I say Tomato and You Say Tomato…
An update on Sex Addiction
Susan J Campling, RN, Psy.D
Magnolia Creek
A Rose by Any Other Name…
Sex Addiction
Hypersexuality Disorder
Problematic Sexual Behaviors- SASH
Paraphilia Related Disorder
Compulsive Sexual Behavior
Impulse Control Disorder
Don Juanism
A Nice Review
• Kraft-Ebbing (2) described the first case of abnormally increased
sexual desire in Western Europe, which he named “hyperesthesia
• Many years later, Kinsey and colleagues (3) developed the concept
of total sexual outlet (TSO), which corresponded to the total
number of orgasms achieved by any combination of sexual outlets
(e.g., masturbation, sexual inter- course, oral sex) per week. These
authors reported that only 7.6% of American males (younger than
30 years of age) reported a mean total sexual outlet per week
above seven for at least five years. Considering these data and
other confirmatory studies, Kafka et al. (4) proposed that
hypersexual behavior could be characterized by TSOs of at least
seven times per week.
1886 Case Study
“For three years, farmer D. a universally
respected married, aged thirty five, had
manifest states of sexual excitement with
increasing frequency and severity, which during
the past year had become true paroxysms of
satyriasis. It was impossible to discover heredity
or other organic causes. D. was compelled at
times to perform the sex act from ten to fifteen
times in a twenty-four hour period without
deriving any feelings of satisfaction.
“Gradually he developed a condition of general
nervous irritability with increased emotional
irritability to the extent of pathological
outbreaks of anger and impulse to over indulge
in alcohol… D. himself thought that he must
have had moments in which he no longer had
control of his senses.”
Origen (185)- Not fond of sex even in
Benjamin Rush (1745-1813)masturbation caused TB, epilepsy, and
loss of memory
Sylvester Graham (1794-1853)
developed a dietary theory attached to
chastity and venereal excess. Graham
J.H. Kellogg (1852 - 1943)- a bland diet
of 2 meals a day would decrease sexual
urges; advocated circumcision, used
sutures and chemicals to decrease
arousal in males and females.
P. Carnes (19xx-) major modern voice of
sex addiction model
Religious Views on Sex
Buddhism has few restrictions other than
monks and nuns. Extramarital sex is
acceptable if both people love each other.
Hinduism believes that sex can be a form of
worship in which couples surrender their ego
for pleasure, children and enlightenment.
Christianity is heavily influenced by
Augustinian dualism and the belief that sex is
bad. Augustine remained celibate after his
conversion to Christianity. Aquinas proposed
Natural Law.
Islam obtains its teachings of sexuality from
the Quran and religious leaders. Sex is for
marriage between a man and woman.
Sodomy us forbidden as is homosexuality
and premarital sex.
Judaism does not view sex as intrinsically
dirty or bad. Orthodox Jews follow rules
around cleanliness and honoring G-d but
view sex like are drives where intent
influences goodness or badness.
Victorian Era
• Women were institutionalized for
nymphomania if they were raped,
had affairs or had children
outside of marriage.
• Women with nymphomania with
“enlarged clitoris” underwent
treatment that could also include
clitorectomies or clitoral
• Masturbation was a treatment
provided by physicians to female
patients until the invention of the
“The sexual instincts are
remarkable for their
placidity, for the facility
with which they can
change their aim…for the
ease with which they can
substitute one form of
gratification for another”
(Freud 1938).”
Wilhelm Reich
• “It is not just to
fuck…not the embrace
itself, not the
intercourse. It is the real
emotional experience
of loss of your ego, of
your whole spiritual
self” (2011).
• Founder of Orgonomy
The Emergence of Sexual Addiction
• ''For one, you first have
to determine the limits
of ordinary sexuality that's not an easy
matter. The boundaries
are blurry. Where does
normal lechery end and
a sexual problem
begin?'’ Dr. Robert
Samuel Tesset 1760
Benjamin Rush
Sigmund Freud
Wilhelm Reich
Patrick Carnes
John Money
Mark Swartz
DSM and Sex
• DSM I (1952) similar to ICD 6
• DSM-II (1968) similar to DSM I without neurosis; rape
• DSM III (1980) homosexuality no longer a mental
• DSM-III-R (1987) sex addiction under “Sexual DO NOS.
