between "hypersexual" and "asexual"

Transcription

1 Tensions in sexual scripts: between "hypersexual" and "asexual" AIUS / SFMS Symposium ESSM Copenhagen 2015 Alain Giami INSERM U 1018 Le Kremlin Bicêtre, France

2 A social science perspective Medical and sexological categories regarding sexual activity are considered as "cultural scenarios", i.e. as a social legitimized discourse about sexuality in a culture where Health and Medicine have become central moral values organizing behavior. Medical and sexological reveal social norms rather than actual sexual behavior. The concepts of excess and absence of sexuality reveal underlying representations of what is the "normal" and "sane" sexual behavior

3 Sexual scripts perspective Ü The scripting of behavior is examined on three distinct levels: cultural scenarios (instruction in collective meanings), interpersonal scripts (the application of specific cultural scenarios by a specific individual in a specific societal context), and intrapsychic scripts (the management of desires as experienced by the individual. Ü These concepts of the scripting of behavior are then applied to sexual behavior. Interpersonal scripts are seen as the ordering of representations of self and other that facilitate the occurrence of a sexual act; intrapsychic scripts represent the ordering of images and desires that elicit and sustain sexual arousal Ü (John Gagnon, 1986)

4 Hypersex Vs Asexuality Hyperaesthesia sexualis Excess Hypersexuals / Sexual addicted individuals are supposed to be asking for treatment and the "condition" is not recognized by the major disorders classification systems (DSM-5 and ICD 10/11) Clinician claims Pathologization Sex Addicts Anonymous in the UK Anaestesia Sexualis Inhibition / Absence Asexuals refuse to be considered as hypoactive sexual desire disorder and challenge the sexual optimism which links sexual health to well-being and good health : no category? Social / Identity / community movement De-pathologization Free choice / human right Asexual Visibility and Education Network (AVEN)

5 Asexuality : Absence of sexual activity or absence or desire?

6 Definition Ü the term asexual refers to individuals with low or absent sexual desire or attractions, low or absent sexual behaviors, exclusively romantic non-sexual partnerships, or a combination of both absent sexual desires and behaviors, and they often consider the label pejorative. (Prause, & Graham, 2007). Ø Absence of sexual desire / attraction / interest Ø Absence of Partnered sexual activity? Ø Self definition of an identity related to the LGTQIA coalition

7 Absence of sexual conduct or Absence of sexual desire, fantasies urges? DSM 3 : Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1980): "Inhibited Sexual Desire, disorders". DSM-IV-TR (American Psychiatric Association,2000) a deficiency or absence of sexual fantasies and desire for sexual activity, which causes marked distress or interpersonal difficulty: hypoactive sexual desire disorder DSM-5 : female sexual interest/arousal disorder ; male hypoactive sexual desire disorder

8 Prevalence Ü I have never felt sexually attracted to anyone at all. Life long: 1% (Johnson,Wadsworth,Wellings,&Field, 1994) Absence of sexual activity /0 Sexual partner Ü Lifelong: M = 4% F = 5% Ü Last year: M = 6%, F = 12% Ü Lifelong: M = 1,4%; F = 0,8% Ü Last year: M = 6,6%; F = 10,8% (France ACSF, 1993) Ü Do not want to have sex = 40% (France CSF, 2008)

9 Prevalence 2 Ü Absence or diminution of sexual desire (Often = 12 months) Ü M = 1,9%; F = 6,8% Ü It is not a problem : M = 49,4%; F = 39,3% Ü It is a problem : M = 10,8%; F = 14,5% Ü (France CSF, 2008)

10 Asexual Visibility and Education Network AVEN Ü An asexual person is a person who does not experience sexual attraction. Ü An asexual is someone who does not experience sexual attraction. Unlike celibacy, which people choose, asexuality is an intrinsic part of who we are. Asexuality does not make our lives any worse or any better, we just face a different set of challenges than most sexual people. There is considerable diversity among the asexual community; each asexual person experiences things like relationships, attraction, and arousal somewhat differently. Asexuality is just beginning to be the subject of scientific research.

11 AVEN Community Ü The Asexual Visibility and Education Network (AVEN) was founded in 2001 with two distinct goals: creating public acceptance and discussion of asexuality and facilitating the growth of an asexual community. Since that time we have grown to host the world s largest asexual community, serving as an informational resource for people who are asexual and questioning, their friends and families, academic researchers and the press. AVEN members throughout the world regularly engage in visibility projects, included but not limited to distributing informational pamphlets, leading workshops, arranging local meetups and speaking to interested press. The AVEN community centers around the web forum, which provides a safe space for asexual and questioning people and their partners, friends and families to discuss their experiences.

