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Sally presents to counseling with a sexual dysfunction stating she thinks about sex all the time and masturbates when unable to have sex. She takes strangers home from the bar just to have sex and looks at pornography but is more interested in reality. Sally also states she pays for sex at least 3-4 times a month and has been overly sexual as long as she can remember. Her actions have gotten her into trouble at work twice for looking at porn and she is worried about what will happen if her partner finds out about her sexual behavior.
According to the American Association of Sexuality Educators, Counselors, and Therapists (AASECT, n.d.), people do experience physical, psychological, and sexual health consequences due to their sexual urges, but they do not support the classification of sex addiction as a mental health disorder. ASSECT also does not believe that a person should go to counseling or participate in therapy for a hypersexual behavior (ASSECT, n.d.). The American Psychiatric Association (APA), rejected adding a diagnosis for hypersexual disorder added in the DSM-5 but when considered the criteria was intense sexual urges or behaviors that occurred over a period of six months (Reid, 2015). The APA stated it is hard to distinguish what is normal or abnormal with sexual urges (Krueger, 2016). Hypersexuality is associated with mania, depression, and anxiety disorders (Nair, Pawar, Kaira, & Shah, 2013). In a study by Nair et al. (2013), the hypersexuality behavior inventory (HBI), was given to 93 patients with a mood and anxiety disorder and found 25% screened positive for hypersexuality disorder. Sally would need to be given assessment instruments to check for a mood disorder or anxiety disorder. With the information presented, the diagnosis that may be used in the DSM-5 is other specified sexual dysfunction F52.8, as the ICD 10 code of 52.8 is for other sexual dysfunction not due to substance or known physiological condition, and includes excessive sexual drive, nymphomania (women), and satyriasis (men) (Krueger, 2016). ICD-10 code 52.7 is excessive sexual drive that was taken out of the United States version but changed to 52.8. The V and Z codes to be further investigated are V65.49 (Z70.9) sex counseling, as Sally is seeking help due to her sexual behavior, V69.9 (Z72.9) problem related to lifestyle as Sally’s actions are risky sexual behaviors that is creating problems at work and possibly at home if discovered (APA, 2013).
Cognitive behavioral therapy (CBT), can be used to treat Sally as it helps to identify unhealthy, negative beliefs and behaviors and replace them with more adaptive ways of coping. Acceptance and commitment therapy (ACT), can also be used as it is a form of CBT that emphasizes acceptance of thoughts and urges and a commitment to strategies to choose actions that are more consistent with important values. Sally can also be treated using psychodynamic psychotherapy, as it is a therapy that focuses on increasing the awareness of unconscious thoughts and behaviors, developing new insights into a personâ€™s motivations, and resolving conflicts. Sally could also be referred for medication such as mood stabilizers to reduce compulsive sexual urges. If it is determined that Sally has depression or an anxiety disorder she can be prescribed medications such as anti-depressants or anti-anxiety medication that would also control her sexual urges.