This past April (2016), Dr. Richard Krueger from Columbia University as well as the New York State Psychiatric Institute provided a short commentary on the ways in which clinicians, if and when its appropriate, can make a DSM-5 and/or an ICD-10 diagnosis of sexual addiction. As most clinicians know, diagnoses are not just clinically useful, but insurance companies often require diagnoses when it comes to coverage. Ultimately, insurance companies don’t especially like to pay for the treatment of issues that aren’t diagnosed and identified by an alphanumeric code.
Although the American Psychological Association ultimately rejected, with little explanation, the strong recommendation to include Hypersexual Disorder (aka, sexual addiction) in the DSM-5, Dr. Krueger believes there are ways to work around this rejection.
Earlier this year the ICD-10-CM was published and featured Other Sexual Dysfunction Not Due to Substance or Known Physiological Condition (F52.8). Although this diagnosis includes dated terminology, it ultimately can be used as a viable option to diagnose sex addiction.
Meanwhile, the DSM-5 lists a pair of equally unwieldy options: Other Specified Sexual Dysfunction (302.79) and Unspecified Sexual Dysfunction (302.70). These both apply to sexual dysfunction that causes clinically significant distress but does not meet the full criteria for any specific sexual dysfunction disorders. For instance, a clinician would record “other specified sexual dysfunction” followed by the specific reason (e.g. hypersexual).
Although these are viable options for diagnoses and insurance purposes, the criteria are largely unrelated to the benchmarks used by certified sex addiction treatment specialists (CSATs) when identifying sexual addiction. Typically CSATs identify sexual addiction based on three categories: sexual preoccupation to the point of obsession; loss of control over sexual urges, fantasies, and behaviors (often evidenced by failed attempts to quit or cut back); and negative life consequences related to compulsive sexual behaviors.
Thus, in the future it would be nice to work with an official diagnosis that reflects the reality of sexual addiction previously described. For the time being, however, 302.79 and 302.70 in the DSM-5 and F52.8 in the ICD-10-CM provide the language we must work with if and when we need an official diagnosis.