Sex addiction is an emerging psychological condition that is gaining recognition within the field of addiction research and treatment. A growing body of evidence substantiates this condition, characterized by compulsive and problematic sexual behavior. An official diagnosis for this condition is imminent, but the details of what this disorder will be called and how it will be classified remain uncertain.
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Is Sex Addiction Real?
Currently, sex addiction inhabits a gray area, lacking formal recognition from certain important institutions, such as the American Psychiatric Association, that would grant it complete legitimacy as a psychiatric disorder. Still, most experts agree that the disorder, or a similar disorder, exists Recently, the World Health Organization (WHO) provided the first official recognition when it announced a new disorder called Compulsive Sexual Behavior Disorder (CBSD). CBSD, however, is being classified as an impulse control disorder instead of an addiction.
While this provides an official diagnosis for problematic sexual behaviors, it stops short of acknowledging it as an addiction. Another reason why the answer is unclear is that sex addiction isn’t included in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. The DSM-5 is the American Psychiatric Association’s diagnostic reference book. Another disorder called Hypersexual Disorder was considered for the last revision of the DSM-5 but ultimately was excluded, despite evidence supporting that the condition existed.5
In coming years, it is highly likely that there will be more formal acknowledgment for a disorder very similar to sex addiction, possibly with a different name.
What Is Sex Addiction?
Sex addiction is an unofficial term used to describe compulsive and problematic sexual fixations and behaviors. While there are several types of problem sexual behavior, all feature a loss of control over repetitive sexual fantasies, urges, and/or behaviors. If sex addiction is similar to substance addiction, it could be defined as a disorder characterized by compulsive sexual obsessions or behaviors that are continued even after causing harmful consequences and lasting changes in the brain.8
Addiction to drugs and alcohol is often conceptualized as a disease of the brain because of the way repeated substance use causes the formation of reward pathways in the brain (also called addiction pathways). Once formed, these neural pathways create strong urges and cravings to repeat the behavior, making it much more difficult to cut back or stop.8
These same reward pathways are also activated by sexual thoughts, stimuli, and behavior, helping explain the many similarities between compulsive sexual behaviors and compulsive drug use.
Types of Sex Addiction
Some researchers split problematic sexual behaviors into two broad categories: paraphilic disorders and non-paraphilic disorders.6 Paraphilic disorders are a cluster of existing disorders listed in the DSM-5, and are diagnosed when a person’s problems revolve around specific sexual fetishes. Non-paraphilic disorders describe problematic sexual behaviors, as opposed to fetishes.
Types of Paraphilic Disorders
Paraphilic disorders are characterized by atypical and problematic sexual interests, fetishes, or fantasies. Having unusual sexual interests or fetishes isn’t always pathological. It is only when these fetishes become upsetting or harmful to the person or others that they are classified as paraphilias or in the future, as CBSD.
Some researchers believe that paraphilias should remain a separate category, while others see them as forms of sexual addiction.6
In the DSM-5, there are currently 8 listed paraphilic disorders,1 which are:
- Sexual masochism disorder: A preoccupation with being humiliated or hurt by another
- Sexual sadism disorder: A preoccupation with the physical or emotional pain of another
- Voyeuristic disorder: A preoccupation with watching or spying on others who are undressed or engaged in sexual activity without their knowledge or consent
- Exhibitionistic disorder: A preoccupation with exposing one’s genitals or engaging in sexual behavior in front of another person or people without their consent
- Fetishistic disorder: A preoccupation with specific body parts, objects, or situations
- Frotteuristic disorder: A preoccupation with sexual touching of another without consent
- Pedophilic disorder: A preoccupation with sexual activity with prepubescent children
- Transvestic disorder: A preoccupation with cross-dressing or clothing/accessories for people of the opposite sex
Types of Non-Paraphilic Disorders
For some people who report being addicted to sex, their addiction revolves around specific sexual behaviors, as opposed to fetishes. These behaviors are not unhealthy for everyone, but some people describe losing control and continuing the behavior even after it has led to problems or consequences.
