你有性瘾吗 [美国媒体]

Could You Have a Sex Addiction

你有性瘾吗



The World Health Organization stepped into the fray by recognizing compulsive sexual behavior disorder.

世界卫生组织承认强迫性性行为紊乱，从而卷入了这场争论。

Sex addiction is not about who you sleep with, who you’re attracted to sexually or what kind of sex you have. “It’s about how my sexual behavior is affecting my ability to function.”

性上瘾与你和谁睡觉、你被谁吸引或者你有什么样的性行为无关。“这是与我的性行为如何影响我的性功能有关。”

FOR DECADES MENTAL health professionals have been debating the question: Can a person be addicted to sex? Then the World Health Organization stepped into the fray last month – and didn’t totally answer the question.

几十年来，心理健康专家一直在争论这样一个问题：一个人是否会对性上瘾？其后，世界卫生组织就于上个月介入了这场争论——但是并没有完全回答这个问题。

WHO announced that compulsive sexual behavior disorder had been added to its updated listing, the International Classification of Diseases. In the ICD-11, it’s described as being “characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.”

世界卫生组织宣布，强迫性行为障碍已被列入其最新清单，即《国际疾病分类》目录。在第11版的《国际疾病分类》中，它被描述为“表现出无法控制强烈的、重复的性冲动或强烈欲望的持续模式，从而导致反复的性行为。”

The controversial decision was hailed by many supporters of the change as advancing the conversation surrounding problematic behavior that goes by many names: sex addiction; out-of-control sexual behavior; hypersexuality; and hypersexual behavior disorder. Yet while the inclusion of the disorder has been proposed, it’s not been accepted into the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders.

这一颇具争议的决定受到了许多支持者的欢迎，因为这一改变推进了围绕相关问题行为的讨论，对这些问题行为有不少名词来称呼：性上瘾、失控的性行为、性欲亢进，以及亢进性行为紊乱。然而，尽管已经有人提议将这种疾病包括在内，但它并没有被美国精神医学学会的《精神疾病诊断和统计手册》所接受。

So WHO’s decision made waves.

所以世界卫生组织的决定引起了轩然大波。

“I’m too old to dance on table tops,” says Robert Weiss, a sex addiction expert based in Santa Monica, California, and author of “Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction.” “But were it 30 years ago when I started in this field, that’s what I would have done. It’s incredibly important to have a diagnosis – it’s essential. Because without a diagnosis, you get moral judgment, you get religiously influenced clinical decisions and you get misdiagnosis.”

“我已经老了，没法再在学术前沿起舞了 ，但是如果是在30年前，当我才开始涉足这个领域的时候，我会这么做。毫无疑问诊断是非常重要的——也是必不可少的。因为如果没有经过诊断，你就要经受道德判断，会得到受宗教影响的临床决策，那么你就会被误诊。”罗伯特•韦斯表示，他是加州圣莫尼卡的性瘾专家，也是《性瘾101：从性、色情及爱成瘾中康复的基本指南》的作者。

Others point out – as Weiss does himself – that WHO stopped short of calling the behavior disorder an addiction. However, most who support or oppose adding a diagnosis acknowledge that the WHO decision is significant and will only spur more conversation.

其他人指出——就像韦斯自己一样——世界卫生组织没有把行为紊乱简称为上瘾。然而，大多数支持或反对增加诊断的人都承认，世界卫生组织的决定值得注意的，而且只会激起更多的讨论。

In its position statement on sex addiction, the American Association of Sexuality Educators, Counselors and Therapists “recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors.” But it “does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder.”

美国性教育工作者、顾问和治疗师协会在其关于性上瘾的立场声明中指出，“协会已经认识到，人们可能会经历与他们的性冲动、想法或行为相关的重大身体、心理、精神和性健康后果。”但是“并没有找到足够的经验证据来支持将性上瘾或色情上瘾归类为精神健康障碍。”

WHO’s decision to add compulsive sexual behavior disorder to the ICD-11 is “getting ahead of the research,” says Michael Vigorito, a certified sex therapist in the District of Columbia and co-author of “Treating Out of Control Sexual Behavior – Rethinking Sex Addiction.” Vigorito helped draft AASECT’s position statement on sex addiction. Instead of creating a new diagnosis, he argues what’s needed is to treat other underlying psychiatric conditions like depression or problematic, harmful sexual behaviors, or paraphilias. “When you try to isolate this condition as a discreet disorder that fits the criteria of sex addiction, it doesn’t materialize in the research because most of those folks meet criteria for other established psychiatric disorders,” he asserts. “So once you treat that disorder, the sexual behavior problem will likely remit.”

