9/10/2018

Is Sexual Addiction Real?

This is a question that is often fraught with contention and high emotions. There are many people who would feel that they are themselves victims of uncontrollable sexual behavior or they have family members who they believe are. When people share their stories it is hard to argue that there isn't a problem in the sexual lives of these people. When there are families being torn apart, lives ruined, and disastrous legal and health problems all because of some behavior that the individual was not able to control, it becomes difficult to say there isn't a problem. But what exactly is the problem? Is this addiction or something else? 

What is Addiction?

Addiction is a term often used in day to day talk by all of us, but do we really know what that word means? According to the Diagnostic and Statistical Manual of Mental Disorders V (DSM V), “the essential feature of a substance use disorder is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance related-related problems.” So in a nutshell I keep using a substance even though its ruining my life. But that's talking about substance use, what about sex addiction? It isn't listed in the DSM V so it technically can't be diagnosed but does that mean it doesn't exist? Gambling addiction was added to the DSM V when it was published in 2013 but before this time the previous editions did not include gambling as an addiction. So does that mean gambling addiction didn't exist until 2013? Of course not! It just means that there wasn't enough research to be able to definitively say that this is a mental disorder. There are many things that people get addicted to. SOme are substances, some are behaviors or “process addictions” most of these behaviors are not listed in the DSM V. video games, food, shopping, shoplifting, social media, exercise, adrenaline, and many many others including pornography and sex. Just because something can’t technically be diagnosed does not mean it isn’t causing problems for people. So technically someone can be addicted to almost anything and that includes sexual behavior. Some will say that sex is not something that can become addictive, their reasoning? Because sex is a natural human function, which is very true. They would say that this sex addiction idea comes from some people’s morals and values, based off of conservative religious belief systems that say that any sexual behavior outside of certain boundaries is addictive and that the shame and distress that the behavior causes people is just because of a lack of acceptance by their conservative culture. So does it exist or is it an idea created by conservative religious groups to “keep people in line.” I tend to take more of a middle ground when discussing sexual addiction.

I believe sex is a normal human function and I do think that, in some conservative circles, any sexual interest or behavior, outside of marriage, is often seen as addictive. For example, it is not uncommon for me to have some parents bring in their teenage son because he has a “ponography addiction.” I always take these cases with a grain of salt. Usually I meet with the parents and they explain that their son’s sexual behavior is out of control. In the end after talking to both the parents and son I realize that his behavior is not out of control but very normal for a boy his age. It is normal for a young teenage boy to be interested in sex and the human body. Pornography is a very accessible way for a young teenager to explore this new emerging interest and part of himself. While the family might have a moral objection to viewing pornography, which I understand those beliefs are important for people, that does not mean that the child has an addiction. Masturbation is another thing that I often see parents worrying about. What parents need to understand is that masturbation is normal and a young teenager mastubating a few times per week does not mean that the individual has an addiction. Telling the child they have an addiction or “a Problem” does not help the child to stop. In fact it often just creates shame which the child then often starts to use the porngrahy or masturbation to deal with and that is when it begins to take more of an addictive form. 

So What is Sexual Addiction?

The best way to look at a process addiction like sex or pornography is to look at how we classify another process addiction. As stated above, currently the only process addiction that we can diagnose,by using the DSM V is gambling. So what does is take to be diagnosed with gambling addiction? Following is the DSM V diagnostic criteria for gambling addiction; 

A. Persistent and recurrent problematic gambling behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12­month period:

a. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 

b. Is restless or irritable when attempting to cut down or stop gambling.

c. Has made repeated unsuccessful efforts to control, cut back, or stop gambling. 

d. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 

e. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 

f. After losing money gambling, often returns another day to get even (“chasing” one’s losses). g. Lies to conceal the extent of involvement with gambling. 

h. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 

i. Relies on others to provide money to relieve desperate financial situations caused by gambling. 

B. The gambling behavior is not better explained by a manic episode. 

I believe that if we just change the behavior in the criteria, making gambling, sex, then we have a very clear outline of what a diagnosis of sexual addiction would look like. 

A. Persistent and recurrent problematic Sexual behavior leading to clinically significant impairment or distress, as indicated by the individual exhibiting four (or more) of the following in a 12 ­month period:

a. Needs to have sex in increasing amounts or with increased risk in order to achieve the desired excitement. 

b. Is restless or irritable when attempting to cut down or stop the sexual behavior.

c. Has made repeated unsuccessful efforts to control, cut back, or stop the sexual behavior. 

d. Is often preoccupied with sex (e.g., having persistent thoughts of reliving past Sexual experiences, or planning the next venture, thinking of ways to get sexual partners). 

e. Often has sex when feeling distressed (e.g., helpless, guilty, anxious, depressed). 

f. After suffering consequences of sexual behavior, often returns another day to experience the same sexual interaction.

g. Lies to conceal the extent of sexual behavior. 

h. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of sex. 

i. Relies on others to provide money to relieve desperate financial situations caused by sex. 

B. The sexual behavior is not better explained by a manic episode. 

I believe that much of what is thrown around as sexual addiction rarely fits this criteria. In addition we also have to look at the idea that sex, and a strong desire for sex is something, that, unlike gambling, is part of us as human beings, that's what pushes us to reproduce as a species, so I believe that would in part negate some of the above criteria. For example a teenager being preoccupied by sexual thoughts would not necessarily qualify him for the above corresponding criteria because its normal for a teenager to have those thoughts. But someone who has been arrested, lost a job, lost a marriage because he was picked up with prostitutes and spent $20,000 on prostitution in a year, probably would qualify for some kind of problematic sexual behavior.

What About This Common Situation?

It is not uncommon for there to be a situation where a man comes to my office who is separated from his wife because she discovered pornography on the computer. He has tried to stop as he knows it will hurt his wife, he keeps slipping up so he lies, once again, so as not to hurt his wife. Even after her discovery he still finds himself viewing pornography. Is this an addiction? Ultimately it could be viewed that way but it might also not be viewed that way. This is why sexual addiction gets complicated to diagnose. He technically could meet the above criteria, however, many of his behaviors could be seen as normal and healthy sexual functioning. It’s complicated because there is truth there, however, the behavior is causing problems in his life. In the end, sexual dysfunction and “addiction” are often left to the discretion of the individual. Are they personally okay with the behavior? One behavior some people might find acceptable while someone else might find it unacceptable. Mental illness is based off of what is abnormal behavior based on the norms of a culture. When it comes to sex, as a culture we have no norms. What is normal changes from person to person and from one group of people to another. Some people find pornography as normal while others find it abnormal. Some people find swinging to be be healthy and normal while others see it as disgusting and wrong. Because of this we might never be able to define what sexual addiction really is. In the meantime I would say sexual addiction is up to the individual. Is the behavior causing distress? If it is then we need to do something about it, whether that is normalize the behavior, reduce the behavior, or stop the behavior. 

In Conclusion

Is sex addiction real? I would say that it is but defining that is anything but simple. In the end if your sexual behavior or the sexual behavior of someone else is causing significant issues, it should probably be addressed, as anything that is causing problems in our lives needs to have some changes made, whether that is in our thinking or in our behaviors. Regardless we need to understand the complexity of human sexuality and cut ourselves and others some slack and be kind as we try to understand this complex part of our development. If you are concerned with someone's behavior, talk to them, show love and understanding and if they need some help, get them to a trained professional. Don’t degrade or shame the individual as this has been proven to never create effective and positive change.