Sex Addiction

Sex addiction

You may have heard of term “sex addiction” and wondered – is that real, or is it just an excuse for people who lack moral fiber? Is it just a fad? Is it a way to judge people with sexual behaviors and preferences that are not mainstream?


Does Sex Addiction Exist?

Sex addiction is a relatively young and controversial field in the mental health community. It stirs passionate debates between clinicians, unfortunately not always helpful or productive. The way the term has been usually portrayed in the media has made this situation more confusing, and created more stigma around it.

The term “sex addiction” itself has pros and cons. On one hand, it offers people a way to understand and make sense of their patterns of behavior. It can also offer, through multiple programs supporting sex addiction recovery, a community of peers who share similar experiences and are struggling with similar challenges. On the other hand, some people believe that the term "addiction" is moralistic and can pathologize certain behaviors (i.e., whatever is not the "norm," sexually speaking), or be misused to label as “addicts" people with non-mainstream sexual preferences.

Other terms that have been used to describe this phenomena are hypersexuality (even though sex addiction is not about being "too sexual" or having "too much" sex) or compulsive sexual behavior (although compulsivity is only part of the experience). Another term used more recently, which I think is useful, is Out of Control Sexual Behavior (OCBS).

Whether we call it sex addiction or something else, the fact of the matter is that many people are affected by it, living a double life, overwhelmed with shame and hopelessness, and making their lives and the lives of the ones they love unmanageable. While I am not married to any term in particular, I think “sex addiction” is a useful analogy to the experience many people have.


What is Sex Addiction?

Sex addiction can be understood as a pattern of sexual obsessions and behaviors. These behaviors have the following characteristics:

  • They are performed compulsively.
  • They continue despite their negative consequences (e.g., shame, isolation, lost relationships, legal or health issues).
  • They typically increase in frequency, duration, intensity, or severity.
  • They continue despite repeated attempts to stop.
  • They are often used as a coping mechanism to deal with overwhelming negative and positive emotions.

Sex addiction is a disorder of intimacy, which usually interferes with the capacity to trust and be vulnerable in relationships. Impaired relationships are oftentimes a cause of addiction, and it is almost always a consequence. You can read more about addictions and relationships in this post.


Sex Addiction is not about Sex

Sex addiction is not about sex, but about the individual’s relationship with sex. It is not defined by specific behaviors, but by the relationship the person has with those behaviors. Common behaviors such as masturbation can generate a compulsive dependence, while less common preferences such as BDSM can be practiced in a healthy and trusting way.

Is someone who wants to have sex “all the time”, has an affair, or visits strip clubs a sex addict? Not necessarily. Is watching porn, having a foot fetish, wanting an open relationship, or having same-sex fantasies a sign that there is a problem? There might be a problem if these things create emotional distress, but that doesn’t mean that the problem is sex addiction.


Types of sex addiction

It is important to distinguish two types of sex addiction, which we can call "traditional" and "modern."

  1. "Traditional" sex addiction is often rooted in attachment issues. This means that it is a response to patterns of neglect, rejection, lack of safety, inconsistency, or physical or emotional abandonment during childhood. In these cases, sex addiction is often rooted in traumatic experiences and could be considered an attachment disorder. We have a "relationship" with the addiction that serves a purpose, like self-soothing after an injury, avoiding fear or anxiety, or coping with fear of rejection (read more about addiction and relationships in this post and this paper). Therefore, the addiction is a symptom of deeper underlying issues, related to our conscious and unconscious views about ourselves and others. The specific behaviors involved can be very diverse, and may include anything from sexual fantasies and compulsive masturbation to pornography, to serial extramarital affairs, paying for sex, manipulating others for sex, or engaging in exhibitionistic behavior.
  2. "Modern" sex addiction has been on the rise as the internet became mainstream, even among people who have had a healthy and secure upbringing. "Modern" sex addiction is mostly expressed as a compulsive, and sometimes exclusive, use of online pornography. Our brains are not prepared for the unprecedented overstimulation available online. For example, the amount, variety, and intensity of sexual acts that a person can watch in 10 minutes online, dramatically exceeds what a person could see in a lifetime only a couple of generations ago. When pornography overstimulates our brain, its chemistry changes in ways similar to other addictions, by “hijacking” the mechanisms that make us repeat pleasurable behaviors. This is a bigger problem when the person exposed to excessive porn is a child or a teenager, because their brain is still in development. As a result, it becomes more difficult to connect and engage sexually in real life, resulting in shame and intimacy issues. For our brains, real life is just no match for the "high" of porn.


Sex Addiction Treatment

Many people seek help for sex addiction when their life is in disarray. Their spouse found out about their multiple affairs, they lost their jobs for watching pornography at work, or were arrested for solicitation. Others are not in crisis, but feel tired of living a double life, don't understand why they can't stop certain behaviors, or just want to make changes in their life. 

I do not think there is only one path to recovery from sexual addiction. That said, there are multiple 12-step programs (based on the principles of Alcoholics Anonymous) that help thousands of people around the world. They can be a great complement to psychotherapy, and provide a space for people to open up and connect with others who have similar experiences. Read here about how 12-step programs and therapy and complementary.

While the addiction is not defined by the behaviors themselves, these behaviors can be problematic. They usually create painful shame for the people who engage in them, and immense suffering for those who love them. An important step in recovery from sex addiction is breaking from denial, recognizing the behaviors experienced as problematic, and taking full responsibility for them. This needs to be done in a non-judgemental and sex-positive environment, with compassion and safety.

The behaviors are usually the symptom of something else, so focusing on them can be necessary but it is not enough. It is equally important to address the underlying issues. These might include shame about our sexual preferences or behaviors, identity and orientation issues, unprocessed traumatic experiences, mistrust or fear of others, and difficulties with intimacy in relationships.

Therapy for sex addiction is not only about modifying certain behaviors. Treatment is also about understanding why the addictive behaviors became a way to cope with reality, becoming aware of the role they play in the our life, letting go of shame and hopelessness, and regaining our capacity to have intimate relationships. Recovery does not mean not having sex, or having only a specific kind of sex. The goal is to work through the relationship we have with sex and develop a lasting understanding and experience of healthy sexuality.