哥伦比亚区的注册性治疗师迈克尔•维格奥里托说，世界卫生组织将强迫性性行为障碍纳入第11版《国际疾病分类》的决定“超前于研究”，他也是《治疗失控性行为——重新思考性上瘾》一书的合着者。“维格奥里托帮忙起草了美国性教育工作者、顾问和治疗师协会关于性上瘾的立场声明。他认为需要的不是创造新的诊断，而是治疗其他潜在的精神疾病，如抑郁症或有问题的、有害的性行为，或是性欲倒错。他断言：“当你试着将这种情况作为一种符合性上瘾标准的严格规范的疾病区分开来时，就会发现这种情况并没有在研究中确现，因为大多数人都符合其他已确定的精神疾病标准。所以一旦你治疗了这种疾病，性行为问题很可能会缓解。”

Proponents of sex addiction therapy, however, contend that approach misses some people whose consensual sexual behaviors are disruptive to their lives and undermine their ability to function at home or work or in their social lives.

然而，性成瘾疗法的支持者认为，这种方法会使一些人错失（治疗机会），他们两厢情愿的性行为会破坏他们的生活，削弱他们在家庭、工作或社交生活中的能力。

Most consensual sexual behaviors are not a cause for concern, experts say. “But if you come to me and tell me that you’re losing your marriage, you’re losing your family, you’re losing your job, you’re unable to get through college because you’re looking at porn instead of studying. If you tell me that the behavior engaged in is affecting your ability to function, then I’m looking at addiction or compulsion,” Weiss says. He adds that sex addiction is not about who you sleep with, who you’re attracted to sexually or what kind of sex you have. “It’s not like if I’m into leather, I’m a sex addict, but if I’m into vanilla sex I’m not. So it’s not about who or what,” he says. “It’s about how my sexual behavior is affecting my ability to function.”

专家称，大多数双方同意的性行为并不令人担忧。“但是如果你来找我，告诉我说你失去了婚姻，失去了家人，失去了工作，你无法读完大学，那是因为你想的是色情而不是学习。如果你告诉我所实施的行为正在影响你的性功能，那么我要就要研究下是不是成瘾或强迫性的了” ，韦斯表示。他还补充说，性上瘾与你和谁睡觉、你被谁吸引或者你有什么样的性行为无关。“这不像要是我喜欢皮草性爱，我就是一个性上瘾者，而如果我喜欢香草性爱，我就不是，所以这跟是谁或是什么没有关系，”他说，“这是与我的性行为如何影响我的性功能有关。”

But unlike with an addiction to, say, alcohol or drugs, where a person in recovery is advised not to drink or get high, experts who have conflicting opinions on the sex addiction debate agree that few people would be willing to give up sex entirely – and that they shouldn’t be expected to.

但是，与酗酒或吸毒成瘾不同的是，在这种情况下，康复中的人是建议不要喝酒或酗酒的，对于性上瘾的争论有不同意见的专家们一致认为，很少有人愿意完全放弃性——不应该期望他们去这样做。

Weiss suggests cognitive behavioral addiction treatment, therapy that’s used to treat other addictions. But his strategy in treating people with sex addiction focuses on containment and maintenance, and it varies by the person, where problems might range from infidelity in a monogamous, marital relationship or spending hours viewing porn while one is supposed to be working. “So we’re working with them on containing behaviors that are out of control – for them – that are going to ruin their marriage, their career” or other aspects of a person's life, Weiss says. “We’re not saying that you’re not going to be sexual anymore. We’re saying now what sexual behaviors are affirming for your life, healthy for your life? … That’s where it is very individual.”

韦斯建议使用认知行为成瘾疗法，这种疗法用于治疗其他成瘾。但是他治疗性上瘾者的策略侧重于遏制和维持，而且这要因人而异，问题可能包括一夫一妻制婚姻关系中的不忠或者当一个人应该工作的时候却花几个小时在看色情片。韦斯说：“所以我们正和他们一起努力遏制失控的行为——对他们来说——这些行为将会毁掉他们的婚姻、事业”或者是生活的其他方面。“我们不是说你不要再有性行为。我们现在所指的是什么样的性行为对你的生活是合适的，是健康的？……这就是它非常独特的地方。”

As Weiss notes on his website, the first step for treating a sex addiction is a thorough “bio-psycho-social assessment.” The uation involves looking at nearly every aspect of that person’s life, including one’s sex and relationship history. “Individuals are assessed not just for sexual addiction, but for other psychological issues (including other addictions), along with relationship, family, legal, work, social, recreational, and financial concerns that may need to be dealt with.”

