Ego-Dystonic or Instinctive? On the Misclassification of Sexual Desire as Compulsive Disorder

Ego-Dystonic or Instinctive? On the Misclassification of Sexual Desire as Compulsive Disorder

Recently, The New York Times introduced books by authors who self-identify as having ‘sex addiction,’ noting that regardless of whether we label it as addiction, the psychological distress stemming from sexual behaviors is indeed real. There is intense debate over whether the next edition of the DSM will include ‘sex addiction,’ while the World Health Organization advocates classifying frequent, uncontrollable sexual impulses and behaviors as ‘Compulsive Sexual Behavior Disorder’ (CSBD) in ICD-11.

However, the CSBD diagnosis in WHO’s ICD-11 lacks substantial practical diagnostic value. This is because it mandates excluding distress caused by ‘frequent, uncontrollable sexual impulses’ if it stems from cultural or moral factors—a criterion that is operationally impossible in practice. Yet, without such an exclusion, the diagnosis would inevitably conflate ‘compulsivity’ or ‘addiction’ with normal, vigorous sexual desire.

True compulsive symptoms are characterized by an intrusive sense of being invaded or controlled externally and internal experience of otherness/ego-dystonic experience, along with a rigid behavioral experience. Yet, in so-called ‘sex addicts’ or those with CSBD, no such intrusive or rigid qualities and intrapsychic alienness are ever observed in their sexual impulses. At most, it is a strong, internally consistent desire that insists on timely fulfillment. If this qualifies as ‘compulsivity’ or ‘addiction,’ then animals during mating season—who exhibit restlessness, irritability, and agitation when unable to copulate—would all be deemed to have CSBD or ‘sex addiction,’ wouldn’t they?

When applied to humans, whose sexual instincts are inherently active year-round, frequent in arousal, and rich in complexity, layers, and multifaceted directions, can the mere frequency of sexual impulses or their ‘uncontrollability’ truly be considered an addiction or compulsive disorder? Instinctive drives, by nature, are not fully controllable—try willing your hunger or libido to disappear for a set period and see if it succeeds. Without an external intrusive element, it cannot be deemed compulsive.

For those labeled with ‘sex addiction’ or CSBD, the true affliction lies not in their sexual psychology or instincts per se, but in their attempt to use otherwise normal sexual or romantic pleasures to mask underlying emotional traumas or abnormalities. This is why satisfaction in sex and love relationships is always fleeting: the post-intimacy sense of pleasure and harmony dissipates quickly, plunging them back into anxiety from unresolved emotional wounds and tensions—not related to sexual fulfillment itself. They then resort to sex and romance again for brief distraction, but this strategy is largely ineffective and does not involve escalating the ‘dosage’ of sex or romance to regain short-term relief (as even temporary alleviation remains unreliable). This starkly contrasts with true addiction patterns, revealing that their issue is not a compulsive disorder in sexual desire itself—their sexual experiences do not distort instinct but serve merely as an unsuccessful tool to conceal other problems.

From a practical perspective, those who self-identify as having ‘sex addiction’ and seek medical help often require diagnostic codes for insurance reimbursement. Therefore, diagnostic criteria should be more scientifically precise and practical, clarifying the condition as, for example, ‘symptoms involving the use of sex and romance as a defense mechanism to mask inner emotional entanglements’—rather than perpetuating subconscious legacies of traditional asceticism, which views sexual desires as inherently non-instinctual or unnatural if they fail to adhere to prohibitions.

Similarly, if modern people were denied internet and smartphones, reverting to handwritten letters, or if societal wages were rolled back to poverty-era levels, the widespread reactions would mirror those of ‘compulsive high-income disorder’ or ‘compulsive smartphone and internet use addiction’—restlessness, irritability, and all. Yet these are not pathologized, simply because they do not infringe on the subconscious taboos of ascetic sexual anxieties!

自我失调还是本能？论性欲被误认为强迫症

纽约时报最近介绍一些自认性成瘾的作者的书籍作品，并写道无论是否将其称为成瘾，这些由性造成的痛苦心理是存在的，下一版本的DSM是否要将性成瘾纳入其中存在激烈争议，而世界卫生组织则提倡将这些频繁不能自控的性冲动和性行为称为“强迫性性行为障碍”。但是，这些由性世界卫生组织的ICD-11的那个强迫性性行为障碍、其实并没有实际的诊断意义，因为诊断中由“频繁、不可控制的性冲动”而造成的烦恼需被排除“包含文化、道德的因素”，这就实际操作上是不可能的，但这种标准又不可避免，否则肯定会将“强迫性”“成瘾”和正常而性欲旺盛相混合，所谓的“强迫性”，其潜意识体验特征是“被侵入、内部异质感、被外来操控感”和僵硬的行为体验感，在所谓的“强迫性性欲”那里，从来就没有发现那些所谓性成瘾或者强迫性性行为障碍的“患者自身的性欲冲动是有着“侵入性”“僵硬的行为体验感”“内部异质感”这等特征，充其量就是发自内部的内在一致性的强烈需求一定要求及时满足，如果以此为“强迫性”和“成瘾”的标准，动物发情期频繁交配的性欲不能满足时也会出现坐立不安、焦躁易怒，是否动物在发情期也都“强迫性性行为障碍”或“成瘾”？对应到一年四季随时可以发情、发情本来就频繁、性本能本来就活跃而丰富复杂富有层次感和多向性的人类性本能及其情欲而言，性冲动频繁和“不能自控”这种作为性本能的本能欲望真的是“成瘾”“强迫性的障碍”吗？性本能作为“本能”当然是“不能自控”的，有谁试试“自控”一下性欲食欲消失一点自主调节的时间给我看好不好？没有外来侵入性即非强迫性。所谓性成瘾或者强迫性性行为障碍的“患者”，真正患病的并不是其性心理或者性本能本身，只是他们想通过本身并未出现异常的性或者爱情关系的快乐去掩盖出现异常的情感创伤之类而已，所以才总是不能满足、在性和爱情的关系中得到的满足总是很转瞬即逝，性爱过后的愉悦和谐感很快消退，重新陷入本身并不是追求性体验的满足上的其他情感创伤和紧张所带来的心理自体不安全感的焦虑当中，继续需要用性爱和浪漫爱情去短暂转移注意力，而这种用性爱和浪漫爱情去短暂转移注意力并不怎么成功，也没有出现“加大性爱和浪漫爱情关系的剂量”来重新成功短期转移注意力（因为即使短期内依然很容易重新焦虑），这就明显与成瘾产生鲜明的截然不同，而且看得出而这并非性欲望自身出现什么强迫性障碍，他们本身的性体验并不是对性本能的扭曲，而只是被用作一种不成功的掩盖其他问题的道具而已。

如果从实用性出发，那些自认为自己存在性瘾的人寻求医疗时需要获得诊断代码从而获得医疗补助，那么诊断标准应该更加科学实际地厘清那些状况，应该诊断为比如“存在以性和爱情为防御机制去掩盖内在纠结的症状问题”等等，而不应该延续传统禁欲主义潜意识的遗留，觉得好像这是一种性欲本身不够遵守禁令所以就是非本能非自然的状况，同理地，不让现代人使用互联网和智能手机而改回用笔写信、社会上涨了的工资重新减回到贫困时代，全社会的人的反应其实也跟“强迫性高收入、强迫性使用智能手机和网络、对此成瘾”差不多，只是没有触犯禁欲主义性心理纠结的潜意识禁忌所以没有被注意到而已！