It seems the DSM-V might revive (and rename) a contentious old diagnosis: hypersexual disorder is proposed to take up the spot previously occupied by “sexual addiction” and, on occasion, “sexual compulsion.” Over the past century, we have seen this shifting set of symptoms in many other guises, including hyperesthesia sexual, satyriasis, nymphomania, Don Juanism, paraphilia, sexual deviance, hypereroticism, hyperlibido, hyperphilia, and perversion. It has been categorized as a form of obsession, a compulsion, an impulse-control disorder, an addiction, and, in more private conversations, perhaps, bad behavior, tom-foolery, men-being-men, she’s-gotta-have-it, no-good-two-timing, misogyny, macking, swinging, or just dating.
This newest diagnosis describes “recurrent and intense” sexual fantasies, urges, and behaviors that emerge in response to “dysphoric mood states.” People who suffer from this disorder engage in non violent sexual activity “while disregarding the risk for physical or emotional harm to self or others.” The last time we saw a similar diagnosis was in the 1987 DSM IIIR. That entry, on “sexual addiction,” described “distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used.” In the DSM-IV, the entry was removed due to a lack of data. All that remained was an unnamed reference to “[d]istress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual as only things to be used.” It is bookended by distress about inability to conform to gender roles and distress about sexual orientation.
The revision (and renaming) of this set of shifting symptoms marks some significant changes in thinking. The term “addiction,” after all, carries with it notions of powerlessness, consumption, dependence, withdrawal, and escalating need. It also implicitly proposes a mode of self-treatment through a modified twelve-step recovery program, individual therapy, or pharmacological intervention. Hypersexuality (literally: over/above/excessive + sexuality), on the other hand, only amplifies what is normal human activity. When it comes to sexuality, this term might imply, too much is not never enough. The term shifts attention from the more complex emotional qualities of addiction to the biological. Finally, the notion of harm to self and others has replaced the more judgmental assumption that a sexual addict (or player, or swinger, or casual dater) only uses people without actually recognizing their humanity. Being a cold-hearted snake no longer means you’re a sex addict; harmful excess might.
Before “sexual addiction” was removed from the DSM, there was some question about whether it named and described behavior that we might otherwise consider thoughtless, cruel, selfish, or sexist. After all, this diagnosis coincided with the third wave of feminism as well as the so-called sex wars. How could it not be informed by debates about pleasure and danger, porn and sex work, BDSM and other “non-normative” sexual and romantic activities? So, I imagine, people probably wondered: Does a cheating husband really have a mental disorder, or is he just a jerk? Is a man who thinks he’s entitled to look at porn, go to strip clubs, and purchase sex a male chauvinist pig, or is he suffering from a compulsion? Is a woman who sleeps around a slut or a sex addict? Is a serial monogamist just looking for love in all the wrong places, or is that person addicted to love?