negative symptoms of excessive interest in porn are depression, social isolation, loss of career, and large expenditures of money. nine0003
To be considered a problem in its own right, hypersexuality must not be the result of other mental disorders and addictions.
Increased sexual excitability is characteristic, for example, of bipolar disorder in the phase of hypomania or mania, as well as substance abuse.
What doubts exist
Some doctors doubt that sex addiction should really be considered a medical diagnosis. Classical addictions, such as alcohol and drugs, involve a withdrawal syndrome. This means that after giving up the object of craving, a hangover or withdrawal occurs. At the same time, people who claim to be sexually addicted definitely experience pain in abstaining from compulsive sex (the same support groups are aimed precisely at preventing relapses). nine0003
The compilers of the latest edition of the ICD suggest that we do not yet have enough scientific research to draw an unambiguous conclusion and equate sex addiction with the rest. In addition, the medicalization of the problem may raise ethical objections and legal issues.
After all, if sex addiction is a disease, then harassment and violence can be its symptoms. And the one who commits them should not be judged, but treated, because he does not control himself and cannot be held responsible for his actions. nine0003
For example, in 2017, actor Kevin Spacey went to an elite clinic for treatment for sex addiction, which also treated producer Harvey Weinstein.
This approach raises a number of ethical questions and opens up the possibility of abuse. Can we tell for sure whether a person commits harassment because of an irresistible impulse, or simply because he had the power and opportunity to harass with impunity? Of course, lawyers will insist on the first. nine0003
What is the result
Not every person who needs a lot of physical intimacy is a sexaholic. Often having sex with an attractive partner is completely normal. But regularly and against one's own will to seek erotic adventures, and even more so to violate other people's rights, is already problematic behavior.
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