• Miranda L. Galbreath, MA, MA, LPC

Is sex addiction a thing?

Updated: Jan 17

I have been working with folks who have committed sex offenses for about 20 years. In the last five years or so, the term “sex addiction” has started to pop up in my treatment groups. Prior to that, I might hear it occasionally, but not that often. Nowadays, when I am assessing someone to start treatment, there’s a pretty good chance that they will attribute their sexual behavior to being a “sex addict.” When we do introductions in our very first treatment group meetings, at least one or two guys will introduce themselves as a “sex addict.”

What do they mean when they say that? And where did they get the idea that they had an addiction to sex? Who told them that? And how does it serve them to take on that label? How does it NOT serve them?

Here are a few examples of the experiences of guys I’ve worked with who call themselves sex addicts:

“I don’t find my wife that attractive anymore, so I had a few affairs. My wife says I’m a sex addict. I guess I must be. Otherwise why wouldn’t I just have sex with her?”

“I’ve been jacking off to gay porn. But I’m not gay. That’s a sin. My family and my church will disown me if they find out. I have to stop. Help me with my sex addiction.”

“I’m having a difficult time getting it up and keeping it up since I’ve gotten older. Masturbating to porn helps me feel like I’m not losing my manhood. What kind of guy does that? A sex addict, that’s what I’ve read on the internet.”

“I get off on women’s feet. I can’t tell my partner. She’ll think I’m a pervert. Once I tried to suck her toes during sex and she freaked out, so I mostly just meet up with sex workers. Obviously I have a sex addiction, or I would stop thinking about women’s feet.”

If you look at this sample, you can see that it doesn’t make a lot of sense to give all of these guys the same diagnosis and treatment. They’re dealing with different issues. And engaging in different behaviors as a result. Sending them all to a one-size-fits-all addiction/disease model of treatment isn’t going to get at what they really need.

The first person is dealing with extremely common issues that occur in many committed long-term partnerships. The second person seems to have internalized homophobia and is grappling with his erotic interests conflicting with how he sees himself as a person. The third person seems to be dealing with the totally normal effects of aging, combined with the unrealistic sexual expectations we place on men to always be ready to perform. AND he’s not communicating with his partner about it. The last person seems to have a very specific and non-mainstream sexual interest that he’s learned to be ashamed of, and that he has thus far not negotiated successfully with his partner about.

When I work with guys who claim to have a sex addiction, my first thought is that they’re looking for a quick, easy explanation. Something to blame. Somewhere to point the finger. Something they can say to their partner or family or workplace or church. A nice, neat bow that ties up this complicated constellation of feelings, thoughts, and behaviors. A way to avoid really getting into what’s going on. They hold that label up like a shield that protects them from the judgment of the world. “This isn’t really my fault. It’s my addiction. I’m not really a bad person. I’m an addict.” Or, “I’m not (gay/a pervert/losing my manhood/a criminal/etc.), I have an addiction.” And more and more the media, our popular entertainment, and our celebrities are telling us that sex addiction is a thing. And treatment programs have sprung up all over, purporting to treat people who claim to be sex addicts. So, is it a thing?

Quite a dramatic split exists in the field of folks who treat sexual issues about whether sex addiction is a thing. Obviously on one side of that debate are the folks who run sex addiction treatment programs! I'd assume they think it's a thing. The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Ed), the bible of mental health diagnoses does NOT include sex addiction as a diagnosis. Hypersexual Desire Disorder was proposed as an addition to the DSM-5, but was not included due to the lack of evidence that the issues people labeled as “hypersexual” were all the same issue, with the same cause.

The ICD-11 (International Classification of Diseases) put out by the World Health Organization included a diagnosis of Compulsive Sexual Behavior Disorder (CSBD) in 2020. According to the ICD-11, which takes effect in January 2022, CSBD is an impulse control disorder that includes the following:

· Persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior

· Repetitive sexual behaviors become the focus of one’s life to the exclusion of concerns regarding one’s health, personal care, or responsibilities

· Repetitive sexual behaviors continue despite adverse consequences or not deriving any satisfaction from conducting them.

In addition to those criteria, the behaviors must persist longer than six months and cause impairment in multiple areas of a person’s life. You’ll note, the word addiction is very specifically NOT used in the ICD criteria. You might also be noticing that this diagnosis, which is, again, NOT sex addiction, doesn’t fit for most of the example scenarios above. Another interesting thing to note is that historically when a sexual behavior has been targeted to be part of a “sex addiction,” it’s often based on the fact that the behavior is one that isn’t necessarily accepted by parts of our society. These behaviors may be out of the mainstream or believed to be immoral by some segments of society (such as fetishes, masturbation, use of pornography, online sexual behaviors, crossdressing, etc.). One person’s completely harmless, consensual activity is another person’s “sex addiction.” How can we say someone has the disease of addiction if another person can be perfectly comfortable engaging in the same behavior (for example masturbating to internet pornography) with no distress whatsoever and no disturbance to their personal life?

I’m currently reading “Treating Out of Control Sexual Behavior: Rethinking Sex Addiction,” by Douglas Braun-Harvey and Michael A. Vigorito. I highly recommend it to anyone who is providing treatment to folks who may raise issues about sexual behavior that feels out of control or incongruent with their sense of selves. These clinicians use the admittedly imperfect term “Out of Control Sexual Behavior” to talk about sexual thoughts, feelings, or behaviors that feel out of control, or feel incongruent with a person’s sense of self and values or that is causing issues in their life. They work with individuals to develop a vision of what a healthy sexual life would look like to them. They help a patient explore any medical, mental health, substance abuse, attachment, current relationship, or childhood issues that may be contributing to the way they are living their sexual lives today. Their goal in treatment is to help individuals learn to self-monitor their thoughts, feelings, and behaviors, and understand what issues are interfering with their ability to live the healthy and pleasurable sexual lives they desire. All of this work is done in a sex-positive, goal-oriented, non-judgmental way that asks the patient to define their own vision of sexual wellness and does not point to any specific type of behavior as unacceptable as long as it is consensual behavior involving individuals who are able to consent.

If you are a person who has labeled yourself a “sex addict,” or you have been thinking of your partner or someone in your life that way, I encourage you to consider seeking an evaluation from a qualified sex therapist who does NOT use the addiction model, and who is informed about treating sexual behavior that feels out of control, incongruent with sense of self, or is causing trouble in your life. Some good places to start are the provider directories for ATSA (Association for the Treatment of Sexual Abusers) and AASECT (American Association of Sexuality Educators, Counselors, and Therapists). Also check out the position statements on sex addiction from ATSA and AASECT to see how these organizations address this issue. AND check out this great definition of sexual health and a description of possible symptoms of out of control sexual behavior from The Harvey Institute.

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