Until recently, sex addiction seemed like a disorder that was exclusive to the rich and famous: Michael Douglas, R&B singer Eric Benet, David Duchovny, baseball analyst Steve Phillips, and most recently Tiger Woods. But is sex addiction a real disorder, a true addiction or just an excuse for behaving badly? How much sex is too much? What are the true signs and symptoms of sexual obsession and compulsion? When does sexual preoccupation cross the line into pathology?
Is There a Definition for Sexual Addiction?
The term sexual addiction is used to describe a set of behaviors by a person who has an unusually intense sex drive or an obsession with sexual behaviors or exhibitions. Sex and thoughts of sex dominate the sexual addict's thinking and behavior. These thoughts are characteristically distorted, and are frequently an attempt to rationalize or justify their behavior. There is a strong denial by addicts that they have any type of a problem whatsoever; they are simply manly men acting manly. If confronted, they will frequently blame others. The addiction invariably progresses and escalates; eventually resulting in negative consequences for the addict, his career, personal relationships, and even legal and financial problems.
Many mental health professions liken sexual addiction to any other type of addiction; urges, cravings, patterns of sexual planning and behavior, followed by a sense of relief and elation. The pattern is cyclical: the addict will go through withdrawal and then be lured back by the obsessions, compulsions and cravings.
Sex addiction was listed in the official "Diagnostic and Statistical Manual of Mental Disorders III" in 1980. It was removed from the DSM IV in 1994, related to a belief that only substances, not behavior, could be addictive. A task force is considering restoring it to the DSM V due in 2012, but it could be a long debate.
So who are these so called sex addicts? They are predominately male. Men with sexual compulsive disorders outnumber woman by about 5 to 1. The National Council on Sexual Addiction Compulsivity estimated that 6%-8% of Americans are sex addicts, which equates to 18 to 24 million people. The percentage has ballooned in recent years due to the Internet's accessibility, affordability, and anonymity concerning pornography. 25 million Americans visit cyber-sex sites between one to ten hours per week. Another 4.7 million in excess of eleven hours per week. Sex is the #1 searched topic on the Internet.
Signs and Symptoms of Sexual Addiction
The sexual addict experiences impulses that are so intense, he truly believes that they are beyond his control. Generally, a person with a sex addiction achieves little satisfaction from the sexual activity. He forms no true type of emotional bond with his or her sex partners.
- A lack of control over the behavior, despite negative financial, health, social, and emotional consequences
- Using compulsive sexual behavior as an escape from other problems; loneliness, depression, or anxiety
- Compulsive masturbation, as often as 10 to 20 times a day
- Multiple sexual partners or extramarital affairs
- Anonymous sexual partners: daily ads or the use of prostitutes
- Consistent use of pornography
- Unsafe sex: continuing to engage in risky sexual behavior despite serious consequences, such as the potential for getting or giving someone else a sexually transmitted disease, or an unwanted pregnancy
- Excessive phone or computer sex
- Complaints by others of sexual harassment
- Engaging in types of sexual behavior that you would not have considered acceptable: masochistic or sadistic sex, pedophilia, bestiality, rape
- Anxiety about the secrecy and being discovered
Causes of Sexual Addiction
There have been numerous medical and psychological theories about why sexual addiction occurs. There is no known single cause. Psychological theories include childhood trauma; including physical and sexual abuse. Additionally there are certain diagnostic mental illnesses for which hypersexuality is included: bipolar disorder, depression, obsessive-compulsive disorder, as well as other personality disorders.
Sexual addiction may be the result of an imbalance of natural brain chemicals: serotonin, norepinephrine, and dopamine. Rarely, some neurological disorders can result in sexual addictions: epilepsy, multiple sclerosis, Huntington's disease, head injury and dementia. Certain medications have also been found to cause hypersexuality including apomorphine and dopamine replacement therapy (for Parkinson's disease).
The Possible Consequences of Sex Addiction
The consequences of sexual addiction can be quite overwhelming as our most notorious bad boys can tell you. Just ask Tiger.
Obviously, sexual addiction is associated with many levels of risk taking. A person with a sex addiction engages in various forms of sexual activity, despite the potential for negative and/or dangerous consequences to himself or others, emotionally and physically. The major consequences of sexual addiction include the loss of the individual's standing within his community, his career, his interpersonal relationships and his own self esteem.
