Diagnosis
Despite "Sexual Addiction" not being classified as a mental disorder in the DSM-V, Dr. Patrick Carnes has developed "criteria" for Sexual Addiction, Collateral Indicators and a list of Sexually Addictive Behaviors.
I am using a list of these from a website by Dr. Linda Hatch, who offers sexual addictions counseling, and was trained by Carnes. Generally, I have found some of her written materials helpful, although as I have stated many times, I do NOT agree that spouses are co-addicts in need of a 12-Step Program.
Criteria for Sex Addiction
Recurrent failure to resist sexual impulses in order to engage in specific sexual behaviors
Frequently engaging in those behaviors to a greater extent or over a longer period of time than intended
Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors
Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experiences
Preoccupation with sexual behavior or preparatory activities
Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social obligations
Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior
The need to increase the intensity, frequency, number, or risk level of behaviors in order to achieve the desired effect; or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk
Giving up or limiting social, occupational, or recreational activities because of the behavior
Distress, anxiety, restlessness, or irritability if unable to engage in the behavior
Collateral Indicators of Sexual Addictions
(referenced from Facing The Shadow by Patrick Carnes, Ph.D.)
In addition, there are 20 collateral indicators which assist in the assessment of sexual addiction. A minimum of 6 criteria must be met.
Has severe consequences because of sexual behavior
Meets the criteria for depression and it appears related to sexually acting out
Meets the criteria for depression and it appears related to sexual aversion
Reports history of sexual abuse
Reports history of physical abuse
Reports history of emotional abuse
Describes sexual life in self-medicating terms (intoxicating, tension relief, pain reliever, sleep aid)
Reports persistent pursuit of high-risk or self-destructive behavior
Reports sexual arousal to high-risk or self-destructive behavior is extremely high compared to safe sexual behavior
Meets diagnostic criteria for other addictive disorders
Simultaneously uses sexual behavior in concert with other addictions (gambling, eating disorders, substance abuse, alcoholism, compulsive spending) to the extent that the desired effect is not achieved without sexual activity and/or other addiction(s) present
Has history of deception around sexual behavior
Reports other members of the family are addicts
Expresses extreme self-loathing because of sexual behavior
Has intimate relationships that are not sexual
Is in crisis because of sexual matters
Has history of crisis around sexual behavior
Experiences diminished pleasure for same sexual experiences
Comes form a “rigid” family
Comes from a “disengaged” family
Sexually Addictive Behaviors According to Levels of Severity*
Level One:
Masturbation
Affairs, chronic infidelity, romance addiction
Sexual relationships with multiple partners
Pornography use and collection (with or without masturbation)
Phone sex, cybersex
Anonymous sex
Prostitution – strip clubs
Level Two:
Illegal prostitution
Public sex (bathrooms, parks, etc.)
Voyeurism – online or live
Exhibitionism
Obscene phone calls
Frotteurism
Stalking behaviors
Sexual harassment
Level Three:
Rape
Child molestation
Obtaining and viewing child pornography
Obtaining and viewing rape, snuff pornography
Sexual abuse of older or dependent persons
Incest
Professional boundary violations (clergy, police officers, teachers, physicians, attorneys,
etc.)
*Severity relates to cultural and legal standards regarding violation