At the age of 19, Devin’s parents, when he was home on summer break from college, learned that he was looking at gay porn on his laptop, and that he had posted his profile on several gay hookup apps. As members of a conservative religion, they sought advice from their pastor, who told them that he thought Devin was probably a sex addict, recommending treatment with an equally religious therapist (whose website described her “extensive training and clinical work with sex and porn addicts”). When Devin’s parents threatened to cut him out of their lives unless he agreed to this treatment, he agreed to go. However, instead of being (needlessly) treated for sexual addiction, he was subjected to reparative therapy (also known as gay conversion therapy) – a much-reviled, thoroughly debunked, and potentially harmful process. Unsurprisingly, this misguided attempt to “cure his sexual addiction” (i.e., to change his sexual orientation) failed miserably. Sadly, it also exacerbated the preexisting shame he felt (thanks to the lifetime of anti-gay messages he’d received from his parents and his religion) about his sexual desires and behaviors. To numb his insecurities, self-doubt and emotional discomfort, he started drinking heavily on a regular basis, feeding a very real problem he’d been struggling with since his mid-teens – alcoholism. Eventually, at the age of 22, Devin entered treatment at a nonreligious facility for substance abuse, where they addressed not only his drinking but his internalized homophobia. They also debunked the sex addiction diagnosis he was saddled with at 19, informing both Devin and his parents that his use of porn and hookup apps was consistent with most other males his age and not in any way pathological, with the content simply reflecting his sexual orientation. The treatment team also suggested that whether or not Devin’s parents could accept his sexual orientation was more their problem to deal with than Devin’s.
As you can see from the example above, the sex addiction label can easily be misapplied – co-opted by therapists with religious and/or moralistic agendas that trump their clinical judgment. Homosexuality, bisexuality, fetishes, polyamory and the like – all of which fall well within the bounds of healthy adult sexuality – have all been inappropriately pathologized in this way. Sometimes even well-meaning, non-moralistic therapists can misidentify other disorders (especially sex-related ego dystonia) as sexual addiction. At the same time, those who’ve been caught engaging in problematic and possibly even illegal sexual activity will sometimes self-identify as sexually addicted, hoping to use “addiction” as a catch-all excuse for their sexual misconduct.
Sadly, the APA has not helped matters with its decision to not include sexual addiction, with proper diagnostic criteria, in the DSM-5. In lieu of this much needed official diagnosis, it is sometimes helpful to understand what sexual addiction is NOT.
- Sex addiction is not fun. When you say the phrase sexual addiction, the kneejerk response is often something like: “Hey, sounds fun. Sign me up.” In truth, sex addiction is the opposite of fun. It is a compulsion that leads to shame, depression, anxiety and a wide variety of adverse consequences, just like every other form of addiction. Sex addiction is not about having a good time any more than alcoholism is about having a good time.
- Sex addiction is not an excuse for bad behavior. As mentioned above, many of the people who get caught in embarrassing, objectionable and/or illegal sexual situations will try to use sex addiction as an excuse, hoping to avoid or at least to minimize the judgment and/or punishment they experience. Sometimes these individuals really are sexually addicted, but just as often they are not. Either way, a diagnosis of sexual addiction never justifies bad behavior. Under no circumstances are sex addicts absolved of responsibility for the problems their choices have caused. In fact, part of healing from sexual addiction is admitting what you’ve done, accepting any consequences, and making amends as best you can.
- Sex addiction is not related to sexual orientation, even when that orientation is unwanted. Neither homosexual nor bisexual arousal patterns are factors in the diagnosis of sexual addiction, even if those arousal patterns are ego-dystonic. Being gay, lesbian or bisexual does not make someone a sex addict any more than being straight makes that person a sex addict. Put another way: Sexual addiction is not in any way defined by who or what it is that turns a person on.
- Sex addiction is not related to fetishes or paraphilias, even when they are unwanted. Fetishes and paraphilias are recurrent, intense, sexually arousing fantasies, urges and/or behaviors involving nonhuman objects, specific body parts, the suffering of oneself or one’s sexual partner, or nonconsensual sex (in appearance or actuality). We’re talking about BDSM (a la Fifty Shades of Grey), foot worship, chubby chasing, diapers/infantilism, etc. Fetishes and paraphilias may cause a person to keep sexual secrets, to feel shame and/or distress, and even to feel out of control, but they are not indicators of sexual addiction. Furthermore, they are typically fixed in most individuals with little likelihood of change by early to mid-adolescence. Fetishes and paraphilias are pathologized only if they are causing significant distress or impairment of social, occupational or other areas of functioning, or they entail harm or risk or harm to self or others. So, once again, sexual addiction is not in any way defined by who or what it is that turns a person on.
- Sex addiction is not just a guy thing. The common perception is that only men are sex addicts. This is not true. Plenty of women are sexually addicted. That said, men are usually easier to identify, because they are generally more forthcoming about the purely sexual nature of what they are doing. Women, on the other hand, tend to talk about their issue in terms of relationships, even when they’re having just as much sex, and the same types of sex, as their male counterparts.
- Sex addiction is not driven by drug use. Some drug abusers and drug addicts, particularly those who abuse cocaine, methamphetamine and other stimulant/party drugs, can become hypersexual when high. This does not, however, make these people sex addicts. If the hypersexual behavior ends when the drug use ends (and the individual lacks a history of hypersexual behavior when sober), then a diagnosis of sexual addiction is likely inappropriate.
- Sexual addiction is not a symptom of bipolar disorder, ADHD, OCD or any other psychiatric condition. In order for the diagnosis of sexual addiction to be made, clinicians must first rule out any number of major mental health disorders that sometimes include hypersexuality as a possible symptom. These include the active stages of bipolar disorder, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. In other words, not everyone who is impulsively or compulsively sexual has a problem driven by sexual addiction. That said, it is certainly possible to have any of the aforementioned psychiatric conditions and to also be sexually addicted. This is similar to being both bipolar and alcoholic, which is relatively common.
- Sex addiction is not sexual offending. By definition, sexual offending involves illegal and/or nonconsensual sexual behavior. This is not the same thing as sexual addiction. Yes, the behavior of some sex addicts does escalate into offending – usually lower-level offenses like voyeurism, exhibitionism, viewing inappropriate pornography, and engaging in prostitution. That said, most sex addicts are not sex offenders, and vice versa. (It is critically important that the criteria for sexual addiction be very strictly applied when dealing with sex offenders, as these individuals are the group most likely to self-identify as sex addicts in an attempt to avoid judgment and/or punishment.)
- Sex addiction is not sex negative. In some quarters, there is a fear that sex addiction therapists are trying to be the new “sex police,” imposing moral, cultural and/or religious values on sexuality, thereby creating a narrow version of sexual health. Sadly, as we saw in the example with Devin, this fear is not entirely ungrounded; there are indeed some moralist and/or highly religious therapists who misapply the sex addiction diagnosis, using it to marginalize and pathologize sexual behaviors that don’t mesh with their personal or religious belief systems. However, as stated previously, sexual addiction has nothing whatsoever to do with who or what it is that turns a person on.
- Sex Addiction Recovery is Not the End of Sex. With substance addictions, the usual goal of recovery is long-term abstinence. Knowing this, many people think that recovering from sexual addiction also means long-term abstinence. (And if that’s true, they want no part of recovery.) Happily, this is not the case. Instead, sex addiction is treated with a harm reduction model, where problematic sexual behaviors (for that person) are identified and eliminated, with healthier behaviors permitted (and even encouraged). This is similar to the treatment of eating disorders, another area in which total abstinence is not feasible.
To properly identify and diagnose sexual addiction, clinicians must look not at their own morals or at the client’s ego-dystonia, but at the following three factors:
- Preoccupation to the point of obsession, lasting six months or longer, with sexual fantasies and activities
- Loss of control over sexual fantasies and behaviors (usually evidenced by failed attempts to quit or cut back)
- Directly related adverse consequences – relationship woes, problems at work or in school, depression, anxiety, isolation, diminished self-esteem, loss of interest in previously enjoyable activities, financial trouble, legal issues, diminished social functioning, etc.
If these three factors are present, then sexual addiction is probably also present. Otherwise, clinicians should dig deeper, looking for other possible issues, before making a diagnosis. If necessary, therapists may want to rely on the anonymous sexual addiction self-tests available through 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 founded The Sexual Recovery Institute in Los Angeles in 1995. 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 Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships and Always Turned On: Sex Addiction in the Digital Age. 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.