Hypersexual Disorder: Just More Muddled Thinking

Abstract

Kafka (2010) has proposed a new diagnosis, Hypersexual Disorder, for inclusion in the Sexual Disorders section of the fifth edition of the DiagnosticandStatisticalManualofMental Disorders (DSM), to be published by the American Psychiatric Association (APA). Kafka indicates that ‘‘Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component’’ (p. 377). As will be seen, Kafka’s proposed diagnostic criteria do not indicate that the sexual interest must be either nonparaphilic or have an impulsivity component. The problems with Kafka’s (2010) proposal are much more pervasive. His ‘‘Historical Overview of ‘Excessive’ Sexual Behaviors’’is erroneous (p. 378). He is correct that, throughout history, there has been interest in the‘‘appropriate’’frequency of some sexual behaviors, but the frequent behaviors clinically documented by early sexologists (masturbation, non-marital coitus, sodomy) were not normophilic for the historical period in which they occurred. The frequency of marital coitus, the only clearly normophilic behavior, was not considered clinically worrisome by most early sexologists. In contrast to Kafka’s (2010) assertion that Hypersexuality has been documented in recent editions of the DSM, that documentation related to the individual’s impersonal use of others who exist‘‘only as things tobeused’’(APA, 1980, p.283, 1987, p. 296, 1994, p. 538, 2000, p. 582). With the exception of DSM-III-R (APA, 1987), the frequency or normophilic focus of the sexual activity was not mentioned. In DSM-III-R (APA, 1987), the term ‘‘sexual addiction’’ was added, without any definition, and then removed ‘‘because of a lack of empirical research and consensus validating the sexual behavior as a bona fide behavioral addiction’’ (Kafka, 2010, p. 378). That criticism is still valid today. Kafka does not refute this statement by citing new empirical research or consensus validating the sexual behavior as a behavioral addiction. Even if it were validated as a behavioral addiction, it is miscategorized as a sexual disorder. The DSM-5 Substance-Related Disorders category is being expanded to include behavioral addictions, but that workgroup is not considering hypersexuality (sexual addiction) because of insufficient research data (APA, 2010a). Kafka (2010) reviewed the epidemiological literature, but could not find ‘‘a distinct bimodal distribution or taxon that effectively defines ‘excessive’ sexual behavior or hypersexuality’’ (p. 380). There is no doubt that individuals with all levels of sexual interest exist and individuals can attribute their distress or impairment to their level of sexual interest. Nevertheless, just because the individual (or the psychiatrist) believes the level of sexual interest is problematic does not make it so. It seems obvious that people who have more sex are more likely to experience more negative (and positive) consequences from their sexual behavior than those who have less sex. Individuals with normative (or low) levels of sexual interest may experience other consequences, both positive and negative. Kafka (2010) presents no data suggesting the purported consequences of Hypersexual Disorder—‘‘sexually transmitted diseases, unwanted pregnancies, severe pair-bond impairments, excessive financial expenses, work or educational role impairment and other associated morbidities’’ (p. 389)—were related to increased sexual frequency rather than other psychiatric co-morbidities. Kafka and Hennen (2002) found many other diagnoses present in ‘‘hypersexual’’ individuals and all of the individuals in the nonparaphilic hypersexual subsample had at least one other Axis I diagnosis. This C. Moser (&) Department of Sexual Medicine, Institute for Advanced Study of Human Sexuality, 45 Castro Street, #125, San Francisco, CA 94114, USA e-mail: Docx2@ix.netcom.com