Sexual Addictive Behavior: Is It Real?

(Featured in Southern California Psychiatrist, July 2001, Volume 49, No. 11)

Sexual addictive behavior, sexual compulsive behavior, sexual dependent behavior and hypersexuality are all terms referring to pathological sexual acting-out with associated denial of negative consequences and /or loss of control of such behavior.  Note it is not the type of behavior, its object, its frequency, or its social acceptability that determines whether a pattern of sexual behavior qualifies as sexual addiction; rather it is how this behavior pattern relates to and affects an individual’s life negatively.

Most “sex addicts” act-out against their own ethics and principles.  Like most addictions, it continues to escalate to where many ultimately suffer legal consequences.  Hence, some addicts do commit sexual offending behavior, but all sex offenders are not addicts.  More common negative consequences are massive losses of time, loss of career and marriage, loss of integrity with associated profound shame, and strong feelings of isolation and loneliness.  Ultimately, many become deeply depressed and suicidal, feeling there is nowhere to turn for help.

For the past ten years, as Medical Director of the Del Amo Hospital Sexual Addiction Recovery Program, I have had the privilege to work with hundreds of men and women caught in this devastating behavior.

Because the sex addict becomes increasingly attached to fantasy, relationships in the real world become less important and often ignored.  The most common sexual addictive behavior today is cybersex, with many addicts losing their jobs viewing pornography on the job or performing poorly due to the vast hours spent compulsively on home computer pornography.  Many professionals have been caught up in the intensity of the “web” which can provide unlimited anonymous, accessible, and affordable pornography of any type.

Sexual addiction was dropped from the DSM-IV apparently because it was felt that no solid research supported its existence.  In March of this year, a major symposium at Vanderbilt University sponsored by the American Foundation of Addiction Research, began the task of designing a diagnostic and interview instrument to be used over the next three years to substantiate this diagnosis for consideration in the DSM-V.  The name for the diagnosis is yet to be determined, but it will not be sexual addiction because the term itself has too much controversy.

Meanwhile, we must prepare to treat these people as they present to us.  Currently, the addiction model seems to work the best in providing guidelines and support for ongoing recovery.  There are four different 12 Step Recovery Meetings for sex addiction: SA (Sexaholics Anonymous), SAA (Sex Addicts Anonymous), SLAA (Sex and Love Addicts Anonymous) and SCA (Sexual Compulsives Anonymous). There are also two 12 Step Meetings for partners of sex addicts who are often the most devastated when they find their trusted partner has been living a secret life: S-Anon family Groups (S-ANON) and Codependents of Sex Addicts (COSA).  Individual therapy along with 12 Step meetings can be very helpful, especially in working through past abuse, especially sexual, which is very high in sex addicts. SSRIs, although not a silver bullet, can improve mood, allow more access to feelings and in some cases reduce sexual drive.  However, it is important to be cautious as excessive masturbation can increase on SSRIs because of the increased orgasmic threshold side effect.  As the therapist, you can be of immense support in not shaming or trivializing the behavior, but promoting re-connection to self and others who really care, establishing integrity and self-esteem, and cognitive restructuring.  Patients are profoundly grateful when they learn to trust again and reclaim their lives.