Some of the more commonly reported problem sexual behaviors include:
- Pornography use
- Cybersex
- Strip clubs or massage parlors
- Prostitution or paid sexual encounters
- Repeated infidelity or casual sex
Signs of Sex Addiction: What It Looks Like
People with sex addictions often describe feelings of guilt and shame about their sexual preferences or behaviors, and in some cases, this can be mistaken as a sign of sex addiction. Instead, these feelings might be related more to moral or religious beliefs, or even feelings of discomfort or shame surrounding sex and sexuality.
Another commonly mistaken sign is having frequent or strong sexual urges or desires, which sometimes is just an indicator of having a high sexual drive, as opposed to a sex addiction.
A more reliable indicator of sex addiction is when the sexual thoughts or behaviors become problematic in some way, which is also a hallmark sign of drug or alcohol addiction. The types of problems, consequences and impairments that sex addiction cause can be different from those caused by problem drug or alcohol use, and act as warning signs.
Some of the common warning signs for sex addiction include:
- Sexual behavior occurring in inappropriate places, times and situations
Example: breaking professional boundaries by hitting on an employee you supervise - A lack of sexual desire with real life partners or significant other
Example: preferring to masturbate alone instead of having sex with your partner - An inability to perform sexually with real life partners or significant other
Example: unable to get or maintain an erection unless watching porn - Being overly secretive about sexual behaviors or living a “double life”
Example: Lying about working late but instead going to the strip club - Developing sexual preferences that scare, upset, or disgust you
Example: Needing extremely rough sex or violent porn to become aroused or to orgasm - Lower relationship satisfaction, more infidelity, damage to committed relationships
Example: Comparing partner’s attractiveness to adult film stars and being dissatisfied - Direct sexual health consequences as a result of unsafe practices
Example: Contracting STIs or unwanted pregnancies - Using sexual behaviors as a way to cope with or escape stress or difficult emotions
Example: Feeling a “need” for sex to stop feeling bad as opposed to wanting sex for pleasure
While sex addiction is much more common in men, women can also develop the condition. Women with sex addictions are more likely to arrange real-life sexual encounters, as opposed to virtual sex.2 Men with sexual addictions usually opt for more impersonal sexual encounters, which often occur online or through paid encounters. In some cases, this preference might be driven by personal insecurities that prevent them from forming romantic or intimate relationships with others.
Females with sex addictions may also have different motivations for their sexual behavior than men. Some research suggests that women are more likely to engage in sexual behaviors to reduce anxiety, as opposed to fulfilling a sexual desire.9 Men with sex addictions also use sex as a coping mechanism, but for a wider variety of issues, including stress, depression, loneliness, or even another addiction.4
Symptoms of Sex Addiction
The DSM-5 is the ultimate reference for diagnosing all mental health and addictive disorders, but sex addiction is not recognized as a disorder in the DSM-5. For now, the only available guides outlining the symptoms for sex addiction come from prior research on Hypersexual Disorder and the symptoms for the new CSBD disorder.
Symptoms of Hypersexual Disorder
Research conducted in 2010 outlined the following symptoms for Hypersexual Disorder:5
A. Over a period of at least 6 months, experiencing recurrent and intense sexual fantasies, sexual urges, or sexual behaviors in association with 3 or more of the following 5 criteria:
- Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.
- Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, irritability).
- Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events.
- Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.
- Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.
B. There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or behaviors.
C. These sexual fantasies, urges or behaviors are not due to the direct physiological effect of a substance (e.g., a drug of abuse or a medication).
Hypersexual disorder also included an option to identify specific types of the disorder, including:
- Masturbation
- Pornography
- Sexual Behavior with Consenting Adults
- Cybersex
- Telephone Sex Strip Clubs
Symptoms of Compulsive Sexual Behavior Disorder
The symptoms used to diagnose Compulsive Sexual Behavior Disorder are:10
A. A persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior over an extended period (e.g., six months or more) that causes marked distress or impairment in personal, family, social, educational, occupational or other important areas of functioning.
B. The pattern is manifested in one or more of the following:
- Engaging in repetitive sexual activities has become a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities;
- The person has made numerous unsuccessful efforts to control or significantly reduce repetitive sexual behavior;
- The person continues to engage in repetitive sexual behavior despite adverse consequences (e.g., repeated relationship disruption, occupational consequences, negative impact on health); or
- The person continues to engage in repetitive sexual behavior even when he/she derives little or no satisfaction from it.
Causes of Sex Addiction
No single factor explains why some people develop an addiction and others do not. There are, however, several psychological, biological, social, and environmental factors that can heighten the risk for addiction.
Psychological risk factors for sex addiction include an existing mental health diagnosis, and people with depression, anxiety, OCD, personality disorders, or other addictions are especially susceptible.4 People with sex addictions also report lower self esteem and lower overall life satisfaction. They also struggle more to regulate their emotions, and tend to score higher on impulsivity ratings.7
Research also suggests that certain neurological and biological factors can also heighten the risk for sex addiction. Specifically, people with delays or abnormalities in certain regions of the brain are more likely to struggle with problem sexual behaviors, as are those with neurological conditions like dementia, epilepsy, and Huntington’s disease.4,7
In some instances, sex addiction may be indicative of underlying social or relationship deficits. Research has found that sex addicts (especially males) are more likely to report difficulty forming close relationships, and as many as 95% have an insecure attachment style.2 Insecure attachment styles often stem from trauma, suggesting that sex addicts may be more likely to have been the victim of physical, emotional or sexual abuse.
Certain types of sexual behaviors may also present unique risks for addiction. There has been a marked rise in the use of pornography and the number of people self-reporting a porn addiction.
Unlike real-life encounters, porn does not require a person to consider the needs, preferences, and boundaries of another person, and unlike real life, is accessible 24/7.
Some experts believe that these factors can result in people developing very specific sexual preferences and to form unrealistic expectations that are difficult to meet offline. This could lead to difficulty engaging in real-life sexual encounters and increased dependence on pornography.3
Sex Addiction Treatment
In most major cities, there are treatment options for sex addiction available. Many of the treatments for substance addictions have expanded to offer treatment for behavioral addictions, including sex addiction.
Different types and levels of addiction treatment exist. Some of the most common treatments are:
- Inpatient or residential treatment programs: These are intensive programs that offer 24 hour treatment to people struggling with addiction, and may be appropriate for people with more intensive treatment needs or more severe addictions.
- Individual therapy: Individual therapy is typically provided by a licensed counselor, psychologist, or social worker in an office-based setting. Sessions are generally around an hour in length and occur once or twice per week, depending on the individual’s needs.
- Couples or family therapy: Because sex addiction often impacts relationships, couples or family therapy is sometimes needed, and can be a standalone treatment or an addition to other treatment. Couples and family therapy generally occurs in office based settings for 1-2 hours per week, and is provided by a licensed counselor or family therapist.
- Medication: Medication is a less common form of treatment for sex addiction, but may be a necessary component of treatment for some, especially those with other underlying mental health conditions. Medication is often prescribed by a doctor, psychiatrist, or other licensed medical professional.
- Self-help or support groups: Support groups for people recovering from addiction are available in most communities, and are often free of charge. These groups can provide support and guidance for people in recovery. They are not considered treatment because they are usually peer-led, but can be a helpful resource, especially when combined with formal treatment.
How to Get Help for Sex Addiction
Finding the right treatment option is important in providing the best opportunity for a successful recovery. Those seeking treatment for themselves or a loved one struggling with sex addiction can begin the process by following these steps:
1. Find Available Treatment Options
Do research to find available treatments in the community where you live. In many cases, this can be done by searching on google for “sex addiction treatment near me.”
