Whether or not sex addiction is real and should be diagnosed and treated as an official disorder (currently, sex addiction is not recognized in the Diagnostic and Statistical Manual of Mental Disorders, the DSM-5) is definitely not a new debate. In fact, sex addiction is a highly controversial area among both the general public and professionals in the field of addiction and mental health.
Proponents for legitimizing sex addiction in the next edition of the DSM and other important diagnostic references believe it’s a very real, underreported and undertreated disease that’s common among those with early-life trauma, including childhood sexual abuse. In addition, these mental health professionals argue that the brains of sex addicts react to sexual stimuli in the same way the brains of drug addicts respond to substances.
Those opposed to making sex addiction an official diagnosis, recognized by the American Psychiatric Association (APA) — which publishes the DSM-5 — and by other leading authorities in the realm of mental health, say that there is little to no scientific proof that there is any amount of sex that’s unhealthy (or healthy) and that the terms “sex addict” and “sex addiction” themselves are based on social and moral values toward sex. Naysayers also argue that labeling problematic sexual behavior as “addiction” undermines the individual’s personal responsibility for that behavior. Some have gone on to say that sex addiction is just a media-inflated term abused by high-profile celebrities (Tiger Woods, John Edwards, Anthony Weiner, David Duchovny, to name a few) looking to justify serial infidelity.
Addiction.com asked Robert Weiss, LCSW, CSAT-S, senior vice president of clinical development at Elements Behavioral Health, and the author of Always Turned On: Sex Addiction in the Digital Age, and David J. Ley, PhD, a clinical psychologist in Albuquerque, New Mexico, and author of The Myth of Sex Addiction, to share their expertise on this complex, controversial issue.
“Sexual addiction (as a diagnosis), readily meets the criteria that have been used for decades to identify both substance addictions and other behavioral addictions/compulsions (gambling, spending, video gaming and even eating disorders). And hypersexual behavior, as is seen in sex addicts, is already acknowledged as appearing in concert with several mental health diagnoses, such as mania and some forms of ADD. Furthermore, we have enough clinical research to support sex addiction as a stand-alone diagnosis. We know that it exists, we know what causes it and, most important, we know how to provide useful treatment. Nevertheless, sex addiction is an under-acknowledged, underreported emotional disorder, highly subject to misinterpretation and ongoing political posturing within the American Psychiatric Association (APA). In some ways, the creation of a stand-alone diagnosis of sex addiction has sadly become both a political and cultural ‘hot potato’ issue.
To more fully understand what sex addiction is all about, I suggest reading some of the tier-one, peer-reviewed research, or take some time to check out one of many books I’ve authored on the subject — all now revised and updated to reflect the ways in which digital technology now so thoroughly impacts sexual addiction. In addition to my work, many others have written highly useful self-help books, scholarly articles and personal accounts, all focused on understanding and healing from sexual addiction. For a personal experience of the issues as presented by addicts themselves, it is well worth attending an open 12-step sexual recovery meeting at Sexaholics Anonymous, Sex Addicts Anonymous, Sexual Compulsives Anonymous or Sex and Love Addicts Anonymous. Note that these meetings are the very same places where tens of thousands of self-identified sex addicts seek no-cost help and support daily. Frankly, these programs provide the most telling evidence that sexual addiction exists, causing the same basic problems as any other addiction. I mean, why would all these people, from all over the world, voluntarily attend and participate in a 12-step sex addiction recovery group? Why would they waste precious time in this way unless they had, in fact, found an environment that offers them both hope and direction toward sexual behavior change?
That said, all you really need to know is that sex addicts universally experience the following:
I think it is important to state here that the internal and external experience of sex addicts mirrors that of other addicts. For example, recent research shows that the brains of sex addicts respond to sexual stimuli differently than the brains of non-sex addicts. Furthermore, sex addicts’ brains respond to sexual stimuli in the same way that drug addicts’ brains respond to drug-related stimuli. These findings, when coupled with earlier research, strongly suggest that sexual addiction most definitely exists and that it forms and manifests in profoundly similar ways to more commonly accepted forms of addiction such as alcoholism and drug addiction.
Moreover, sex addicts (like most other addicts) are nearly always the adult survivors of early-life trauma – neglect, emotional abuse, physical abuse, overt and/or covert sexual abuse as well as profound parental enmeshment. These trauma survivors start to self-medicate their emotional discomfort relatively early in life via sexual fantasy and self-stimulation – most often during adolescence but sometimes even before. Over time this process of self-soothing can also involve addictive substances and/or food. However, many children also learn (or are taught) that they can distract and soothe themselves with sexual behaviors (including fantasy and masturbation), usually by eroticizing and mentally reenacting some aspect of early trauma. In fact, self-soothing through eroticized reenactment is a relatively common response to early abuse.
