COMMENTARY

'Sex Addiction' in 10% of US Men, 7% of Women?

F. Perry Wilson, MD, MSCE

Disclosures

November 13, 2018

Welcome to Impact Factor. I'm Perry Wilson. This week: sex addiction. Does it exist, and if so, how many people have it?

Okay, what we're actually talking about today goes by many names. The latest moniker is compulsive sexual behavior disorder, or CSBD—coming soon to ICD-11!

Source: ICD-11 for Mortality and Morbidity Statistics (ICD-11 MMS), 2018 version

But let me start by saying that the idea that one can be addicted to sex or have a sexual compulsion is controversial, with psychiatrists on both sides. CSBD doesn't mean that you have a lot of sex; it means that you are distressed by sexual urges. The idea is that if these urges are causing distress, they must be pathologic. Subtext: If they are pathologic, they should be treated.

But first, just how many people have CSBD? This JAMA Network Open article argues that the condition is surprisingly common.[1]


 

Researchers from the University of Minnesota used data from the National Survey of Sexual Health and Behavior, which is a nationally representative and, well, really interesting dataset to review.

Have you ever wanted to know whether cuddling increases sexual satisfaction? This is the dataset for you.

Source: Wikimedia Commons

Spoiler alert: It does.

In any case, the survey includes the Compulsive Sexual Behavior Inventory, which is a validated set of 13 questions that ask about sexual urges. Higher scores are consistent with CSBD. And a lot of people had high scores.

Top-line results: 10% of men and 7% of women reported clinically significant levels of distress about their sexual urges or desires.

A number of factors were associated with CSBD. Rates were significantly higher among non-whites and dramatically higher among sexual minorities. But no factor was as strongly associated with distress about sexual urges as income.

Source: Dickenson JA, et al.[1]

But the relationship with income was weird: a U-shaped curve showing higher rates of distress about sexual urges from the poorest and richest portions of the population. It might be time to re-watch Eyes Wide Shut.

Source: Alamy

But here's the thing: Pathologizing sexual desires can go really wrong really quickly. There may be people who feel distress about their sexual urges because they are totally consuming and intrusive; but much more common is the distress that comes from moralistic or societal pressures to conform to certain sexual norms. The survey can't capture that crucial difference.

Do I think that 10% of American men and 7% of American women have a sexual pathology like this? No.

I think there are plenty of reasons for people to have hang-ups about sex and sexuality. But most of those are cultural. In the end, if you're not being hurt by a sexual feeling, and no one else is either, it probably doesn't deserve a diagnostic code.

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