There is debate over whether or not sex addiction exists. Both professionals and the lay public have their own divergent opinions about the topic. This debate is likely due to the constant evolution of the sexuality continuum. However, it is difficult to argue the point of whether sex addiction exists when one sees the destruction that uncontrollable sexual behavior can have on people’s lives and families. To be clear, we know that sexual appetites vary from one person to the next and can fluctuate over a month, as well as over a lifetime.
While the public is quite familiar with the terms alcoholic and drug addict, many are puzzled by the term sexoholic. An often asked question is, “How can someone be addicted to something that happens naturally?” This question may also be raised when discussing food or exercise addiction. After all, if eating, exercising and sex are generally healthy behaviors, how can one be addicted to them?
Let’s start with some basics. Sex addiction is somewhat of an old school term. Those in the fields of psychology, sexology and sex addiction more often use the terms compulsive sexual behavior or hyper sexuality. While this may seem of little relevance to the lay person, it is actually very important. These terms more accurately describe the high level of sexual compulsivity and impulsivity which may occur with uncontrollable sexual behavior. The term “sex addiction” doesn’t capture these aspects and can make it difficult for anyone to view this problem as an actual disorder.
That said, the Diagnostic and Statistical Manual for Mental Health Disorders, Fifth Edition (DSM-5) currently does not recognize compulsive sexual behavior as a psychiatric disorder. The term “sex addiction” was, however, in the DSM-III, but was removed in 1994 due to lack of causal research. The DSM task force did not feel the condition had been successfully identified as analogous with substance addictions, as the name implies.
The diagnosis of Hyper sexual Disorder was proposed for inclusion in the DSM-5 in 2010, but was ultimately rejected because there was no specific theory attached to a cause or causes of the behavior. Due to lack of research, the question of whether or not compulsive sexual behavior or hyper sexuality are legitimate psychiatric disorders continues to dog professionals in the field of sexology.
We live in a world where such theories must be proven by research in order for them to have merit. Many who are identified as having compulsive sexual behavior continue to be accused of using the diagnosis as an escape or a convenient excuse for bad or morally wrong behavior.
Seemingly, a diagnosis of compulsive sexual behavior would identify individuals who are experiencing repeated sexual urges, fantasies and behaviors not attributable to medical conditions, substance abuse issues or medications, and which are affecting other areas of their lives in a negative way. The diagnosis is not about tallying the number of sex partners one has; rather, it is about identifying the level of impaired functioning in a person’s life. Some examples of impaired functioning are: not practicing responsible sex; inability to maintain a healthy intimate relationship; and, in some cases, losing employment as a result of unacceptable sexual behavior. Individuals exhibiting compulsive sexual behaviors may also end up with legal issues because of sex offenses such as lewd behavior in public, indecent exposure or other illegal sexual behaviors.
People who are sexually compulsive often have poor sexual boundaries and social skills. For them, social and sexual interactions may be awkward. Most require education and training to identify appropriate sexual behaviors, as well as to create intimate sexual relationships. With such training they can begin to build successful relationships with others and, perhaps more importantly, with themselves.
Frequently, a major focus of treatment is to break through denial and to manage the crisis that often brings someone to the point of seeking treatment. The therapist must explore the origins of the compulsivity, as well as the individual’s sexual history.
Perhaps the most difficult aspect of treatment is teaching the concept of sobriety as it applies to sexuality. Unlike compulsive drug and alcohol use in which the goal is most often to completely stop the use of the substance, compulsive sexual behavior patterns need to be identified, understood, accepted and essentially changed. This is often accomplished through an integrative approach to therapy with the goal of achieving a commitment to specific behavioral changes, not necessarily sexual abstinence.