A Federal judge once concluded in a famous lawsuit: It was clear that psychiatrists get together to define various disorders, and then every so often, get back together to redefine them.

HereĀ is an article on Anthony Weiner, whose sexual activities played such a big role in the last election campaign. He’s now apparently in treatment for sex addiction. The article suggests that can’t be true, because there’s no such thing as sex addiction.

Problem: In order to prove that sex addiction doesn’t exist, we first have to agree on a universal definition of addiction. And that’s where everyone runs into trouble. It’s true that the term sex addiction is not recognized in the DSM. But then again, neither is drug addiction, at least under that name, because the term is no longer used in diagnosis. Hasn’t been for a long time now.

So instead of alcohol or opioid addiction, the doctor now specifies one or another type of Substance Use Disorders. Gambling disorders did make it into DSM5, but sex disorders of the type that Weiner exhibits did not.

That doesn’t mean they don’t exist. It means they haven’t yet met the criteria for inclusion.

It’s a situation that can change. As previously noted, the DSM functions more as a dictionary than a psychiatric Britannica. Others have called it a glossary of terms. It has specific utility in diagnosis, when used by trained, qualified clinicians.

The DSM is intended to undergo periodic revisions as the knowledge base grows. As a Federal judge once concluded, it’s clear that psychiatrists get together to define various disorders, and then every so often, get back together and redefine them.

It’s meant to be a dynamic process. Even before the latest iteration of DSM was released, experts were already considering revisions. Likely that we haven’t heard the last of efforts to include a sex-related diagnosis of the type that didn’t make the last cut.

However, I’ve noticed that when reporters in the popular media interview experts, they come away with an impression of consensus that in my experience does not actually exist. For instance, we’re seeing rapid growth in the use of functional magnetic resonance imaging (fMRI). Findings from same have created excitement among researchers.

Still, as far as I know, there’s no standard that requires the brain of a ‘sex addict’ to perform in a certain way on an fMRI. Maybe someday there will be, but not yet. I checked.

Many folks who went through treatment for sex addiction would dispute the relevance of such technology to their personal situation. They might counter: “Well, so what? I know what happened to me. Who cares what my brain looks like on a frickin’ photo? For all I know, that could be a cabbage.”

Perhaps someday the debate will end. Maybe it’ll be a lab on a moon of Saturn that will provide the breakthrough…


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