Sex is a normal part of the human experience, and one that modern society now embraces and encourages. Our media is flooded with sexualized images, from advertisements in magazines, billboards, and TV commercials to sexually explicit lyrics and music videos, to sex scenes in television shows and movies.
Sex is not a problem for most people, but it can become an issue for some. The term sexual addiction is frequently used to describe the problem some people have when they act out sexually in ways they feel they cannot control, and which are detrimental to their health and relationships. However, there is no official clinical diagnosis of sex addiction, making consistent identification and treatment of this issue a little murky.
The Challenges of Defining Sex Addiction
Part of the challenge in defining sexual addiction is that the religious and cultural norms of our society are disregarded by many as overly restrictive. A person who engages in what he or she may consider a normal, active sex life—such as having multiple partners, or engaging in a threesome—may be viewed as suffering from sexual addiction by someone else who views the situation through the lens of different values.
“…even behavioral health professionals do not agree if sexual addiction is truly an addiction…”The American Society for Addiction Medicine (ASAM) defines an addiction as the pathological pursuit of “reward and/or relief by substance abuse or other behaviors.”1 The organization notes that in addiction, the neurotransmitters and structure of the brain play an integral role and are affected by the addiction. Impairments in impulse control, judgment, and memory factor into addiction too. Presently, ASAM does consider sex to be a real addiction for some people.1
The Diagnostic and Statistical Manual (DSM-5), however, does not include a category of diagnosis for sexual addiction. The diagnosis was proposed but not accepted for final inclusion in the latest edition. Many in the field are adamant that sexual addiction is very real, but a significant number of people believe that sexual addiction is made up to help adulterers justify their behaviors.2
Sex Addiction vs. Porn Addiction
Many people casually use porn with no negative repercussions. However, other people become consumed with pornography, leading to a negative impact on their relationships in a number of ways. Many who are preoccupied with porn prefer porn to actual partners when it comes to sexual activity. And some findings correlate porn viewing with violent attitudes toward women.3
Porn is not sex, however, and people who are so-called porn addicts should not also be labeled with a sex addiction unless there is solid evidence to the contrary.
The Harmful Effects of Sex Addiction
Sex addiction can lead to many negative repercussions. A person who has a relatively large number of compulsive sexual encounters might be at much greater risk of contracting an STD or putting him or herself in dangerous situations. The behaviors of those with a sex addiction often lead to problems in their primary relationships too. When partners discover the affairs and deceit, they naturally feel anger at the betrayal of trust. Many addicted people become so out of control that they suffer legal consequences for their sexual activities.
Additional problems arise related to sex addictions when they manifest as paraphilias, or a set of behaviors that causes you distress or impairment, may cause you harm, or place you at risk of harming yourself or others. It is common for a person to have multiple paraphilic disorders.
The DSM-5 includes 8 major types of paraphilic disorders, including:4
- Voyeuristic disorder: The act of observing others in sexual activity. This may also include observing naked people or people who are getting undressed.
- Exhibitionistic disorder: When a person exposes their genitals in public. This does not include urinating in public.
- Frotteuristic disorder: Includes touching and rubbing one’s genitals against a person who has not consented to this behavior (such as in a public place like a subway).
- Sexual masochism disorder: May include engaging in humiliation, bondage, or suffering at the hands of another. People will engage in these sexual acts despite concerns of death by erotic asphyxiation (choking).
- Sexual sadism disorder: Refers to inflicting humiliation, bondage, or suffering on another.
- Pedophilic disorder: This refers to a sexual focus on children and is defined when a perpetrator is 16 years old or older and the child is 5 years old or younger.
- Fetishistic disorder: This refers to using nonliving objects, such as clothing, shoes, or leather, for sexual arousal. This disorder also includes eroticism over non-genital body parts such as toes or hair. The use of vibrators or women’s clothing when used for cross-dressing does not meet the criteria for this disorder.
- Transvestic disorder: Cross-dressing for sexual arousal.
There are other definitions of sex addiction based on high levels of sexual activity, including hypersexual disorder (a high-volume sexual disorder). However, this type of disorder is not included in the DSM-5.
Signs and Symptoms of Sex Addiction
Sex addiction of any kind is marked by a loss of control: the person can no longer control the compulsion to have sex, despite negative consequences. Compulsive masturbation, compulsive pornography use, and multiple affairs are a few types of behaviors that evidence this lack of control.5 Keep in mind that one sign or symptom on its own does not equal proof that a person necessarily has a sex addiction. Typically, multiple symptoms need to occur simultaneously to indicate a sex addiction and cause significant distress to you and disruption to your life.
The addicted person continues to engage in the behaviors even in light of consequences that may include:
- Social: Family relations are impaired. Jobs may be affected or lost.
- Physical: May have STDs or unintended pregnancies.
- Emotional: Anxiety and depression.
- Legal: Arrests for behaviors such as soliciting sex from prostitutes, having sex in public, and sexual harassment.
