Should Hypersexuality Be a DSM-5 Diagnostic Category?

One of the proposed new diagnostic categories for the upcoming DSM-5 is Hypersexual Disorder (proposed criteria can be found at dsm5.org). The question arises, though, if a person is watching pornography or having a number of one-night stands, does that constitute a mental illness? Consensual sex, even if quite frequent or with prostitutes, certainly hadn’t been considered a mental disorder before recent times. However, the highly publicized extramarital affairs of pro golfer Tiger Woods and reality-television star Jesse James resulted in rehab for both men. Some may look at hypersexual behavior as similar to alcoholism and drug addiction, and sexual addiction rehabilitation programs primarily use a version of the AA 12 Steps program as the foundation of treatment. Step 1 of the 12 Steps is to admit to the “powerlessness” and “unmanageability” of one’s life as a result of the addiction, and the fact that Mr Woods lost commercial endorsements proves that the consequences of hypersexual behavior can have an enormous social impact, especially if the individual is well known to the public. Others may see hypersexual behavior as “acting out” a depression or anxiety disorder. Still others might view the behavior as a manifestation of a narcissistic or borderline personality disorder.

The adoption of hypersexual disorder as a DSM-5 diagnostic category may have a profound impact on treatment centers and the pharmaceutical industry. At the present time, most commercial insurers do not cover treatment for hypersexual behavior since it is not yet considered a mental illness. Insurance coverage would follow the categorization of hypersexuality as a mental disorder, leading to an increase in the number of treatment programs, as cheating spouses would enter treatment to pacify their partners. Parents might push for treatment of their sexually active children because they’re afraid their children might contract a sexually transmitted disease or become pregnant. Additionally, the pharmaceutical industry might begin trials of medications to treat the new disorder. We know that many of the medications we use in psychiatry have sexual side effects, especially the selective serotonin reuptake inhibitors and antipsychotics, and the mechanisms of how sexual desire and performance are affected by these drugs have already been investigated. It is conceivable that new medications would be developed to down-regulate libido and/or the ability to have an erection. There would also be forensic and legal consequences should hypersexual disorder become a new diagnosis.

Financial Disclosure:Dr King had no relevant personal financial relationships to report.

Abbreviations: AA = Alcoholics Anonymous, DSM-5 = Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition​