Sex addiction has been a controversial topic in our field since the term was first coined by Patrick Carnes in the 1980s. To this day it is not recognized as a mental health disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). But does it exist?
On one side of the debate, there are those who believe that problematic hypersexuality can have the hallmark features of an addiction, such as a lack of control and continuing despite the adverse consequences. There are the celebrities who claim to suffer from the disorder such as Anthony Weiner, Tyger Woods, Kevin Spacey, and Harvey Weinstein. And there are the Sex Addiction treatment programs that emulate the longstanding 12-step treatment programs for various substance abuses. The researchers, psychologists, and therapists who argue that sex addiction is a legitimate illness might point to the neurobiological parallels that sex addiction shares with substance dependence according to certain research studies (Bostwick & Bucci, 2008; Seok and Sohn, 2015).
On the other side of the debate, there are those who consider sex addiction to be a harmful social construct. I stand firmly on this side of the debate for many reasons. But before I elaborate, I want to acknowledge that people do suffer from problems related to sexual urges, thoughts, or behaviors and some of these people might find the diagnosis of sex addiction to be validating. To these people I say—your suffering is valid; your difficulties are real; and the sex addiction diagnosis will prevent you from getting the help you need.
Let’s get into it. Firstly, there is simply not enough empirical evidence to support the concept of sex addiction. Many research studies have been unable to identify sexual addiction pathology consistent with substance addiction models (Prause et al., 2015; Moholy et al., 2015). Also, the constructs characterizing sex addiction such as “loss of control,” are loosely defined, making it difficult to measure. Another measurement issue is that research has not been able to determine a threshold to quantitatively assess for excessive, out-of-control sexual behavior. The existing measures of “sex addiction” are highly subjective, reflecting an individual’s personal beliefs about the appropriateness of their sexual behavior and thoughts, which might be misplaced, rather than an objective measure.
Not only does sex addiction lack scientific legitimacy, but it is also can be used as a vehicle for political exploitation and social control. The most common sex addiction assessment, the Sex Addiction
Screening Test (SAST), contains many items that pathologize sex that does not fit within monogamous heterosexual norms—for example “I have maintained multiple romantic or sexual relationships at the same time” and “I have regularly engaged in sadomasochistic behavior.” Diagnosing non-conforming sexual behavior as a clinical disorder is reminiscent of when “homosexuality” used to be considered a pathological disorder in the DSM.
In many cases, for people with “sex addiction,” the source of their distress might be incorrectly believing that their behavior is pathological, as opposed to their behavior being objectively out-of-control or problematic. The SAST includes items that exploit these fears such as “Do you feel that your sexual behavior is not normal?” and “Do you ever feel bad about your sexual behavior?” For most people, fearing their sexuality is abnormal is not an expression of pathology, but instead a product of living in a sex-negative society. Diagnosing them with a sex addiction will only worsen their psychological distress. At this point you might not be surprised to learn that the man who came up with the sex addiction model, Patrick Carnes, had no training in human sexuality whatsoever.
Another gripe I have with sex addiction is that this diagnosis can excuse predatory and non-consensual sexual behavior as with the aforementioned celebrities.
Finally, for people who struggle with hypersexuality or out-of-control sexual behavior, the diagnosis of “sex addiction” will prevent them from getting to the bottom of what’s really going on. There are so many potential causes of hypersexuality. For instance, it could be caused by shame, loneliness, low self-esteem, or an existential dilemma; or it could be a symptom of an underlying psychological disorder such as Obsessive Compulsive Disorder or Bipolar.
So if sex addiction doesn't exist, then how do we treat it? More on treatment options for hypersexuality soon.
References
“Aasect Position on Sex Addiction: AASECT:: American Association of Sexuality Educators,
Counselors and Therapists.” AASECT, www.aasect.org/position-sex-addiction#:~:text=AASECT%20recognizes%20that%20people%20may,unduly%20pathologize%20consensual%20sexual%20behaviors. Accessed 18 Oct. 2023.
Bostwick, J. M., & Bucci, J. A. (2008). Internet Sex Addiction Treated With Naltrexone. Mayo
Clinic Proceedings, 83(2), 226–230. https://doi.org/10.4065/83.2.226
Brewer, G., & Tidy, P. (2019). Sex addiction: therapist perspectives. Sexual and Relationship
Therapy, 34(1), 40-53.
Kraus, S.W., Voon, V., & Potenza, M.N. (2016) Should compulsive sexual behavior be
considered an addiction? Addiction, 111(12), 2097-2106. https://doi.org/10.1111/add.13297.
Moholy, M., Prause, N., Proudfit, G. H., Rahman, A. S., & Fong, T. (2015). Sexual desire,
not hypersexuality, predicts self-regulation of sexual arousal. Cognition and Emotion, 29(8), 1505-1516. https://doi.org/10.1080/02699931.2014.993595
Prause, N., Steele, V. R., Staley, C., Sabatinelli, D., & Hajcak, G. (2015). Modulation of late
positive potentials by sexual images in problem users and controls inconsistent with “porn addiction.” Biological Psychology, 109, 192–199. https://doi.org/10.1016/j.biopsycho.2015.06.005
Seok, J.-W., & Sohn, J.-H. (2015). Neural Substrates of Sexual Desire in Individuals with
Problematic Hypersexual Behavior. Frontiers in Behavioral Neuroscience, 9. https://doi.org/10.3389/fnbeh.2015.00321
“Sexual Addiction Screening Test (SAST).” Psychology Tools, Psychology Tools, psychology-tools.com/test/sast. Accessed 18 Oct. 2023.
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