Diagnosing Sexual Addiction, Part One: Casual vs. At-Risk vs. Addicted

April 26th, 2015 | Posted by Rob Weiss in Sex Addiction

There are three main criteria for the diagnosis of sexual addiction:

  • Preoccupation to the point of obsession with sexual fantasies and behaviors – online and off, with self and/or others
  • Loss of control over sexual fantasies and behaviors, typically evidenced by multiple failed attempts to either quit or curtail these activities
  • Negative life consequences directly related to out-of-control sexual fantasies and behaviors – relationship woes, trouble at work or in school, financial issues, legal problems, declining physical and/or emotional health, loss of interest in nonsexual activities, etc.

Diagnosing Sexual Addiction, Part One: Casual vs. At-Risk vs. AddictedAlthough these criteria seem (and are) rather straightforward, it can nevertheless be difficult to distinguish sex addicts from people who are only at-risk for sexual addiction, and sometimes even from mere casual users of sexuality. This difficulty arises for those who are truly addicted, for their loved ones, and even for clinicians.

Sometimes understanding the basic definitions of casual, at-risk and addicted sexuality can help to clarify.

  • Casual Users are men and women who find non-intimate sexuality (online pornography, virtual sex, digital flirting, in-person casual/anonymous hookups, affairs and the like) to be fascinating and fun. They get involved in these pleasurable distractions occasionally. Much of the time their behavior is driven either by curiosity and novelty or life-stage events. For instance, they may engage in non-intimate sexual activities (online or real world) more in late adolescence or after a relationship breakup. Typically, casual users of sexual fantasy and activity use non-intimate sexuality as an intermittent source of fun and relaxation, but they ultimately find it less meaningful and less satisfying than deeper, more intimate connections. As such, their interest in non-intimate sexuality is not sustained over time.
  • At-Risk Users are men and women who go through periods of intense engagement with non-intimate sexuality, mostly abusing sex and the excitement it brings as a distraction from life’s stressors (both internal and external). They may experience addiction-like periods. However, they can and nearly always do curtail their activity if/when they start to experience – or even to see the possibility of experiencing – adverse consequences. Sometimes at-risk users look a lot like addicted users, hiding the nature and extent of their sexual behaviors, temporarily ignoring potential and even actual consequences, and escalating the nature and extent of their use. What differentiates at-risk users from sexually addicted users is at-risk users can stop their sexual activity on their own while addicted users cannot. Put simply, at-risk users retain control and choice over their engagement with non-intimate sexual fantasy and behavior. Addicted users do not.
  • Addicted Users are men and women who compulsively and repetitively use non-intimate sexual fantasy and behavior as a means of escape and dissociation, regardless of potential and/or actual consequences to themselves or others. In other words, addicted users consistently abuse sexual fantasies and behaviors as a way to “numb out” and avoid feeling stress and/or other forms of emotional discomfort. Usually, they find themselves leading a double life, separating their sexual activity from their work and home life – keeping secrets, telling lies, manipulating, juggling, minimizing, justifying, etc. They often lack empathy for those negatively affected by their addiction, including spouses and partners, kids, friends, neighbors and employers. Like other addicts, sex addicts will often blame their “need to escape” on the attitudes and actions of these others, thereby using (and often exaggerating) external experiences as a way to validate and justify their acting out. Addicted users sometimes try to quit or curtail their patterns of non-intimate sexual behavior, and they may even succeed for a few days or a few weeks, but before long they’re right back where they started. They simply cannot stop themselves, because they have lost control and choice over their sexual behaviors.

One common issue with sex addicts is that they are usually not willing to be completely honest about their sexual fantasies and behaviors. In fact, they are typically excellent liars – to both themselves and others – about their hidden patterns of sexual behavior. As such, it is not at all unusual for a sexually addicted client to cover up elements of his or her sex life even in therapy.

If you have a client who seems to be keeping secrets from you and/or others about his or her sexual life, no matter what that person’s presenting issue is, then the topic is absolutely worth further exploration. (Sex addicts often seek help for their addiction’s co-occurring symptoms, such as depression and/or anxiety, hoping to not address the addiction itself.) In such cases, there are specific questions that can be asked to help uncover the nature and extent of the client’s sexual fantasies and behaviors, and to determine if these fantasies and behaviors are out of control and causing negative consequences in the person’s life. This will be the topic of my next posting to this site, or, if you’re in a hurry, you can use this confidential sexual addiction screening quiz as a guide.


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 founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of numerous books, including Cruise Control: Understanding Sex Addiction in Gay Men and Always Turned On: Sex Addiction in the Digital Age (co-written with Dr. Jennifer Schneider). He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe and Asia. For more information you can visit his website, www.robertweissmsw.com.

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Robert Weiss PhD, MSW, CEO of Seeking Integrity LLC, is a digital-age sex, intimacy, and relationship specialist. Dr. Weiss has spent more than 25 years developing treatment programs, educating clinicians, writing, and providing direct care to those challenged by digital-age infidelity, sexual addiction/compulsivity, and other addictive disorders. He is the author of several highly regarded books on sex and intimacy disorders including Prodependence, Out of the Doghouse, Sex Addiction 101, and Cruise Control, among others. He also podcasts (Sex, Love, & Addiction 101) and hosts a free, weekly interactive sex and intimacy webinar via SexandRelationshipHealing.com. His current projects are: SexandRelationshipHealing.com, an extensive online resource for recovery from sex and intimacy disorders; and Seeking Integrity Los Angeles, an Integrated Intensive Program for Sex and Intimacy Disorders (Opening in Feb, 2019). For more information or to reach Dr. Weiss, please visit his websites, RobertWeissMSW.com and SexandRelationshipHealing.com, or follow him on Twitter (@RobWeissMSW), LinkedIn (Robert Weiss LCSW), and Facebook (Rob Weiss MSW).

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