What Sexual Addiction is NOT...As an addiction and sexual disorders specialist, I often write about sexual addiction. As most readers are “psychologically minded” in venues like this one, I typically assume that you already understand what that term means and does not mean. Nevertheless, it seems like a good idea to at least occasionally state what sexual addiction – aka, sexual compulsion, hypersexuality, hypersexual disorder, etc. – means to those of us who treat it. To that end I have provided below a brief overview of what sexual addiction is and is not.

Sexual Addiction: The Disorder

The criteria for sexual addiction are similar to the criteria for any other addiction. Addicts of all types (substance and behavioral) experience:

  1. Ongoing obsession/preoccupation with their drug/behavior of choice
  2. Loss of control over use
  3. Directly related negative life consequences

Diagnosing a chemical addiction is usually fairly straightforward – an individual is hooked on drugs, alcohol, or some other substance and can’t seem to quit, even though he or she is experiencing, as a result, relationship issues, trouble at work or in school, declining physical and emotional health, financial turmoil, loss of interest in previously enjoyable activities, legal issues, and/or other negative life consequences.

Diagnosing process addictions (behavioral addictions) can be more difficult, especially when the activity in question is a natural and even necessary part of life, as is the case with things like food and sex. Sometimes it helps to look at why an individual is engaging in compulsive sex (or eating, gambling, shopping, etc.) If the person is compulsively abusing sex (or any other potentially pleasurable behavior) as a way of self-soothing and/or dissociating from intolerable emotions and/or underlying psychological conditions such as early trauma, attachment deficits, social deficits, depression, anxiety, and low self-esteem, that is usually an indicator of potential addiction. Short of that, the behavior may be compulsive and causing problems but not equate to addiction.

Unfortunately, the powers behind the DSM-5 chose to not include sexual addiction as an official diagnosis, making it much harder for many therapists to identify and treat this very real issue. For now, clinicians who rely on the DSM can utilize the “impulse control disorders not elsewhere classified” diagnosis when dealing with sexual compulsivity.

Misdiagnosis

Unfortunately, some people use the term “sex addiction” to define virtually any type of sexual behavior that doesn’t meet their values (religious, relationship, cultural).

  • He’s had two affairs in the past few years so he must be a sex addict.
  • In our church you can be excommunicated for looking at porn. I hear that he looked at porn at least half a dozen times, so he must be a sex addict. Why else would he take risks like that?

Other individuals toss around “sexual addiction” as a catch-all excuse for virtually any type of sexual misconduct. In other words, some people who get caught red-handed engaging in inappropriate, problematic, possibly even illegal sexual behavior will blame their actions on an addiction, hoping to avoid or minimize the judgment and/or punishment they experience. Occasionally these individuals really are sex addicts, but just as often they are not. Either way, a diagnosis of sexual addiction is never intended to justify bad behavior or to let people “off the hook” for what they’ve done.

Unfortunately, it’s not just layperson-generated “diagnoses” that are a problem. Plenty of well-meaning but under-informed therapists are willing to label all sorts of things as sexual addiction. Frankly, the mental health profession provides minimal training in terms of what constitutes healthy (and unhealthy) human sexual behavior. Because of this, some therapists mistakenly believe that any form of sex/gender driven dysphoria equates to sexual addiction. This is simply not the case. The fact that an individual feels bad about his or her sexualized thoughts, feelings, desires, or actions does not mean that he or she is a sex addict. That individual might be a sex addict, but only if the above-stated criteria (obsession, loss of control, and negative consequences) are met.

Rule Outs…

  • Sexual Orientation ≠ Sex Addiction

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 you a sex addict any more than being straight makes you a sex addict. Sometimes self-loathing homosexuals or bisexuals will seek out sex addiction treatment, hoping it will change their unwanted sexual orientation. Occasionally they do this at the behest of a misguided clinician. However, changing one’s arousal template is not possible. If you’re attracted to men, that’s the way it is; if you’re attracted to women, same story; and if you like both genders, you’d better get used to it, because that’s not going change no matter how much analysis you have or how many 12-step meetings you attend. In other words, sexual addiction is not in any way defined by who it is that turns you on.

