Hypersexuality Disorder in Line to Become a Mental Diagnosis

Psychiatric association wants to add excessive sexual urges to mental disorders.

OCT. 16, 2012— -- He goes by the online name Candy Cane, and his sexual urges have taken over his life, escalating exponentially each day.

Married and the father of five children, the 51-year-old spends more than six hours a day Internet video-chatting, taking photos of himself and seeking out male and female partners.

Candy, a retired combat medic who lives in the Southwest, said he has survived two military conflicts, but nothing has been as challenging as fighting his addiction to sex.

"I have become reckless and uncaring about losing anything," said Candy, who was too embarrassed to use his real name. "I care more about my sexual urges than my family right now."

"I am losing control and I am going to end up with an STD or AIDS," he said.

Candy exhibits all the symptoms of hypersexuality disorder, a proposed medical diagnosis that psychiatrists hope will be part of the DSM-5, the latest version of the Diagnostic and Statistical Manual of Mental Disorders.

Dr. Martin Kafka, an associate professor at Harvard Medical School who is the primary author of the revisions to the DSM, said proponents hope the DSM listing would open the door to more research that might help people like Candy.

"If you review the empirical research literature in the last 20 years from a variety of perspectives, it looks at the problem and calls it by different names, but all of these names have a lot in common when describing the same phenomenon," said Kafka.

If approved, hypersexuality disorder will be defined as exhibiting repetitive, intense sexual fantasies, urges and behavior in association with the following criteria in adults:

-- excessive time consumed planning and engaging in sex

-- in response to a dysphoric mood state like anxiety, depression, boredom and irritability

-- in response to stressful life events

-- unsuccessful efforts to control or reduce such urges, disregarding risk for physical or emotional harm to self or others

The behavior must also cause "clinically significant distress or impairment" in a person's daily personal or work life.

"If this problem gets to the point where you are being labeled as a philanderer or a scoundrel or a nasty narcissist, and it happens there is a label of hypersexuality disorder that does validly describe the nature of your behavior, one possibility is reframing the problem and getting medical treatment," Kafka added.

But Dr. Allen Frances, professor emeritus of psychiatry and behavioral sciences at Duke University in Durham, N.C., said the proposal is "a really stupid idea" that might lead those who misbehave to cry, 'It's not my fault.'"

"There may be some very small percentage of people who could qualify for addiction to sex, but if it ever became a diagnosis, it would be wildly misapplied," he said.

"Addiction implies that you keep doing it when there is no more pleasure and it causes harm. It becomes an excuse to misbehave."

Frances, who worked on the DSM-4, argues that too many "normal behaviors" have been viewed as illness.

"Medicalizing this sort of misbehavior is reducing personal responsibility and acting like there is a medical solution," he said. "There is very little scientific evidence and the boundaries are fuzzy."

Kafka admits that there is more clinical than scientific data on sexual hyperactivity, but including it as a disorder in the DSM-5 will open doors to that kind of research.

"By calling it an illness, you could be quite relieved that for something you have not really been able to control on your own, help is available," he said.

Candy, who finds support from others on the Experience Project website, admitted that he needs help, as he fought back tears sharing his story.

After reading the proposed DSM criteria for hypersexuality disorder, he said, "It describes me to an absolute T," adding that people would be less judgmental if his behavior is defined as a mental disorder.

A disabled vet with a back injury, Candy retired two years ago. His wife of 32 years works to support them, and so he is responsible for raising their two youngest children, ages 6 and 8. He loves his family, but his sexual urges have taken over.

While the children are in school, he goes online and lives a secretive life, dressing up as a woman and having online sex with men.

"I am on the Internet for about four hours, then I race around doing the dishes and then two more hours on the Internet," he said. "Then I spend 30 minutes dressing up as a woman and taking pictures."

For Candy, it all began when he "lost a child," blaming himself for the family tragedy. He said he slipped into a deep depression that emasculated him.

Sex Addict Spends Money Recklessly

Candy says he had not been physically abused as a child, but that his father kept pornography and once punished him for misbehavior by making him wear a dress outside for a day.

Now, he says he has spent money "recklessly," at least $5,000 on women's lingerie. "It's out of control," said Candy, adding that he feels appreciated by the men and women who respond to him online.

He says he satisfies his sexual urges by masturbating "more than once a day, sometimes until exhaustion."

His wife of 32 years is not aware of the extent of Candy's compulsions and he lies to her.

"I made up something when she found mascara on the sink," he said. "She knows I have a ton of pictures of myself dressed up as a woman and the curiosity is driving her insane."

He told her that the interview with ABCNews.com was with a psychiatrist.

Men rarely seek help on their own, according to Douglas Weiss, a psychologist who runs Heart to Heart, a counseling center in Colorado for sex addicts. Usually, the wives find out.

"They are checking their husbands' cache and websites," Weiss said. "There is porn blocker software. Men get caught quicker because of technology."

Women also have sex-addiction issues, Weiss said, but men are more apt to leave them before seeking help. Women are usually willing to "save the family," he said.

With a team of professionals, he runs 12-step programs, support groups and out-patient counseling.

An estimated 80 percent of people who are identified as hypersexual have been abused as children, Weiss said. Many, like Candy, have suffered trauma or abandonment or emotional neglect as children.

Some with sex addictions have what Weiss calls a "biological basis," with unhealthy attachments that form, often with exposure to pornography, which begin in early adolescence.

"They prefer the object of sex rather than relationship sex ... where they are present with a committed partner," he said. "It's like people who smoke who don't taste the food."

A smaller group of people have other mental imbalances, such as bipolar disorder, which manifests itself hypersexuality.

But that, according to the working draft of the DSM-5, would not meet the criteria for hypersexuality disorder, nor would repetitive behavior associated with the effects of substance abuse.

The key is getting help for both husband and wife, Weiss said.

"If he gets better and she doesn't, it doesn't work," he added. "There are three pieces: him, her and the marriage. Most men and women can forgive if there is plausible explanation."

As for Candy, he loves his wife, but that hasn't stopped him from risky online affairs.

And, for the first time last weekend, Candy set up a date and drove four hours from home to meet a woman in person for sex. She never turned up.

"It's so complicated and I don't understand it," Candy said of his hypersexuality.

"I am so ready for my wife's support, but how do I tell her without a divorce that I've done something she probably would never forgive me for? What would my adult kids say or do, disown Dad? Where do I turn?"

But he is convinced that his behavior is driven less by sexual impulse than the need for love.

"I don't feel appreciated anymore," he said, "because I don't love myself anymore."