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Discussion and review of recent empirical research and findings on the topic
of sex addiction.
Rebecca Xiberras (B. Psy)
31595(G)
Addictive Behavior
PSY3159
Profs. Marilyn Clark B.A (Hons), M.A (Liv),P.h.D (Sheff.)
University of Malta
Rebecca Xiberras PSY3159 31595G
What is Addiction?
According to W.R.Miller, an individual can become an addict, dependent or compulsively
obsessed with a substance, person, object, behavior or activity. Numerous researchers suggest that a
person can become psychologically dependent on activities such as gambling, sex and work and have
similar implications as those who have a physical addiction like alcohol or heroin.
Many researchers suggest that both physical and psychological dependencies have more
similarities than differences and that we shouldn’t divide them in categories. Researchers suggest that we
should look at both the physical and psychological impact during the addictive process to all addictive
behaviors; this is because even physical dependencies to substance still have a psychological component.
What is Sex Addiction?
One particular addiction that has been debated for years whether it should be called an addiction
is Hyper sexuality. Known also as sex addiction. Back in 1998 when Bill Clinton’s scandal broke, it had
everyone question his infidelity and why he would do such a thing. Therapists and psychiatrists were
quoted by the media saying that Clinton’s behavior was clear evidence of sex addiction. They continued
to say that maybe he was predisposed to have a gene for addiction, after all his father was an alcoholic
and his brother was addicted to cocaine. But is it true that sex could be addictive as a drug? Both
epidemiological and clinical evidence suggest that hypersexual disorders behaviors can be both
accompanied by clinical significant distress and even social and medical morbidity. A hypersexual
disorder is conceptualized as a nonparaphilic sexual desire disorder with an impulsivity component.
“Since the publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-III) (American Psychiatric Association,1980), psychiatric diagnosis has been criterion-based and
atheoretical in defining psychiatric disorder. Caine (2003) notes that at this juncture, we simply do not
have the empirical science to establish causality or pathogenesis for psychiatric disorder , including
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sexual behavior disorders (M.P.Kafka,2009). Although, this is a limitation there are over a 100 years of
clinical information describing excess sexual activity, both paraphilic and normophilic.” (Kafka.M.P,
2009)
The same dependency and compulsive behaviors that characterize other addictions such as
gambling, alcohol and drugs applies to sex addiction. The American Society of Addiction Medicine
(ASAM) defines sex addiction like any another addiction as a dysfunction in the person’s reward system.
The person continues to engage in activities that feed the reward system leading to pathological pursuit of
rewards. However one can see that sex addiction is different. This is because we can still lead a happy,
healthy life without any consumption of alcohol or substances or without any behavior such as gambling.
On the other hand sexual activity is considered to be part of a healthy lifestyle, like eating, drinking and
sleeping, having sex is necessary for survival, unless one choses celibacy. One should also note, that
before, sexual intercourse only referred to penis- vaginal penetration. However in today’s society sexual
activity has various meanings such as masturbation, phone sex and sexting. So where do we draw the
line? When does sexual activity become an addiction?
The National Council on Sexual Addiction and Compulsivity defines sexual addiction as
“engaging in persistent and escalating patterns of sexual behavior acted out despite increasing negative
consequences to self and others.” In other words, a sex addict will continue to engage in certain sexual
behaviors despite facing potential health risks, financial problems, broken relationships or even arrest.
Miller, Levison, Hatterer, and others suggest that there are common characteristics in all addictive
behaviors. They describe addiction as constantly thinking or obsessing over an activity, behavior, object
or substance. The person will appear to have lost control over how long or how much they will engage in
that behavior or activity. The person will continue engaging in that activity over and over again. Many
times the person is in denial and does not admit to having a problem even if the individuals surrounding
the person notice the negative effects.
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Is sex addiction a real addiction?
Many researchers have argued whether sex addiction should be seen as an addiction or not.
Several researchers consider addictive behaviors as ‘diseases’ but others say that it’s a learned behavior in
response to the complex interplay between environmental and heredity factors. Some researchers say that
unlike real diseases such as cancer, addictive behaviors don’t have a cause.
This confusion causes problems for treatment especially to physical dependencies such as alcohol
and drugs, even if these are areas researched by many. Some argue total abstinence is needed, for example
when it comes to gambling, others argue that a substitute would be more ideal, for example substituting
heroin with methadone. But when it comes to sex addiction one can’t have total abstinence from sexual
activity since this is an integral part for having an intimate relationship.
