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Normal sexual behavior may be overpathologized (that is, treated as disordered when it is not) if a clinician fails to recognize the wide range of normal human sexual expression—not only in frequency but also in variety. Overpathologizing can also occur among family members and health care providers who possess overly conservative attitudes and values regarding sexual expression. It is important for people who feel they have CSB (compulsive sexual behavior) to find a professional they are comfortable with when it comes to discussing a wide range of sexual behavior. They should consider seeking consultation from a specialist in sexuality. Patients who see a clinician who is not well educated about sexuality may end up feeling more embarrassment and shame than they did before the appointment.
Some individuals, with their own restrictive values, will diagnose themselves with this disorder, thus creating their own distress. Therefore, it is very important to distinguish between people who have a values conflict with their sexual behavior and those who engage in sexual behaviors that are driven by impulsive, obsessive, or compulsive mechanisms. For example, one man who came to our clinic did so because he masturbated once every few weeks but felt that any masturbation was “sinful and perverted.” In this case, “treatment” consisted of simply explaining to him the range of sexual behaviors that are normal and healthy, including his own.
There is an inherent danger in diagnosing CSB simply because someone’s behavior does not fit the values of the individual, group, or society. There has been a long tradition of pathologizing behavior that is not normative within a culture. For example, masturbation, oral sex, homosexual behavior, viewing pornography, or having an extra-relational affair could be viewed as compulsive behaviors because someone might disapprove of these behaviors. There is no scientific merit, however, to viewing these behaviors as disordered, compulsive, or “deviant.” When people are distressed about these behaviors, they are most likely experiencing a conflict with their own or someone else’s value system rather than suffering compulsive sexual behavior.
Behaviors that are in conflict with someone’s value system may be problematic but not necessarily out of the person’s control. Sexual problems are often caused by a number of non-pathological factors. People may make mistakes. They may lack awareness of the law. They may, at times, act impulsively. Their behavior may cause problems in a relationship. Some people use sex as a coping mechanism similar to the use of alcohol, drugs, or eating. This pattern of sexual behavior may become problematic. Problematic sexual behavior is often remedied, however, by time, experience, education, or brief counseling.
Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, PhD, MPH, and Samuel R. Chamberlain, MD, PhD are the co-authors of "Why Can't I Stop?: Reclaiming Your Life from a Behavioral Addiction"
