dsm5After over a decade a new Diagnostic and Statistical Manual of Mental Disorders has been published, the DSM-5.

Why should we care?
The DSM is what makes the mental health field tick.  It decides who gets treated, what people get treated for and who gets insurance coverage.  It’s big business. The DSM-1 came out in 1952 and with each subsequent edition its power has become larger. Truth be told the APA in their infinite wisdom often times remains behind the curve instead of ahead of it. Their first well known blunder was in 1952 when the APA listed homosexuality in the DSM as a sociopathic personality disturbance. A large-scale study of homosexuality in 1962 was used to justify inclusion of the disorder as a supposed pathological hidden fear of the opposite sex caused by traumatic parent–child relationships. This view was widely influential in the medical profession. In 1956, however, the psychologist Evelyn Hooker performed a study that compared the happiness and well-adjusted nature of self-identified homosexual men with heterosexual men and found no difference. Her study stunned the medical community and made her a hero to many gay men and lesbians, but sadly homosexuality remained in the DSM until 1973. I can only wonder how many people got affected negatively by the APA’s little whoops.

For this newest version, the DSM-5, the APA originally proposed including a new chapter titled Behavioral Addictions, according to Darrel Regier, vice chair of the DSM-5 Task Force,  but in the end no such chapter appears in the new edition.  There was also some talk about including a proposal to create a category called hypersexual disorder, which many people viewed as another name for sex addiction, but it was also rejected from the new manual entirely.

The version published in 1987 (DSM-III-R), referred to “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.” The reference to sexual addiction was subsequently removed. The current version, published in 2000 (DSM-IV-TR), no longer mentions sexual addiction as a mental disorder. The DSM-IV-TR still includes a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified, which included: “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.” (Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.) Even this still-present diagnostic definition does not mention sexual addiction, but focuses on the patient’s distress as to their sexual behavior (contrary to the pattern of denial in addiction as mentioned below), not on the sexual behavior itself.
FYI: Hypersexuality, by itself, can also be a symptom of hypomania and mania in bipolar disorder and schizoaffective disorder, as defined in the DSM-IV-R.

So what does all this mean for people who suffer from Sex and Love addiction?
It means that in the eyes of the medical world and the insurance world YOU and your issues DO NOT EXIST.
Sad to say in 2013, thirty years after Dr. Patrick Carnes first published “Out Of The Shadows.”

What does that mean in real life?
This week one of my men finally got the courage to call Keystone ECU in Chester PA with willingness to go to treatment for his dis-ease that takes him to behavior that can get him dead, arrested, fired and no less divorced.
As it is for most people money is an issue and as I predicted to him his insurance will not cover one penny of the cost. Sad to say, he will not be receiving the level of care he needs. The APA and the DSM’s myopia have real life consequences.

There is trouble in paradise…
“Just two weeks before DSM-5 was due to appear, the National Institute of Mental Health (NIMH), the world’s largest funding agency for research into mental health, has indicated that it is withdrawing support for the manual.
In a humiliating blow to the American Psychiatric Association, Thomas R. Insel, M.D., Director of the NIMH, made clear the agency would no longer fund research projects that rely exclusively on DSM criteria. Henceforth, the NIMH, which had thrown its weight and funding behind earlier editions of the manual, would be “re-orienting its research away from DSM categories.”

At the end of the day all any of us can do is to keep a good thought and to keep fighting this illness one day at a time even if the DSM says it does not exist.

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