PART ONE: Should Sexual Addiction Become A Legitimate Mental Health Diagnosis?

By Robert Weiss LCSW, CSAT-S

Is Sex Addiction Real?

There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma.

Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors.

More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering.

Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.

Lamentably, at the very same time that sexual addiction disorder began its technology generated escalation, the American Psychiatric Association (APA) backed away from the provision of either a diagnostic indicator or a workable diagnosis. Consequently, the past 25 years have wrought a somewhat anguished and inconsistent history in the attempts of the psychiatric, addiction, and mental health communities to accurately label and distinguish the problem of excessive adult consensual sexual behavior.

Today, American outpatient psychotherapists and addiction counselors are reporting a marked increase in the number of clients seeking help with self-reported crises related to problems like “I find myself disappearing for multiple hours daily into online porn” or “I feel lost on a never-ending treadmill of anonymous sexual hook-ups and affairs,” not to mention the tens of thousands who daily struggle with the dopamine-fueled nightmare combination of stimulant (meth/cocaine) abuse fused with intensely problematic sexual behavior patterns.

It would seem that these clinicians and clients would benefit greatly from the guidance the APA and DSM might offer them, but does not currently provide.

Sex Addiction and the DSM: A Brief History

In 1987 the APA’s Statistical Manual of Mental Health Disorders (DSM-III-R) added for the first time the concept of sexual addiction as a specific descriptor that might be applied under the more general diagnosis of “Sexual Disorders NOS (Not Otherwise Specified).” The DSM-III-R then stated this descriptor could be applied if the individual being assessed displayed “distress about a pattern of repeated sexual conquests or other forms of non-paraphillic sexual addiction, involving a succession of people who exist only as things to be used.”

This early DSM descriptor is not inconsistent with language commonly used by clinicians currently treating sex addicts and their spouses, who typically define sexual addiction much as Dr. Patrick Carnes did in the early 1980s: repetitive and problematic compulsive or impulsive sexual behavior patterns involving excessive shame, secrecy and/or abuse to self and/or others. Ruling Out: ego dystonic sexual arousal or behavior patterns directly related to sexual orientation, active fetishes, sexual offending, or major mental health disorders such as the manic stage of a bipolar episode or Obsessive Compulsive Disorder.

Active sex addiction causes relationship, career, legal, emotional and physical health problems, and untreated sex addicts will continue their sexual behaviors despite repeated attempts to limit or eliminate them, even when facing the negative life consequences that inevitably result.

Unfortunately, subsequent and current versions of the DSM (DSM-IV and DSM-IV-TR) retracted the DSM-III-R descriptor due to “insufficient research” and “a lack of expert consensus.” In hindsight, this decision has left the clinical community without adequate criteria for the assessment, diagnosis, and treatment of individuals with problematic consensual adult sexual behavior patterns. And the timing couldn’t be worse.

During this same period the tech-connect boom has dramatically increased the average person’s ability to affordably and anonymously access endless amounts of highly graphic pornography, casual sexual experiences, and online prostitution.

This proliferation of access is causing tremendous problems for many individuals with pre-existing addictive disorders, social inhibition, early trauma, and attachment and mood disorders, along with those who are more profoundly mentally ill – all of which can contribute to long term, profoundly problematic, and repetitive patterns of sexual acting out.

How Does Sex Become an Addiction?

In essence, whenever intensely pleasurable and arousing substances, like cocaine and crystal meth, or experiences, like gambling and sex, become more readily affordable and accessible, the potential for addiction rears its ugly head. This is especially true when these substances or experiences are highly refined and amplified as in the case of newer pharmaceutical drugs and Internet porn.

As our increasing technological interconnectivity has brought with it affordable, easy links to intensely pleasurable sexual content and anonymous sex, addiction and mental health professionals are seeing a corresponding increase in the number of people struggling with sexual and romantic addictions. It’s just that simple.

For reasons as varied as the individual, the increasing availability of intensely absorbing sexual content and experience has become a “drug of choice” for those who abuse sexual intensity and fantasy-based dissociation as a replication of intimacy, and those who use the search for romance and sex to self-regulate challenging emotions as well as tolerate stressors that unconsciously evoke past trauma or abuse. Despite this, The DSM currently provides no guidelines for assessing, diagnosing, and treating those individuals for whom sex has become an obsession.

What Does the Future Hold?

Ironically, at the same time the APA backed away from both defining and providing the research dollars needed to help define addictive sexual behavior, the concept of “sex addiction” has gained widespread media and public acceptance as well as grudging therapeutic legitimacy.

