DSM, Epistemology, and Addictions

The DSM’s are developed by mental health and medical practitioners who are guided by “current” research and knowledge. It is a clinical tool that is as good as the times in which it was written, the culture it was written for and the current understanding (the science) of mental illness. It guides our conceptualization, perception and treatment of our clients’ mental/psychological conditions. Even with its limitations, the DSM diagnostic procedures are highly “reliable” and “valid.” As the most widely accepted diagnostic resource manual in our field, we are stuck with it – at least until another one is written.

Epistemology is the study or theory of the nature and grounds of knowledge, especially with respect to its limits and validity. Epistemologically speaking, I believe we have not yet evolved enough to embrace the psychopathological elements of sexual addiction (as well as other process/behavior addictions). As I have said before, we are a part of the evolution of knowledge. What we know to be “true” now, may actually be groundbreaking stuff, or as history may have it, a laughable matter. Lest we forget that the DSM-II famously listed homosexuality as a mental disorder – specifically, it was listed under Personality Disorders and Certain Other Non-Psychotic Mental Disorders, Sexual Deviations (302.0).

The evolution of the DSM doesn’t happen because new disorders are discovered, but instead, because our understanding of mental health continuously evolves. As far as the debate on sex addiction: just because the DSM-IV has not recognized it as a bona fide disorder doesn’t mean it doesn’t exist. Our field is in its infancy. Twenty-five years from now, the DSM will look differently than it looks now. Practitioners will scoff at our ignorance – as we do with former DSMs.

As Mark Twain once said, “To a man with hammer, everything looks like a nail.” The writers of the DSM utilize a hammer that is “manufactured” by physicians. Their hammer can only be used with special “nails” that work with practitioners who think/conceptualize according to the medical model. Sexual addictions, as we understand them now, don’t conform to the rules of these highly evolved “carpenters.” As a tool of their trade, their hammer doesn’t work well with sexual addition. Sexual addiction, therefore, still isn’t considered a psychopathology or mental health disorder worthy of being placed in our “big book.”

What I’m trying to say is let’s not take the DSM-IV (and the future DSM-V) so damn seriously. It is just a guide – a bible of sorts – to be used as we choose to use it. Many of us choose to interpret it loosely. Insurance companies live and breathe it. Some of you may choose to use it precisely without questioning its authenticity or validity. It isn’t the “law of the land.” Just like with laws disallowing gay marriage: just because it is a “law,” doesn’t make it right.

Finally, the draft version of “Hyper-Sexual Disorder” looks good to me. It is a good start and I am hopeful they will more fully develop it. I have included it below.

Ross Rosenberg, M.Ed., LCPC, CADC
Clinical Care Consultants, P.C.

Updated October-14-2010

Hypersexual Disorder [14]

A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following five criteria:

(1) Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior. [15]

(2) Repetitively engaging in these sexual fantasies, urges, and behavior in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). [16]

(3) Repetitively engaging in sexual fantasies, urges, and behavior in response to stressful life events. [17]

(4) Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges, and behavior. [18]

(5) Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others. [19]

B. There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges, and behavior. [20]

C. These sexual fantasies, urges, and behavior are not due to direct physiological effects of exogenous substances (e.g., drugs of abuse or medications) or to Manic Episodes. [21]

D. The person is at least 18 years of age.

Specify if: [22]

Masturbation
Pornography
Sexual Behavior With Consenting Adults
Cybersex
Telephone Sex
Strip Clubs

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