Sex Addiction: Signs, Symptoms, & Treatments

What Is Sexual Addiction?

Sex addiction is an unofficial term used to describe compulsive and problematic sexual fixations and behaviors. While there are several types of problematic sexual behavior, they all feature a loss of control over repetitive sexual fantasies, urges, and/or behaviors. 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.¹

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. 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.²

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.

Signs of a Sex Addict

A key sign of sex addiction is when someone’s sexual thoughts or behaviors become problematic in some way. Having obsessive sexual thoughts, spending excessive time on sex, and feeling shame or depression around sex are other indicators of a sex addict.

Some 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

Does Female Sexual Addiction Look Different?

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.³ Men with sexual addictions usually opt for more impersonal sexual encounters, which often occur online or through paid encounters.

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.⁴ 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 (called a cross addiction).⁵

Sex Addiction Symptoms

For now, the only available guides outlining the symptoms for sex addiction come from prior research on Hypersexual Disorder and the symptoms for the CSBD disorder.

Symptoms of Hypersexual Disorder

The symptoms of hypersexual disorder include:²

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:⁶

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.

What Causes 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 Causes

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.⁵ People with sex addictions also report low self esteem and lower overall life satisfaction. They also struggle more to regulate their emotions, and tend to score higher on impulsivity ratings.⁷

Biological Causes

Research also suggests that certain neurological and biological factors can also heighten the risk for sex addiction. 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.^5,7

Relationship Problems, Attachment, & Trauma

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 a fear of deeper intimacy, and as many as 95% have an insecure attachment style.³ 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.

Porn Addiction

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.⁸