Sexual addiction is becoming an official mental health diagnosis. The World Health Organization (WHO) met in May of this year and adopted the new ICD-11, which includes the diagnosis of Compulsive Sexual Behavior Disorder (CSBD).
Covenant Eyes users might think, “What does this mean for my struggle with porn? How should we approach this diagnosis?” These are important questions that I want to help you think thoroughly about.
What Is Compulsive Sexual Behavior Disorder?
If you care to read the official definition for CSBD, here it is. These types of definitions can be technical, but they’re important to understand:
“Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intense repetitive sexual impulses or urges, resulting in repetitive sexual behavior over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.”
What are the implications of this that we can clearly affirm?
- There are good expressions of sexual behavior and bad expressions of sexual behavior. The ICD would say healthy and unhealthy. Christians would add holy and unholy. Healthiness and holiness are not competing concepts, and both should be considered important in this conversation.
- Sexual behavior has the propensity to be ensnaring and can disrupt many areas of life. This is aligned with the Christian view that sin has a predatory intent to destroy people’s lives.
- For a habit to become enslaving, an extended period of repetition is required. This is common sense.
- Pornography is not a victimless activity; many people are negatively affected. This counters one of the most common lies in our culture about the innocence of viewing pornography.
- There is hope for change. The entire point of placing diagnoses in the ICD is that these diagnoses represent experiences for which some degree of freedom or relief is possible.
Why Was CSBD Included as a Diagnosis?
While it may get a little nerdy, to evaluate the inclusion of CSBD in this diagnostic structure we also need to consider why this diagnosis was added.
“Although this category resembles that of substance dependence, it is included in the ICD‐11 impulse control disorders section in recognition of the lack of definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders and behavioral addictions. Its inclusion in the ICD‐11 will help to address unmet needs of treatment seeking patients, as well as possibly reducing the shame and guilt that distressed individuals associate with seeking help.”
So to summarize:
- Researchers are unsure if CSBD has the same physiological features as substance dependence. Uncertainty on this point is why they don’t use the more common label of sexual addiction to describe this experience.
- A large number of people struggle with compulsive sexual behavior. Diagnoses are included in the ICD when it becomes common enough that clinicians see an increase in prevalence for an experience.
- The official diagnosis makes it easier for these individuals to be reimbursed for counseling. Insurance companies require a diagnostic code to reimburse for services, which made it difficult for individuals to receive counseling. Adding a diagnosis to the ICD is as much about third party reimbursement as it about discovering something new.
- It allows for better research on compulsive sexual behavior. Research helps us to differentiate speculation from empirically verifiable approaches to working with a given life struggle. This kind of research should enrich both professional and lay-based care strategies.
Does This New Recognition Present Any Concerns?
Sexual behavioral can get out of control. When it does, lots of people are affected, and WHO wants insurance companies to reimburse for counseling. If we want people to be free from destructive sexual behavior, this all seems fine. But are there any reasons to be cautious with this new label?
When a pattern of behavior receives a diagnostic label, it often creates an external locus of control. Diagnostic labels lead us to think something is happening to us rather than being done by us. There is some concern that this label could reinforce a sense of passivity towards change and a lack of ownership for one’s choices.
The moral nature of the activity can be lost with a label. Too often we fail to realize that something can be both unhealthy and immoral. We treat it as an either-or instead of a both-and. There is some concern that this diagnostic label could distract from the role of repentance in change.
Also, we often assume the remedy for a diagnosis will be medicinal. Again, this doesn’t need to be either-or. The remedy for diabetes involves both insulin and exercise. If there is a medicine that can help with impulse control, we should be happy. But regardless, the fruit of the Spirit known as “self-control” will be required in both taking the medicine as prescribed and other behavioral choices towards righteous living.
How Should We Approach This New Diagnosis?
The answer to this question will vary from person to person. Diagnostic labels are a tool. Any tool can be used for good purposes. In contrast, any tool can also be used for destructive purposes. The problem with tools is usually not with the tool, but with how a given individual utilizes that tool.
If you serve as an ally for someone who comes across this new diagnosis, affirm the following:
- Your friend is not alone in their struggle. This can help alleviate some of the stigma associated with sexual sin.
- Sexual activity has an enslaving tendency. If someone fights a bear and loses, we don’t call them weak. It’s the nature of the bear to be stronger. When someone engages sexual sin and becomes enslaved, it doesn’t mean they’re uniquely weak. It means it’s the nature of this activity to be enslaving.
- Even secular health experts (meaning, those without the bias of Christian morals) want individuals enslaved to sexual activity to have access to help in the pursuit of freedom. Appealing to secular experts helps reveal the frustration point, “I only need to change because I’m a Christian and God’s hung up about sex,”which is not true.
If you serve as an ally for someone who comes across this new diagnosis, caution the following:
- Your choices matter. A label can explain why change is hard; it is not a reason to quit trying.
- Abstinence and repentance are not the same thing. A secular counselor would just want you to stop engaging in self-destructive behavior (abstinence). God invites you to a restored relationship with Him (repentance).
- No amount of science will make change easy. But the work is worth it. If there is anything we can learn from science to make our efforts at change more effective, we will. But just like science has taught us a great deal about dieting, those advances in science haven’t made losing weight easy. Peer support and wise choices are still the central elements to change. So, let’s keep going together.
If you are interested in history of diagnostics, I would recommend Allen Frances’ book Saving Normal. Dr. Frances is a psychiatrist who loves his profession but is concerned about overmedicating normal physical struggles. Here is a brief excerpt from his book and few reflections to whet your appetite to read more.