A response to Aviel Goodman's “Sexual addiction: Designation and treatment”

Dr. Goodman’s recent article” concerning the concept of sexual addiction was very interesting, but brings up several points I would like to discuss. He correctly reports that there is agreement that the behavior exists but there is still controversy as to how to designate it. He unfortunately glosses over the controversy concerning whether the behavior is secondary to other diagnoses or comprises a separate diagnostic category. Additionally, how a therapist would distinguish the nonpathologic presentations of the behavior from the pathologic is not well documented. These are not trivial points to his thesis. To accomplish his goal of creating the diagnostic label “sexual addiction” he first must create the diagnostic label “addiction.” While the term “addiction” is commonly and extensively used by both professionals and lay persons, the term does not exist in DSM-III-R2. The manual does recognize psychoactive substance dependence of several licit and illicit substances, but the word “addiction” is clearly and purposely absent. The manual does allow for pathological gambling, under the heading of “Impulse control disorders not elsewhere classified,” clearly avoiding the addiction concept again. Further, DSM-111-R does not recognize a diagnostic category that would be equivalent to a food addiction. While the development of the theory of addiction and a discipline of addictionology is currently ongoing, this part of Goodman’s paper appears to be misplaced. Proposals for instituting or changing the diagnostic criteria for addiction should appear in the psychiatric or addiction literature, so that the criticism of this proposal can be debated by experts in those fields. A review of the criticisms of the term “addiction” is beyond the scope of the present essay. Nevertheless, if the concept of addiction continues to be rejected, Goodman’s thesis must also be rejected by similar reasoning. Goodman’s criteria for the diagnosis of sexual addiction are germane to the readers of the Journal o f s e x €3 Mam’tal Therapy. For a new diagnostic