Sex Addiction

Can I be addicted to sex?  This is never a simple question to answer – but that doesn’t mean that the question is a bad one.  First, the idea that a person can be addicted to sex is controversial with professionals.  Addiction to substances has long been recognized, but how brain chemistry works with behavior is a relatively a new thought.  Gambling is generally accepted to be an “addictive behavior” and was recently added to the manual that psychiatrists and therapists use to make diagnoses.  Other “behaviors” such as video gaming, shopping, internet, pornography and sex have also been suggested to be addictive behaviors, but at this time there is no formal diagnosis.  That doesn’t mean it’s not possible.

What is an addiction?

In it’s simplest terms an addiction is something people do over and over despite negative consequences such as spending increased money, losing relationships, health problems, and problems with work performance.   Additionally addiction has the sense of needing more and stronger events to get the same satisfaction.  This creates an escalation of use including increased intensity, duration and frequency.  Often people struggling with addictions have tried to stop in the past, but find that willpower is not enough.  Usually there are “withdrawal symptoms” which may include depression, anxiety, nervousness, problems enjoying life, obsessive thinking about it, social withdrawal, problems sleeping or falling asleep.  Subjectively addicts usually report feeling “out of control” or driven by their addiction.  While there may not be a “sex addict” diagnosis – some of my clients over the years can relate to the above!

What sex addiction is not.

On the other hand I often get spouses asking if their partner is sex addicted simply because they want more, or more varied, novel sex than they think is “normal.”  Sexual libido in humans is highly varied. Some want to have sex daily and still may masturbate.  Others may be happy with once or twice a month and rarely masturbate.  These individuals are within what is “normal” – but it is in the contrast with their spouse’s libido (also normal) that they appear “addicted.”  I call this a libido mismatch and it is not an addiction, but it serious. Libido mismatch can cause serious damage to a relationship over the years, and while couples sex therapy is an important part of addressing this issue, it’s not helpful to label it as sex addiction.

Other issues that cause people to be afraid they are addicted are normal sexual preferences that they are ashamed about or feel are wrong. This might include same sex fantasies.  We know that sexual orientation is a fairly “set” feature of a person’s sexual identity.  This is supported by the medical and therapy fields which have condemned “conversion therapy” designed to change one’s sexual orientation as being unethical practice (including asexual individuals).  On the other hand we also know that the one-or-the-other (i.e., gay or straight) model is also not accurate.  People fall all along a continuum from 100% gay to 100% heterosexual.  It is a minority of individuals whose fantasy and sexual interest fall exclusively in one or the other extreme.  Recurrent same sex fantasies are not a sign of “sex addiction.” Individual or couples sex therapy can help with this issue without labeling yourself as sex addicted.

Likewise both men and women struggle with BDSM shame as well.  They struggle to feel that they are normal when they are afraid of their own fantasies broadly known as “kink.”  Feeling shame about kinky sexual fantasies that include power, dominance, submission, pain play, bondage/tying, etc. are not a sign of sexual dysfunction or immoral fantasy. Introducing these fantasies to your spouse may create high degrees of shame. They may play out in what feels like addictive behavior as outlets for this sexual fantasy are secretly sought to avoid that shame. Couples sex therapy can help with this issue without labeling someone as addicted.

Signs of sex addiction

What might sex addiction look like then?  Looking away from sexual behavior, frequency and fantasy as the definition – I typically look to the subjective experience of sexual behavior and the emotional cycle that individuals report.  Hallmarks that stand out in people who present as addicted to sex in my practice are:

• Unsuccessful attempts to stop or cut back despite negative consequences.
• Has never had a long term relationship.
• Uses sex as the one solution for many different emotional problems (board, lonely, angry, stressed, etc.)
• Reporting increased euphoria while seeking sex but deep depression (not satisfaction or pride) soon thereafter.
• Reporting excessive time dedicated to seeking sex (sometimes 4-8 hours a day).
• Near exclusive preference for anonymous sexual encounters.
• Only able to achieve arousal for pornography, inanimate props, or specific activities rather than partners.
• A general desire to use sex to make an urge go away rather than to enjoy sex for pleasure and connection.
• A general feeling of being “out of control” sexually and never satisfied.
• Illegal or harmful sexual behaviors (not just fantasies).

Obviously any of the above may represent a barrier to healthy sexual expression, but these can be treated as stand alone issues without the need to define the problem as a sexual “addiction.”  While any individual may relate to couple of these things to some extent, it is the more global picture that suggests that treating the sexual behavior as an addiction is needed.    Finally, it’s important to recognize that the term sexual addict comes with no small amount of social stigma.  Needing to get help with sexual issues is hard enough without adding a label of “sex addict.”

If you’re concerned that you or your partner may be a sex addict.  Assessment by an experienced sex positive professional can prevent therapeutic missteps and fruitless worry.

AASECT Position Statement – Sex Addiction

“Am I (or my spouse) sex addicted?”  It’s a question that comes up often when sex and sexuality are a clinical area of focus for a therapist.  I take a very cautious approach to labeling someone as “sex addicted” or “porn addicted.” Generally the answer is, “no.” The reasons for this are multiple.  First, by making someone “addicted” means that one person is the problem and the other supports their recovery.  It leads to a sense of helplessness and loss. This is often not to be the best way of solving a problem for either person.  Additionally, intimacy needs are very real and it is scary to trust for fear of being judged or rejected.  Often rather than solving an “addiction issue” I find that intimacy issues as a dynamic of both partners in the relationship needs to be addressed.  Finally, sex addiction “therapy” often leads to goals where complete sexual abstinence and feeling that sexuality is damaging. Instead I strive to help the sexual expression to be something to be proud of.

AASECT (American Association of Sex Educators, Counselors and Therapists) released a position paper on “sex addiction.”

AASECT Position Statement – Sex Addiction

Founded in 1967, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) is devoted to the promotion of sexual health by the development and advancement of the fields of sexual education, counseling and therapy. With this mission, AASECT accepts the responsibility of training, certifying and advancing high standards in the practice of sexuality education services, counseling and therapy. When contentious topics and cultural conflicts impede sexual education and health care, AASECT may publish position statements to clarify standards to protect consumer sexual health and sexual rights.

AASECT recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors. AASECT recommends that its members utilize models that do not unduly pathologize consensual sexual problems. AASECT 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge. Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.

AASECT advocates for a collaborative movement to establish standards of care supported by science, public health consensus and the rigorous protection of sexual rights for consumers seeking treatment for problems related to consensual sexual urges, thoughts or behaviors.

I applaud the AASECT for taking such a stance against such a popularized and often overly “diagnosed” condition.  I have many esteemed colleagues that I know will take issue with this and I understand their concerns; however I happen to find in my clinical practice with many, many couples that I agree with this statement.

I also find that problem sexual behavior does exist – often compulsive in nature.  Addressing such compulsive sexual behavior should be always working toward healthy sexual expression that falls somewhere within the vast array and breadth of human sexuality with a goal for sexual wholeness not sexual denial and starvation.  On those occasions when I have recognized sexual behavior as an addiction within my practice it has been under rare circumstances that the client themselves is dissatisfied with their sexual expression, harming themselves, devoting large amounts of resources to it at the expense of choosing to find a healthy sexual partner.  Even under these circumstances, the client leads the therapy and is challenged to explore why their current sexual practices are unsatisfying and learn skills to build more satisfying sexual experiences.

If you or your partner is struggling with sexual behavior in your relationship, come seek help today.