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19: Out-of-Control Sexual Behavior

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Almost every provider has had someone seek help for problematic sexual behavior, whether looking at pornography to the exclusion of engaging in sex with their real-life partner to having multiple sexual experiences outside of their committed relationship. But how to diagnose such issues has been under debate for decades, with a renowned split between providers who believe sex can be addictive and those who do not. The fact that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition does not include any diagnosis perhaps adds to the confusion about how to conceptualize and treat out-of-control sexual behavior. Why did the WHO determine that problematic sexual behaviors are an impulsive/compulsive disorder rather than an addiction? After all, turning to the description of addiction in the International Classification of Diseases-10, one will find “substance use or addictive behaviors” grouped together, which demonstrates that someone can be addicted to alcohol and to gambling.