When they hear the words “sex addiction” most people probably have a similar, simplistic assumption of what that means. They will picture someone who has sex a lot throughout the day, or maybe someone who has a lot of sexual partners. Some people associate it with over-indulging in pornography or engage in an inappropriate sexual behavior.
However, these are not necessarily the defining features of sex addiction. Not everyone who suffers from it will have multiple partners, and they most certainly don’t all act out inappropriately. While some of these scenarios may be present in those who experience sex addiction, many advocates believe the vital element of sex addiction has to do with the consequences of their behaviors and their inability to control them. Other terms for sexual addiction include:
- Hypersexual Behavior Disorder
- Sexual dependency
- Compulsive sexual behavior
It is also known as nymphomania in females and satyriasis in men. So what is sex addiction, and can it be treated?
The DSM Debate
The most difficult part of the conversation is trying to talk about what sex addiction actually means when it is not officially recognized as a mental health disorder.
One of the most essential tools we use for understanding and treating mental health is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a widely recognized compendium of mental health diagnostics. This crucial resource receives regular updates from the American Psychiatric Association (APA).
At this point in time, the DSM does not include criteria for sex addiction. Among mental health professionals in the APA, this is the cause of a great deal of debate. For a quick timeline:
(DSM-III-R), referred to “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.” The reference to sexual addiction was subsequently removed.
The DSM-IV-TR did not include sexual addiction as a mental disorder.
Some authors suggested that sexual addiction should be re-introduced into the DSM system; however, sexual addiction was rejected for inclusion in the DSM-5, which was published in 2013.
Darrel Regier, the vice-chair of the DSM-5 task force, stated:
“Although ‘hypersexuality’ is a proposed new addition… [the phenomenon] was not at the point where we were ready to call it an addiction.”
The proposed diagnosis does not make the cut as an official diagnosis due to a lack of research into diagnostic criteria for compulsive sexual behavior, according to the APA.
As of 2017, none of the official regulatory bodies for Psychosexual Counselling or Sex and Relationship therapy, have accepted sex addiction as a distinct entity with associated treatment protocols.
The World Health Organization produces the International Classification of Diseases (ICD), which is not limited to mental disorders. The ICD-10 includes “excessive sexual drive” as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).
However, the ICD categorizes these diagnoses as “compulsive behaviors” or “impulse control disorders” and not specifically addiction.
The most recent version of that document, ICD-11, includes only “compulsive sexual behavior disorder” as a diagnosis, but does not use the addiction model.
Opposing Expert Opinions
Some opposing it believe that it is an agenda put forth by “sex-negative” clinicians trying to control the private behaviors of their patients. Indeed, some practitioners regard sex addiction as a potentially harmful diagnosis. Some even draw parallels with controversial gay conversion therapy that has caused a great deal of outrage over the years.
Of course, this is an understandable reservation to have. No one should be made to feel that their sexual preferences are an illness. So the debate is not an easy one to solve. When does one draw the line and say what should be considered “healthy” sexuality? In the end, some do fear that having a sexual addiction classification will make problems out of nonproblematic experiences.
However, there are still many experts and mental health professionals advocating for the inclusion of sex addiction as an official psychiatric condition. Many therapists and psychiatrists say that excluding sex addiction from the DSM completely disregards the pain, confusion, trauma, fear, and hopelessness of sex addicts and their families.
What Advocates Consider Sex Addiction
Even though there are no official DSM criteria for sexual addiction, provisional diagnostic criteria for sexual addiction that follow DSM format have been derived from DSM-IV-TR criteria for substance dependence.
According to Aviel Goodman, MD, sexual addiction is a maladaptive pattern of sexual behavior that leads to clinically significant impairment or distress, as manifested by at least 3 of the following within a 12 month period.
- A distinctly increased amount or intensity of the sexual behavior to achieve the desired effect or markedly diminished effect with continued involvement in the sexual behavior at the same level of intensity.
In other words, needing more in order to feel something. This is often seen in relation to substance abuse when people develop a tolerance to a drug over time.
- Characteristic psychophysiological withdrawal syndrome. When someone discontinues a sexual behavior and experiences
- Physiologically described changes
- Psychologically described changes
- The sexual behavior is often engaged in over a longer period, in greater quantity, or at a higher level of intensity than was intended.
