Let’s consider hypersexual behavior without bias. Let’s forget that many celebrities like Charlie Sheen, Tiger Woods, and dead NASCAR-great Tim Richmond have been (pejoratively) branded “sex addicts” as a convenient way to write off prurient behavior. Let’s forget that hypersexuality is a joke and made light of in countless movies and television shows.
So, if we were to examine hypersexual disorder for what truly is, like all good diagnoses, it needs criteria right? However, a cursory examination of the DSM-5 offers little guidance on criteria and leaves us, well, unsatisfied. According to the DSM-5, “Research suggests that sexual response is not always a linear, uniform process and that the distinction between certain phases (e.g., desire and arousal) may be artificial.” An oft-quoted dismissal that’s loaded with incredulity. When parsed, notice how even fundamental word choice belies support for classifying hypersexual behavior as a disorder. More specifically, the powers that be use the modal auxiliary verb “may” which is much stronger (and more damning) than the alternative “might.”
I had to dig a little to come up with criteria for a potential hypersexual behavior diagnosis. Fortunately, I found an article titled “Measuring Hypersexual Behavior” by Stephanie Womack and colleagues which does an excellent job of expatiating. Womack writes, “The term hypersexual behavior (also referred to as sexual addiction, compulsive sexual behavior, or sexual impulsivity) refers to excessive and uncontrollable sexual fantasies, urges, and behaviors.” She then goes on suggest the following criteria (please note that I restructured and paraphrased these criteria for perceived clarity):
• Hypersexual behavior must last six months or more.
• Hypersexual behavior needs to interfere with activities of daily living and responsibilities.
• Hypersexual behavior occurs in response to stressful life events or dysphoric mood states like anxiety or depression.
• People with hypersexual behavior are unable to control or reduce symptoms.
• People with hypersexual disorder engage in such behaviors with little concern for personal injury or harm.
• Hypersexual behavior results in personal distress.
• Hypersexual behavior is not attributable to drugs.
• The person with hypersexual disorder is at least 18 years old.
Womack then goes on to specify the type of hypersexual behavior, whether it involves pornography, consensual sex with others, frequenting strip clubs, cybersex, masturbation and so forth. Of note, and without getting into specifics, a person with a diagnosis of hypersexual behavior need not exhibit all of these criteria.
Although I am neither a “sex addict” nor a psychiatric professional, these potential criteria sound solid (firm?) to me. Of note, I have a few observations. First, lots of people with purported hypersexual behavior don’t seem all that distressed by it. For example, Charlie Sheen is engaged to a porn star and, according to various sources, is seemingly really happy with his find. Second, I’m sure that some people who are older than 18 years old and exhibit hypersexual criteria similarly exhibited such critieria when they were younger than 18, too. Such people never “grew out” of being hypersexual. Third, if hypersexual behavior were real—in a clinical sense, that is—wouldn’t it be a good idea to restrict access to outlets which facilitate symptoms? For instance, some people with gambling problems who self report are arrested once they show up at a casino. Maybe something similar could be done for a person with hypersexual disorder who shows up at a strip club.