Although several high-profile celebrities have sought treatment for sexual addiction, the diagnosis tends to elicit eye rolling and sarcastic reactions ("Right, Im a sex addict too"). Because, really, who doesnt love sex?
To some, saying you have a sex addiction is a bit like saying youre addicted to the gym or eating cookies; its an innocent exaggeration. Add in the fact that many experts arent convinced eithersexual addiction is not formally recognized in the bible of psychiatry, The Diagnostic and Statistical Manual of Mental Disorders (DSM)and the diagnosis smacks of a philanderers last-ditch grasp at redemption.
While sex may indeed be akin to drugs in its ability to bring on serious relationship wrecking and life-altering (not in a good way) behavior, it is not supported by the same hard evidence that proves addiction, says Charles OBrien, MD, the chair of the substance-related disorders work group for the American Psychiatric Association, which will publish the DSM-V, the fifth version of the manual.
"Drugs activate [an addicts] brains reward system directly, like getting food or water," says Dr. OBrien, a professor of psychiatry at the University of Pennsylvania. "It could be that there are some similarities in those people who are called ‘sex addicts, but it hasnt been studied or demonstrated."
Sexual behavior that might elsewhere be called addiction will instead fall into a new DSM category called hypersexual disorder. Many of the symptoms are similar to what mental health providers consider sex addiction.
But until larger studies are conducted by evaluators who dont have a hand in providing treatment, there just isnt enough proof. "Good evidence that it should be classified with addictions doesnt exist," says Dr. OBrien. "Established professionals wont use that term."
Still, addiction therapy and rehab programs are booming, and patients swear by their treatment. Despite the debate over the diagnosis, sex addiction counselors say there are distinct differences between the sexually addicted and people who just love sex.
Sex as a coping mechanism
"Individuals who act out sexually are usually doing so because they do not want to feel their feelings," says Maureen Canning, a licensed marriage and family therapist and the clinical consultant for sexual disorders at the Meadows Dakota, a sexual addiction recovery center in Arizona. "Theyre using this as a way to get high, just like taking a drink or snorting a line of coke. They use their sexuality as a means of escape."
Often sexual addiction has some basis in childhood experiences that have affected sexual development, says Canning. "It depends on how profound those experiences are and how the individual processes that," she says. "It could be traumatic for one child and not for another."
About 25% of male sex addicts have experienced overt sexual traumas like sexual abuse or incest during their childhood, says Robert Weiss, a licensed clinical social worker and a certified sex addiction therapist who founded the Sexual Recovery Institute, an intensive out-patient treatment center in L.A. About 75% of female sex addicts have had a similar experience, he adds.
The addiction is less about sex and more about the obsessive behavior pattern that accompanies it, says Weiss. Sex addiction is similar to gambling, over-exercising, and impulsive spending, which are known as process addictionsaddictions to a set of rituals rather than to a mood-altering substance.
"Neurologically, acting out or thinking about acting out [sexually] releases dopamine, serotonin, and adrenaline, creating a chemical cocktail in the brain that is extremely pleasurable," says Canning. "It creates a euphoria."
This euphoria keeps them coming back for more. "Its a lot more fun to look forward to than the day-to-day stuff that life bringsdealing with the finances or struggling with the kids," says Weiss. "Most [addicts] have difficulty tolerating day-to-day stressors and use fantasy and intense arousal to distract themselves."
Research suggests that about 75% to 80% of sex addicts are men. Weiss says the typical client at his treatment centerwhere therapists see 150 clients a week, for two-week-long periodsis a heterosexual man in his late 30s whos been married for 8 to 10 years and has two kids under the age of 5.
Could you be a sex addict?
Addicts often say theyve experienced potentially life-alteringeven life-threateningconsequences of their behavior, according to SexHelp.com, created by psychologist Patrick Carnes, PhD, a leading author in the field.
Almost 70% have exposed themselves to AIDS and other sexually transmitted diseases, and 40% have had unwanted pregnancies. More than 70% have reported thoughts of suicide, and 17% have actually attempted to end their lives. Often the consequences worsen over time as the behaviors continue.
However, when faced with the negative consequences of their behavior, many addicts still dont want to stop. Even if they do want to stop, they often find they cant.
Addicts may move to a new house, thinking a fresh start will stop their behaviors, or get married, thinking a stable home life will curb their desire for sex. Some even turn to religion, but the behavior is likely to come back without treatment, according to SexHelp.com.
A spouse or partner of a sex addict is likely to notice an emotional distancing, and a decrease in sexual intimacy in the relationship. And people may find their behavior has caused them to lose close friends, compromise their values, lie to those closest to them, or put themselves in serious danger, says Canning. "We [have] them look at where their life is today when they start [treatment] to help them see how much their behavior is encroaching on what they thought was important in their lives," she says. "Often they will start to see that its more of a problem than they thought."
Treating sex addiction
Therapists gather and analyze this information to help understand if a persons behavior is a sign of addiction. Although sex addiction is not currently a psychiatric diagnosis like other addictions, Canning says therapists treat it like one by comparing behaviors to the list of criteria used to diagnose chemical dependency.
Most treatments follow a typical 12-step model, just like Alcoholics or Narcotics Anonymous. Addicts can attend meetings through Sex Addicts Anonymous, spend a week at a rehab facility, or meet with licensed therapists in private practices.
But treatment should not be viewed as a quick fix. "I dont think you come to us and youre never going to do it again," says Weiss. "What we can do is really spoil the behavior for someone, so they will never go see a prostitute or go to a massage parlor and say it was no big deal again. It will never be the innocent fun thing that they think they can get away with."
Addicts re-learn crucial parts of healthy relationships, like how to foster friendships and how to interact with family in a healthy way, as well as new coping mechanisms for stressful situations that dont involve sex, like how to put in extra hours at work "before it makes you want to stop at the adult bookstore on the way home," says Weiss.
As with alcoholics, however, relapse is a slippery slope. Addicts need to make lifestyle changes that support their emotional, mental, and behavioral treatments. "You may need to travel with your wife and children, or [only] when you can come home at the end of the day," says Weiss. "You cant go out with a whole bunch of guys anymore. Other guys can do that because they can walk away. [Addicts are] vulnerable to doing this again for the rest of their lives."