Is sex on your mind all the time?

It’s the fantasy, isn’t it? To be able to do it whenever, with whoever, and however many times we want. It’s much cooler to say ‘I’m addicted to sex’, than admit to being dependent on, say, alcohol or drugs. Why else would celebs brag about the numbers of partners they’ve had?

Actors Charlie Sheen and Jack Nicholson are believed to have done it with over 5,000 and 2,000 women respectively. And British comedian Russell Brand claimed he had “a harem of about 10 women, whom I would rotate in addition to casual encounters and one-night-stands.” 

All these celebrities may come across as simply promiscuous, but there’s a more hip term to describe their behaviour: sex addiction. In a global culture presided over by a sex-saturated media, it’s glamorous to be ‘addicted to sex’, even if not all experts agree that there is such a thing as a ‘sex addiction’.

It’s not just celebrities who have too much sex with multiple partners to help them ‘relax’. Ordinary people feel the same “clinical need” too. The Diagnostic And Statistical Manual Of Mental Disorders (DSM), a reference guide for mental health professionals the world over, claims that “these men and women are presenting themselves to clinicians because of recurrent, ‘out of control’ sexual behaviours”.

This is not technically an ‘addiction’ but a “dependence on sex which impairs social functioning”. While it isn’t a clinical condition yet, by 2013, when the DSM-V is released, ‘hypersexual disorder’ will be a recognised sexual dysfunction.

Yes, if you’re having too much sex, it could mean you have a mental problem, according to the DSM-V. Experts say that just because we label it doesn’t mean its ‘brand new’.

“It’s not as if premenstrual syndrome didn’t exist 1,000 years back. It’s just that now there’s a label to it,” says psychiatrist Shefali Batra of MindFrames counselling centre. But the DSM finding a clinical name for ‘hypersexual disorder’ will help improve awareness about the problem, say experts.

Are we over-medicalising sex?
There’s another camp of clinicians that believes hypersexual disorder is nothing more than an excuse to legitimately run a ‘sex clinic’, or ‘treat’ people for their overactive sex drives. Experts argue that we’re ‘over-medicalising’ any behaviour that deviates from the norm. Why is too much sex being branded a ‘dysfunction’?

“The terminology defined by the DSM will propagate myths within the medical community and with patients. Take the term ‘premature ejaculation’ — what is a ‘mature’ ejaculation? Who defines the benchmarks? Who gets to say what’s normal?” asks sexologist Prakash Kothari, also an advisor to the World Association for Sexual Health.

Then there’s the argument that while we may be having more sex than our ancestors, what’s really changed is that we’re talking about it much more, and there’s easier access to all things sex. Thanks to the internet, a whole generation of youngsters now has easy access to porn. All kinds of porn: doing it with strangers, siblings, werewolves, hookers, gay people, even ghosts and aliens.

Arun*, a 29-year-old engineer, says he was addicted to porn. He started his day with half an hour, sometimes more, of watching porn online. He had a collection of porn that spanned different types and themes or sexual acts, various positions, and in different languages. His routine often made him late for work but he just couldn’t stop. Besides his daily onanisms, he had sex with his girlfriend once or twice a week. After they were finished, he didn’t feel satisfied unless he logged on to the internet and let himself go again.

So when is it a disorder?
But what exactly is hypersexual disorder (HD)? According to the DSM-V, HD can be diagnosed if someone has “recurrent and intense sexual fantasies, urges and compulsive behaviour for a period of at least six months, and this causes significant personal distress and affects one’s social functioning.”

This also includes excessive masturbation,  cybersex, pornography addiction, frequent sex, phone sex, and visits to strip clubs. Experts in Mumbai agree that it’s a growing problem that needs to be discussed.

No one’s really sure what causes hypersexuality. Another psychological condition, bipolar disorder (BD), also manifests itself in the form of heightened sexual urges. One study reported that 82% of sex addicts were sexually abused as children. But sometimes, just an emotionally disturbing situation could be a trigger.

Take Mitesh*, 26, for instance. After his girlfriend of three years dumped him, he couldn’t stop thinking about sex. He was masturbating every few hours at work, and after office hours, he’d go looking for action even if it meant having to pay for it. He started looking at every woman, literally, as a ‘sex object’. The only friend he had was Neha*, a colleague at the chartered accounting firm he worked. Initially, she was his shoulder to cry on, but soon they became ‘friends with benefits’.