- Persistent desire to engage in sexual behavior and being unable to control the sexual behavior.
- Excessive time is spent on activities necessary to prepare for the sexual behavior, to engage in the behavior, or to recover from its effects.
- People reduce or discontinue important social, occupational, or recreational activities because of the sexual behavior.
- The sexual behavior continues despite knowledge of the harmful consequences of the behavior.
This outline is not the final word on sex addiction. It is possible that our understanding of sex addiction will evolve as research grows. For now, this is a starting point to better understanding how sex addiction impacts people.
What Sex Addiction Is NOT
Due to there being no clear-cut definition of sex addiction, there are also those who mislabel certain behaviors. While everyone may not agree on sexual addiction as a condition, those who do typically agree on what is NOT sex addiction. Most notable examples are the controversies surrounding allegations of sexual misconduct and how certain individuals have used sex addiction as an alibi for inappropriate sexual activity.
Also, some people may be mislabeled by others as sex addicts because of their preferences. However, this is also incorrect. It is significant to point out that no form of sexual behavior in itself constitutes sexual addiction. A pattern of sexual behavior does not qualify as sexual addiction based on things like:
- The type of behavior
- The object of the behavior
- Social acceptability
Sexual addiction is determined by how it impacts the individual’s life. Essentially, any sexual behavior has the potential to be engaged in addictively. That does not make the behavior itself inherently wrong. Again, we reiterate that the key features distinguishing sexual addiction from other patterns of sexual behavior are:
- The inability to control the sexual behavior reliably
- Continuation of the sexual behavior despite significant harmful consequences
There are plenty of situations where people find it very difficult to determine what constitutes a sexual addiction and what does not.
A great example of a circumstance that isn’t so black and white is paraphilia.
Paraphilia is a condition where people have sexual desires that typically involve extreme or dangerous activities. Again- this is another term that causes contention because some people label the behavior as abnormal, while others say it is simply a fetish. The symptoms of sex addiction and paraphilia overlap to some extent, but they are not identical. Some sex addicts are not paraphiliacs, and some paraphiliacs are not sex addicts.
A similar distinction exists between a sex addict and sex offender, where the area of overlap is considerably smaller. However, this does not mean the behaviors of a sex offender are justified by sex addiction.
Sex Addiction Treatment
After all that, we have to ask- can sex addiction be treated? According to an article published on healthresearchfunding.org, an estimated 12 to 30 million people in America experience sexual addiction. So do they have opportunities to get help?
This is why it is important to have more research on sex addiction so that more can be done to create better opportunities for treatment. For now, some people find a great deal of help utilizing the same concepts presented in substance abuse treatment. Most people who do get help for sex addiction receive help from addiction professionals.
Current treatment options aim to reduce any excessive urges and to encourage the nurturing of healthful relationships. An important element in treating sexual addiction is not to shame people for their preferences or their experiences and try to help them design a personalized recovery plan that will help them have a happier and healthier life. A lot of people who get treatment for sex addiction do find help with options such as:
Residential treatment programs
Residential treatment programs exist to help individuals struggling with various addictive disorders. These are in-patient programs where individuals live on-site at a facility while receiving direct care from specialized therapists in a safe and controlled environment.
Cognitive behavioral therapy (CBT)
Many programs that work to treat sexual addiction provide cognitive behavioral therapy. This comprehensive approach gives people a variety of techniques that help the individual change their behavior. CBT can equip a person to avoid relapses and reprogram harmful sexual behaviors by helping them recognize patterns and develop healthier coping skills.
Beyond traditional addiction treatment options, there are always self-help organizations and support groups. Numerous 12-step programs offer to help the individual in self-managing their sexual addiction, including:
- Sex Addicts Anonymous
- Sexaholics Anonymous
- Sexual Compulsives Anonymous
- Sex and Love Addicts Anonymous
For some, sex addiction goes hand-in-hand with a substance use disorder, such as alcoholism. In cases like this, medical detox is always a good idea in order to get professional support through the initial process of withdrawal. Also, it is important for those struggling with co-occurring disorders to consider dual diagnosis treatment in order to address both issues for a stronger foundation for recovery.