Dr. James M. Cantor
Hypersexuality (including “sex addiction,” “sexual compulsivity,” and many other terms) has been widely discussed by professionals and the public for many years. Although there has been some increased interest in the science behind the problem (mostly due to the American Psychiatric Association’s current efforts to revise the DSM), there is still only little actual science going on. My own experience working with people asking for help with sexual urges they say they cannot control is that very many different problems can lead a person to label themselves as “sex addicts.”
The original version of the conversation below is available at http://www.magazine.utoronto.ca/leading-edge/dr-james-cantor-sex-addiction/. For anyone who happens to receive it, the print version of the UToronto Magazine carried an abbreviated version of the following, complete interview.
Leading Edge/Summer 2010
“Addicted to Love”
The American Psychiatric Association is considering whether “hypersexual disorder” should be included in its next guide to mental illness
by Scott Anderson
Is “sex addiction” an excuse for philandering or is it a mental illness? The jury is out, but perhaps not for long. The American Psychiatric Association is proposing to include “hypersexual disorder” in the next edition of its Diagnostic and Statistical Manual of Mental Disorders. Dr. James Cantor is head of the Law and Mental Health Research Section at the Centre for Addiction and Mental Health and a professor at U of T. He spoke recently with U of T Magazine editor Scott Anderson about what “sex addiction” is and is not.
Prior to this proposal to define “hypersexual
disorder” as a mental illness, how was this kind of behavior classified?
But are they essentially describing the same set
Consider people who complain to their doctor of a headache. A headache associated with a migraine is completely different from a headache associated with a brain tumour, which is completely different from a headache caused by hitting your head on the floor. So even though we can put together everyone who complains of the same symptom, we’re not necessarily talking about people with the same problem. And we have no reason to believe that they would respond the same way to the same treatment. What’s really going on depends on where the problem started and what’s likely to happen if we intervene or not intervene.
It’s the same with sex addiction. People come in the door saying, “Doc, I think I’m a sex addict,” but that doesn’t mean that they’re literally a sex addict; they’re just describing their symptom.
Why is hypersexual disorder being proposed for the
What is the difference between someone who enjoys
having a lot of sex and someone who is “sexually addicted”?
For example, I’ll get a male patient who says he believes he’s a sex addict because he has uncontrollable sexual fantasies about men. The immediate thought in my head is “You’re not a sex addict, you’re gay.” But the word “gay” for this person holds more stigma than the term “sex addiction” does. The best thing we can do is to help him come to grips with being gay rather than trying to control – or get rid of – his sexual interest in men.
Another example: some people say they spend many hours a day masturbating or surfing for porn on the web and they’re not getting work done. They call themselves sex addicts. But what these people are doing is using masturbation to avoid whatever task it is that they normally need to be doing. It’s an issue they have about their work. When you help these patients develop better work habits, the sex just goes away.
Some people have enormous amounts of sex. Most of them are fine with it. People start looking for help when they – or when people in their lives – think their behaviour is causing a problem. When they’re failing grades, being put on probation at work or causing family members to suffer is when we would start saying the person is addicted.
Some people describe hypersexuality as an
addiction, akin to alcohol or gambling; others see it as a compulsive
behavior more like OCD. What’s your stance?
Should sexual addiction be defined as a mental
For example, there’s another class of disorders called the personality disorders. Among these are histrionic personality disorder and borderline personality disorder. In each, one of the symptoms is hypersexual behavior. If you look at the person’s entire presentation, one will often see the other symptoms of the personality disorder. But if one is paying attention only to the sex, ignoring everything else about the person, then one comes out saying, “Look at all the sex this person is having, I think it’s a sexual problem.”
My suspicion is that there are a small set of people who would be accurately called hypersexual, but others would be better diagnosed as having other disorders.
What percentage of the population does this
For example, somebody in the gay community could be having sex with dozens of people a year. It would be perfectly typical among that person’s peer group and would have no negative effect on his or any other person’s life.
If a married heterosexual male does the same thing, we have a very different set of expectations of what’s typical. So he could be having the same amount of sex with the same number of partners but for him there might be a problem. A survey for amount of sex doesn’t always capture what’s going on.
One rarely hears in the media about women who
suffer from hypersexual disorder. Why is this?
Some people have suggested that behaviours once
considered character flaws are now being defined as mental illnesses. What do
you think of this observation?
It may be the same critics who also say that by
including more problems in the DSM-V, drug companies simply gain the
opportunity to sell more drugs. What’s your opinion of this?
Although I share the public’s cynicism over how corporate interests can influence science or clinical practice, we don’t want to over-correct either. The answer is in the science. It’s always worth asking the question, is there a bias here somewhere? But I think it’s a mistake when people won’t take no for an answer.
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Last updated 15 August 2010