Sex Addiction

The complainant, Rebecca Rosenblat, is a certified sex addiction therapist, and objected to a Quirks and Quarks interview which disputed that such a condition exists. It is true that both participants did not use that label, but one of them did believe that it can be a disorder. The complainant’s view was not reflected in this discussion, but more than one perspective was.

COMPLAINT

You objected to an interview on Quirk and Quarks on the subject of sex addiction. The segment was done in the context of the revelations about Hollywood producer Harvey Weinstein and the many accusations of his history of sexual harassment and assault. There were reports that he was entering a rehabilitation facility to treat sex addiction. The discussion centered around whether such a condition exists, and how to define it. The web article based on the radio interview is entitled Sorry Harvey Weinstein, sex addiction isn’t real. You said this was inaccurate and biased. You are a certified sex addiction therapist and state that sex addiction is real. You questioned why the programmers did not talk to the experts in the field:

They refuse to speak to any experts in the area, and stand by the opinions of those who’re not specialized in the area, even though they’re legitimate therapists. It’s like getting a well-known cardiologist to comment on pediatric deformities – they’re both MDs, but clearly with different areas of expertise.

You stated that although sex addiction is not recognized by the Diagnostic and Statistical Manual of Mental Health (DSM-5), the medical guide, it does not negate its existence. You pointed out that a World Health Organization International Classification of Diseases “very much recognizes sex addiction.”

You thought this one-sided discussion did a disservice to all the people who suffer from this disorder:

I agree that it's a shame when someone uses their power to assault women in any capacity - but let's stick to that versus challenging a serious illness and giving a one-sided approach...Shouldn't we be more open with reporting the realities, so people can get help versus letting this thing turn into an epidemic? Where's the responsibility to those in pain who use various addictions as an escape - their families let them down, and now media is following suit. I expected different from CBC! Sexual violence against women is a serious issue, as is sex addiction - they both need to be addressed separately, instead of making a mockery out of two serious issues for a "good" opinionated story!

MANAGEMENT RESPONSE

The Executive Producer of Quirks and Quarks, Nick McCabe-Lokos, responded to your concerns. He explained to you why the programmers framed and presented the segment the way they did. He noted that the DSM-5 does not list sex addiction:

Given the fact that this is a highly regarded, factual and widely used tool for both diagnosing and treating mental disorders, we felt that this was a good measure of whether or not sex addiction is an addiction.

He added that while one of the interviewees, Dr. David Ley, is strongly opposed to such a designation, the other expert, Dr. Eli Coleman, did disagree with Dr. Ley and presented a different view:

Dr. Eli Coleman acknowledged that many people struggle with the role that sex plays in their lives, and the dependency they have on it. He argued that we need "more individualized treatment approaches". He also said science is working to determine, "the exact mechanism [behind it], whether there is a failure in executive control or impulse control or mood regulation".

Dr. Coleman even went so far as to say that he may be "more on the side of really recognizing that this could be a clinical disorder. We don't have enough evidence to really prove all of this, but we see this clinically every day." His is a view I imagine you would share, in light of your practise and the patients you meet.

REVIEW

CBC Journalistic Standards and Practices calls for balance for the presentation of a range of views over a period of time. Specifically, it states:

On issues of controversy, we ensure that divergent views are reflected respectfully, taking into account their relevance to the debate and how widely held these views are. We also ensure that they are represented over a reasonable period of time.

There is a divergence in the scientific and therapeutic community about how to label a hypersexual disorder and if it should be described as an addiction. Psychology Today defines it this way:

Specific criteria for hypersexual disorder were proposed for the DSM-5 in 2010 to capture symptoms reported by people seeking help for out-of-control sexual behavior. Many clinicians and researchers support the existence of this diagnosis because it may be used to help people who engage in "excessive" sexual behavior and simultaneously, and as a direct result, experience a great deal of personal distress. In the proposed criteria for the DSM-5, hypersexual disorder was conceptualized as a nonparaphilic sexual desire disorder that had an impulsivity component.