A person may feel an increased sense of tension or arousal before committing the act and then
experiences pleasure, gratification, or relief at the time the act is committed. Following the act, there may
or may not be regret, self-reproach or guilt. (American Psychiatric Association, 2000, p. 663)
Carnes (1983) says that since our sexuality is one of our fundamental life processes, its
compulsiveness is threatening to us. Once we go over the accepted limit, we break the rules and norms
that allow us to live comfortably together in society; once we deviate from what we were taught to be
acceptable, then the trust is broke, our ground is shaken and bonds are broken. The addiction seems to
take over, the individual seems like s/he lacks controls and there seems to be no neutral response to sexual
compulsivity.
Treatment
Most popular treatment for sex addiction is therapy. Research shows that sex addicts tend to have
a genetic factor that predisposes them to any kind of addiction. However environmental factors also come
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in play . Sex addicts tend to have rigid and authoritarian families. Their caregivers can have a history of
affairs, multiple marriages or unwanted pregnancies.
Normally a sex addiction comes from a fear to trust others enough to bond with them and develop
intimate relationships. Due to this, the therapist can have a difficulty acquiring a history of acting out
behaviors. Extreme religiosity, excess sexual negativity, childhood abuse and significant losses are also
factors found during clinical interviews to sex addicts. ( Earle, R. H., Earle, M. R., & Osborn, K. (1995 ).
Like drug addicts and alcoholics, sex addicts refuse the idea that they have a problem and engage
in distorted thinking, blaming others and defending their behaviors. Clients may not realize the impact of
their addiction, until the therapist asks them questions that make them reconsider their behavior.
Questions like how many affairs they had, how many times they masturbate a day or how frequent they
watch porn make them question their judgment. Addicts tend to compartmentalize their life and one
compartment is not shared with the other. They might be going through an intense divorce but be able to
manage and run a company impeccably. You can see that once addicts open up about their history you
might see a pattern emerging.( Carnes, P., & Adams, K. M. (Eds.). (2013).
Patrick Carnes (2009) says that one of the ways to recovery is to focus on the uncontrollable
behavior. He says that part of the recovery is acquiring enough information and accepting one’s own
sexuality. He continues to suggest that many of us have a sexual binge at one point of our life, especially
youths and adolescents when they are discovering their sexuality, on one hand there is peer support on the
other there is parental proscription. A person who is going through a divorce might engage in a sexual
binge, feeling free from any marital obligations, or to retaliate to a lover’s indiscretion. There are also
those who have episodes of compulsivity going through a middle- age transition. However these episodes
might happen from time to time but will not affect their lifestyle and day to day pattern. Addicts tend to
describe their sexual binges as being episodic too; they might even go through a long time without any
sexual binge. And being able to go through these long periods without any problems creates the illusion
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of control. However when they engage in sexual binges they have severe consequences on their work,
life, relationships and self-esteem. Sometimes the behavior becomes so frequent that it becomes constant
and that reveals an unmistakable addiction. An addiction is seen when there are different forms of sexual
compulsiveness.
Treatment for sex addiction is divided into three phases, unfortunately many times sex addicts
tend to go to a twelve-step program; which is the first step of intervention. They tend to complete the first
three steps, however they don’t further their therapy, lessening the chance for success. In fact many times
this results in relapse. Similarly, if the patient has a partner but doesn’t find support from them, it
significantly reduces desired outcomes.
The initial stage for treatment is ‘Intervention’ this includes surveying the extent of the
problematic behavior, teaching the patient about the illness, refer them to the twelve- step program,
confront denial and agreeing on a behavior contract. The second phase is ‘Initial treatment’ which
includes attendance to twelve- step program, completing the first step of the twelve-step process,
agreement on writing an abstinence definition ,a written relapse-prevention plan ,a complete period of
celibacy ,developing a sex plan ,partner and family involvement, multiple addiction assessment, trauma
assessment ,group therapy and shame reduction.
The final phase is that of ‘Extended therapy’ which is crucial and it consists of completing steps
two, three and four of the twelve-step process, addressing developmental issues, deal with family-of-
origin issues, grief resolution , marital and family therapy, career issues and trauma therapy. (Carnes.P ,
2009 ).
