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(This is the second of a two-part series on sexual addiction. Part I appeared in the July issue and presented a theory of sexual addiction-Ed.)
The diagnostic criteria for sexual addiction are derived from the behaviorally nonspecific criteria for addictive disorder that were presented in Part 1 (Goodman, 1998b), by replacing "behavior" with "sexual behavior" (see Table). A definition of sexual addiction, which facilitates preliminary diagnosis of the disorder, can similarly be derived from the simple definition of addiction.
Accordingly, sexual addiction is defined as a condition in which some form of sexual behavior is employed in a pattern that is characterized by two key features: 1) recurrent failure to control the sexual behavior, and 2) continuation of the sexual behavior despite significant harmful consequences. Consequently, sexual addiction is a syndrome in which some form of sexual behavior relates to and affects an individual's life in such a manner as to accord with the simple definition of addiction or to meet the diagnostic criteria for addictive disorder.
Significantly, no form of sexual behavior in itself constitutes sexual addiction. Whether a pattern of sexual behavior qualifies as sexual addiction is determined not by the type of behavior, its object, its frequency or its social acceptability, but by the relationship between this behavior pattern and an individual's life, as indicated in the definition and specified in the diagnostic criteria. The key features that distinguish sexual addiction from other patterns of sexual behavior are: 1) the individual is not reliably able to control the sexual behavior, and 2) the sexual behavior has significant harmful consequences and continues despite these consequences.
The paraphilic and hypersexual behaviors that characterize sexual addiction also can occur as manifestations of underlying organic pathology. Paraphilic or hypersexual behavior can be a symptom of a brain lesion, a side effect of medication or a symptom of endocrine abnormality.
The differential diagnosis is usually facilitated by the presence of additional symptoms or circumstances that suggest the underlying etiology. Clues that invite an organic evaluation include: onset in middle age or later, regression from previously normal sexuality, excessive aggression, report of auras or seizure-like symptoms prior to or during the sexual behavior, abnormal body habitus and presence of soft neurological signs.
Also of value in determining whether a case of paraphilia or hypersexuality represents sexual addiction are the diagnostic criteria for sexual addiction. Tolerance, psychophysiological withdrawal symptoms on discontinuation of the sexual behavior (usually affective discomfort, irritability or restlessness), and a persistent desire to cut down or control the behavior are generally not observed in patterns of paraphilic or hypersexual behavior that are not part of the sexual addiction syndrome.