By Elizabeth Hartney, PhD | Reviewed by Steven Gans, MD
Many people dismiss sex addiction as a futile attempt to give legitimacy to what is simply irresponsible or greedy behavior. Others say that those people are unaware of or indifferent to the emotional pain that is frequently reported by those who consider themselves sex addicts and their loved ones.
Sex addiction is not a new concept. Historical records dating back to ancient Rome and second century Greece report excessive sexuality, also known as hypersexuality or hyperaesthesia, and nymphomania or furor uterinum (uterine fury) in women.
The modern concept of sex addiction was popularized by Dr. Patrick Carnes, author of “Out of the Shadows: Understanding Sexual Addiction,” and clinical director of sexual disorders services at a clinic in Arizona. Carnes and his colleagues have written several books on the subject, and tend to dominate popular understanding of sex addiction. However, others have also written extensively on the subject, including both researchers and people who believe they have suffered from sex addiction.
Goodman argued that, although sex addiction shares features of both a compulsive and an impulse control disorder, it does not fit clearly into either category. He suggested that it is best described as an addiction and proposed diagnostic criteria that mirror the criteria for alcohol and substance dependence in the DSM 5, the reference manual for clinical diagnosis.
Sex addiction was not included in the DSM 5, despite a number of conditions relating to limited sexuality — such as hypoactive sexual desire disorder and sexual aversion disorder — being included.
This belies a bias that challenges the recognition of excessive sexual desire or expression as a problem. In other words, regularly experiencing sexual desire, physical sexual arousal, sexual relations, and achieving orgasm is considered the norm for both sexes, despite the fact that people who never experience difficulties at any of these stages of the sexual experience are in the minority. In general, having less sexual desire and activity is seen as a greater problem than having more sexual desire and activity.
Over the past century, society has become increasingly permissive, with various aspects of sex and sexuality forming the basis for many types of entertainment. In recent decades, the pharmaceutical industry has supported this, with the development of drugs such as Viagra reinforcing the view that one is not living a complete and happy life without regular, non-problematic sex. In this climate, it is not surprising that so many people are becoming preoccupied with sex, and that those who might in the past have succumbed to other pleasures are developing compulsive sexual behaviors.
Sex Addiction in the Headlines
Sex addiction gained widespread attention in 2009 when actor David Duchovny — apparently happily married with a family — surprised the world by publicly admitting to being a sex addict and going into rehab. Toward the end of the year, many speculated whether or not golfer Tiger Woods was a sex addict after several women claimed to have had extra-marital affairs with him.
The Internet has led to an unprecedented amount of porn being made available to anyone with a computer. Many people are bombarded with advertising for porn and commercial sex sites without even seeking them out. Many more people are being exposed to porn than ever before, including children and adolescents, and the nature of the web makes it difficult (if not impossible) to censor or place limits on the nature or amount of what is portrayed. In addition, it is easy to find and conduct an online affair, or online dating through sites such as tinder.
At the same time, there is increasing concern about online porn addiction, a type of online sex addiction, which far outstrips the provision of support for people who feel their porn use is excessive, unmanageable, or causing them problems. Without sufficient specialized treatment services, relationships and families will continue to struggle, often in secret, with problems that they are not adequately equipped to deal with. The semi-underground and often corrupt nature of the sex industry has rendered it useless in providing research or treatment funding or other supports for people who are harmed by its output. This differs from the gambling industry, for example, which has funded research into treatment and services.
Case For Sex Addiction
Research indicates that the same reward system in the brain is activated in sex addiction as in a number of other addictions, including drug addictions. This supports the idea that sex addiction has a similar physiological and psychological process as other addictions.
People with sex addiction often have concurrent substance and/or behavioral addiction problems, or “crossover” to other addictions when they attempt to overcome their sex addiction. Some authors argue that this lends support to the legitimacy of sex addiction as a real addiction and that, if recognized, cross-over risk can be addressed directly to prevent it from happening after treatment for other addictions.
Sex addiction causes a great deal of distress to those affected and their loved ones. Sexual desire and expression in people with sex addictions are commonly reported to be unmanageable and unpleasant, in stark contrast with the way that healthy sexual experiences are reported, which are typically described as fulfilling and satisfying both physically and emotionally. Recognizing sex addiction means these people can get the help they need to overcome their addiction, and eventually resume enjoyable sexual relationships.
At present, few readily accessible addiction services provide help for people with sex addiction. Recognition of sex addiction can allow sex addiction treatment to be included in community addiction services. With specialized training in sex addiction being provided to addiction services staff, many more people could easily access help for sex addictions.
Case Against Sex Addiction
An important criticism of the sex addiction concept is that it does not provide enough differentiation between different conditions that might look like sex addiction, such as hypersexuality accompanied by mania or hypomania in bipolar disorder; character disorders; personality disorders; some forms of depression; OCD and PTSD.
Critics of the concept of sex addiction argue that it has grown out of a cultural focus which associates sex with danger, powerlessness, and victimization, and is just a new way of making moral judgments about people who enjoy sex. As such, it can be used by people with a political and/or religious agenda to be negative about sex.
There is also a risk that the label of sex addiction might pathologize normal sexual desire and behavior, making healthy people appear to have an illness that does not exist. The concept of sex addiction has also been criticized for being based on the idea that some sexual experiences, for example, intimate relationship sex, are better than others. These are argued to be moral rather than clinical arguments.
At the other end of the spectrum, some people believe that a label like sex addiction can be used as an excuse for irresponsible sexual behavior, such as rape and child molestation. According to this criticism, people who have committed sex crimes can hide behind the label of sex addiction and avoid taking responsibility for their actions. These acts are deemed to be inexcusable, and the idea that a sex addiction diagnosis encourages pity and sympathy to people who do not deserve sympathy is also inexcusable.
Finally, there is the argument leveled at all behavioral addictions — that addiction is about chemical dependency, and no matter how similar the patterns of behavior, addictions occur in relation to addictive substances and not behaviors.
Where It Stands
Sex addiction, or certainly excessive sexual behavior, is widely recognized in the media and in popular culture. The growth of the internet has lead to an unquantified escalation of “cybersex addiction,” which includes both addictions to pornography and addiction to online sexual interactions with partners, including sex workers. Still, the psychiatric community has been hesitant to acknowledge excessive sexuality, in and of itself, as a disorder.
In 1987, the Society for the Advancement of Sexual Health (SASH) was founded to provide up-to-date research to professional members who work with sex addictions, and to the public. They publish the journal Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention, and hold a conference annually to disseminate research findings on sex addiction.