But she couldn’t cope with his demand for sex three or four times a day during office hours, followed by a night of more sex. Unable to keep up, Neha eventually had to seek help. The sexologist she consulted spent weeks talking to Mitesh and found out that the ‘sweet, shy boy’ who once had trouble initiating a kiss with his girlfriend had become this sex-starved Casanova-like person after she dumped him. He’d loved and respected her, and when that didn’t work out, he decided not to take women seriously at all. Months of counselling later, Mitesh realised he was abusing sex and ill-treating his best friend Neha. The two are now preparing for their wedding later this year.

Like in Mitesh’s case, it’s usually the partner who approaches the expert. “In my practice, more women come to me than men because they can’t cope with their partner’s sexual demands,” says sexologist Deepak Jumani. However, he adds, there are women who suffer from a heightened sex drive too. “But most women I’ve seen with hypersexuality are initially forced to have sex with husbands or lovers but find that they enjoy it and look for gratification from other males too,” he says.

How much is too much?
Experts are reluctant to quantify and define what a ‘normal’ sexual appetite really is. “There’s no ‘normal’ limit for sex. On a honeymoon, eight times a day could be normal for a couple, whereas after the holiday, eight times a week may be too much,” says Batra. “No two partners have the same desire. What’s ‘comfortable’ for both will be considered normal,” she adds.

The DSM disagrees. It has quantified what ‘normal is’. Once diagnosed, HD can be classified in terms of severity. Mild HD is when the person spends 15-30 minutes fantasising about sex on an average day and indulges in hypersexual activity once in an average week. Severe hypersexuality is when the person spends more than 2 hours a day preoccupied with sex and displays hypersexual behaviour (masturbation and/or partner-related) six or more times in an average week.

This idea of ‘normal’ is what will confuse people, say some experts. That’s probably why, even though the DSM is reluctant to label it, hypersexual disorder is otherwise known as sex addiction. Like with alcohol-, gambling- or drug-addictions, sex addicts know they need help when it starts interfering with their everyday lives.

Take the case of Akshay*, a 39-year-old account manager at an ad firm. After a promotion in 2007, he found that his stress levels had increased. He was spending more time at work and reaching home long after his wife and 8-year-old son were asleep. It started with an affair at work that lasted all of one week. After that, he needed to ‘relieve’ himself at least one a day during the workday, before going home, waking up his wife and doing it again. Pretty soon he was going out during office hours to cheap hotels with women he didn’t know. 

Sex as a de-stressor
His wife tried to talk him into seeing a therapist, but he refused. Even after they separated, he couldn’t bring himself to stop. But when women at his workplace started complaining about how he propositioned them, management took things more seriously. He was asked to go. That was the breaking point. He met a counsellor and apologised to his wife. A year later, the two are still separated. Akshay managed to get a job at another ad firm and still has the odd sexual encounter with a stranger, but he isn’t as compulsive about it anymore. Therapy, he says, helped him deal with stress.

During sex, higher serotonin levels in the brain give a natural ‘high’. Serotonin is a neurotransmitter that helps uplift one’s mood. “That’s why, even though depression causes a low sex drive, people suffering from it have sex to elevate their moods,” says Batra. The downside of this is that random acts of sex with strangers are known to cause low self-esteem.

Sex addiction clinics in the West follow a 12-step de-addiction programme, like rehabs for alcohol and drug abuse. A forum called ‘Sexaholics Anonymous’ works on the lines of an AA (alcoholics anonymous) programme — with members working like a support group for fellow-addicts. In India, a treatment plan includes lots of counselling, psychotherapy, and drugs, as a last resort.

While psychologists don’t agree that a heightened sex drive should be classified as a problem, patients feel they need help — whether or not it’s an excuse for promiscuity and infidelity. That’s one of the reasons the DSM is including hypersexual disorder as a mental condition.

The DSM is, after all, a reflection of society’s needs. Interestingly, what the DSM proposes to remove from the manual is ‘sexual aversion disorder’ — currently defined as a persistent psychological aversion to genital sexual contact with a partner. This doesn’t mean that we’re having more sex with different partners — on the net and in real time — and that no one’s averse to sex anymore…  or does it?

Names of patients have been changed on request