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.
Weiss: “Considering all the conflicting cultural, moral, ethical, political, personal and religious messages we receive every day about something as basic as sex, it’s no wonder that there is escalated conflict over what might define a sexual problem. These challenges are today amplified, as past legitimate bodies of psychology and psychiatry have mislabeled non-pathological sexual behaviors (homosexuality, transgenderism, fetishes and kink), as diagnosable disorders — only later to change their rules, in sync with (but more often behind) our sociocultural evolution. In 1965, homosexuality was considered an incurable, chronic mental illness for which long-term institutionalization was a serious option. In 2015, two men can marry and two women can marry.
All fields of science are vulnerable to being tainted by human interference. Perhaps nowhere is this more true than in the area of human sexuality. In sex addiction, this plays out when highly moralistic or religiously focused therapists act out of their beliefs, by misusing the term ‘sex addiction’ by applying it to any sexual behavior that doesn’t fit their belief system. As a result, fears have evolved that some self-proclaimed sex addiction therapists are actually people with a pre-set agenda about what defines healthy mating; sadly, sometimes these fears are well-founded. These therapists, armed with a clinical license and a biased view of what defines healthy sex, sometimes misdiagnose people as sexually addicted in an attempt to promote sexual conservatism. Homosexuality, bisexuality, transgenderism, recreational porn use, casual sex, polyamory and fetishes — all of which fall well within the spectrum of normal and healthy adult sexuality — have at times been misdiagnosed in this way. This, despite the fact that, as stated earlier, sexual addiction is unrelated to who or what it is that turns a person on.
Unfortunately, clinicians who inappropriately use the sex addiction diagnosis as a form of cultural, moral or religious control have done a great deal of harm over the years. Some have become quite wealthy by playing on people’s sexual shame and self-hatred toward their own personal gain. Their actions have created unnecessary confusion and even acrimony within the treatment community, all of which makes diagnosing and treating people who truly are sexually addicted more difficult than it should be. And, sadly, because of this, combined with our general cultural avoidance of all things sexual (as opposed to sexy), we are still debating the existence and nature of sex addiction 45 years after it was first identified, instead of working to accurately assess, diagnose and treat those who suffer from it.”
Dr. Ley: “Challenging sex addiction has been an eye-opening issue for me. I’m a psychotherapist and work with people in pain, many of whom have been horribly shamed by the label of sex addict. My writing and advocacy is on their behalf, because I regularly see the harm that is done under the idea of preventing or treating sex addiction. So it saddens me when I am regularly attacked as being unethical, blind or uncompassionate, simply because I disbelieve sex addiction.
I’ve been called a sex addict in denial more times than I can count (by sex addiction therapists) and even had my family and friends attacked online, merely due to questioning the validity and value of the idea of sex addiction. I recognize that many people have adopted the concept of sex addict into their sense of identity, and they experience my challenge to the concept as though it is a deeply personal attack on their core sense of self.
My challenges are never meant to be personal, but come from an ethical commitment that health care and medicine should never be used to assert or impose morality, particularly around sexuality. I believe that understanding, accepting and owning one’s sexuality is the first step towards gaining the ability to feel in control of oneself. Sadly, I think that the concept of sex addiction often moves away from that personal responsibility, understanding and acceptance.
As a clinician and a scholar, I believe it’s critically important for us to recognize that health care (and mental health care especially) can do great harm when we allow treatment to be based on morality rather than science. We’ve seen this many times, in the treatment of homosexuality, nymphomania and recovered memory. The field of sex addiction represents a similar intrusion of moral judgment about sex into health care, without sound science. As a result, we should be extremely skeptical of it.”
What do you think: Is sex addiction a true addiction?