Medical and psychological professionals generally identify addictions and compulsions to repeat a pleasurable activity based on the following three criteria:
1. Preoccupation to the point of obsession with the substance or behavior of choice.
2. Loss of control over use of the substance or behavior, typically evidenced by failed attempts to quit or cut back.
3. Directly related negative consequences—relationship problems, trouble at work or in school, declining physical health, depression, anxiety, shame, isolation, financial issues, legal trouble, etc.
That said, there are plenty of other (strikingly similar) ways to identify addictions. One is provided in a policy statement by the American Society of Addiction Medicine. This statement reads, in part:
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. … Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.
If we want to specifically define sex and porn addiction and compulsivity, we can find official (and again very similar) criteria in the forthcoming ICD-11 (the International Classification of Mental and Behavioral Disorders, which is compiled and published by the World Health Organization). In this update to the ICD, the WHO defines Compulsive Sexual Behavior Disorder as:
Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behavior; and continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.
Another great way to identify and diagnose sex and porn addiction and compulsivity is to use the list of Characteristics Most of Us Seem to Have in Common compiled by the 12-step sexual recovery program, Sexual Compulsives Anonymous (SCA). The shortened version of this list is:
1. Sex and porn addicts use sexual fantasy and masturbation to avoid feelings.
2. Compulsive sexuality becomes a drug, used to escape emotional and psychological discomfort.
3. Sex and porn addicts can be frozen by romantic and sexual obsessions, neglecting other aspects of life.
4. Sex and porn become a distraction, a time-killer, a reward, and a punishment.
5. Sex and porn are used as a replacement for self-esteem, (temporarily) helping users feel validated and complete.
6. Sex and porn are used for intensity and excitement, and to cover ever-increasing feelings of emptiness.
7. Sex and porn are compartmentalized, rather than holistically integrated into life.
8. Sexually compulsive people struggle to distinguish between sex, love, and affection.
9. Other people are idealized and endowed with “magical” qualities, with the magic disappearing after sex.
10. Sexual and porn addicts are often drawn to emotionally unavailable and/or abusive partners.
11. In relationships, sex and porn addicts feel smothered. Out of relationships, they feel empty and incomplete.
12. Sex and porn addicts often find that the desperation of their need to connect makes true intimacy nearly impossible.
13. When sex and porn addicts are in a relationship, it’s not enough for them, and they continue to chase other people and relationships.
14. Sex and porn addicts, no matter how many relationships they’re in and how much sex they’re having, feel isolated and alone.
In SCA meetings, newcomers often gasp as the full version of this list is read aloud, as half a dozen (or more) of these items cause them to think, “Yes, that’s me! That’s exactly me!” Even old-timers with long-term recovery recognize themselves in the characteristics—sometimes choosing to share in meetings about which of the characteristics they are struggling with (and how they are coping in healthy ways) on that particular day.
SCA’s list was compiled more than a decade ago, before porn and hookup apps became prevalent. Nevertheless, the feelings that drive the behaviors, the magical qualities bestowed on other people and certain activities or relationships, and the short-term and long-term consequences of sexual compulsivity have not changed; so SCA’s list still works extremely well. That said, there can be differences between old-school sex addicts and digital-era sex/porn addicts—especially in terms of what underlies the behavior and how to effectively provide treatment.