March 2, 2018


A few years ago, introversion was considered a mental health disease and was listed under the DSM index. It wasn’t until the fifth version of the DSM that it was acknowledged as a personality trait and expunged from the list. In the same way, many personal challenges are either lumped as problems or misdiagnosed, causing even more distress.

This is a recurring issue in the area of sexual health, where preferences and ill-advised habits are sometimes framed in a negative light, making the matter worse. Early ejaculation treatment is often a casualty of these misunderstandings. It’s an easily resolved difficulty that is often misrepresented and swept under the rug, so it never gets sorted out.

Similarly, CSBD (Compulsive Sexual Behaviour Disorder), more commonly described as sex addiction, is a problematic condition. Its implied inclusion in the 11th edition of the ICD (International Classification of Diseases) is a big step

However, David J. Ley, Ph.D., has some reservations. CSBD would be classed as an impulsive disorder rather than an addictive or substance use disorder. He argues that because treating sexual addiction is such a lucrative industry, patients are frequently misdiagnosed with sex addiction. He lays out certain exclusions which he believes will cut down over-diagnosis:

  • Conclusions based on moral conflict or social constructs
  • Psychological distress has driven solely by feelings towards longer lasting
  • Self-diagnosis of ‘sexual deviance’
  • Underlying mental health disorders
  • Judgments on the ‘right’ or ‘wrong’ kind of sex

If these exclusions are effectively and responsibly applied, then patients who have been diagnosed as sex addicts will now fall outside the spectrum. As a practical demonstration, Dr. Ley believes you will not be diagnosed with CSBD just because:

  • Your partner, church, or community rejects homosexuality or bisexuality
  • You, your spouse, or your therapist are distressed by your sexual desires
  • You see yourself as a sex addict or porn addict
  • You use sex as a coping mechanism for depression or anxiety
  • Someone in your life disapproves of how you want to have sex

Dr. Ley believes that adopting CSBD in the ICD 11 – if the news is true – is a positive step. It will more clearly define the basis for a CSBD diagnosis, which could drastically lower the statistics and pathologizing of sex addiction. It will no longer be used as a way to validate self-professed sex addicts. However, Dr. Ley is unsure of how soon this will change things.

He points out that the previous edition – the ICD  10 – was published in 1992 but wasn’t implemented until 2015. Health insurance companies don’t recognize any diagnosis until the ICD is officially applied, and from past experience, that could take more than twenty years.

Disorders of impulse controls are mental health diagnoses, which fall under the DSM, not the ICD. Medicaid and other health insurance providers are therefore unlikely to accept CSBD as long as it’s classed under the ICD but not the DSM. This means sex addicts still wouldn’t receive assisted treatment for their condition.

Dr. Ley concludes that sex addiction advocates shouldn’t celebrate just yet. The exclusion may disqualify many sex addicts as genuine contenders for CSBD. Verifiable diagnoses do not excuse the alleged addictiveness of sex or porn, and even valid patients may be unable to get the medical assistance they need unless they can pay cash.

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