Unfortunately, though sexual behaviors can be pleasurable and distracting in the moment (much like alcohol, illicit drugs, gambling), over time they sometimes create more problems than they solve. This, of course, increases the person’s day-to-day fears and anxiety, creating an even greater need for escape and distraction. Many such trauma survivors eventually find themselves mired in cycles of self-hatred and sexual shame, temporarily alleviated by sexual fantasy and activity, followed by still more self-hatred and shame. In short, their escapist addictive sexual fantasies and behaviors repeatedly trigger the need for more of the same. This is the basis of the never-ending downwardly spiraling cycle of sexual addiction.”
“Since its inception, sex addiction has been a concept based on social and moral values toward sex, tainted by subjectivity and reliance upon anecdotes as evidence. Like the old idea of nymphomania, sex addiction is an attempt to medicalize the belief that there is a ‘right’ amount or form of sex, despite the fact that science has shown that sexual desires and behaviors occur in a great diversity, and there is no amount or type of sex that is inherently unhealthy. However, in recent years, many core components of the sex addiction model have been empirically tested and researchers have consistently found that addiction is a poor way to explain sexual behavior problems.
In 2010, Jason Winters, PhD, of the University of British Columbia demonstrated that alleged sex addicts appear to have just as much self-control as their counterparts; that libido predicts sexual behaviors much better than measures of addiction; and that an internalized religious-moral conflict over sex is at the core of the sex addiction label. Joshua Grubbs, PhD, of Case Western Reserve University recently replicated this latter finding, showing that self-identification as a porn addict was predicted by moral conflict and religiosity and not by levels of porn consumed.
Nicole Prause, PhD, and other researchers at UCLA have demonstrated that there is no evidence of the brain patterns associated with chemical addictions in those who are self-described sex addicts, and in fact, pre-existing traits such as libido and sensation-seeking explain far more of the variance in people’s behaviors. Sex addicts are seen by others and by self-report as having executive function deficits in areas such as impulsivity and self-control. However, Rory Reid, PhD, of UCLA has conducted research showing that neuropsychological testing reveals that sex addicts actually demonstrate no measurable problems in impulse control and executive functioning.
Overwhelmingly, the research invoked by proponents of the sex addiction model is based on cross-sectional data, with poor research design, extreme sample bias and core assumptions which are rarely, if ever, considered or tested. For instance, sex addiction therapists have commonly assumed that when they see a man who is depressed having lots of sex or watching lots of porn, that the sex or porn are causally related to the depression. Instead, longitudinal research has revealed in multiple cases that sex and porn are ways in which males commonly, and effectively, cope with negative emotions. In other words, sex addiction mistakes a symptom for the cause. While many life problems are commonly blamed on sex, these problems most often reflect conflict with social and relational expectations, and with moral conflicts. “Sexual addiction” problems are always symptoms of other issues – this is tantamount to diagnosing and treating “sneezing disorder” and distracts from assessment and treatment of the more complex underlying issues.
What is commonly called sex addiction is a label without explanatory power applied to a heterogeneous group of people and problems. Calling something a sex addiction seems to imply an explanation, a cause and a treatment. But unfortunately, this is really nothing more than naming something we don’t understand — giving it a name relieves some anxiety, but does nothing to further greater comprehension. Indeed, the label is a distraction, because by asserting that sex is addictive, it deters further investigation into the complex, nonsexual issues involved in these behaviors. But this is not just a semantic debate. The sex addiction label negatively distracts from addressing the many other significant emotional, personality, social and relational issues involved in sexual behavior problems. This focuses attention on sex in a manner that is a disservice to patients. It promotes treatment based on an addiction theory — treatment for which there is no evidence of effectiveness in the area of sexual problems.
Further research by Josh Grubbs, PhD, published in 2015, demonstrates that self-perception as a porn addict is contributing to psychological difficulties. In longitudinal research, Grubbs and his team have shown that regardless of how much porn one consumes, emotional distress is causally related to self-identity as an addict. In other words, porn consumption or sex don’t predict distress, but believing that oneself is addicted to sex does.
Our society’s adoption of the idea that one’s sexual desires are addictive is a form of iatrogenic harm, which leads to shame and fear of one’s sexuality. When proponents of sex addiction argue that they are being compassionate and supportive of people in need, their methods may in fact be part of the problem. Until it can be empirically demonstrated that sex addiction is the best and most effective explanation for these problems, it is unethical to render this experimental, unproven and informal diagnosis.”