I was married to someone with some disturbing mental disorders all explained in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) during my research and studies on Abnormal Psychology. The Impulse Control Disorders with Impulsive Sexual Behaviors: Sexual disorder of Sexual addiction/ hypersexuality addiction was with his abnormal use of pornography and content, obsessed over fantasies of sex and multiple sexual partners, promiscuity in relationships, and sexual deviance. Intermittent Explosive Disorder With Mixed Disturbance of Emotions and Conduct happened frequently resulting in road rage for a car cutting him off, making a comment he did not approve of, not being able to handle a disagreement or criticism, and not getting his way with compliance from people he manipulated and control, resulting in explosive rage. The last and most disturbing disorder is Narcissistic Personality Disorder, his is severe and he meets every requirement in with high severity. The older he gets the more prevalent the disorder is within his daily interactions. The worst part of this disorder is that he must be able to recognize the disorder to seek treatment, and it is rare for this type of personality disorder to be able to recognize and seek treatment because these people do not think they have a problem.
Diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)
Axis I: Clinical Disorders
302.72 Male Erectile Disorder
312.30 Impulse Control Disorders with Impulsive Sexual Behaviors: Sexual disorder of Sexual addiction/ hypersexuality addiction
312.34 Intermittent Explosive Disorder With Mixed Disturbance of Emotions and Conduct
Axis II: Personality Disorders
301.81 Narcissistic Personality Disorder, Severe
Axis III: General Medical Conditions
V71.09 No diagnosis
Axis IV: Psychosocial and Environmental Problems
Victim of Child Neglect
Possible Victim of Child Abuse
Axis V: Global Assessment of Functioning
30 (current)
302.72 Male Erectile Disorder
A. Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The erectile dysfunction is not better accounted for by another Axis I disorder (other than a Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type: Lifelong Type, Acquired Type, Generalized Type, Situational Type, Due to Psychological Factors, and Due to Combined Factors.
312.30 Impulse Control Disorders: with Impulsive Sexual Behaviors: Sexual disorder: Sexual addiction/ hypersexuality addiction
This is a residual category for those impulse control disorders that do not fulfill either the criteria for the specific disorders outlined or those other mental disorders with impulsive characteristics that have been covered in other sections of the DSM IV-TR (eg. substance abuse, paraphilias).
Impulsive Sexual Behaviors
“Sexual addiction”, habitual promiscuity, compulsive masturbation, compulsive use of telephone sex lines and/or internet pornography, and pornography dependence are some of the sexually related behaviors classified in this section.
Sexual addiction
Schneider identified three indicators of sexual addiction: compulsivity, continuation despite consequences, and obsession.
- Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior.
- Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires. Despite all of these consequences, they continue indulging in excessive sexual activity.
- Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected.
Models and labels
Sexologists have been describing cases of hypersexuality since the late 1800s. In some cases, the hypersexuality was a symptom of another medical disease, such as Klüver-Bucy syndrome or bipolar disorder, or the side effect of a medication, such as the drugs used to treat Parkinson’s disease. In other cases, the hypersexuality was reported to be the primary problem.
Sexologists have not reached a consensus over how best to describe when hypersexuality is the primary problem. Some researchers assert that such situations represent a literal addiction; other researchers assert that such situations represent a type of obsessive-compulsive disorder (OCD) or “OCD-spectrum disorder”; and other researchers assert that it is a disorder of impulsivity. Moreover, some authors assert that there is no such thing as hypersexuality at all and that the condition merely reflects a cultural dislike of exceptional sexual behavior.
Consistent with they’re not being any consensus over what causes hypersexuality, authors have used many different labels to refer to it, sometimes interchangeably, but often depending on which theory they favor or which specific behavior they were studying. Contemporary names include compulsive masturbation, compulsive sexual behavior, cybersex addiction, erotomania, “excessive sexual drive”, hyperphilia, hypersexuality, hypersexual disorder, problematic hypersexuality, sexual addiction, sexual compulsivity, sexual dependency, sexual impulsivity, “out of control sexual behavior”, and paraphilia-related disorder. Other, mostly historical, names include Don Juanism, the Messalina complex, nymphomania, and satyriasis.
