Related or synonymous models of pathological sexual behavior include hypersexuality (nymphomania and satyriasis), erotomania, Don Juanism, and paraphilia-related disorders.
[24] Darrel Regier, vice-chair of the DSM-5 task force, said that "[A]lthough 'hypersexuality' is a proposed new addition...[the phenomenon] was not at the point where we were ready to call it an addiction."
According to the APA, the proposed diagnosis was not included due to a lack of research into diagnostic criteria for compulsive sexual behavior.
The most recent approved version of that document, ICD-10, includes "excessive sexual drive" as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).
[30] The most recent version of that document, ICD-11, includes "compulsive sexual behavior disorder"[31] as a diagnosis (code 6C72) – however, it does not use the addiction model.
[citation needed] Some mental health providers have proposed various, but similar, criteria for diagnosing sexual addiction, including Patrick Carnes,[33] Aviel Goodman,[34] and Jonathan Marsh.
His diagnostic model is still largely used by the thousands of certified sex addiction therapists (CSATs) trained by the organization he founded.
"[41] In 2017, three new USA sexual health organizations found no support for the idea that sex or adult films were addictive in their position statement.
If scientists, researchers, and clinicians in this domain want to bring the field forward and provide evidence-based care to people who report out-of control sexual behaviors, all of the above are needed.
[47][48][49] Chronic and excessive activation of certain pathways within the reward system and the accumulation of ΔFosB in a specific group of neurons within the nucleus accumbens has been directly implicated in the development of the compulsive behavior that characterizes addiction.
[48][51][52][53] In humans, a dopamine dysregulation syndrome, characterized by drug-induced compulsive engagement in sexual activity or gambling, has also been observed in some individuals taking dopaminergic medications.
[54] ΔFosB also plays an important role in regulating behavioral responses to natural rewards, such as palatable food, sex, and exercise.
[47][49] From an evolutionary standpoint, human sexual behavior evolved under conditions in which reproductive opportunities were limited by social, environmental, and biological constraints.
A strong sex drive would have historically conferred fitness advantages for individuals, especially men, by increasing reproductive success.
[57] This mismatch can intensify or hyperactivate normal mating motivations, leading, in some cases, to behaviors labeled as “sex addiction."
Today, however, near-limitless sexual content allows evolved drives to manifest in ways that may be harmful or distressing, exemplifying how novel features of modern society can transform an adaptive predisposition into a potentially maladaptive compulsion.
Indeed, some practitioners regard sex addiction as a potentially harmful diagnosis and draw parallels with gay conversion therapy.
[70] A paper dating back to 1988 and a journal comment letter published in 2006 asserted that sex addiction is itself a myth, a by-product of cultural and other influences.
[71] "Love addiction" falls into the same controversial area as well since it refers to a frequent pattern of intimate relationships which can be a by product of cultural norms and commonly accepted morals.
[73] In a report from 2003, Marty Klein, stated that "the concept of sex addiction provides an excellent example of a model that is both sex-negative and politically disastrous.
[75] According to Apryl Alexander, historically, in the US, the claim of sex addiction has been the preferred defense of white men who committed felonies.
[78] Since this is a disputed diagnosis, Gola and Kraus (2021) found that the WHO reached a "good compromise" by listing CSBD as an impulse-control disorder.
[79] Julie Sale stated "No-one refutes that clients access therapy for help with sexual behaviours that they feel they have no control over.