Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual thoughts and acts. Like all addictions, its negative impact on the addict and on family members increases as the disorder progresses. Over time, the addict usually has to intensify the addictive behaviour to achieve the same results.
For some sex addicts, behaviour does not progress beyond compulsive masturbation or the extensive use of pornography or phone or computer sex services. For others, addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, child molestation or rape. Sex addicts do not necessarily become sex offenders. Moreover, not all sex offenders are sex addicts. Roughly 55% of convicted sex offenders can be considered sex addicts.
The same compulsive behaviour that characterizes other addictions also is typical of sex addiction. But these other addictions, including drug, alcohol and gambling dependency, involve substances or activities with no necessary relationship to our survival. For example, we can live normal and happy lives without ever gambling, taking illicit drugs or drinking alcohol. Even the most genetically vulnerable person will function well without ever being exposed to, or provoked by, these addictive activities.
Sexual activity is different. Like eating, having sex is necessary for human survival. Although some people are celibate — some not by choice, while others choose celibacy for cultural or religious reasons — healthy humans have a strong desire for sex. In fact, lack of interest or low interest in sex can indicate a medical problem or psychiatric illness.
According to DSM-IV-TR, sexual addiction, under the category ‘Sexual Disorders Not Otherwise specified’ is characterised by 3 or more of the following symptoms over a period of at least 6 months:
- Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges, or sexual behaviours in association with 3 or more of the following 5 criteria
- Time consumed by sexual fantasies, urges or behaviours repetitively interferes with other important (non-sexual) goals, activities and obligations
- Repetitively engaging in sexual fantasies, urges or behaviours in response to dysphoric mood states (E.g. anxiety, depression, boredom, irritability)
- Repetitively engaging in sexual fantasies, urges or behaviours in response to stressful life events
- Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviours
- Repetitively engaging in sexual behaviours while disregarding the risk for physical or emotional harm to self or others
- There is clinically significant personal distress or impairment in social, occupational or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or behaviours.
- These sexual fantasies, urges or behaviours are not due to the direct physiological effect of an exogenous substance (E.g. a drug of abuse or a medication).
Risk Factors and Causes
Why some people, and not others, develop an addiction to sex is poorly understood. Possibly some biochemical abnormality or other brain changes increase risk. The fact that antidepressants and other psychotropic medications have proven effective in treating some people with sex addiction suggests that this might be the case.
Studies indicate that food, abused drugs and sexual interests share a common pathway within our brains’ survival and reward systems. This pathway leads into the area of the brain responsible for our higher thinking, rational thought and judgment.
The brain tells the sex addict that having illicit sex is good the same way it tells others that food is good when they are hungry. These brain changes translate into a sex addict’s preoccupation with sex and exclusion of other interests, compulsive sexual behaviour despite negative consequences and failed attempts to limit or terminate sexual behaviour.
This biochemical model helps explain why competent, intelligent, goal-directed people can be so easily side-tracked by drugs and sex. The idea that, on a daily basis, a successful mother or father, doctor or businessperson can drop everything to think about sex, scheme about sex, identify sexual opportunities and take advantage of them seems unbelievable. How can this be?
The addicted brain fools the body by producing intense biochemical rewards for this self-destructive behaviour.
People addicted to sex get a sense of euphoria from it that seems to go beyond that reported by most people. The sexual experience is not about intimacy. Addicts use sexual activity to seek pleasure, avoid unpleasant feelings or respond to outside stressors, such as work difficulties or interpersonal problems. This is not unlike how an alcoholic uses alcohol. In both instances, any reward gained from the experience soon gives way to guilt, remorse and promises to change.
Research also has found that sex addicts often come from dysfunctional families and are more likely than non-sex addicts to have been abused. One study found that 82% of sex addicts reported being sexually abused as children. Sex addicts often describe their parents as rigid, distant and uncaring. These families, including the addicts themselves, are more likely to be substance abusers. One study found that 80% of recovering sex addicts report some type of addiction in their families of origin.
Unlike drug or alcohol treatment, the goal of sexual addiction treatment is not lifelong abstinence, but rather a termination of compulsive, unhealthy sexual behaviour. Since it is very difficult for a sex addict to distinguish between healthy and unhealthy sex, programs usually encourage abstinence from any sexual behaviour during the first phase of treatment. Many programs suggest a 60- to 90-day period of self-imposed abstinence. This enables you, along with the treatment team, to understand the emotional cues and circumstances that trigger sexual thought and compulsive sexual behaviour.
Treatment will focus on two main issues. The first is the logistical concerns of separating you from harmful sexual behaviour in the same way drug addicts need to be separated from drugs.
Accomplishing this might require inpatient or residential treatment for several weeks. An inpatient setting protects you from the abundance of sexual images and specific situations or people that trigger compulsive sexual behaviour. It’s simply harder to relapse in a structured and tightly controlled setting. Sometimes, you can succeed in an outpatient setting with adequate social, family and spiritual support.
The second and most difficult issue involves facing the guilt, shame and depression associated with this illness. It takes trust and time with a competent therapist to work through these emotions. If you are very depressed, the best treatment might be an inpatient residential setting where professionals can monitor and properly manage your symptoms.