For the most part, the core signs and symptoms of sexual addiction are the same regardless of age, race, gender, social history, and psychological underpinnings. And you can expect nearly all sex addicts to report, in some form, the following:
- Obsessive Sexual Fantasy and Preoccupation: Sex addicts obsess about sex. They spend hours, sometimes even days, fantasizing about it, planning for it, pursuing it, and engaging in it. The majority of their decisions revolve around sex, including what they wear, which gym they go to, the car they drive, and perhaps even the career path they choose.
- Loss of Control: Sex addicts lose control over their ability to not engage in sexual fantasies and behaviors. They try to quit or cut back, making promises to themselves and/or others, but they repeatedly fail in these efforts.
- Related Adverse Consequences: Sex addicts eventually experience the same basic negative life consequences that alcoholics, drug addicts, compulsive gamblers, and compulsive spenders deal with, such as job loss, trouble in school, financial woes, ruined relationships, declining physical and/or emotional health, loss of interest in previously enjoyable activities, isolation, anxiety, arrest, etc.
Tolerance and withdrawal are not necessary elements for a sexual addiction diagnosis. However, they are often present with sex addicts, as they are with substance abusers. Tolerance manifests when sex addicts spend increasing amounts of time engaging in sexual fantasies and/or when they escalate the intensity (the thrill-level) of those experiences. Over time, many find themselves engaging in sexual behaviors that had not even occurred to them early on in their addictive process; many report acting out in ways that violate their personal moral codes, spiritual beliefs, and core values. Withdrawal for sex addicts manifests not so much physically (as often occurs with substance abuse), but emotionally and psychologically. Sex addicts in withdrawal tend to become either depressive – with feelings of longing, emptiness, loneliness, despair, and the like – or irritable, rageful, and quick to anger.
Active sex addicts organize their entire lives around sexual fantasy and the behaviors that follow. They spend inordinate amounts of time thinking about, planning, pursuing, and engaging in sexual acts (with themselves or others). Sex is an obsession to the point where they will forsake important relationships (significant others, kids, siblings), interests (exercise, hobbies, creativity), and responsibilities (work, finances, childcare), in exchange for a few hours/days of fantasy-driven, emotionally aroused dissociation. Like all addicts, sex addicts engage in denial, which keeps them out of touch with the process, costs, and reality of their addiction. They routinely ignore the kinds of warning signs that would be obvious to anyone actively observing them or to a healthier person, often externalizing blame for the consequences of their sexual acting out. They seem unable or unwilling to see the destructive effects wrought by their repetitive patterns of porn abuse, sexting, affairs, casual/anonymous/paid-for sexual encounters, etc.
Given the typically hidden and compartmentalized nature of sexual addiction, it is up to the treating counselor or therapist to “read between the lines” with certain clients, understanding that issues like depression, anxiety, low self-esteem, and attachment disorders can be symptomatic of a hidden addiction rather than the underlying cause of a patient’s distress. Professionals working with stimulant addicts (meth, cocaine, etc.) should expect sexual acting out to be a part of the client equation, especially with men (but also with women), as male stimulant addicts often add drugs like Viagra and Cialis to the mix, which allows them to be sexual for hours or even days on end. To assess beneath the surface, counselors must be willing to ask direct, often-uncomfortable questions regarding client’s sexual history, along with current sexual thoughts, fantasies, and behaviors. This is not always an easy task, especially for therapists untrained in sex and intimacy disorders treatment, but it is essential when clients present with statements like:
- I’ve engaged in a lot of infidelity.
- I usually have sex whenever I get high.
- My spouse keeps complaining about my porn use (or other sexual behavior).
- The only way I can really enjoy sex is when I’m high.
- I seem to lose a lot of time to viewing porn (or to other sexual behavior).
- I go on sex and drug binges.
Direct, non-graphic questions need to be asked of these and similar clients. Inquiries about frequency of porn use, frequency of masturbation, number of sexual encounters, number of sexual partners, drug use combined with sex, and the like need to be made. Additionally, a full sexual and romantic history should be taken in conjunction with the standard life history.
Therapists interested in being trained and certified in the treatment of sexual addiction can find useful information about on websites for the Society for the Advancement of Sexual Health and the International Institute for Trauma and Addiction Professionals. To learn more about referral resources, visit the website of the Sexual Recovery Institute.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and The Sexual Recovery Institute in Los Angeles. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction,and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and the upcoming 2013 release, Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships.