Sex addiction?

This article is worth reading twice, I think, especially the paragraph about infidelity and the last paragraph, where it talks about the role of culture.  Having lived at the seams of two cultures, I think about that often.

Why Isn’t Sex Addiction in the DSM-5?
by Mark Griffiths, PhD on March 5, 2015 in Porn Addiction Expert Blogs, Sex Addiction Expert Blogs

Sex addiction appears to be a highly controversial area among both the general public and those who work in the addiction field. Some psychologists adhere to the position that unless the behavior involves the ingestion of a psychoactive substance (e.g., alcohol, nicotine, cocaine, heroin), then it can’t really be considered an addiction. But I’m not one of them. If it were up to me, I would have given serious consideration to including sex addiction in the latest (fifth) edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Given that “gambling disorder” was reclassified from a disorder of impulse control to a behavioral addiction in the DSM-5, there is now no theoretical reason why other behavioral addictions can’t be added in the years to come. So why wasn’t sex addiction included in the latest DSM-5? Here are some possible reasons:

Some researchers think that sex addiction just doesn’t exist (for moral and theoretical reasons): Many scholars have attacked the whole concept of sex addiction, saying it is a complete myth. It’s not hard to see why, as many of the claims appear to have good face validity. Many sociologists would argue that “sex addiction” is little more than a label for sexual behavior that significantly deviates from society’s norms. The most conventional attack on sex addiction is a variation on the position outlined in my introductory post to this blog (that “addiction” is a physiological condition caused by ingestion of physiological substances and must therefore be defined physiologically). There are also attacks on more moral grounds, with people saying that if excessive sexual behavior is classed as an addiction it undermines individuals’ responsibility for their behavior (although this argument could be said of almost any addiction).

The word “addiction” has become meaningless: There are also those researchers within the social sciences who claim that the everyday use of the word “addiction” has rendered the term meaningless (such as people saying that their favorite television show is “addictive viewing,” or that certain books are “addictive reading”). Related to this is that those that work in the field don’t agree on what the disorder (e.g., “sex addiction,” “sexual addiction,” “hypersexuality disorder,” “compulsive sexual behavior,” “pornography addiction,” etc.) should be called and whether it is a syndrome (i.e., a group of symptoms that consistently occur together, or a condition characterized by a set of associated symptoms) or whether there are many different sub-types (pathological promiscuity, compulsive masturbation, etc.).

There is a lack of empirical evidence about sex addiction: One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak. Although there has been a lot of research, there has never been any nationally representative prevalence surveys of sex addiction using validated addiction criteria, and a lot of research studies are based upon those people who turn up for treatment. Like Internet Gaming Disorder (which is now in the appendix of the DSM-5), sex addiction (or, more likely, “Hypersexual Disorder”’) will not be included as a separate mental disorder until the (i) defining features of sex addiction have been identified, (ii) reliability and validity of specific sex addiction criteria have been obtained cross-culturally, (iii) prevalence rates of sex addiction have been determined in representative epidemiological samples across the world and (iv) the etiology and associated biological features of sex addiction have been evaluated.

The term “sex addiction” is used an excuse to justify infidelity: One of the reasons why sex addiction may not be taken seriously is that the term is often used by high-profile celebrities as an excuse by those individuals who have been sexually unfaithful to their partners (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand). In some of these cases, sex addiction is used to justify the individual’s serial infidelity. This is what social psychologists refer to as a “functional attribution.” For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position in which they’re bombarded with sexual advances and they succumbed. But how many people wouldn’t do the same thing if they had the opportunity? It becomes a problem only when you’re discovered, when it’s in danger of harming the celebrity’s brand image.

The evidence for sex addiction is inflated by those with a vested interest: One of the real issues in the field of sex addiction is that we really have no idea of how many people genuinely experience sex addiction. Sex addiction specialists like Patrick Carnes claim that up to 6% of all adults are addicted to sex. If this was really the case I would expect there to be sex addiction clinics and self-help support groups in every major city across the world – but that isn’t the case. However, that doesn’t mean sex addiction doesn’t exist, only that the size of the problem isn’t on the scale that Carnes suggests. Coupled with this is that those therapists that treat sex addiction have a vested interest. Put simply, there are many therapists worldwide who make a living out of treating the disorder. Getting the disorder recognized by leading psychological and psychiatric organizations (e.g., American Psychiatric Association, World Health Organization) legitimizes the work of sex addiction counselors and therapists so it is not surprising when such individuals claim how widespread the disorder is.

