Is Sexual Addiction Real?

When a new TV seasons starts up and one of the hit shows is about sex addiction, suddenly everyone is focused on sexual addiction. “Look, a new disorder!” “Look, David Duchovny actually has it!” Like most other compulsive behavioral conditions, sexual addiction is not recognized as a “real” disorder by the psychiatric diagnostic book, the Diagnostic and Statistical Manual of Mental Disorders (the DSM).

However, unlike most other behavioral compulsions, sexual addiction does have a fairly rich and long research history (over 550 citations appear in PsycINFO on sexual addiction). The concept of sexual addiction, according to Levin and Troiden (1988), first came from a member of a Boston-area Alcoholics Anonymous chapter, who recognized his sexual behaviors as something he called “sex and love addiction.” He then adopted the 12 steps to this problem, which then began to spread and was eventually picked up by psychology clinicians and researchers. The first professional conceptualization and description of sexual addiction in the research literature appeared in 1983 (by Carnes, an ex-prison psychologist, who claimed he actually discovered the problem in the 1970s but didn’t write about it until years later). Debate swirled back and forth about the legitimacy of these labels when they first appeared on the scene.

Sexual addiction, like other behavioral compulsions outside of gambling, has never made it into the DSM, however (contrary to what is claimed in the Wall Street Journal article, which inaccurately states it was in the DSM-III [don’t newspapers fact-check any more?]). In fact, the DSM-IV, the most current revision of this book, makes absolutely no mention of the concept of sexual compulsions or addiction, not even under categories for further study. Given that the DSM-IV was published in 1994, a full decade after the concept of “sexual addiction” made it onto the research scene, it does suggest that this is a category that was never seriously considered a full-blown disorder unto itself.

So Why Isn’t Sexual Addiction a Recognized Disorder?

It’s hard to say with any certainty. Levin and Troiden (1988) argue that simply shifting societal values are the main reason to blame. They also bemoaned both the soft science underlying the supposed condition and the spate of media attention of “sexual addiction” in the 1980s (not unlike the media attention given to this same concern nearly 20 years later!). Levin and Troiden also level many additional criticisms at “sexual addiction” as a stand-alone disorder, but most of them are comparatively weak and technical in nature.

Compulsions, as defined by the DSM-IV, are not something that bring a person pleasure. That is why gambling is defined as simply “pathological” and not “compulsive.” The only recognition in the DSM-IV that a person might engage in an enjoyable sexual activity to some extreme is the inclusion of a class of sexual disorders known as paraphilias. Paraphilias are “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving (1) nonhuman objects, (2) the suffering or humiliation of oneself or one’s partner, or (3) children or other nonconsenting persons.” So while arguably the DSM-IV recognizes sexual compulsions, it’s only in the context of some sexual object, scene or person.

One can’t deny the people who flock to clinicians’ doors looking for treatment for sexual addiction, however, no more than one can deny that people believe they are “addicted” to the Internet. What is both amazing and a little disturbing, however, is to see entire professional societies, such as the Society for the Advancement of Sexual Health, spring up around a disorder that isn’t even officially recognized as such. And despite no clinical agreed-upon criteria for sex addiction, the Society estimates that 3 to 5% of Americans have it.