Percent of Sex Addicts with Lifetime Histories of Axis I Disorders

Comorbidity Table

Do sex addicts suffer from elevated rates of mood disorders (a category that includes various forms of depression and bipolar disorder), anxiety disorders, and substance addictions? As I reported in the May issue of The "S" Newsletter", no high quality studies (i.e., based on a large random sample) have investigated this question. However, three of the best available studies were conducted by Martin Kafka at McLean Hospital (a Harvard psychiatric hospital; Kafka & Hennen, 2002; Kafka & Prentky, 1998, 1994). All total, Kafka studied 240 men who presented consecutively at his clinic requesting treatment for sex addiction. Lifetime prevalence rates reported by the participants in his studies are provided above. In two of the studies, Kafka inquired about a childhood history of ADHD. Kafka & Hennen (2002) found that ADHD was more common among the subset of their participants who had a history of paraphilias than it was among those with hypersexuality but no history of paraphilic interests. A history of ADHD Combined Type (as opposed to purely inattentive type) was particularly associated with paraphilic interests. Consistent with findings in many studies that have not involved sex addicts, Kafka & Hennen found that ADHD Combined Type was also associated with a history of Conduct Disorder.

Black et al. (1997) studied 36 sex addicts who responded to a newspaper ad for an anonymous research study of "compulsive sexual behavior." Discrepancies between Kafka and Black's studies are likely due to the small sample sizes (especially in Black's study) as well as the different methods that Black and Kafka used to recruit their research participants (patients who presented for treatment versus those who responded to a newspaper ad). Black and Kafka included sex addicts with and without paraphilic interests in their samples.

Like Black, Raymond (2003) recruited a small sample (n = 25) through a newspaper ad. However, Raymond's sample is unique as she ruled out sex addicts who had a history of paraphilic interests. Largely for this reason, 90% of the individuals who volunteered to participate in the study were screened out. This reinforces findings by Langstrom (2006) concerning high rates of paraphilic interests among sex addicts**. Clearly, prevalence rates obtained by Raymond may differ from Black and Kafka's because Raymond screened out anyone with a history of paraphilias whereas Black and Kafka included such individuals. Rates may also vary due to the small sample sizes and differences in recruitment methods.

I have omitted studies of the comorbidity of sex addiction that relied on extreme (i.e., unrepresentative) samples. Such studies have investigated comorbidity in sex addicts who are convicted sex offenders (reviewed in Marshall, 2007), are in residential treatment (Carnes, 1991), or who have been in outpatient treatment for a number or years (Carnes & Delmonico, 1996).

* Dysthymia is a low grade, chronic form of depression.

** Large percentages of the participants in Kafka's studies also reported high rates of paraphilic interests: Kafka & Hennen, 2002 = 73%, Kafka & Prentky, 1998 = 70%, and Kafka & Prentky, 1994 = 57%.

Key articles:

Black, Kehrberg, Flumerfelt, & Schlosser, 1997
Kafka & Hennen, 2002
Kafka & Prentky, 1998
Kafka & Prentky, 1994
Kuzma & Black, 2008 (reviewed pp.607-8)
Langstrom & Hanson, 2006
Raymond, Coleman, & Miner, 2003

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