part0024

Disclaimer: I am a social psychologist and a researcher, not a clinical psychologist licensed to diagnose disorders. My expertise in this area is in understanding research, scientific consensus, and how disorders are defined and legitimized within the scientific community, not in diagnosing addiction.

There exists a socially conservative, scientifically and sexually ignorant segment of the population who, for a variety of reasons, attempt to pathologize healthy sexual activities and relationships by referring to the behavior as “pathological” or “addiction”. Perhaps in response to this, there have been a variety of books written on what has been dubbed “the sex addiction myth,” as well as increased visibility of several outspoken critics of the idea of sex addiction 20 21 22 . To answer this question without prejudice or bias, we need to talk a bit about how addiction is recognized by the scientific and medical communities and we need to define “addiction.”

There are essentially two “Bibles,” or authoritative books, used to diagnose mental disorders (including addiction) in the mental health profession: The Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychological Association (APA) and the International Classification of Diseases (ICD) published by the World Health Organization (WHO). The current version of the DSM (DSM-5) has some pretty specific language referencing sex addiction. The following paragraph appears in the “Substance-Related and Additive Disorders” section (emphasis mine):

In addition to the substance-related disorders, this chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders. Other excessive behavioral patterns, such as Internet gaming, have also been described, but the research on these and other behavioral syndromes is less clear. Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as “sex addiction ,’’ “exercise addiction,” or “shopping addiction,” are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders 23 .

So according to the APA, at the time of the publication, there was a lack of peer-reviewed evidence to include “sex addiction” as a mental disorder. Note that there is no claim that sex addiction is a “myth”, that it is not “real,” or even that it does not pose a serious problem for some people. It is also important to note that the APA does not claim that there is no peer-reviewed evidence (as some have suggested); just that there is insufficient peer-reviewed evidence. In addition, the lack of evidence specifically referenced is regarding establishing “the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders,” not the existence or prevalence of the addiction.

The World Health Organization, which published the IDC (currently the IDC-10), does include “Excessive sexual drive” as a diagnosis (code F52.8), subdividing it into satyriasis (for males) and nymphomania (for females) 24 . Many would argue this is synonymous with what is generally referred to as “sex addiction.”

Just like followers of religions don’t necessarily follow their books exactly (e.g., parents don’t stone their rebellious children to death as per Deuteronomy 21:18-21), many mental health professionals use the DSM or ICD as more of reference and for general guidelines. The DSM and ICD can be described as both descriptive and prescriptive documents. That is, although they instruct mental health professionals on how to diagnose disorders, they are a result of decades of research of scientists and the experience of practitioners. Therefore, as what might be considered “living documents,” they are always necessarily behind. I have explained this not to discredit these documents or justify the claims of any single researcher or practitioner that are in conflict with these documents, but to demonstrate the subjective element that is involved in diagnoses as well as explain how these documents might not always reflect the current scientific consensus. More important, this might help explain why there are so many highly qualified experts who disagree about the legitimacy of sex addiction.

The word “addiction” has many meanings in our everyday language. One can often be heard saying that he or she is “addicted” to a new show on TV or “addicted” to a new frozen yogurt flavor at the mall. It might go without saying, but alcoholics or people with narcotics addiction would probably enjoy shoving frozen yogurt up certain orifices of these people. Psychology Today 25 outlines some of the characteristics of addiction, specifically

The key here is the last point about interfering with ordinary life responsibilities. This is what we refer to in psychology as something being maladaptive . Imagine a couple that has sex twice a day—every night and once after lunch. They enjoy it (obviously), they have this irresistible urge for sex that develops about twice a day, but their daily “afternoon delight” does not interfere with their responsibilities, it strengthens their relationship, and only benefits their health (sex is good for you). While some outsiders may view this as maladaptive behavior (perhaps out of jealousy), the people who really matter are the ones involved in the behavior.

In the late 1940’s sex researcher Alfred Kinsey realized that sexual orientation exists on a spectrum ranging from exclusively heterosexual to exclusively homosexual. Much more recently, researchers are beginning to understand that another dimension of sexuality exists… hypersexuality/hyposexuality, which refers to the level of sexual interest. Just like we now accept people with different sexual orientations as normal, we must accept people with different levels of sexual interest as normal, as well. Again, the key is that the level of interest can be managed in such a way that the associated behaviors do not become maladaptive .

The thing about maladaptive behavior is that there is a level of subjectivity to it. For example, consider the thirteen-year-old boy going through puberty and experiencing the surge of hormones leading to thoughts, desires, and “self-gratification” behaviors. If the boy is convinced that his behavior is “sinful” or harmful (i.e., he will go mad, grow hairy palms, go to Hell, etc.) he will experience fear, guilt, shame, and other negative and harmful feelings resulting in the behavior actually becoming maladaptive (as in a self-fulfilling prophecy). However, if he understands that his desires and behaviors are perfectly normal and he is not conditioned to associated fear, guilt, or shame with his desires and behaviors, the desires and behaviors would not be maladaptive. We have seen the same social phenomenon with homosexuality. In general, the more societies and cultures stigmatize normal and harmless feelings and behaviors related to sex, the more problematic these otherwise normal and harmless feelings and behaviors will become .

It has been suggested that sex addiction would be more accurately described as a “symptom of something much deeper like depression, social isolation, or reaction to trauma, abuse or divorce” 26 . If this were true (which it likely is), it does not negate the fact that the addiction exists and should be addressed. We can say the same thing for those who become addicted to drugs and alcohol or even gambling due to a deeper issue. This fact doesn’t warrant exclusion from the DSM nor does it make the addiction any less real.

Some who argue that sex addiction is a myth do so based on the presumption that addiction can only really apply to external substances introduced into the body. However, science disagrees 27 . Even the APA has acknowledged “gambling addiction” based on the sufficient peer-reviewed research “reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and produce some behavioral symptoms that appear comparable to those produced by the substance use disorders”. This lays the theoretical foundation for other non-substance related addictions including sex addiction. In fact, evidence supporting sex addiction continues to accumulate as more research is being done in this area 28 . I strongly suspect that we will see some form of sex addiction diagnosis in a future revision of the DSM-5.

Very often, addicts distort reality and fail to reasonably evaluate their own situation for how problematic it really is. If others, especially friends and family, express concern about your sexual behavior, you might want to listen while keeping in mind your own biases and the possibility that the concerns of others may be more of a result of their own ignorance or jealousy rather than your well-being. Sometimes it is society that needs changing, not you. However, if you recognize that you are struggling with anything that interferes with ordinary life responsibilities, such as work, relationships, or health, then you should seek help . Don’t let other people convince you don’t have a problem despite your six hours a day of porn viewing and ignoring your spouse’s sexual needs because he or she doesn’t look like the people you see on the Internet. Don’t write off your friend’s compulsion to view child pornography as “normal and healthy.” Call it addiction or not, any behavior that reduces well-being or reduces the quality of relationships should be addressed.

Certainly the way that some people define sex addiction makes that version of sex addiction more myth than science, but we would be committing the strawman fallacy if we were to rage against the idea of sex addiction based on an extreme view. The debate on whether it is an “addiction” or not is often one of semantics. Clearly people struggle with sexual desires and behaviors that have a significant negative effect in their lives. These people deserve help, not accusations of struggling from a problem that doesn’t exist.