正如韦斯在他的网站上所指出的，治疗性上瘾的第一步是彻底的“生理-心理-社会评估”。“这项评估包括审视该人生活中的几乎每一个方面，包括一个人的性和关系史。“评估个人的不仅仅针对性上瘾，还有其他心理问题（包括其他上瘾），以及可能需要处理的关系、家庭、法律、工作、社交、娱乐和财务问题。”

After that, the focus is on a person’s behaviors and well-being. He also recommends going beyond one-on-one therapy to get support to change deeply rooted patterns of behavior. “Group therapy helps sex addicts learn that their problems are not unique, which goes a long way toward reducing the shame associated with their behaviors,” the website notes. Weiss also suggests joining a sex addiction support group, just as one might join Alcoholics Anonymous for alcohol addiction to get lifelong support, for what he sees as a chronic – lifelong – issue.

之后，重点才是一个人的行为和幸福感。他还建议不要局限于一对一治疗，要获得支持来改变根深蒂固的行为模式。网站指出：“集体治疗有助于性成瘾者了解他们的问题并不独特，这大大有助于减少与他们行为相关的羞耻感。”。韦斯还建议可以加入一个性瘾支持团体，就像一个人可能加入匿名酗酒团体以获得终生支持一样，因为他认为这是一个长期的终身问题。

Others, like Vigorito, say the answer lies not in considering whether one might have a sex addiction, but rather in getting a better understanding of – and treating as necessary – what’s driving problematic behaviors. In some cases, it may be about uating attitudes that lead to thinking there’s a problem in the first place. “It could be around their negative moral judgment about either the sexual behaviors they’re engaging in or the sexual fantasies that turn them on; and that internal conflict is what they are describing as feeling out of control,” Vigorito says.

其他专家，如维格奥里托，则表示答案不在于考虑一个人是否有性上瘾，而在于更好地理解——并且在必要时进行治疗——是什么导致了有问题的行为。在某些情况下，可能与评估态度有关，这种态度导致一开始就认为（这种行为）存在问题。“这可能是因为他们对自己所实施的性行为或使他们兴奋的性幻想的负面道德判断；这种内在的冲突就是他们所说的失控的感觉，” 维格奥里托表示。

Those who do have a serious sexual problem that’s disrupting their life will benefit from digging deeper to understand what’s causing that. “I think most folks presenting with this issue likely would qualify for a psychiatric disorder that’s already recognized and researched and has evidence-based treatments for, such as major depressive disorder [or] anxiety disorder,” Vigorito says. “It could be a symptom of ADHD. We can then provide the treatment based on those disorders without becoming distracted that the symptom of that disorder is sexual.”

那些确实有严重的性问题，进而扰乱了他们的生活的人将受益于更深入的研究，因为深入的研究将了解到导致这种情况的原因。维格奥里托说：“我认为大多数提出这一问题的人，很可能是患上了已经得到认可和研究的精神疾病，并接受过循证治疗，比如重度抑郁障碍或焦虑障碍。这可能是注意缺陷多动障碍的症状。其后我们可以根据这些疾病来提供治疗，而不会因为该疾病的症状是有关性的而分心。”

Whatever the cause – and however contentiously debated – experts at least agree it’s important to seek help. Nor is it about taking an all-or-nothing approach to sex – that’s either permissive of even behaviors that are self-destructive or hurt others, or that’s repressive.

无论原因是什么——无论争论多么激烈——专家们至少认同寻求帮助是很重要的。既不是要对性采取全有或全无的态度——也不是要允许甚至是自我毁灭或伤害他人的行为，或者说是要进行压制。

“Sexual health is a health domain on par with physical health, mental health and spiritual health,” Vigorito says. “So it is such an important aspect of people’s life satisfaction that to me my work is to help them integrate sexual pleasure into their life where it will contribute to their overall health and wellness.”

维格奥里托说：“性健康也是一个健康领域，与身体健康、心理健康和精神健康同等重要。因此，这是一个人们生活满意度的重要方面，对我来说，我的工作就是帮助他们将性快感融入生活，这将有助于他们的整体健康。”

Michael Schroeder is a health editor at U.S. News. He covers a wide array of topics ranging from cancer to depression and prevention to overtreatment. He's been reporting on health since 2005. You can follow him on Twitter or email him at [email protected].

迈克尔•施罗德是《美国新闻》的健康编辑。他的写作涵盖了广泛的话题，从癌症到抑郁症，从预防到过度治疗。自2005年以来，他一直在写作与健康有关的报道。你可以在推特上关注他，或者给他的电子邮箱[email protected]发邮件联系他。