- Financial: Spending money on porn and prostitutes. Lost wages due to the impact of an addiction on the ability to maintain quality performance on the job.
Other signs of a sex addiction include:5
- Efforts to stop the sexual behavior, but the inability to do so.
- Preoccupation with sex as it becomes all-consuming and is used as a way to escape.
- Escalation: over time the behaviors become riskier and more intense when what once provided a thrill no longer does.
- Inability to fulfill obligations: Missing work due to visiting prostitutes, for example, or not paying bills because of money spent on porn.
- Withdrawal: When a person tries to stop, or is prevented from acting out, he or she might experience irritability, anger, restlessness, and extreme frustration.
Treatment for Sex Addiction
An important step to take initially in working with sexual addiction is a careful screening, which ensures that the sexualized behaviors are not caused by other disorders, such as Alzheimer’s, or from taking certain types of drugs.
Once other possible causes are ruled out, treatment can begin. Studies show that some medications demonstrate promise in treating sexual addiction. The drug naltrexone, when added to an SSRI–type of antidepressant, was found to significantly reduce sexual acting out.6
Cognitive Behavioral Therapy
Cognitive behavioral therapy is the most commonly used form of treatment for sexual addiction because it is directed at identifying triggers for addictive behavior and learning skills to cope with these triggers.
“Cognitive behavioral therapy is the most commonly used form of treatment for sexual addiction…”Currently, there is limited research in the field of sexual addiction, so more definitive best practices have not been established.5 However, some programs offer insight-oriented, psychodynamic counseling, which has proven beneficial for some people.7
Each person’s needs are different. In some cases, the person struggling with sexual addiction is also dealing with other addictions, such as alcohol or opioids, and these co-occurring addictions need to be addressed. Many people with sex addictions also have co-morbid psychiatric issues, such as depression and anxiety that should be treated as well.7
One of the key elements of treatment is a thorough assessment. This is often difficult to accomplish as people with sexual addictions tend to minimize their self-reports of sexual acting out.7 This is why it is essential to find a trained mental health professional who can accurately assess the situation and provide the help you or your loved one needs.
Family therapy is critical to the success of treatment too, since sexual addiction impacts relationships at the most intimate levels. Feelings of betrayal and anger must be addressed in order for the sexually addicted person and his or her partner to make it through this difficult process of treatment and recovery.
Further complicating the process is that fact that spouses or significant others of sex addicts often play a codependent role in enabling their partner’s addiction. This facet of the addiction should be addressed in therapy to give the person with a sexual addiction the best possible chance of recovery.7
Inpatient and Outpatient Programs
Formal programs strictly for sex addiction do not currently exist, so look for a treatment program that focuses on behavioral addictions or compulsive addictions. The principles employed there will serve the sex-addicted person equally well.
If you discover an inpatient program like this, expect to live at the treatment center for a predetermined period of time, often 30 days. Outpatient programs, however, allow a person to live at home while attending therapy several times per week. Inpatient treatment may be best for those who are suicidal or who have underlying psychiatric or substance abuse disorders.
Regardless of whether the treatment is inpatient or outpatient, group therapy is a great option for treating sexual addictions. Group work helps people feel less isolated; provides a peer group who can confront faulty thinking as it arises; and provides information and real examples of coping with sexually compulsive behaviors. Group therapy also improves communication skills with others.7
Aftercare and Support Groups
For ongoing aftercare, there are several 12-step programs designed to address the specific needs of people with sex addictions. These programs, including Sexaholics Anonymous and Sex Addicts Anonymous, use the same principles found in other well-known 12-step addiction programs. Just as with Alcoholics Anonymous and Narcotics Anonymous, participants attend regular meetings and receive recovery wisdom and support from a program sponsor.
Different from the abstinence-based goals of drug and alcohol treatment, though, the goal for those with sex addiction is not complete abstinence, but rather a return to healthy sexual behavior.
The recovery process in sexual addiction is a difficult and challenging one. “Slips” are common and frequently occur throughout the course of treatment. Unlike drug addiction, where a person can avoid situations in which drugs are present, sex addicts cannot avoid sexual messages, images, and temptations in the form of other people.
It is important for a person seeking help for a sexual addiction to find a trained and skilled therapist who understands the nuances of healthy sexual relationships versus unhealthy ones, and can help guide the person toward long-term recovery.7
- American Society of Addiction Medicine. (2011). Quality and Practice: Definition of addiction.
- Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400.
- University of Minnesota. (n.d.). Recent research in pornography.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Publishing.
- Carnes, P. J. (2001). Out of the Shadows: Understanding Sexual Addiction. (3rd ed.). Center City, MN: Hazelden.
- Derbyshire, K. L. & Grant, J. E. (2015). Compulsive Sexual Behavior: A Review of the Literature. Journal of Behavioral Addictions, 4(2), 37–43.
- Hagedorn, W. B., & Juhnke, G. A. (2005). Treating the sexually addicted client: Establishing a need for increased counselor awareness. Journal of Addictions & Offender Counseling, 25(2), 66–86.