This week we received a blog from world renown sex addiction therapist, Dr Stefanie Carnes. I was in awe when this particular piece arrived in my inbox, firstly because as she rightly says the World Health Organisation accepting Compulsive Sexual Behaviour as a diagnosis will create clarity and provide answers for millions of people in pain. It will also give clinicians and professionals clearer guidelines as to how to address their clients needs.

Secondly, the quality of Stefanie's analysis of the implications of such a groundbreaking decision are truly insightful - unsurprising really for such an international academic expert and practitioner, and her words filled me with hope and personal reflections on how addressing sex still remains a difficult societal issue even amongst clinicians and within the medical world.

I am thrilled and impatient to announce that Dr Stefanie Carnes is presenting at iCAAD London 6-8 May 2019 and there you will be able to hear her elaborate on what she covers in the following blog and more.

I am sure you'll enjoy reading it as much as I did.

Christophe Sauerwein, Academic Director - iCAAD

A blog by Dr Stefanie Carnes - Clinical Architect, Therapist & Supervisor, The Meadows Behavioural Healthcare

For years the sexual health field has lacked a legitimate diagnosis for sexually compulsive and addictive behavior, causing many to wonder, “Is sex addiction real?” Recently, in a groundbreaking decision, the World Health Organization (WHO) decided to acknowledge Compulsive Sexual Behavior Disorder as a legitimate condition in the latest edition of its International Classification of Diseases (the ICD-11). This important move is a critical first step in de-stigmatizing this common problem. As a result, treatment and research can be advanced and more resources can be developed for our sexually addicted clients.

At this point you might be wondering, “Why has this taken so long?” Sadly, compulsive sexual behavior has a long history of being de-legitimized and unacknowledged as a serious mental health condition. In the early 1990’s, for instance, the diagnosis was removed from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (the DSM), leaving the field bereft of a diagnosis and stalling progress in research and treatment efforts.

One of the long-standing concerns was that a diagnosis for compulsive sexual behavior would be used as a weapon forensically as a way to get sex offenders a reduced sentence. This concern was unfounded. At most, in some cases, a statement about “significantly reduced mental ability” could be taken into consideration during sentencing. But reduced mental capacity is not even remotely the same as a diagnosis for sexual compulsivity.

Another concern was that an official diagnosis could be used to over-pathologize normal sexual responses or a high sex drive. Interestingly, this is precisely why a standardized diagnosis is so important. Without a specific diagnosis, misinformed therapists could (and sometimes did) impose their own values on a client and call it sex addiction.

Consider, for example, a recreational pornography user who looks at porn once or twice per month, yet feels bad about this behavior (thanks to social or religious messaging). Basically, there is some incongruence between this person’s morals/values and the behavior of using porn. This individual may well benefit from addressing his or her porn use in therapy, but it would be inappropriate to call this person’s problem addiction.

So having an official diagnosis with specific criteria that must be met for a client to qualify sexually addicted/compulsive is beneficial in terms of reducing the number of false positives. Long-standing critics of a sex addiction diagnosis should now be reassured that the terms “sex addiction” and “compulsive sexual behavior” will no longer be overused and misapplied.

As a matter of fact, the WHO very specifically took this concern into consideration when creating its new diagnosis. The language explicitly indicates that “distress that is entirely related to moral judgements and disapproval about sexual impulses, urges, or behaviours is not sufficient for a Compulsive Sexual Behavior Disorder diagnosis”. In other words, a patient must be unable to control his or her sexual impulses and be engaging in repetitive sexual behaviors that have become problematic in ways beyond violating his or her values.

Unfortunately, the lengthy controversy over the creation of an official diagnostic label and criteria has created confusion for the individuals and families that are legitimately suffering from addictive and compulsive sexual behaviors. This has been exacerbated by significant amounts of misinformation in the media, often propagated by well-meaning but uninformed clinicians who think, for whatever reason, that “sex addiction isn’t real.” With the new WHO’s new diagnosis, however, patients and families can finally rest assured that sex addiction is a very real problem with equally real solutions. Hopefully, the WHO’s decision will finally put the sex addiction controversy to rest so those who are suffering and those who want to help them can focus entirely on understanding and implementing the solution.