12 Excessive sexual activity Excess or addiction?

13 Excessive Sexual ac-vity or Sexual addic-on Frequency of sexual activities Frequency of sexual urges, fantasies, feelings Control or absence of control over sexual activity Distress about higher frequencies of sexual activities Stigma related to excessive / uncontrolled sex

14 Hypersexuality Ø Only 7.6% of American males (adolescence to age 30) had a mean Total Sexual Outlet (TSO) of 7 or more for at least 5 consecutive years duration Ü (Kinsey et al., 1948, p. 197 quoted by Kafka, 2010).

15 DSM- III and DSM- III- R : a moralis-c perspec-ve? DSM-III (American PsychiatricAssociation, 1980 ) classified paraphilic disorders as distinct pathologies (Psychosexual Disorders) and a residual diagnostic category, Psychosexual Disorder Not Otherwise Specified (diagnostic code ) included distress about a pattern of repeated sexual conquests with a succession of individuals who exist only as things to be used (Don Juanism and nymphomania) (p. 283). In DSM-III-R (American Psychiatric Association, 1987 ), the Sexual Disorders Not Otherwise Specified category (diagnostic code ) added the concept of non-paraphilic sexual addiction for the first time by stating: distress about a pattern of repeated sexual conquests or other forms of non-paraphilic sexual addiction, involving a succession of people who exist only as things to be used (p. 296).

16 DSM- IV / ICD 10 Ü In the DSM-IV (American Psychiatric Association, 1994 ) and its text revision, DSM-IV-TR (AmericanPsychiatricAssociation, 2000 ), the original DSM-III characterization of these behaviors was reestablished. Sexual Disorders Not Otherwise Specified (302.9) included a condition characterized by: distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used (p. 582). Ü CIM 10 (2007) : excessive sexual drive (Diagnostic Code F52.7), further subdivided into nymphomania (for females) and satyriasis (for males) Ø Diagnos(c category as moral category?

17 Proposed diagnostic criteria for Hypersexual Disorder / DSM-5 (not approved) Excess and absence of control Ü A. Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria: Ü A1. Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations. Ü A2. Repetitively engaging in sexual fantasies, urges or behaviors in Ü response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability). Ü A3. Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events. Ü A4. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.

18 Proposal for DSM-5 (not approved) Ü A5. Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others. Ü B. There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or behaviors. Ü C. These sexual fantasies, urges or behaviors are not due to the direct Ü physiological effect of an exogenous substance (e.g., a drug of abuse Ü or a medication) Ü Specify if: Ü Masturbation, Pornography, Sexual Behavior with Consenting Adults, Cybersex Ü Telephone Sex, Strip Clubs, Other:

19 Sexual addic-ons Defini(ons Obsessive compulsive disorder Disorder of impulse control Addic(on disorder Clinical dimensions Frequent distress in rela(on with behavior High frequency of (me devoted to sexual ac(vi(es Adverse consequences related to the behavior Repeated and unsuccessful efforts to try to reduce the behavior Ü Duarte Garcia,F., Thibaut, F. (2010) doi: /

20 Sexual addiction : a modern invention? Ü Its success as a concept lay with its medicalization, both as a self-help movement in terms of self-diagnosis, and as a rapidly growing industry of therapists on hand to deal with the new disease. The media has always played a role in its history, first with TV, the tabloids, and the case histories of claimed celebrity victims all helping to popularize the concept, and then with the impact of the internet. Ü A short history of social opportunism, diagnostic amorphism, therapeutic self-interest, and popular cultural endorsement is marked by an essential social conservatism sex addiction has become a convenient term to describe disapproved sex. Ü (Reay, Attwood, Gooder, 2012)

21 Sex Addicts Anonymous in the UK Are you in control of your sex life or is it in control of you? Ü Sure, it s true that not every person who has an affair is an addict. And not everyone who s watched pornography is an addict. And not everyone who has lots of sex with lots of people is an addict. Some people just have high sex drives, or just happen to like certain things. That s fine, we re not trying to label everybody as an addict, or create excuses for irresponsible or unfaithful people. But sex addiction does exist. And it s different from generally high libido, in two major ways: 1. Once we ve started, we can t stop Ü 2. We can t stay away, no matter what the consequences

22 Discussion Ø Distress related to sexual conducts or to deviation to contemporary social norms of "sexual health"? Ø Distress of absence of control Ø Sex as a response to stress and depression Ø Valorization and pride of absence of sex Ø Development of new identities Ø The role of sexologists : helping suffering individuals or re-establishing social norms???

23 Merci / Thanks alain.giami@inserm.fr