  • Concurrent Drug Use ≠ Sex Addiction

Sometime drug addicts, especially those who abuse cocaine, methamphetamine, GHB, and other stimulant/party drugs, can become hypersexual while high – especially if they add Viagra or other erection enhancing drugs to the mix. This does not, however, make these people sex addicts. If the sexual compulsivity only occurs with drug use, a diagnosis of sexual addiction is not appropriate. However, sexual activity must be identified as a trigger for drug relapse in individuals for whom drug use and sexual activity are co-occurring behaviors.

  • Fetishes and/or Paraphilias ≠ Sex Addiction

Fetishes and paraphilias are recurrent, intense, sexually arousing fantasies, urges, or behaviors involving nonhuman objects, specific body parts, the suffering of oneself or one’s sexual partner, or non-consenting sex (in appearance or actuality). Fetishes and paraphilias may cause a person to keep sexual secrets, to feel shame or distress, and even to feel out of control, but they are not indicators of sexual addiction. In fact, they are only considered pathologic when: 1) they become obligatory for sexual functioning; 2) they involve inappropriate partners (meaning minors or unwilling participants); or 3) they cause significant distress and/or impairment of social, occupational, or other important areas of functioning. And even when a fetish or paraphilia does qualify as pathologic, it is not considered sexual addiction, per se.

  • Mania, OCD, Adult ADD ≠ Sex Addiction

In order for the diagnosis of sexual addiction to be made, professionals must first rule out any number of major mental health disorders that sometimes include hypersexuality or impulsive sexual behavior as a primary symptom. Some of these include the active stages of bipolar disorder, obsessive-compulsive disorder, and adult attention deficit disorder. The problem here is one of differential diagnosis. Not everyone who is impulsively or compulsively sexual has a problem driven by sex addiction, as hypersexual and impulsive sexual behaviors are legitimate symptoms of many other disorders.

  • Sexual Offending ≠ Sex Addiction

An unknown percentage of sexual offenders do sexually act out in a compulsive/addictive manner, but not all sex offenders are sex addicts. Usually sexually addicted sex offenders start out by engaging in non-offending behaviors (porn, casual/anonymous sex, serial affairs, etc.), but over time their sexual acting out escalates into offending. That said, sexual offending is not, per se, indicative of sexual addiction (or vice versa). The criteria for sexual addiction need to be very strictly applied when dealing with sexual offenders, as these individuals are the group most likely to self-identify as sex addicts in an attempt to avoid judgment and punishment for their problematic sexual behaviors. (As mentioned above, the diagnosis of sexual addiction is NEVER an excuse for bad behavior. Sex addicts are ALWAYS responsible for the hurt and pain they have caused.)

Why We Need to Get it Right…

Sadly, some mental health professionals choose to inappropriately incorporate the label of “sex addict” into treatment. This sometimes occurs through ignorance; other times this choice is the result of agendas more focused on moral, cultural, or religious values than clinical ones. These clinicians do a great deal of harm by abusing the term “sex addict.” Their actions have created a great deal of confusion and even acrimony within the treatment community, which makes diagnosing and treating people who truly are sexually addicted all the more difficult. It also has a tendency to send media members on the proverbial “wild goose chase” every time a celebrity, sports hero, or community leader has an affair, gets caught with a prostitute, or acts out in some other sexually inappropriate way. An official DSM Sexual Addiction (or Hypersexual Disorder) diagnosis would certainly help to clarify matters, but that is not coming anytime soon. Thus, it is up to those of use working in the field to help other clinicians learn how to clearly identify (and, equally importantly, not misidentify) people who are struggling with compulsive, addictive, and impulsive sexual disorders, diagnose them properly, and direct them toward useful, accurately planned models of treatment.

Clinicians (and clients) who are interested in learning more basic information about sexual addiction may want to grab a copy of my recently published book, Sex Addiction 101, available in both eBook and paperback formats.

 

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 has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous treatment centers throughout the United States, Europe, and Asia.

 


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From Psych Central's World of Psychology:
Best of Our Blogs: July 12, 2013 | World of Psychology (July 12, 2013)






    Last reviewed: 10 Jul 2013

APA Reference
Weiss LCSW, R. (2013). What Sexual Addiction is NOT…. Psych Central. Retrieved on November 1, 2014, from http://blogs.psychcentral.com/sex/2013/07/what-sexual-addiction-is-not/

 

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