There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma.
Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors.
More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering.
Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.
In the world of addiction treatment, there are two major areas of concern: addiction to substances, and addiction to patterns of behavior. Substance addictions involve abuse of and dependency upon chemicals such as alcohol, nicotine, prescription drugs, and illegal drugs like heroin and cocaine.
Behavioral addictions, often called “process” addictions, involve problematic repetitive behavior patterns involving potentially pleasurable or compulsive activities such as gambling, sex, working, spending, eating, etc. Some individuals struggle with both types of addiction simultaneously.
Sadly, the general public often mistakenly views process addictions as “moral flaws” or as “less serious” than substance addictions, yet those of us who treat these concerns directly witness firsthand the countless ways in which out-of-control impulsive, compulsive, and addictive behaviors wreak as much havoc on families, careers, and lives as drug addiction and alcoholism.
We also see that process addictions often contribute significantly to substance abuse relapse.
There’s a saying in addiction recovery that “we’re only as sick as our secrets.” Even after completing drug addiction treatment, some people continue to keep long-held secrets and/or act out in unhealthy ways. Much to the dismay of concerned family and friends and despite their best attempts at healing, some men and women may find themselves relapsing repeatedly on drugs and alcohol, even though they’ve tried counseling, 12-Step programs and drug rehab.
Is the chronic relapser doomed to a life plagued by addiction? Was drug rehab a waste of time?
Chronic relapse has varied causes. For some, ongoing stressors such as family dysfunction and major life transitions can trigger a return to drug or alcohol abuse. Others may stop using drugs only to “transfer” their addiction to other substances or behaviors that stimulate the reward circuitry in the brain, such as gambling, spending, overeating or sex. In some cases, an unrecognized and untreated sex or love addiction may contribute to the relapse cycle.
This is the friend you worry about. You wonder how she doesn’t end up in the hospital or on the late-night news. She doesn’t seem the least bit afraid of hooking up with strangers, even those she just met online. When it comes to sex and intimate relationships she takes a typical male role. Much like the character Samantha in Sex in the City, Dora has all the sex she wants and that’s just how she likes it. No one gets too close; no one can really hurt Dora.
Into the high of meeting new men, Dora hooks up online, through social networks on her smart phone, and in local bars. Dora often meets men for the first time at their apartments, never considering this might be dangerous because it’s so exciting.
Lucy the Love Addict – you have likely encountered her: She is dying for love. Always on the hunt for Mr. Right, her eyes scan every crowd looking for him wherever she goes. Unable to tolerate dinner or a movie out alone, and unwilling to go places or attend events unless available men will be there, she stays home alone a lot … but searches online. When out, Lucy’s made up and ready for a date whether at the Laundromat or picking up a few things at the corner store. You never know, he could be there — the man who will make everything okay. The one who will finally make her feel whole.
For a love addict like Lucy, every place has the potential for her to meet her one true love. Obsessed with finding the guy who will make her life complete, Lucy’s needful drama and intensity tend to turn men off. Sadly her relationships rarely go beyond the first few days, yet she doesn’t understand why.
Sex, love and porn addiction aren’t just gay issues; rather, they are predominately male issues. These diagnoses are as widespread and problematic among straight men and bi-sexuals as they are among gays. Heterosexual male sex addicts act out in many of the same ways gay men do; they just act out in different settings and choose female rather than male partners.
Gay men go to sex clubs, straight men go to strip clubs; gay men use Grindr, straight men use Ashley Madison. In fact, the similarities between gay and straight sex addicts are much more apparent than their differences.
For most adults, healthy sexuality is an integrated life experience. Being sexual with mates, with oneself or as a part of relationship exploration is for most of us enjoyed as a pleasurable act of choice. However, unlike the passion and interests that draw healthy people toward sexuality, sexual addicts misuse the sex act as well as the search for sex as a means of coping with intolerable feelings, stressors and to fill an often unacknowledged need for consistent validation.
Sexual Addiction is defined as an excessive preoccupation with the idea of, pursuit and acting-out of sexual behavior (with self or others), most often accompanied over time by related negative life, relationship, career and health consequences. In truth, most sex addicts spend more time and energy on the hunt, chase and pursuit of their sexual or romantic highs then in the sexual act itself. Much as drug addicts initially abuse drugs to recreate and avoid reality-sex addicts repeatedly seek to lose themselves in the emotions generated by sexual fantasy, ultimately coming to depend on these emotions as a reliable form of comfort and distraction. As sex addiction does not involve the direct ingestion of substances to get high – but rather the use of fantasy and behavior to achieve a high, sexual addiction itself can be categorized as a process addiction, similar to binge eating, gambling, spending, workaholism and related emotional disorders.
Sexual Addiction without a Sexual Partner?
Compulsive masturbation to fantasy and/or online porn carries some of the most shame, secrecy and isolation of all the problem sexual behaviors practiced by active sexual addicts – both male and female. Often devoid of intimate sexuality and healthy intimacy in adult life and frequently raised with extensive histories of childhood abuse and/or neglect, compulsive masturbators are often the last to seek help as they don’t see or relate to their solo sexual behaviors as being the underlying source of their adult unhappiness.
While most sex addicts race to find treatment the moment they have serious relationship, legal, work or health problems related to sexual acting out, the solitary nature of the compulsive masturbator’s behavior often leaves their actions less subject obvious problems.
From what the media tells us, sexual addiction is a strictly male problem – or least that is all we seem to hear. Men cheating on their wives, men seeing prostitutes, men going to strip clubs, massage parlours and of course, male politicians sexting online.
Does this mean that there are no female sex addicts? If there are women out there who are acting out with sex, where are they and why don’t we hear more about them?
The news media gives endless examples of famous husbands who betray their wives in ways that often result in public humiliation for them both (Clinton, Sanford, Tiger, Weiner, etc.). But what about women who ‘act out’ with sex and romance? While we know that women act out additively with food, drugs, alcohol, gambling spending and caretaking, the truth is that there is little to no research on female sex and relationship addiction.
What do you think?
Just as concrete and predictable diagnostic criteria help medical professionals determine whether your burning stomach pain is a case of chili-induced heartburn or appendicitis, so do categories of well-researched mental health symptoms provide the scientific underpinning for the identification of psychiatric and emotional disorders. New mental health diagnosis are not arbitrarily determined, but come about as consistent sets of reliable sample data are codified through years of repeatable clinical research and study.
This is the science of diagnosis.
The Diagnostic and Statistical Manual of Mental Disorders or DSM, renewed or revised in sporadic 10 to 20 year increments is, as every trained psychotherapist knows, the diagnostic ‘bible’ of mental health. In 2013, the American Psychiatric Association (APA) through their various working groups and committees will deliver a shiny new DSM 5, the formal guide that will differentiate and re-standardize our definition of mental health for at least a decade to come.
Like it or not, there is no single work more important to the daily practice of mental health diagnosis and treatment in America than the DSM. Though some clinicians consider the book demeaning as it purports to apply broad labels to the behavior of individual human beings, the DSM remains the authoritative guide to mental health diagnosis and its influence cannot be underestimated. The codification and language of the upcoming DSM 5 will come to establish not only what is considered mental health from pathology, but will also help determine and recategorize our systems of insurance reimbursement and legal casework along with the content and organization of counseling psychology education for a generation to come.