• DSM-IV (1994) sex addiction removed
• DSM-IV TR (sexual DO NOS)
• DSM 5 (May, 2013) no SA
ICD 10
bestiality F65.89
erotomania F52.8
exhibitionism F65.2
fetishism, fetishistic F65.0
transvestism F65.1
frotteurism F65.81
masochism F65.51
multiple F65.89
necrophilia F65.89
nymphomania F52.8
pederasts F65.4
pedophilia F65.4
sadism, sadomasochism F65.52
satyriasis F52.8
specified type NEC F65.89
transvestism F64.1
voyeurism F65.3
• Key changes to the manual will include
removal of the multiaxial system used in the
DSM-IV; the inclusion of binge eating,
hoarding, and excoriation (skin-picking)
disorders in Section 2 for "categorical
diagnoses"; and the addition of attenuated
psychosis syndrome, non suicidal self-injury,
and Internet use gaming disorder in Section 3,
for those conditions deemed to require
further research.
Sex Addiction
Goodman et al 1994
• A. Recurrent failure to resist impulses to engage in a
specified sexual behavior;
• B. Increasing sense of tension immediately prior to
initiating the sexual behavior;
• C. Pleasure or relief at the time of engaging in the
sexual behavior;
• D. At least five of the following criteria:
• (1) Frequent preoccupations with sexual behavior or
with activity that is preparatory to the sexual behavior;
• (2) Frequent involvement in sexual behavior to a
greater extent or over a longer period than intended;
Goodman (con.)
• (3) Repeated efforts to reduce, control, or stop sexual
• (4) A great amount of time spent in activities necessary
for engaging in sexual behavior, or for recovering from
its effects;
• (5) Frequent involvement in sexual behavior when the
subject is expected to fulfill occupational, academic,
domestic, or social obligations;
• (6) Important social, occupational, or recreational
activities given up or reduced because of the behavior;
Goodman (con.)
• 7) Continuation of the behavior despite knowledge of
having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated
by the sexual behavior;(8) Tolerance: need to increase the
intensity or frequency of the sexual behavior in order to
achieve the desired effect, or diminished effects obtained
with sexual behavior of the same intensity;
• (9) Restlessness or irritability if unable to engage in sexual
• E. Some symptoms have persisted for at least one month,
or have occurred repeatedly over a longer period of time.
Hypersexuality Disorder
Kafka, 2010
• A. Over a period of at least six months, recurrent and intense sexual
fantasies, sexual urges, and sexual behavior in association with four
or more of the following five criteria:
• (1) A great deal of time is consumed by sexual fantasies and urges,
and by planning for and engaging in sexual behavior;
• (2) Repetitively engaging in these sexual fantasies, urges, and
behavior in response to dysphoric mood states (e.g., anxiety,
depression, boredom, irritability);
• (3) Repetitively engaging in sexual fantasies, urges, and behavior in
response to stressful life events;
• (4) Repetitive but unsuccessful efforts to control or significantly
reduce these sexual fantasies, urges, and behavior; (5) Repetitively
engaging in sexual behavior while disregarding the risk for physical
or emotional harm to oneself or others
• B. The clinically significant personal distress or
impairment in social, occupational, or other
important areas of functioning associated with
the frequency and intensity of these sexual
fantasies, urges, and behavior.
• C. These sexual fantasies, urges, and behaviors
are not due to the direct physiological effect of an
exogenous substance (e.g., a drug of abuse or a
• Specify if: Masturbation; Pornography; Sexual
Behavior with Consenting Adults; Cybersex;
Telephone Sex; Strip Clubs; or other.
• August 2011 refinement of definition
• American Society of Addiction medicine has
proposed that addiction is more than chemical
• Addiction is a primary, chronic disease of brain
reward, motivation, memory and related
• Food, sexual behaviors and pathological gambling
can be associated with this pathological pursuit of
• David Snarch
• Marty Klein
• David J Ley
Problematic Sexual Behavior
• Problematic Sexual Behavior 2012
• Offered certificate program training program
in September 2012
– Not focused upon one treatment approach
– Transparent
– www.sash.net
May today there be peace within.
May you trust your highest power that you are
exactly where you are meant to be.
May you not forget the infinite possibilities that are
born of faith.
May you use the gifts you have received and pass
on the love that has been given you.
Let this presence settle into your bones and allow
your soul the freedom to sing, dance, praise, and
Its there for each and every one of you.
How to reach me 
[email protected]
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I say Tomato and You Say Tomato* An update on Sex