Exploring Sex Addiction
'Sex addiction' is a term that gets bandied around a great deal these days, despite it being a concept that was unheard of a couple of decades ago. It is a phrase that can cause strong reactions, often of derision and disbelief. These may range from ‘is it a real addiction?’ to ‘it’s just an excuse for bad behaviour’. The media is often guilty of sensationalising sex addiction, salaciously reporting on celebrities who have been caught in flagrante and then checked into rehab. Often, people who seem to enjoy having a lot of sex - or sex with many different partners – may be jokingly described as ‘sex addicts’ by their friends. And yet, for many thousands of people, sex addiction is nothing to joke about. It is a very real problem that blights their lives on a daily basis.
For some people, this might take the form of prolific pornography use, while for others it might be weekly visits to escorts or a never-ending stream of one-night stands. It is not the behaviour per se that is the marker of sex addiction, but rather the negative impact that it has on the individual’s life. For sex addicts, rather than being a pleasurable experience, sex is used compulsively to relieve negative emotional states and, as a result, often causes significant distress. Despite this distress, they feel unable to stop the behaviour. Clients usually only walk into the therapist’s consulting room once the addiction has become completely unmanageable, for example because it has resulted in loss of employment due to pornography use on work computers, financial ruin due to numerous escort visits or marriage breakdown due to the multiple affairs.
So, what do we really mean by the term ‘sex addiction’? Are you a sex addict if you watch porn? What about if you have an affair? Or if you visit prostitutes occasionally? How can you – and your partner – identify whether you have this specific problem?
Am I a Sex Addict?
While the term ‘sex addiction’ may not yet have acquired international medical recognition, the World Health Organization has included ‘compulsive sexual behaviour disorder’ in the International Classification of Diseases (ICD-11), the global manual of health disorders. They identify a number of components to this disorder:
So, sex addiction (or compulsive sexual behaviour disorder, to give it it's proper name) is a very specific phenomenon. It does not refer to someone who simply enjoys lots of sex. A sex addict is someone for whom the relationship with sex has become problematic. They keep engaging in sexual behaviours in a compulsive way, even when they recognise that these behaviours are unhealthy and damaging for them. Their relationship with sex brings them great distress and yet, despite this, they find that they are unable to stop the harmful behaviours. It is this element of distress that delineates sex addicts from those engage in the same sexual activities without harmful consequences for themselves or others.
One of the key things we know about sex addiction is that the behaviours often tend to escalate over time. The types of sexual activity that give sex addicts and porn addicts pleasure at one time are not enough to excite them after repeated exposure. They therefore find themselves seeking out increasingly more impactful activities. For one person, this might mean that the type of porn they watch becomes increasingly hardcore. Some people find themselves straying into looking at illegal imagery in their quest for greater levels of excitement. For others, they might move from watching pornography to interactive webcams as they want a greater sense of interaction. Later this might move on to visiting massage parlours or escorts. Often, when people look back at the trajectory of their addictive behaviours, they realise that they never had any intention when they started of letting things progress to the point they had. It is as though something in their brains has taken over the rational part of them that is usually responsible for decision-making.
Examples of Sex Addiction
Sex addiction can take a number of different forms, and it might not always be what we expect. Let’s look at a few examples to see what we might describe as sexually compulsive, and what we would not.
James visits escorts every week, while his friend Greg does so twice a year. James is single, solvent and making what he deems a healthy decision about how to have a fulfilling sex life. He doesn’t experience any conflict about his behaviours and, by choosing escorts who are independent and working of their own free will, does not believe he is harming anyone. Greg, however, is married and in great distress about how his behaviour does not reflect how he wants to be in his relationship. His wife does not know about his behaviours but he still feels a great sense of shame. He has tried to stop the behaviour repeatedly, he despises himself for lying to his wife and he fears that he has brought potential STIs into the relationship. His behaviour is causing him marked distress and yet he finds himself repeating it. Greg may well benefit from treatment for sex addiction.
Let’s take pornography. A couple - Leanne and Scott - view pornography together as a healthy part of their sex life. It doesn’t cause them any problems and their sex life isn’t dependent upon it. This is not sex addiction. Abdul, who is single, watches porn on a nightly basis, masturbating for hours as he tries to find the right image to ejaculate to. As a result, Abdul is not sleeping and his work is suffering. His boss has given him repeated warnings about his poor performance, and each time he vows to himself that he will stop using porn and get a good night’s sleep. However, he finds himself in a vicious cycle: the worry about losing his job leads him to look for something to make him feel better, and he turns once again to porn. Abdul is continuing to engage in sexually compulsive behaviour despite the fact that the consequence may be the loss of his job. He has tried repeatedly to change, but has failed. Abdul meets the criteria for sexual addiction.
A group of city bankers go to lap-dancing clubs to entertain visiting clients. For some of the group, this is simply a little light relief. They enjoy the show and feel no particular remorse about visiting the club. For one of their colleagues, Dan, however, the visit feels very different. He finds himself spending more and more money on alcohol, then private shows. In the morning, he looks at his credit card statement with disbelief. He spent far more than intended and, as this happens on a regular basis, he is finding himself in increasing financial difficulty. Dan vows never to do it again, but the following week, the same thing happens. As Dan is experiencing distress at his behaviours, has tried repeatedly to give them up and failed, and they are having a negative impact on his finances, we would describe his behaviour as sexually compulsive.
