There has been a recent debate over the actual existence of sex addiction. Many wonder if it is just an excuse for bad behavior, or if it’s an actual addiction that is difficult to control.
David Ley, a clinical psychologist who blogs for Psychology Today, just released his book, “The Myth of Sex Addiction,” making clear his stance on the issue. The response from mental health professionals and people who are familiar with sex addiction is mixed.
Nicole Prause, a research scientist for the Mind Research Network, has been working on research associated with sexual compulsivity in both women and men.
“We have completed first study of tolerance in men and women who report problems with sexual compulsivity using measures of brain activity,” Prause said in an email. “We found no evidence that they actually have developed tolerance to sexual stimuli. Does this mean that sexual addiction doesn't exist? Not necessarily, because it depends what you think the essential parts of addiction are.”
She added that in general there is not enough research to suggest the existence or non-existence of sex addiction. As a clinician, she has seen some cases where the label of sex addiction actually helps a couple move on, but it might not be for the correct reasons.
“I have seen couples for whom the sexual ‘addiction’ label was useful in their being able to move past sexual behaviors of a (male or female) partner,” Prause said. “For example, I have seen couples in whom a male partner who had sex with another woman who was not his wife claimed to be sexually addicted. This gave the wife a way to understand his transgression and, while I did not agree that he needed to be in treatment for sex addiction for infidelity, it gave the couple enough compassion for one another to participate in a couple's therapy, for which there was good scientific evidence to support.”
Prause said in general it seems many clinicians are willing to accept the existence of sex addiction and treat it, even though there is not enough research to support its existence, so Ley is unique with this approach and the book that he released.
Ethlie Ann Vare, the author of “Love Addict: Sex, Romance and Other Dangerous Drugs,” disagrees with Ley’s stance on sex addiction. She supports the existence of sex and love addiction, since she has suffered from love addiction, and argues that there is research supporting this type of addiction.
“[Functional Magnetic Resonance Imaging proves] that sexual obsession affects the same ‘reward center’ neurochemistry as compulsive gambling or any other behavioral addiction,” Vare said in an email.
She believes there should be a different type of addiction listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) relating to addiction to various types of behaviors.
“An addiction is the compulsive use of a substance or behavior despite negative life consequences, characterized by the phenomena of craving, tolerance and withdrawal,” Vare said. “I think ‘process addiction’ - what I prefer to call ‘endogenous addiction’ - should be in the DSM, not specifically limited to sexual behavior.”
She added that people don’t choose to hide behind the label of sex addiction.
“Naming something an addiction isn't a get-out-of-jail-free card,” Vare said. “It's the first step to recovery. Misnaming it affects men and women equally, although it probably directs more shame at women. No one seeks help for ‘willful misbehavior,’ which is, by the way, what the Army used to call alcoholism. They simply hide it, thus increasing the spread of STDs.”
Kim Dennis, a psychiatrist and medical director at Timberline Knolls Residential Treatment Center, said in an email that at her center she has seen many women with sexual addiction (the center treats women and girls mainly for eating disorders, drug and alcohol addiction, mood and anxiety disorders, trauma and PTSD).
“We see women and adolescent girls (many of whom have been sexually abused as children) who engage in compulsive sexual behavior despite negative consequences, to medicate inner feelings of powerlessness, loneliness, shame, and other unpleasant emotions,” Dennis said. “They fit the definition of feeling out of control of their behaviors, and feeling depressed/withdraw when they are not using the behaviors.”
Unfortunately, when some women leave the treatment center, she said they end up becoming active in compulsive sexual and love addiction behaviors instead of relapsing when it comes to their drugs and alcohol addiction or eating disorders.
“It is a powerful addiction, especially for women,” Dennis said. “I think society views it as a man’s disease (those who believe it exists). We hear about male sex addicts in the media all the time, rarely if ever of women.”
The latest Diagnostic and Statistical Manual of Mental Disorders actually refers to a disorder that resembles sex addiction in “sexual disorder not otherwise specified.” The definition is “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.”
