Sexual problems are a common topic when people seek counseling. Licensed practitioners are trained to support clients coping with normal issues regarding desire, attractions, guilt and shame, and relationship incompatibilities. When does it make sense to refer a client to a specialist?
If the client’s presenting problem is sexually compulsive behavior and he or she has not found relief using non-specific therapies, and/or, the client’s sexual behavior or dishonesty is interfering with his or her ability to make progress on other important goals (especially around healthy relationships), specialized interventions may be beneficial. If you’re wondering whether a referral to Congruence might make sense for your client, please call.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not recognize compulsive sexual behavior as a disorder. Though a condition called “Hypersexual Disorder” was considered for inclusion in the DSM-5, it was ultimately rejected for a number of reasons – primarily regarding concerns about the strength of the existing research supporting the proposed diagnostic criteria. There were also broader philosophical concerns about the impact of labeling as a mental disorder sexual behavior that might simply be outside conventional social norms or that might more properly be understood as a symptom of another disorder. For a further discussion of the controversy, see Reid and Kafka (2014).
Nonetheless, it is instructive to consider the diagnostic criteria for two of the addictive behavior disorders that are included in the DSM-5: Gambling Disorder and Internet Gaming Disorder. Gambling Disorder is fully recognized as a disorder in the DSM-5, and Internet Gaming Disorder is included under Section III, Conditions for Further Study. Both disorders focus on whether the person experiences “persistent and recurrent (gambling/internet gaming) leading to clinically significant impairment or distress” as measured by criteria that indicate patterns of tolerance, withdrawal, failed attempts to control or cut back, use of the behavior to escape negative emotions, lying, and significant consequences to relationships, career, and educational pursuits. It is not difficult to substitute the concept of “sexual behavior” for “gambling” or “internet gaming” in the above diagnoses, and the thoughtful clinician might also consider if there is a meaningful functional difference between spending hours per day gambling, or on a computer immersed in gaming, and spending those same hours pursuing sexual gratification.