Married men sometimes behave badly. They covet. They flirt. They philander. And when they get caught, they occasionally adopt the insanity defense, telling spouses that an inner demon made them lose control.
Doctors say the line between legitimate clinical disorder and plain old lousy behavior isn't well-understood. That makes it hard to assess U.S. Rep. Anthony Weiner's announcement that he was seeking "professional treatment" following a scandal over lewd photos and messages he sent to women he didn't know.
The congressman hasn't specified what type of care he is getting, or for what, leaving constituents to wonder whether he is seeking treatment as simply a ploy to buy time and sympathy.
Sexual addiction is not recognized as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, an encyclopedic bible for psychologists. Exhibitionism, though, does make the cut. There has also been talk about including a passage in the next edition on hypersexual disorders, involving an overheated sex drive.
"It's still a very controversial diagnosis. There are a lot of people who think this is a lot to do about nothing," said Dr. Richard Krueger, an associate professor of psychiatry at Columbia College of Physicians & Surgeons and director of the Sexual Behavior Clinic at the New York State Psychiatric Institute.
"On the other hand," he said, "practitioners will see people who are completely out of control, and will just destroy their lives, and despite the imposition of a sanction will continue doing it."
Doctors assessing whether an illness is the real deal, or a convenient excuse, would likely take into account whether patients were causing themselves real harm, and whether they had lost some or all of their ability to control themselves, he said.
There seems to be no question about whether Weiner's behavior has been self-destructive.
"He certainly has a media relations nightmare and saying he needs treatment sounds a lot better than the alternatives," said Dr. Jeffrey T. Parsons, a sex addiction expert and psychology professor at Hunter College in New York City. "It's a lot harder to bash someone who says he is seeking treatment and help."
Some experts said Weiner's actions _ making electronic sexual contact with strangers, despite the enormous risk to his political career _ do resemble the characteristics of drug addicts, alcoholics, problem gamblers, or even overeaters.
"People know they are not supposed to be overweight, and if they truly had control over it, they should just be able to make a decision to lose weight, and then do it," Krueger said. "Yet most people can't do it ... and they will engage in very complex, thought-out deliberate behaviors that will still keep them overweight."
If he has opted for an inpatient treatment facility, experts say there are a handful of places where he could be that specialize in sexual conduct, including a Mississippi clinic where Tiger Woods reportedly sought help for his litany of marital indiscretions. Or he could be getting outpatient advice on addiction.
"He's exhibiting behavior of an addict: the secrecy, the risk-taking, the denial," said Robert Weiss, founder of the Sexual Recovery Institute in Los Angeles.
Kimberly Young, clinical director of the Center for Online Addiction in Bradford, Pa., said that in many ways, Weiner's behavior was "very commonplace." Plenty of men and women secretly live out their fantasies on the Internet, sometimes in compulsive fashion.
The treatment, she said, is usually twofold. Patients have to first modify their online behavior; that might mean not using the computer during certain hours, or at certain locations, or only communicating with certain types of people online. Next, they must examine what mental health issues might be causing the behavior.
"Is he depressed? Is he anxious and stressed out?" she said. "First you need to deal with the behavior, then deal with the reasons why that happened. ... It will probably take more than a 28-day rehab program. ... The treatment has to fit the person."
Weiner's weekend announcement that he is seeking treatment was short on specifics; he did not explicitly say that he has entered a rehab facility. A statement said only that he requested "a short leave of absence from the House of Representatives so that he can get evaluated and map out a course of treatment to make himself well."
Timothy Lee, a licensed clinical social worker who runs New York Pathways, which treats sexual addiction on an outpatient basis, said Weiner's proclivity for sending lurid photos of himself to strangers was legitimately "delusional," and probably had deep roots.
"He didn't wake up and just start sending pictures."
Can those types of problems be repaired with 30 to 45 days of counseling? Probably not, experts said.
It also could take even longer than that for Weiner to repair his public image.
Caruso reported from New York.
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