In the DSM-5, there could possibly be a hypersexual disorder as well, which is characterized by “recurrent sexual fantasies, sexual urges, and sexual behavior,” along with other specific criteria like “repetitively engaging in sexual fantasies, urges and behavior in response to stressful life events.”
“To identify a behavioral addiction as an illness is different from saying the person is not responsible for their behavior,” Dennis said. “Everyone is responsible for their own behaviors, whether they are active in addiction or not; addicts have illnesses they didn’t create or ask for ... and they need to take responsibility for getting the help they need to be living in a manner that is in accordance with their value system.”
She said the viewpoint that sex addiction is a myth can harm people who are actually suffering from sex addiction.
“It probably helps those in denial and those who are resentful of sex addicts who have cheated on them (to be more resentful and self-righteous about their pain),” Dennis said. “It ultimately harms the addict and significant others (co-addicts) who might otherwise recognize that they have an illness and that the illness is treatable. And that they could choose to get help.”
Allena Gabosch, the executive director of The Center and Foundation for Sex Positive Culture, said in an email that if anything sex addiction has been mislabeled.
“Much of what is labled sex addiction is OCD (obsessive compulsive disorder) with sex as the compulsion,” Gabosch said. “And it's a way for people who are ashamed of their sexuality ... to explain away what is normal for them.”
She said men seem to carry the label of sex addict more often than women because they tend to engage in or desire sexual behaviors frequently.
“For both men and women it's really wrapped up in shame and how our society views sex. It's very sad,” Gabosch said. “Women who enjoy sex are either sluts or addicts. Neither one is a positive choice. I think that calling it what it is, a myth, will empower some and make it possible for them to embrace their sexuality. It will also quit being used as an excuse for those who commit sexual crimes. And because addiction is such a ‘loaded’ word it will destigmatize sexuality that seems outside of the ‘norm.’”
Sonjia Kenya, an assistant professor of Family Medicine and Community Health at the University of Miami and the author “Sex in South Beach,” said in an email that she does believe in the existence of sex addiction, but that many celebrity stories of sex addiction are merely a matter of a “lack of communication among partners about sexual desires.”
“Addiction is characterized by lack of control, instant gratification coupled with negative long-term effects, and physiological dependence,” Kenya said. “The evidence of sex addiction lies in the significant number of people who cannot stop themselves from engaging in sex behaviors that bring short-term satisfaction but cause negative consequences overall.”
“In many instances of sex addiction, I believe individuals are seeking refuge from intimacy and become physiologically dependent on power. Sex with intimacy leads to vulnerability and society does not reward vulnerable people. Thus, sex without intimacy enables people to experience being as close to another human as possible while maintaining a strong, [impenetrable] bravado (their power). No vulnerability.”
In these cases, the focus can be on learning to be comfortable with intimacy and sex with emotional attachment.
“Intimacy is scary, but people who enjoy intimacy can build deep, honest relationships and develop effective communication patterns with their partner,” Kenya said. “However, lack of intimacy limits trust, communication, and commitment between partners.”
Psychology Today. David J. Ley, Ph.D. Web. March 14, 2012. http://www.psychologytoday.com/experts/david-j-ley-phd
Prause, Nicole. Email interview. March 13, 2012.
Vare, Ethlie Ann. Email interview. March 13, 2012.
Amazon.com. Love Addict: Sex, Romance, and Other Dangerous Drugs. Web. March 15, 2012.
American Psychiatric Association. APA DSM-5 – Hypersexual Disorder. Hypersexual Disorder. Web. March 15, 2012. http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=415
Dennis, Kim. Email interview. March 13, 2012.
Timberline Knolls Residential Treatment Center. Eating Disorder, Drug Addiction & Alcohol Treatment Center – Residential Rehab & Recovery. Web. March 15, 2012. http://www.timberlineknolls.com/
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition: Text Revision: DSM-IV-TR. 2000. http://www.psych.org/mainmenu/research/dsmiv/dsmivtr.aspx
Gabosch, Allena. Email interview. March 14, 2012.
Kenya, Sonjia. Email interview. March 14, 2012.
Reviewed March 15, 2012
by Michele Blacksberg RN
Edited by Jody Smith