Problematic sexual excessesAuthor(s): Stephen B Levine
Known since ancient times, sexual excess has been referred to as ‘sexual addiction’ for three decades. DSM-5 has proposed a new category of ‘hypersexual disorder’ to bring together disturbing situations of masturbation, pornography use, strip club attendance, multiple affairs, internet procurement of partners, prostitution use, unprotected sex with multiple partners and other sexually arousing behaviors. The conditions under which patients come for assessment differ between single and married, heterosexual and homosexual, paraphilic and nonparaphilic, and sex criminals and law-abiding patients. Treatment depends on apparent causes, comorbidities and the patient’s capacities. While questions have been raised about the validity of hypersexual disorder, the numerous requests for assistance from patients should remind the field of psychiatry that utility also drives the employment of a diagnosis.