2. Determine the Time and Money You Can Commit
Everyone’s circumstances are different, and some people might have financial or scheduling restrictions, or have other obligations that can be barriers to certain treatments. Evaluating which options are feasible often involves checking with your insurance provider about coverage and figuring out how much time you can commit to treatment, given your other obligations.
3. Find an Experienced Provider
Finding a provider who specializes in treating addiction is usually important, as is making sure they have experience working with people who have sex addiction. Often, clinicians who are trained in addiction will have a secondary license as an addiction counselor, indicating they are extensively trained in this specialty.
4. Screen for the Best Fit
Once you have narrowed down the list, calling or even visiting different facilities can help determine which would be the best fit. Make sure to ask questions that will help you understand more about the facility, program, and the treatment being provided. If possible, ask to speak directly with one of the treatment providers to help you get a better sense of their personal style.
5. Schedule an Intake Appointment
The final step involves scheduling an initial appointment. Typically, the first appointment is reserved for completing intake forms and the diagnostic assessment. A diagnostic assessment is normally conducted by a licensed mental health or addiction specialist, and is designed to confirm a diagnosis and evaluate treatment options.
Sex Addiction Statistics
Because sex addiction does not have one official definition, there aren’t valid statistics on how prevalent the condition is or even on what populations are most at risk for the disorder.
However, there have been several studies in recent years on problem sexual behavior (sometimes called by different names):2,3
- An estimated 3-6% of the general population is believed to struggle with problem sexual behaviors
- In a study of about 20,000 participants, 4.4% of males considered themselves to have a sexual addiction, as opposed to 1.2% of females.
- The three most common types of compulsive sexual behavior (in order) are: masturbation, pornography use, and promiscuity
- 60% of people who report an inability to perform sexually with a partner do not have these problems when watching porn
- 80% of women engaging in online sexual behaviors escalate to offline encounters, as opposed to only 30% of men
- In one study, 95% of self-proclaimed sex addicts reported difficulty with closeness in relationships
- A study of coupled adults who seek treatment for sex addiction found that 74% of the men and 66% of the women reported improvements in their relationship over time
Living & Coping With a Sex Addiction
Recovery from any addiction tends to be more successful when people get professional help, and also when they have support from family, friends, or loved ones. In early treatment, many recovering addicts also find it helpful to put safeguards and accountability measures into place, like allowing a partner to access their phone or adding parental controls to internet-connected devices.
Because sex addiction is often driven by deeper underlying psychological issues, finding new, healthier ways of coping with stress and difficult emotions is often an essential part of the recovery process.
Sex Addiction Tests, Quizzes, and Self-Diagnosis Tools
There is no official diagnostic tool to determine if a person has a sex addiction because the condition is still in the process of being researched and defined. Existing “unspecified” sexual disorders are sometimes diagnosed instead, but only a licensed and trained clinician can confirm this diagnosis. There are, however, certain screening tools to identify problematic or compulsive sexual behaviors.
The most reliable screening tools are:
- Compulsive Sexual Behavior Inventory: A 13 question screening tool asking respondents to report the frequency of specific sexual thoughts, urges and behaviors.
- Hypersexual Behavior Inventory: A 19 question screening tool which asks respondents to describe the frequency of specific experiences.
- Sexual Compulsivity Scale: A 10 question screening tool asking respondents to rate how much specific statements apply to their experiences.
Additional Resources
If you think you or a loved one are dealing with a sex addiction, the following resources may be helpful in learning more and finding support.
- Online Therapist Directory: Sort therapists by specialty, cost, availability and more. Watch intro videos and see articles written by the therapists you’re considering working with. When you’ve found a good match, book an online therapy appointment with them directly.
- American Association of Sexuality Educators, Counselors, and Therapists
- SexAddictHelp.com: Recommended reading on sex addiction
- SexAddiction.com: A website with information, articles, resources, and treatments for sex addiction
- Smart Recovery: Support group
- Sex Addicts Anonymous: Support group
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