The financial consequences can also be very real. Divorce is pricey. So are prostitutes. Add up the phone and cyber sex bills, as well as travel expenses, you might be surprised. Careers, jobs and endorsements are frequently lost. Some sex addicts are sued civilly, legal costs and financial restitution can also add to possible bankruptcy. In fact, sixty percent of sex addicts have faced financial difficulties.
For some people, the sex addiction progresses to involve illegal activities with resultant arrest and incarceration. 58% of sex addicts have engaged in illegal activities. Their crimes include exhibitionism, voyeurism, making obscene phone calls, stalking, pedophilia, bestiality, molestation or even rape. They are usually not welcome cellmates.
Additionally 83% of sex addicts have other concurrent addictions: alcoholism, drug abuse, eating disorders, or compulsive gambling. Many have coexisting psychiatric diagnoses. The good news is that there is effective treatment for those willing to seek it out.
Treatment for Sexual Addiction
The effective treatment for compulsive sexual behavior typically involves a multitude of modalities: psychotherapy, medications and self-help groups. If an individual presents with a sexual addiction has a severe mental illness, poses as a danger to self/others, or has additional addictions, inpatient treatment is indicated initially. If the addict is considered stable, treatments can be done at a rehab center or on an outpatient basis. Addicts need to find qualified mental health professionals with previous experience in addiction, specifically, sexual addiction.
Psychotherapy consists of increasing the addict’s unconscious thoughts and behaviors, allowing for insight to help resolve conflicts. Whereas, cognitive behavioral therapy helps the addict identify unhealthy, negative beliefs and behaviors and replace them with healthy and more positive ones. Group therapy allows the addict to realize that he is not alone; with the guidance of a mental health professional the addict can share his own experiences, and listen to the experiences of others. The mediator can than assist with problem solving tactics. Finally, family therapy or marriage counseling is essential if the addict has a partner or children. The addict's compulsive sexual behaviors will have affected the entire family. Spouses, partners, and children need to be able to confront the addict and explain how the addict’s behavior has affected each of their lives.
Certain medications have been found to be helpful for sexual addiction as they act on brain chemicals linked to obsessive thoughts and behaviors. They also tend to reduce the chemical rewards these behaviors provide such as euphoria. Which medications will be the most beneficial for any addict can only be determined by an experienced psychiatrist depending on coexisting medical or psychological conditions, as well as a history of other addictions. Antidepressants and mood stabilizers may be prescribed. Naltrexone (generally used to treat alcoholism) may be used to block the part of the brain that feels pleasure with certain addictive behaviors. Anti-androgens (medroxyprogesterone) reduce the biological effects of sex hormones in men, decreasing sexual drive. Luteinizing hormone-releasing hormone (LHRH) may reduce the addict’s obsessive sexual thoughts by reducing the production of testosterone.
Additionally, self-help and support groups can be effective for sexual addiction. These groups are available online and in person. The most popular groups include: Sexaholics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual Recovery Anonymous, and Sexual Compulsives Anonymous. Family members can receive support from Codependents of Sex Addicts (COSA) and S-Anon International.
There are many sexually addicted individuals who are law abiding citizens who hurt no other individuals and rarely rise to general public scrutiny. However, these individuals may be suffering needlessly from a treatable addiction. Then there are the sex addicts who have committed (sometimes horrific) crimes, and will need to be separated from society indefinitely. Most sexual addicts fall somewhere in the middle. They do not break laws, but they do wreak havoc in the lives of other people.
But let's not forget that there are bad guys acting badly, believing they will never get caught. This is the essence of the controversy of the validity of sexual addiction as a valid disorder. With an accepted concept or diagnosis of sexual addiction there is bound to be a rash of individuals who will use their infidelities, abhorrent sexual activities, deceit, and criminal activity as an excuse for misbehaving, or as an insanity defense.
Sexual addicts' lives play out slowly but eventually. Time will tell how Tiger overcomes his addiction, and the fallout it has created in his marriage, fatherhood, career, financial status, etc. Sex addiction does not explain all sexually troublesome behaviors, or excuse harm caused as a result of sexual acting out.