Much of the time, female sexual addicts are more difficult to diagnose and therefore treat than male sexual addicts. This may be due in large part to our Western socio-cultural attitudes about sexuality among women. Whereas men who have a lot of sex are often celebrated as “studs” and “players,” hypersexual women are typically denigrated as “sluts,” “whores,” and “nymphomaniacs.” As such, male sex addicts are usually quite willing to discuss their sexual adventuring in treatment; they may even be proud of themselves, despite the repeated and continually escalating negative consequences wrought by their actions. Conversely, female sex addicts—even when they’re having just as much sex, in the same ways and in the same venues and with the same basic consequences as male sex addicts—tend to downplay their sexual involvement, instead discussing their behavior in terms of relationships. As such, clinicians must sometimes read between the lines, looking and listening for sexual compulsivity couched in romance-oriented language, such as:
- A history of inappropriate, dysfunctional romantic or sexual relationships (with siblings, bosses, subordinates, married men, etc.)
- A lengthy history of short, failed, sexually charged romantic relationships
- Serial or multiple ongoing sexual/romantic affairs
- Using sexual seduction and manipulation to avoid feelings of abandonment and isolation
- A pattern of staying with and/or returning to abusive, neglectful, emotionally unavailable partners
- Equating sexual intensity with love
- Recurrent periods of avoiding sex, during which the client may be compulsive in other areas (drinking, drugging, eating, spending, gambling, etc.)
- Turning to prostitution as a cover for addictive sexual problems, perhaps reenacting a sexual abuse history
- A pattern of trading sex for companionship, money, shelter, gifts, alcohol or drugs, safety, or anything else
- A pattern of using weight gain to push away intimate partners, but then losing the weight and becoming hypersexual when slim
- A history of high-risk sexual activity (dangerous partners, public sex, anonymous sex, unprotected sex, etc.)
- Wearing provocative clothing (a form of exhibitionism) to attract/control potential partners
Essentially, clinicians treating hypersexual women must understand that women will much more readily talk about their search for love and affection and the right partner, while avoiding or glossing over the highly sexual nature of their behavior. For instance, they may be having sex several times a day with men (or women) they meet via smartphone hookup apps, but they’ll probably only tell you about this indirectly by describing their “dating life” and their inability to find “the one.” Simply put, female sex addicts are far less likely than men to self-identify in treatment as having a sex-related problem.
As such, sexual addiction is adult females is often identified only after a woman has entered treatment for another issue—most often an eating disorder, a substance use disorder (addiction), depression, or some form of anxiety. These women seek help for the presenting issue, whatever that might be, and then act out in highly sexual ways during treatment—everything from dressing inappropriately to disrupting group sessions with excessive flirting to engaging in sexual activity with other clients and even staff members. Oftentimes the women who end up in inpatient treatment facilities for sexual addiction get there only after they’ve been asked to leave another treatment setting because of their sexual behavior. In fact, around a third of the women in treatment at The Ranch, a gender-separate sex and love addiction treatment facility that I oversee, fall into this category.
Many of the misdiagnosis issues related to female sexual addiction stem from the fact that therapists are simply not trained to look for sexual addiction in women, so they don’t ask the right questions. If a woman reports relationship-oriented issues or presents with a history of chronic relapse with other disorders—particularly eating disorders and/or substance use disorders—clinicians should ask carefully worded but direct questions about her adult sexual life, both past and present. (Childhood sexual abuse issues are also very important, though with sexual addiction early-life trauma is dealt with later in the recovery process, after problematic adult behaviors are identified and under control.)
The simple truth is when a woman enters psychotherapeutic treatment (for anything), her therapist rarely investigates her adult sexual patterns with the same rigor as her family of origin issues, her drug and alcohol use/abuse, her eating patterns, her social relationships, and the like. That said, sexual addiction is definitely of concern for many women, and it is a counselor’s duty to uncover it, diagnose it, and treat it if possible. This means asking sometimes uncomfortable questions, such as:
- Do you ever look at pornography or read erotic literature (including romance novels)? If so, how often?
- Do you masturbate? If so, how often?
- If married or in a committed relationship, have you ever been unfaithful? If so, how often, and with how many different people?
- Has your sexual behavior ever caused problems for you or someone you cared about (unwanted pregnancy, STDs, jealousy, relationship turmoil, etc.)? If so, what are those problems, and how often have they occurred?
- How many sex partners do you typically have (online and/or in-person) on a daily, weekly, or monthly basis?
- Are you able to say no when you don’t want to have sex?
- How do you feel after having sex?
Frankly, these and similar questions should be incorporated into a standard intake, with increasingly specific (but not graphic) questions to follow if responses to the initial queries point toward potential problem behavior. If, after asking several basic questions about a client’s sexual history and activity, you suspect sexual addiction, you may wish to administer a sex addiction assessment test designed specifically for women, such as the anonymous self-quiz offered by the Sexual Recovery Institute. If sexual addiction is identified in a female client, treatment is the same as it is with male sex addicts—a combination of CBT and other forms of directive therapy coupled with group therapy, social learning, and twelve-step recovery groups. It is my firm belief that sex addiction treatment settings should always be gender-separate. Twelve-step sexual recovery groups, however, are usually mixed gender. The most female-friendly of these groups is Sex and Love Addicts Anonymous.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. He has developed clinical programs for The Ranch outside Nashville, 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 Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships. For more information you can visit his website, www.robertweissmsw.com.