Driven by a combination of media attention, the international rise of 12-Step sexual recovery groups, films and television shows focused on sexual addiction (Shame, Californication, etc.), and the much-publicized problem sexual behaviors of multiple major political and sports figures, the general public appears to have tentatively embraced the concepts of sex addict, porn addict, and romantic and sexual addiction.

Recognizing the need to readdress this issue, the APA has undertaken a review of the topic and is currently considering a potential DSM-5 diagnosis called “Hypersexual Disorder.” While “hypersexual disorder” is not an ideal term for a problem that more accurately involves the lengthy search and pursuit of love and sex rather than the sex act itself, today there seems little doubt that hypersexuality is a legitimate, serious, and not uncommon clinical condition associated with the related concerns of disease transmission, drug and alcohol relapse, family and relationship dysfunction, divorce, mood disorders, unplanned pregnancy, job loss, and even suicide.

Next week’s blog will discuss the APA’s current stance on the proposed DSM-5 “Hypersexual Disorder” diagnosis, and how it is likely to be received.

Robert Weiss is the author of three books on sexual addiction and Founding Director of the premiere sex addiction treatment program, The Sexual Recovery Institute. He is Director of Sexual Disorders Services at The Ranch and Promises Treatment Centers. These centers serve individuals seeking sexual addiction treatment, love addiction treatment, and porn addiction help. Specifically, the Centers for Relationship and Sexual Recovery at The Ranch (CRSR) offer specialized intimacy, sex and relationship addiction treatment for both men and women in gender-specific, gender-separate treatment and living environments.

Copyright Psych Central

Why Religion Is Linked With Better Health And Well-Being

By Philip Moeller, for U.S. News

Choral singing is great for health: It engages people mentally and physically. There is also a strong social networking benefit of a shared activity that is often emotionally uplifting. Now, if this experience occurs in a church service, does it produce even greater well-being and happiness? Is there, in short, a God dividend?

The benefit of choral singing "is pretty cool, really," says Ellen Idler, a professor of sociology at Emory University. Singing can get everyone in the church literally on the same page, moving their bodies and voices in unison, usually with stirring songs. "The singing can be very important" to improving well-being and happiness, she says.

It's also true, researchers say, that people who regularly attend religious services enjoy a boost in their happiness. However, research findings don't agree on how much of the benefit is religious and how much derives from the benefits of social networking and being with other like-minded people.

There is overwhelming research evidence that people can live longer if they actively engage in formal religious activities and follow their faith's behavioral prescriptions. This is especially true for religions that espouse healthy diets and discourage smoking and alcohol.

Research conducted decades ago on Mormons, Seventh Day Adventists, and the Amish "found stunningly lower mortality rates in these religious groups," Idler says. "Overall, they really are much healthier than the rest of us ... In some of them, the mortality rate is 25 percent, 30 percent, or even 50 percent lower, which is really astonishing."

These groups were chosen, in part, because they keep extensive genealogical records. They also advocate healthful lifestyles that set them apart from other religious groups as well as the broader public. However, later research with broader groups has found that religious observers generally enjoy happiness and mortality benefits.

"Regular and frequent religious attendance does seem to be one of the significant predictors of less stress and more life satisfaction," says Scott Schieman, a professor of sociology at the University of Toronto. "It just puts people in touch with like-minded congregants," he says, and thus produces many of the benefits of a strong social network. "It's a period of time when you can actually connect with others and you're not alone in your beliefs."

To identify a deity "bonus," though, is much harder. "You have to break it down into components and look at religious activities and religious beliefs," he explains, "and you have to look at them during times of stress. Is it the activity? If so, which kind of activity? Is it the belief? If so, is it [a belief in] life after death" or some other belief?

Idler grants that some of the most dramatic health benefits of religious observance involve faiths that require adherence to positive lifestyle behaviors. "Some people may write it off as nothing more than a result of lifestyle issues," she says. "My perspective on that is that if you want to have people follow a really restrictive lifestyle over their entire life, you have to have something that holds them together and perpetuates it. You could take religion out of the equation and it would fall apart."

"No matter if it is ancient burial practices or modern injunctions against smoking, the mechanism for the effect of religion on health seems to be that religion provides an effective social control mechanism for compelling behaviors over the course of their lifetimes that may deny individuals freedom, pleasure, or stimulation, but which appear to promote survival," Idler wrote last year in a paper that reviewed studies about religion's impact on mortality.

She also notes the ubiquity of religious symbols and imagery that add meaning and richness to religious observance.

Janet Ramsey, a pastor and theology professor at Luther Seminary in St. Paul, Minn., sees such symbols as part of a broader religious narrative that undoubtedly adds support and meaning to people's lives. In her research, she says, "people in a faith tradition find ways for their lives to intersect with that larger narrative" and a "much deeper, symbolic life."

"There is power there that gives meaning to life, and it also helps people as they get older with their self-identity and aging," Ramsey adds. "It makes you feel like you are part of an ongoing relationship that is bigger than yourself." In her research, she adds, being in a religious organization was not more beneficial in this regard than being spiritual but not active in an organized religion.

Feeling that we are part of something larger than ourselves can be tremendously comforting and supportive, Schieman agrees. "There's an assumption that most people want to feel that there's a sense of order, a sense of certainty [in life] rather than a cold randomness," he says. "Religion provides answers to a lot of these questions and if not answers, at least a big answer: There is God. There is a sense of meaning."

This sense of support produces great comfort and help to people as they get older, and especially as they near the end of their lives, Ramsey says. "The approach of death, coupled with a loss of control during the last days of life, can easily lead to anxiety and anger," she recently wrote. "Spirituality is one pathway among others that appears to mediate end-of-life anxiety by allowing older persons to remain peaceful, even when facing their own death and losing personal control."

Religion and spirituality also can help people achieve a sense of closure about their lives that includes a very important stage of forgiveness—to others, but also to themselves. "Some language and beliefs and rituals are provided [by religion] that help people with their needs for forgiveness," Ramsey says. "We finally make peace with the things we have done."

Postpartum Depression Linked to Higher Health Care Costs

A mom who suffers from depression after giving birth — called postpartum depression — is also likely to incur higher health care costs than a mom who doesn’t suffer from such depression.

This finding is according to a study led by Rada K. Dagher, assistant professor of health services administration at the University of Maryland School of Public Health.

Dagher suggests that employers should create programs to prevent and address postpartum mental health issues, as this could result in significant health care cost savings and a healthier workforce.

This is the first study to examine the link between postpartum depression and health services expenditures.

Postpartum depression is the most common serious mental disorder after childbirth and affects at least 13 percent of women in the United States. Employed women are more likely to experience postpartum depression if they have lower job flexibility, lower social support, and higher total workload.

Previous research has also shown that the more maternity leave a woman is able to take — up to six months — the better protected she is against postpartum depression.

In this new study, the mothers who suffered postpartum depression were more likely to be single, low-income, have no college education, have experienced depressed moods and anxiety during pregnancy, be back to work at five weeks after childbirth, have less social support, and have adverse maternal physical symptoms than non-depressed women.

The study examined employed women 18 and older who gave birth at three community hospitals in Minnesota and calculated their health care costs from the time of discharge from the hospital after birth until 11 weeks postpartum.

Researchers identified the women experiencing postpartum depression (using the Edinburgh Postnatal Depression Scale) through a telephone interview conducted five weeks after childbirth. Those who reported postpartum depression incurred 90 percent higher health care costs than non-depressed women.

Among the health care services utilized, depressed women were four times as likely to visit the emergency room and six times more likely to seek mental health counseling than non-depressed women.

In general, depression among workers has been shown to cost U.S. employers $44 billion per year in lost productivity and about $12.4 billion in health care expenditures.

Given the high labor force participation rate of mothers of infants, which reached 56% in 2010, this study adds important new information about the impact of postpartum depression on the utilization and costs of healthcare services among employed women. This information may benefit expectant mothers, their families, and employers.

Strategies to Prevent Postpartum Depression and Save Healthcare Costs

1. Create workplace policies that promote mothers’ recovery from childbirth and enable them to successfully resume work:

Examples of workplace policies that may help prevent postpartum depression include:

• Pregnancy and parental paid leave benefits
• Flex-time and telecommuting options
• Option for reduced hours upon re-entry to work
• Providing support and space for breastfeeding and pumping breast milk

2. Health care providers, working in collaboration with human resources personnel and top managers, are in key positions to influence such policies to ease the transition for working mothers.

3. Provide health plans with more generous coverage of mental health services.

Under the Patient Protection and Affordable Care Act, employers have the option of purchasing insurance from the state-based insurance exchanges, which offer different tiers of benefit packages, all of which must have a base-level package that includes mental health coverage. Employers with a high proportion of female employees of reproductive age may want to choose plans with more generous coverage of mental health services, as this could result in long-term health care cost savings.

The study is published in the Journal of Occupational and Environmental Medicine.

Source: University of Maryland