Despite there being no agreed-upon clinical definition of the disorder, clinicians and doctors are happily treating thousands of patients for this disorder every year. The treatments of choice? Antidepressants and 12 step programs:
Considerable debate exists about the appropriate conceptualization of this clinical syndrome and its place in psychiatric nosology. Some investigators have suggested that this condition constitutes a nonpharmacologic addiction; others have suggested it constitutes an obsessive-compulsive spectrum disorder. Finally, an impulse control model has been proposed. Nevertheless, there have been encouraging outcomes with psychotherapeutic and psychopharmacologic treatments. Currently, a number of treatments have been suggested as potentially effective: “Twelve-Step” programs, behavioral therapy, cognitive therapy, and several medications, including antiandrogens and selective serotonin reuptake inhibitors (Vesga-Lopez et al., 2007).
And despite there being an entire journal devoted to the condition (Sexual Addiction & Compulsivity), there are surprisingly few outcome studies conducted on what is the best or most effective treatments for this hypothetical disorder. One of the problems is the lack of broad agreement on the definition of the problem; without such a basic building block, it’s hard to conduct comparative, reliable studies on the phenomenon.
Our take on sexual addiction is very similar to our stance on “Internet addiction.” Any behavior taken to an extreme can be considered pathological, especially those behaviors which bring a person some degree of pleasure (such as watching television, pathologically following a particular sports team, gambling, texting, drinking coffee, reading a book, or shopping, amongst the dozens of behaviors that people pathologically take to an extreme everyday). Those behaviors with a social component not surprisingly seem to be more attractive to people than those without. (Heady insights here, I know.)
We’re not clear where one draws the line with such behaviors, except to use that always reliable catch-all that accompanies all diagnoses in the DSM — “the behavior causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.” With that in mind, however, we would suggest a far broader pathological behavior category that encompasses all reinforcing stimuli, since there’s absolutely zero research to show that engaging in mutually consensual sex, playing games on the Internet, or texting one’s friends are inherently dangerous or maladaptive behaviors.
Further Reading:
Wall Street Journal: Is Sex Addiction a Sickness, Or Excuse to Behave Badly?
Slate: Sex Dramedy: What can Choke and Californication Teach us About Sex Addiction?
The New York Times: Some Sexual Behavior Viewed as an Addiction (from 1984, also filled with some factual inaccuracies)
References:
Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare Publications.
Levin, M.P. & Troiden, R.R. (1988). The myth of sexual compulsivity. The Journal of Sex Research, 25(3), 347-363.
Vesga-Lopez, O., Schmidt, A. & Blanco, C. (2007). Update on sexual addictions. Directions in Psychiatry, 27(2), 143-158.
9 comments
I’m always reminded of one of my first clinical psychology lectures. One of the first addictions was considered to be golfing!! (Way back in the day).
I agree that new ‘addictions’ need to be seriously considered in the light of the current cultural trends. One of the main drivers behind new addictions is finding new ways to sell drugs by pharmaceutical companies. Who can forget that ‘Social anxiety disorder’ had never existed until there was a drug to sell. Before then it would have been ‘extreme shyness’
Although I agree with the comment above that pharmacological industry is the main thrust behind inclusion of many psychiatric disorders in DSM-IV, I don’t think excessive interest in sexual activities or excessive indulgence in sexual pleasure should be a disorder until and unless it causes severe problem in occupation, social and academic life of a person and it causes significant distress in the life of the person so much so that he is himself forced to consult any psychiatrict for the treatment of some obsessive behaviours.
Great blog! This website also has some interesting articles on controlling emotions:
http://www.searchforbalance.org
“In fact, the DSM-IV, the most current revision of this book, makes absolutely no mention of the concept of sexual compulsions or addiction”
You’re wrong, there *ARE* sexual compulsions listed in the DSM IV:
Exhibitionism, Fetishism, Frotteurism, Pedophilia, Sexual Masochism, Sexual Sadism, Transvestic Fetishism & Voyeurism.
Generic sexual addiction presumably isn’t listed for the same reason homosexuality isn’t listed any more – most people don’t consider it either a problem or a disorder 😉
Of course I should have said “concept of a general addiction to sex.” I mentioned the disorders you noted two paragraphs down, and what makes them separate and distinct from a more general concept of “sexual addiction” (e.g., addicted to sex itself).
Sexual compulsions exist, they are getting worse (thanks to the internet), and they cause pain and suffering. I don’t see how anyone can dispute this fact. Professionals I deeply respect come down on different sides of the question of whether “sexual addiction” exists. No question the name may be much less accurate than the one I believe we will wind up with. Eli Coleman Ph.D. suggests we call it “Syndrome X.” No professional would say that someone suffered a “nervous breakdown.” But when laypeople say “sexual addiction,” they know what they are talking about.
I worry that the debate about the name of this problem will interfere with people coming in to get treatment for sexual compulsions which pull them farther and farther away from the capacity to want to to experience what I feel is a very wonderful and human experience: sexual intimacy with a live, flesh and blood, imperfect, human with their own needs. Relational sex is imperfect. Always has been. Always will be.
When you look at the internalized and media-driven pressure on men to have instant, rock hard erections seamlessly no matter what, you can see some of the forces that make masturbating to computer porn so enticing. Who can deny that it’s easier to have a mind-blowing orgasm when you don’t have to worry about the back and forth communicating that is a central part of coupled sex? But this is like the Gresham’s Law of sexuality: pornographic sex beats out intimate sex.
When people get so caught up in this pattern of compulsive, non-relational sex that they cannot stop, even when they want to, and they ruin relationships and make having eyeball-to-eyeball sexual pleasure with someone they care for an impossibility,
they need help. They deserve help. Why make them feel crazy for needing help with a condition that doesn’t have enough research or isn’t listed in the DSM. Look at what we understand about sexual trauma that we didn’t understand 15 years ago!
Thanks for opening up this topic.
Aline Zoldbrod Ph.D.
Boston, Massachusetts
http://www.SexSmart.com
I find it ridiculous that in the upcoming DSM V, only gambling can be qualified as a behavioral addiction, and that internet addiction and sexual addiction are not disorders that can be diagnosed.
The research done on sexual addiction is more than sufficient to have it qualify as an addiction in the DSM V. The research data includes the brain mapping of sexual addicts and recovered sexual addicts. It has been clearly shown that the brain mapping matches the chemical addiction studies.
For those curious to learn more, check http://www.sexintegrate.com,
and go to “What is a sex addict.â€
Thanks for addressing such a taboo topic, John.
Paul P. Shepard, Ph.D., CSAT
Oakland, California
I agree with quite a few of the comments that have been left on this page. I do find it hard to believe that gambling is the only behavioral addiction in the DSM-V. It is clear that there has been extensive research on sexual addiction, as well as many other addictions that could probably be diagnosed.
Hopefully, there will be further research in this and possibly a definitive decision on this.