Sara works as an escort. She took the decision after enjoying meeting up with men from a ‘sugardaddy’ site, who paid her for sex while she was a student. She feels empowered by her work and the money she earns gives her the ability to fund her Masters degree. Her friends disapprove of her choice of work and tell her she must be a sex addict. Sara, however, experiences no internal conflict about her escorting, enjoys meeting most of her clients and has fun sexually. While some of her friends might question Sara’s moral judgement, this does not make her a sex addict.
Emily joined Tinder in order to find a partner. Before long, she found herself enjoying the attention of numerous men who wanted to meet her for sex. The sexting conversations led to her often sending risqué photos of herself to strangers and then meeting up with people for exciting sexual encounters. She found the experience thrilling. As time went by, Emily found herself taking increasing levels of risk, meeting people she had just started chatting to in their apartments or in deserted areas. One night, Emily had a narrow escape after one man refused to stop the rough sex they were having. She was left shaken and bruised, and vowed never to meet a stranger again. And yet a week later, she found herself doing the same thing, in a desperate search for the thrill and validation she had experienced previously. Sometimes, she would find herself having sex with people she felt no attraction to, or engaging in sexual acts she didn’t enjoy, because she had put herself in the situation and didn’t know how to back out. In order to get her sexual high, she found herself engaging in increasingly risky sexual behaviours, not always using protection. Emily experienced a great deal of self-loathing as a result of her behaviour. Repeatedly, she told herself that she would stop, but after a few days, she would be drawn back into it. Emily’s behaviour had become sexually compulsive: it was causing her distress and self-loathing, but despite this, she had failed to stop.
Hopefully these examples begin to help us to understand what sex addiction is and what it is not. Perhaps you can relate your own experience to some of them, and you may begin to get an idea as to whether your own behaviour is sexually compulsive.
The Twelve Step Group Sex Addicts Anonymous (SAA) also have a useful quiz that can help you to determine whether you are struggling with out-of-control sexual behaviour.
Do I Have to Identify as a Sex Addict to Benefit from Therapy?
I have chosen to use the term ‘sex addiction’ on this website as it is the language that most clients use when they come to see me, and therefore the term that people are likely to search for when they are seeking out help. Often people find the term 'sex addiction' useful, as it helps them to make sense of their behaviours.
However, for other people, there is too much perceived shame or uncertainty attached to the term ‘sex addict’ for it to seem helpful. If this is the case for you, the important thing to focus on is whether or not your sexual behaviour feels like a healthy or unhealthy part of your life. When I use the term 'unhealthy sexual behaviours', I am not talking about labelling particular behaviours as generically being unhealthy; instead I am talking about behaviours that are unhealthy for you as an individual. For example, I am not labelling porn as inherently unhealthy, it is the relationship that you have with the behaviour that may be unhealthy, rather than the behaviour itself. If your sexual behaviours feel unhealthy and are causing you distress, then you may find it useful to engage in therapy.
Unlike with Twelve Step groups, there is no requirement for you to label or identify yourself as a sex addict in order to engage in therapy with me. Use the term if it feels helpful to you, ignore it if it does not. However, do not use that as an excuse to ignore the unhealthy behaviours themselves. You owe it to yourself to have the opportunity of a healthy fulfilling sex life, rather than one that is destructive and causes you pain.
If you believe that your own relationship with sex has become unhealthy, and that you would benefit from professional help, then please click here to contact me.
Is Sex Addiction Real?
One of the criticisms often levelled at the concept of sex addiction is that it is simply pathologizing natural changes in societal norms. Our societies have definitely become far more sexually open than they were 50 years ago, and we now accept and enjoy all kinds of sexual behaviours that would have probably been frowned upon by our grandparents. The advent of the Internet has been a key factor in this, opening up the possibility to access a wide range of sexual material at the click of a button and often free of charge. These changes have crept up on us without us necessarily being aware of some of their unintended consequences. We did not realise that repeated exposure to highly stimulating sexual imagery would gradually change the brain, leading it to want to seek out more of the exciting materials. And because the imagery that we are looking at is often an enhanced version of our normal sexual stimulus (large, continually erect penises, pert breasts and perfect vaginas), we find ourselves less able to become aroused by the real thing. I see repeated cases of porn-induced erectile dysfunction in my clinic, as well as many individuals lacking sexual confidence because they feel they do not match up to what they see on screen.
It is important to underline that, in speaking up about sex addiction, we are by no means denigrating sex. As a sex therapist, I spend much of my working life supporting people to have healthy, fulfilling, enjoyable sex. I am a champion of sexual exploration for my clients and help them to celebrate sex in all its glorious, weird and wonderful forms. There is no moral judgement intended in describing someone as having a sexual addiction. The term is not intended to condemn certain types of sexual activity or to judge those who make a healthy choice to have multiple partners or watch pornography or even pay for sex. Unfortunately, the term has been misused at times to pass judgement on those who may enjoy a more libertarian lifestyle than our traditional society has deemed morally acceptable. This is a misuse of the term sex addiction. If someone is enjoying their sexual lifestyle and it is not causing harm to them or those around them, then we have no right to pathologise their behaviour. If, however, they are engaging in sexual behaviours that are unhealthy for them and their relationships, then they may need help to stop.
Therapists and academics may continue to argue between themselves as to whether sex addiction is a ‘real’ addiction, but there is one thing all of us who encounter it are clear about: when sexual behaviour becomes out of control, it has disastrous consequences, both for the person concerned and those close to them. Because the behaviour is out of control, the person cannot simply choose to stop. This may work in the short-term, but the behaviours will creep back in if the person has not identified why they are behaving like this and then addressed the root causes. If you feel that you would benefit from help in doing this, then please do click here to contact me.