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