Aug 05

Am I a ‘pervert’ or simply enjoying the extraordinary? The answer to this question has seen remarkable changes over the times. Many sexual practices that might have resulted in getting burned at the stake for being possessed by ‘demons’ or being locked up in a mental ward during the last centuries are considered as nothing else than normal nowadays. However, there are indeed forms of sexual behavior that are considered as psychopathological even if moral issues are left aside. Today, sexual behavior is considered a disorder (or paraphilia) if it causes distress or impairment to the individual or harm to others. This is an important distinction to avoid pejorative positions towards more uncommon sexual interests and practices like a sexual attraction to the same sex which was still part of the diagnostic manuals until 1973.

Upcoming versions of  diagnostic manuals will further make a distinction between paraphilias and paraphilic disorders. A paraphilia by itself would not automatically justify or require therapeutic intervention. A paraphilic disorder will be the aforementioned paraphilia that causes distress or impairment to the individual or harm to others. In other words, non-normative sexual behavior will not automatically be labeled as psychopathological anymore. Cross-dressing, for example, will not automatically be classified as transvestitism anymore – unless the person is unhappy about this activity or impaired by it. Only then it would be diagnosed as ‘disorder’.
While the new generation of classifications will definitely bring improvements compared to diagnoses that were given in a pejorative way before, it will also link diagnoses closer to cultural values again, so in a society with tighter cultural norms like here in Asia, we will probably see more people diagnosed with sexual disorders once the new classifications have become standard, as these person’s behavior patterns are more prone to ‘harm’ or ‘distress’ others…

The most common paraphilias that are considered as disorders are exhibitionism, fetishism (certain objects are required to gain sexual excitement), frotteurism (urges to touch or rub against a nonconsenting person), pedophilia, sexual masochism and sadism, transvestic fetishism, urophilia (sexual excitement with the sight or thought of urination) and voyeurism. These forms of sexual deviance usually become a problem if non-consenting persons are involved, local laws are violated or if sexual arousal can only be reached by acting on the urge of the paraphilia.
Can paraphilias be cured? Many experts claim they can’t, at least not with standard methods of sex therapy. However, often enough, persons suffering from the restrictions their paraphilias impose on them can learn to manage their sexual behavior more efficiently and flexibly – at least to an extent that prevents them from breaking laws or destroying their relationships.

More articles and literature:

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Sep 07

Talking about ‘sex addiction’ in certain Asian cities is like talking about alcoholism during the ‘Oktoberfest’ in Munich: a firework of dirty jokes and winking confessions (‘yes, I’m an addict, too!’) are standard elements of these conversations. However, few people seem to know what sex addiction really is or means.

Sexual addiction (sometimes also called sexual dependency or sexual compulsivity) means that a person is unable to manage her sexual behavior, which is described as ‘compulsive’ in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association. It is thus often also referred as ‘hypersexuality’ in many papers. Excessive sexual drive can cause distress or serious problems not only for the affected persons but also to persons associated with them. Usually they invest a lot of time and money to satisfy their obsession with various activities related to sex, and may risk losing their jobs, ruining their relationships, interfering with their social life, and putting themselves at risk for emotional and physical injury. While for many, their behavior won’t progress beyond compulsive masturbation or the extensive use of pornography or paid sex services, for others, the addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, sexual harassment or abuse and especially here in Asia, violating various Asian laws like filming sexual activities or organizing sex parties. Many sex addicts spend high percentages of their money due to their lowered sexual inhibitions – basically, most of their money-making and thinking ultimately turns around satisfying their sex drive. However, sex addicts hardly gain lasting satisfaction from their sexual activities and rarely form emotional bonds with their sex partners. To many, it feels like constant hunting – without ever achieving the satisfaction of feeling full.

Unfortunately, it is also typical for sex addicts to engage in distorted thinking – justifying and rationalizing their behavior and blaming others for the problems that arise as a result of their actions. As long as possible, they will deny they have a problem and find excuses for their behavior. Thus, it usually takes a significant event like the loss of their job, the break-up of their marriage, an arrest or a health crisis, to force the addict to admit that there is indeed a problem.

While professionals are still struggling with the exact definition and diagnosis of hypersexuality / sex addiction, there is no doubt that this disorder exists. Hypersexuality is also a criterion symptom of mania in bipolar disorders and schizoaffective disorders and often linked to depression or other forms of addiction, like alcoholism or drug abuse. Treatment of sexual addiction focuses on controlling the addictive behavior and helping the person develop a healthy sexuality.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

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