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
Add a Comment2 Comments
Sorry David, but you are engaging in an intellectual sleight-of-hand when you lump porn addiction in with sex addiction. Whether you find the existing evidence of sex addiction persuasive or not, there is ample evidence that novelty-at-a-click causes addiction in some brains - whether it arises in the context of excessive slot machines, videogaming, Facebook or Internet porn use. Perhaps you haven't been keeping up with the latest Internet addiction studies (which include, but are not limited to, porn use). The studies show brain changes that are fundamentally the same as are seen in drug addicts' brains.
Your position that sex addiction is a myth also shows a lack of understanding of the true underpinnings of addiction, which are tied to dopamine dysregulation and related brain changes. It is the presence of these changes that make an addict an addict...not the particular activity engaged in. This is why the American Society of Addiction Medicine publicly stated that both food and sexual behaviors *can* cause addiction in some brains. It's too bad the author of this piece seems unaware of this statement by the leading experts in addiction. Here's a link to their FAQs related to the statement, which discuss the existence of sexual behavior addictions. http://www.asam.org/docs/default-document-library/20110816_defofaddiction-faqs.pdf#search=%22long%20version%22
Incidentally, equating disbelief in sexual behavior addictions with "sex positivity" is particularly unsettling, as those who become addicted to Internet pornography often report sexual dysfunctions (delayed ejaculation, inability to sustain erections with real partners and so forth), which only reverse themselves when they stop using Internet porn for a few months. There's little more "sex negative" than erectile dysfunction.March 17, 2012 - 5:54am
Nice article - one editorial note - my book is nonfiction, not a "novel" - I'll offer a couple of comments, in response to some of the points:March 16, 2012 - 9:32am
1. The inclusion of "distress over a succession of lovers" in the Sexual disorder NOS is a holdover from the days of the Don Juan diagnosis, and does not in fact fit a huge percentage of those individuals allegedly diagnosed as sex addicts - including those with excessive masturbation or pornography use, and does not fit the ideas of the "love addict."
2. Your article illustrates very well one of my main points - sex addiction is very poorly and vaguely defined - each expert you cite has their own pet theory explaining this concept, and their own way of defining it. This leads to incredible subjectivity.
3. The concept of "love" addiction is incredibly gender-biased, in an offensive way. Three are women out there who enjoy anonymous, casual sex, and there are men who cannot get an erection unless they are in love. Love is a powerful, wonderful thing - not a disease or a pathogen.
4. To assert that we should preserve a fictional diagnosis in order to not hurt people is a ludicrous argument - the American Psychiatric Association is responsible to establish and maintain diagnoses based on science and evidence. I assert that it is far more harmful to tell people they have a disorder that doesn't exist - the history the Recovered Memory Syndrome and the controversy around the Sexual Orientation Conversion efforts to make people stop being homosexual are just two examples of the damage that can result from the misuse of unsupported diagnostic categories and treatments. I've seen countless people who were stigmatized and shamed by the label of sex addiction. Where is the voice for them, and their suffering?
5. I agree with you - I am relatively unique in standing up and publishing this book to challenge this concept. Why is that? If, as you assert, most clinicians really don't believe in this disorder, why are they going along with it? I think that's a very interesting story, and reveals the economic conflict of interests of the sex addiction industry, and the way in which this concept has become a moral panic, rather than a medical diagnosis.
My book, The Myth of Sex Addiction, covers all these issues and more, and is available on Amazon.
- cheers, and thanks for writing such a well-done article. Ultimately, my goal is to engage and facilitate the debate.
David Ley PhD.