Addiction model of hypersexuality
The most commonly discussed way of understanding hypersexuality is with an addiction model. The concept of hypersexuality as an addiction was started in the 1970s by former members of Alcoholics Anonymous who believed that their sexual behaviors meant the same thing as their alcohol use. Multiple 12-step style self-help groups now exist for people who identify as sex addicts, including Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous.
Compulsivity model of hypersexuality
Compulsions are behaviors a person performs in order to reduce feelings of anxiety or tension. According to this explanation of hypersexuality, persons engage in whatever sexual behavior in order to reduce feelings of tension, instead of to express sexual desire. Because engaging in the behavior can worsen the situation causing the tension, the person experiences a longer-term increase in tension, despite the shorter-term relief, resulting in a self-perpetuating cycle.
Impulsivity model of hypersexuality Barth and Kinder (1987) argued against classifying hypersexuality as an addiction or as a compulsion, arguing instead for classifying it as an impulsivity problem. They argued that an addiction entails a substance and withdrawal states, whereas sexual behavior has neither, and that compulsive behaviors exclude intrinsically enjoyable activities, whereas sexual behavior is intrinsically enjoyable. Hypersexuality does, however, contain the essential elements of an impulsivity problem: (1) It pertains to the failure to resist an impulse, drive, or temptation. (2) There is an increasing sense of tension before the behavior. (3) There is an experience of either pleasure, gratification, or release at the time of committing the behavior.
312.34 Intermittent Explosive Disorder With Mixed Disturbance of Emotions and Conduct
A. Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.
B. The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.
C. The aggressive episodes are not better accounted for by another mental disorder (e.g., Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer’s disease).
Intermittent Explosive Disorder
Category
Impulse Control Disorders
Etiology
This disorder is apparently rare, with the majority of cases occurring when the individual is between late adolescence and late twenties. There is some evidence of that the neurotransmitter serotonin may play a role in this disorder.
Symptoms
This disorder is characterized by frequent and often unpredictable episodes of extreme anger or physical outbursts. Between episodes, there is typically no evidence of violence or physical threat.
Treatment
Treatment could involve medication or therapy, with the best prognosis utilizing a combination of the two.
Prognosis
Prognosis is fair.
Diagnostic criteria for 301.81 Narcissistic Personality Disorder
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
(1) has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
(2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
(3) believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
(4) requires excessive admiration
(5) has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
(6) is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
(7) lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
(8) is often envious of others or believes that others are envious of him or her
(9) shows arrogant, haughty behaviors or attitudes
Narcissistic Personality Disorder
Category
Personality Disorders
Etiology
Like most personality disorders, there are many factors that may contribute to the development of symptoms. Because the symptoms are long lasting, the idea that symptoms begin to emerge in childhood or at least adolescence is well accepted. The negative consequences of such symptoms, however, may not show themselves until adulthood.
Symptoms
The symptoms of narcissistic personality disorder revolve around a pattern of grandiosity, need for admiration, and sense of entitlement. Often individuals feel overly important and will exaggerate achievements and will accept, and often demand, praise and admiration despite worthy achievements. They may be overwhelmed with fantasies involving unlimited success, power, love, or beauty and feel that they can only be understood by others who are, like them, superior in some aspect of life.
There is a sense of entitlement, of being more deserving than others based solely on their superiority. These symptoms, however, are a result of an underlying sense of inferiority and are often seen as overcompensation. Because of this, they are often envious and even angry of others who have more, receive more respect or attention, or otherwise steal away the spotlight.
Treatment
Treatment for this disorder is very rarely sought. There is a limited amount of insight into the symptoms, and the negative consequences are often blamed on society. In this sense, treatment options are limited. Some research has found long term insight oriented therapy to be effective, but getting the individual to commit to this treatment is a major obstacle.
Prognosis
Prognosis is limited and based mainly on the individual’s ability to recognize their underlying inferiority and decreased sense of self worth. With insight and long-term therapy, the symptoms can be reduced in both number and intensity.
APA. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revieion. Arlington: American Psychiactric Association.