There may of course be other reasons why sex addiction is not considered a genuine disorder. Compared to behavioral addictions like gambling disorder, the empirical evidence base is weak. There is little in the way of neurobiological research (increasingly seen as “gold standard” research when it comes to legitimizing addictions as genuine). But carrying out research on those who claim to have sex addiction can face ethical problems. For instance, is it ethical to show hard-core pornography to a self-admitted pornography addict during a brain neuroimaging experiment? Is the viewing of such material likely to stimulate and enhance the individual’s sexual urges and result in a relapse following the experiment?

There are also issues surrounding cultural norms. The normality and abnormality of sexual behavior lies on a continuum, but what is considered normal and appropriate in one culture may not be viewed similarly in another (what is often referred to by sociologists as “normative ambiguity”). Personally, I believe that sex addiction is a reality, but that it affects a small minority of individuals. However, many sex therapists claim it is on the increase, particularly because the Internet has made sexual material so easy to access. Maybe if sex addiction does eventually make it into future editions of the DSM, it will be one of the sub-categories of Internet Addiction Disorder rather than a stand-alone category.


13 thoughts on “Sex addiction?

  1. Less concerned about the actual label than I am about the acknowledgement that it is a brain disease rather than moral failing. Most sex addicts have other addictions and mental illness such as anxiety and depression. Healing the brain will treat addictions along with a behavior change program, therapy and 12-steps. There are definitely people out there who use sex addiction as a crutch when they are simply cheaters. But there are other criteria that define sex addiction which are not always present with someone who just cheats. I hope the DSM changes so that addicts who want help can get insurance to cover the costs of treatment. Thanks for posting.

    Liked by 1 person

  2. Well, I know it has been a good long time. Eventually, I may just write my own post again. I even have a title worked out, “You cannot run away from yourself, or from SunChips.”🙂

    I did want to comment on some points raised by MC and in this article. Recovery Nation has been a nice tool on several fronts. Talking about values and decision making processes is so useful, but when it gets into the addiction model stuff, I can see MC struggling to try to fit a square peg into a round hole. It just does not fit.

    What it comes down to is. . .a sense of entitlement fueled and rationalized by a sickening level of self-pity, “I deserve” thinking. How does one become a person who feels so entitled? How does one become a person who allows self-pity to be used to justify the unjustifiable? How does one become that person who thinks everyone else owes me something? How does one come to not feel compelled to actually live by their own professed codes of conduct; judging others for moral failings that are far less severe than their own. And, how does one change that type of thinking? What changes in values, decision making processes, and outlook on life must occur to have a happy life as a person of integrity? These are the questions that MC has worked on answering and continues to work on answering.

    There is one more needed component that I think is common to many serial cheaters and/or SAs. The need to learn how to take the right kind of risk, the risk of being vulnerable with and to your mate. Without this, building emotional intimacy is next to impossible. And, what kind of marriage is possible without emotional intimacy?

    Liked by 1 person

    1. I must be using this application incorrectly. I missed this comment before today.

      All these questions about how I turned bad have a corollary, in my opinion. Maybe the question is not, “How could I choose to be so bad?” Rather, maybe it’s, “How did I fail to learn to be good?” That makes more sense to me in terms of how to improve myself and prevent future bad decisions: learn what makes a man good. I suspect it includes learning the value of integrity, gratitude, and perspective.

      Liked by 1 person

  3. Hi again,
    You might like to listen to “Susie Bright Interviews Dr. Leonore Tiefer”. Dr. Tiefer is a sex therapist who does not use the work sex addiction as these days all is thrown on the one pile and it is not helpful.
    Tiefer (like myself) look at harmful sexual behaviour as an obsession and compulsion. Although chemical addictions have a compulsive aspect, there are differences.
    In general obsessions and compulsions form when dealing with unwanted thoughts and anxiety. They often lead to guilt feelings and to distraction, and the circle is round…
    With sex outside the marriage and when harmful to self and partner, there is indeed that other component: being selfish.
    Indeed the label is not that important, but I am taken aback by how many people get very upset with me when I challenge them in reading different views.
    I do not mind sex addiction used…but we have to be clear what we mean by it and that is often not the case.
    I also have a problem with seeing it as being “sick”, and through the eyes of the AA people, as a behaviour over which one has no control.
    This does not mean that for some people the 12-steps cannot be helpful, but for many people it becomes another compulsion, and they become dependent on the meetings.
    will continue…as I am doing more studies…


    Liked by 2 people

    1. I agree. And, I did appreciate listening to that interview.

      I’ve noticed a couple of things about people who cling defensively to the sex addict label and the twelve-step mantra. First, many betrayers cling to it, in my view, because it saves them from having to admit their active, conscious role in choosing adultery.