Interventions & Limitations
Although this kind of treatment is becoming popular more and more, there are still some
researchers out there who question the existence of sex addiction itself. Some say that sex addiction is a
myth and that it comes from different cultures and other influences. Some say that the condition is instead
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a way of projecting social stigma on patients. This is in fact a basic philosophical criticism surrounding
the controversy about this term. Critics argue that this label has taken a behavior and set what is the
excessive variant of it on personal moral standards. This phenomenon of sex addiction has become so
popular that people are diagnosing themselves as sex addicts. This is resulting in individuals who should
be seeing a therapist and aren’t doing so and many who don’t need therapy that are getting it. Some
professionals are even going for these programs instead of ones offered by sexologists. Klein argues that
most of the answers generated by the sex addiction model are pathology-oriented. They're clinically
incomplete putting limitations to solutions. As Eli Coleman says “they don't include issues of differential
diagnosis, they don't alert us to the differences between character disorders, personality disorders, OCD,
PTSD, and so on. And they pathologize sexual behavior and impulses that are not unhealthy”. (Klein.M,
2002)
As time passes by we realize that the answers given by the sex addiction movement to the
questions asked are culturally bound, nowadays we realize that as we are moving into a new
century we see that there are differences in the way people are raised, differences in cultures,
differences between countries and differences in age groups. One should also note that the
answers given by the sex addiction movement have been used politically and this has harmed the
area of sexology. ( Klein. M. ,2002 )
Gifford and Humphreys (2007) note that addiction is not merely based on one factor, but
an interaction between “multidimensional” factors, such as sociological, medical and biological
factors (Clark, M. (2011).
The American Psychiatric Association hasn’t added sex addiction in the DSM- V yet because
there isn’t enough research and there are still some questions unanswered. There seems to be ignorance
for the need for clinical assessment on this popularized label. Rory C. Reid (2012) says that the studies
of the criteria, included people who were already seeking for help so it’s not clear whether the criteria
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would apply to the general population when it comes to diagnosing people, or it only applies to those
who already have mental health issues. Sex addiction is still a new phenomenon for the mental health
arena, and more research needs to be conducted.
Questions like how frequent does one have to engage in sexual behaviors to be considered a sex
addict? Does having a sex addiction imply there are underlying problems? What comes first the
addiction or the depression/ anxiety? Does sex addiction have to do with attachment styles?
Sex addiction will remain controversial until one determines the specific clinical conditions,
since there is no method for externally validating current diagnostic constructs (Caine, 2003). Currently
the task of determining causation is related to either substance- use disorders or psychiatric disorders.
Conclusion
All clinical professional must have certain requirements for their clinical models. What these clinical
professionals require in the model are : consideration of phenomenological context, clinical
sophistication, including differential diagnosis, based on personal agency and responsibility,
cross-cultural insight, minimization of self-diagnosis and political and public policy utility.
Models of sexual normality and symptomatology emerge from things like the increasing
medicalization and biological determinism in sexuality; the increasing legitimacy of religious
concepts and solutions; the increasing political cloud of sex negativity. These all form the
discourse to anyone who is constructing or building models of sexuality nowadays.
Eli Coleman (2002) states that we should construct a model and call it Syndrome X,
while other researchers like Klein (2002) don’t agree and say that this phenomenon is so
complex that there couldn’t be one syndrome. He continues to further state that we need a sexual
health model that is clinically complex and culturally informed. One that doesn’t pathologize a
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broad range of eroticism. One that is supportive of adult identity. Finally the model needs to be
sex positive.
Sexuality as a grown up is complex and scary because society still looks at sexuality
through a negative lens. We need a model where people feel comfortable with their sexuality.
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Reference List
Bancroft, J., & Vukadinovic, Z. (2004). Sexual addiction, sexual compulsivity, sexual impulsivity, or
what? Toward a theoretical model. Journal of sex research, 41(3), 225-234.
Carnes, P., & Adams, K. M. (Eds.). (2013). Clinical management of sex addiction. Routledge.
Carnes, P. (1983).Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare
Carnes, P., & Delmonico, D. (1996). Childhood abuse and multiple addictions: Research findings in a
sample of self-identified sexual addicts. Sexual Addiction & Compulsivity, 3, 258–268.
Coleman, E., Raymond, N., & McBean, A. (2003). Assessment and treatment of compulsive
sexual behavior. Minnesota Medicine, 86,42–47
(Clark, M. (2011). Conceptualising Addiction: How Useful is the Construct? (1-6)
Earle, R. H., Earle, M. R., & Osborn, K. (1995). Sex addiction: Case studies and management.
Brunner/Mazel.
Ellis, H. (1905). Studies in the psychology of sex (Vol. 1–2). New York:
Engs, Ruth C.(1987) "Addictive Bheaviors," Alcohol and Other Drugs: Self Responsibility .
Bloomington, IN:Tichenor Publishing Co.
Gifford, E., & Humphreys, K. (2007). The psychological science of addiction.Addiction, 102(3), 352-361.
Klein, M. (2002). Sex addiction: A dangerous clinical concept. Electronic Journal of Human Sexuality, 5
Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V.Archives of sexual
behavior, 39(2), 377-400.
Miller, W. (n.d.). Guest editor's preface. Addictive Behaviors, 1-2.
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Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliland, R., ... & Fong, T. (2012).
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Reid, R. C., Carpenter, B. N., Spackman, M., & Willes, D. L. (2008). Alexithymia, emotional instability,
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