Although this criteria was tested and found to be valid when used with patients in a clinical setting, the proposed diagnosis was not added to the DSM because of the controversy that surrounds it. A diagnosis of "sex addiction" has also not been added to the DSM because clinicians and researchers agree there is not enough empirical evidence to support this diagnosis. The term "sex addict" is commonly used, however, and refers to a person who compulsively seeks out sexual acts despite negative consequences to self or others. This may be limited to compulsive masturbation or viewing of pornography, or it may extend as far as engaging in illegal sexual behavior such as exhibitionism or rape.

It is not yet clear to clinicians whether compulsive sexual behavior should be viewed as an addiction similar to drug addictions, and many people feel that such a diagnosis is shaming to people who enjoy having a lot of sex with multiple partners. Many people believe strongly that hypersexuality as a concept is real but should not use addiction language and should be described using non-moral terms.

While you and your colleagues strongly believe that it is a true addiction, and treat it that way, much of the scientific community does not share that view. However, the interview you cited does not dismiss the idea that this is a definable disorder. The interview, especially the one which aired on Quirks and Quarks, presented a nuanced view from one of its guests. The conversation was framed around the allegations against Harvey Weinstein and his announcement that he would seek treatment for his addiction. It made it clear from the outset that it was framing it around the DSM, but in the course of the interview one of the guests, Dr. Eli Coleman, mentioned, as you did, that another compendium of diagnoses, one from the World Health Organization, will list a classification:

And in the new classification of the World Health Organization that will come out there is a proposal to include a category of compulsive sexual behaviour.

This reference was in the on-air interview but was edited out of the transcript. As Mr. McCabe-Lokos mentioned, Dr. Coleman described himself as someone “more on the side of really recognizing that this could be a clinical disorder.” He disagreed that this disorder should be understood as an addiction and treated as such, but went on to talk about the need to understand the mechanism better and to develop appropriate treatments. This provided a different perspective from the other guest.

This was one segment on the topic. I understand that there are other underlying issues about those who wish to label this as a disorder and others who reject it. This item had a fairly narrow focus and it was not obliged to bring all views to the table. Given the degree of coverage of accusations of sexual impropriety, I have no doubt many news and current affairs programmes will be looking at a broader framework to understand it. That is why the policy allows for a range of views, based on how widely held they are, to be presented over time. In this case, while one guest, Dr. David Ley, adamantly rejected this kind of labelling, the other made the case for considering it a disorder, if not in the same way you do. There is no obligation to do so in a single episode.

However, there is a difference between the transcript that appears on the website, and the full broadcast. I appreciate that a note indicates it was edited for clarity and length. In so editing, some of the important nuance and support for the notion that there may be some kind of disorder at work, if not in the case of Harvey Weinstein - because no one is in a position to judge that - then in general. I already cited one example. The other is the final question which was completely removed from the transcript. Bob Macdonald asked both participants:

...Right now sex addiction or compulsion is not included in the latest Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5. Do you think it should be included. Dr. Coleman?

Eric Coleman: I think it should be included and the problem is there wasn’t sufficient evidence to really support and also because of the debate about what we can really call this or what part of the DSM we should really put it in.

The programmers might think of including these deleted portions of the conversation so that those reading it have the same understanding of the issue and its challenges as presented by Dr. Coleman, as those who listen to the interview.

As for the headline “Sorry Harvey Weinstein, sex addiction isn’t real” - it is designed to be an attention grabber - but it misses some of the nuance of the interview. It appears to be referring to Mr. Weinstein’s changing explanations for his behaviour. As the introduction pointed out, his earlier explanations of his behaviour, that he came of age in the 60s and 70s “when the rules were different,” made no reference to addiction. Your feedback is a reminder, though, that there is a danger in overselling a headline.

Sincerely,

Esther Enkin
CBC Ombudsman