      Second, many betrayed spouses cling to it because it is easier to reconcile sex addiction with their new reality than to accept the fact that their loved one willfully, knowingly, and consciously betrayed them.

      Liked by 1 person

      1. I actually think the issue is that it is easier for both cheater and betrayed to resolve the intense cognitive dissonance by telling themselves “the reality I’ve always known is still true, the man I thought was my husband still exist, it was just his behaviors associated with his addiction that I deplore, otherwise he was a good man.” Or, for the cheater to be able to tell themselves, “it was/is just the addiction speaking to me. That’s not me, that is just the addiction.” It is a way of resolving their cognitive dissonance. I personally feel that doing so would simply be a form of rationalization in MC’s case. The reality is that MC was a morally corrupt coward. The reality is that he has to choose to change the foundation of his character and choices. I do believe he is working on the foundation of how he thinks, how he makes choices and ultimately the type of human being he wants to be. I know I cannot have a different past with him, but I still have difficulty accepting that past for what it really was. I can totally understand how ascribing to the sex addiction model would allow that acceptance to be more forthcoming. But, for me, the addiction model is a path that feels too flimsy to be the foundation of my new reality.

        Liked by 1 person

        1. Right. It’s so comforting, and so easy to think we are all good or all bad.

          It’s much more disturbing, common, and sadly realistic, to accept the constant shock of knowing that Anakin Skywalker and Darth Vader are the same guy.

          Liked by 1 person

      2. I believe you are spot on with this. It explains the intensity of emotions when you carefully try to challenge people with the lack of evidence…They perceive it as an attack.
        The hardest thing for the betrayer and the betrayed is to come to terms with the choice the betrayer made and their lack of consideration for their partner. If it was an illness….there is an explanation and an excuse. You are correct…and you and TL know from the inside out how hard it is. I do too.
        In addition to this, therapists make money from the myth and talk-show hosts and willing participants get their 5 minute of fame out of it. TED talks are devoted to it…but people willing to read up on both sides, will be able to see how skewed the “evidence” is.

        To me…when there is no scientific evidence, I feel the only ethical thing I can do is to be honest with my clients and on WordPress.

        Thank you!

        Liked by 2 people

    2. I’d definitely be interested in talking to you if you are researching this- I struggle with the label “addiction” and also with the AA modality… though I’ve found some benefit to parts of that program. I feel like there is more of an OCD component than an addiction. I’ve also been told that the refusal to acknowledge it as an addiction is denial. Luckily my therapist, while she refers to AO as a relapse etc, tries to help me understand it as a compulsive behavior. I think there should be more research around the issue- it seems those of us who grew up with constant internet access are facing the struggle more and more.

      Liked by 2 people

      1. Thank you AMGAD!

        There is definitely an overlap and therefore similarities but it is not the same. I have found that people with obsessive and compulsive behaviours are more prone to developing addictions. These can be of any kind; alcohol, drugs, excessive exercising, food issues and of course sex. What these behaviours do is to make people feel temporarily better and because it worked, they will do it again, until the time, they realise that it does not work anymore. When they realise that a quick fix does not take away the emptiness and guilt feelings the day after.

        What many do not know is that even without “addiction” programs, people do kick the habit (of any of the above). It is when they realise that the benefits do no longer outweigh the pain and the consequences. Change also happen after major life altering experiences.

        Denial….Mmm, I often tell my clients who are not ready simply that: They are not ready. It is a process known as the theory of change. Therapists can help the process forward, but ultimately it is the client who decides when they are ready. Many are only temporarily in denial, and they use justifications to push the unwanted feelings away.
        It is interesting as well as painful. I will keep on reading, the for and against…but stay away from pop psychology which is not based on research using sound methods. I will keep people posted.

        In addition to the above, I am delving myself in preventative programs. Too often people seek help when in turmoil. Maybe, only maybe some badass prevention can turn a switch in some of their brains.


        Liked by 1 person

      2. Thanks. My current therapist also approaches my behavior from the perspective of obsessive-compulsive disorder.

        This discussion reminds me of recent documentaries and radio reports on the heroin addiction epidemic sweeping the United States now. Watching those stories about heroin addicts makes it clear to me that I have never been, known, or even seen anyone who is “addicted to sex.”

        Liked by 1 person

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