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The Case for Sex Addiction

On his 60th birthday, Luke underwent surgery for prostate cancer that left him impotent. While he joked about the reality to friends and family, his devastation was apparent to those closest to him. Luke – given up for adoption at the age of 9 and living in a boy’s home until the age of 17 – believes he may have placed more value on his sexual ability and in his sexual relationships than was healthy. In his own words, he “…used sex as a way to feel powerful and important to women.” Given Luke’s early history of abandonment by his mother, the degree to which he placed importance on sexuality and sexual relationships – a different but powerful connection – is not hard to connect.

Before Luke’s prostate surgery, he had engaged in multiple affairs – cheating repeatedly on his wife for the duration of their 30-year marriage. He believes he spent thousands of dollars on exotic dancers and sometimes escorts. After Luke’s prostate surgery, when he no longer had sexual functionality, he began an emotional affair with a woman in her 20s. Luke paid for her rent, utilities, and gave her spending money. For her part, the young woman conceded to Luke’s requests for phone sex, sexting and frequently sent him nude images of herself.

Luke believed he may have had a sexual addiction before his prostate surgery, but because he was no longer able to engage in penis-in-vagina (PIV) sex, he maintained that his behavior with the young woman was not sexual, nor even an affair. Luke’s wife found out about the money and time her husband had spent with the young woman, however, and filed for divorce. Although his wife had remained with him years before after the discovery of two affairs, she believed this relationship had an emotional context and, to her, that was a greater betrayal than any potential sexual one.

It may be that Luke had failed to consider the ways an addiction eventually ceases to be gratifying, even while a person will continue to do everything he can to get his particular fix. He may also not have realized the powerful way compulsion continues even while the substance or process may change.

A Look at the DSM

In the American Psychiatric Association’s (APA) previous revision of the Diagnostic and Statistical Manual of Mental Disorders(DSM) used the term “sexual compulsivity.” The DSM-IV-TR described compulsive disorders as behaviors that reduce anxiety and distress despite the fact that the behaviors are not gratifying. Another possible classification for sexual addiction belongs to the “impulse control disorders,” states marked by an inability to suppress an impulse – one that provides a sense of gratification or relief before becoming a source of discomfort or guilt. Although the APA had a team of experts in the area of compulsive sex to work out the new DSM-5 criteria on the matter, no diagnosis for “sexual addiction” was included in its revision. The DSM does, however, have a set of criteria for addiction in general:

  • Tolerance (marked increase in amount; marked decrease in effect)
  • Characteristic withdrawal symptoms; sexual activities undertaken to relieve withdrawal
  • Persistent desire or repeated unsuccessful attempt to quit
  • Much time/activity to obtain, use, recover
  • Important social, occupational, or recreational activities given up or reduced
  • Use continues despite knowledge of adverse consequences

Many experts believe these criteria may easily be applied to instances of sexual addiction.

Theories of Sexual Addiction

A book published in 1983 by Patrick Carnes, PhD, “Out of the Shadows: Understanding Sexual Addiction,” is noted as a primer in the field even while sexual addiction remains a controversial subject. Carnes teaches that sexual addiction turns on “incorrect core beliefs” arising as a result of emotional wounds, usually occurring in childhood.

Other theorists continue to work on the subject, and some of their hypotheses regarding hyper-sexuality are at odds with Carnes. While some experts maintain that sexually compulsive behaviors are the result of obsessive-compulsive disorders, researchers like Robert Barth and Bill Kinder are on the side of sexual addiction as an impulse control disorder. Still others (e.g., John Bancroft and Erik Janssen) maintain that the matter of hypersexual behaviors is a result of “dysregulations of our excitatory and inhibitory mechanisms.” Still others view sexual disorders as a psychosexual disorder or an intimacy disorder.

Robert Weiss, whose doctoral advisor was Patrick Carnes, is a renowned addictions expert, author and clinician, LCSW, CSAT-S. Weiss calls sexual addiction “a dysfunctional preoccupation (meaning this specific preoccupation negatively affects their work, relationship, family, legal, health, and social situations) with sexual fantasy and behavior, often involving the obsessive and repetitive pursuit of non-intimate sexuality, pornography, compulsive masturbation, romantic intensity and objectified partner sex. Unlike those who enjoy sex as personal exploration, recreation, or part of healthy intimacy, Weiss says the sex addict’s focus is on using the excessive pursuit of sexual images and experiences to bolster an unstable emotional and internal world. Sexual fantasy, urges, and behaviors are used to prop up flagging moments of emotional self-stability, at the same time masking underlying social deficits, extensive histories of trauma, and personality challenges.

Other theorists continue to work on the subject, and some of their hypotheses regarding hyper-sexuality are at odds with Carnes. While some experts maintain that sexually compulsive behaviors are the result of obsessive-compulsive disorders, researchers like Robert Barth and Bill Kinder are on the side of sexual addiction as an impulse control disorder. Still others (e.g., John Bancroft and Erik Janssen) maintain that the matter of hypersexual behaviors is a result of “dysregulations of our excitatory and inhibitory mechanisms.” Still others view sexual disorders as a psychosexual disorder or an intimacy disorder.

Although the DSM does not yet recognize sexual addiction as a diagnostic category, it is likely that in the future, room will be made for it within the volume. In the case of Luke, sexual addiction may or may not be an issue, but according to him, for many years his behavior in sexual relationships fit the diagnostic criteria for addiction. Whether he will move forward with a new understanding of his compulsions around sex now that his sexual functionality has diminished is yet to be seen. That there are many theories out there to explain what may or may not have been Luke’s trouble is not a bad thing; the more we discover about sexual compulsivity, the more equipped we will all be at helping the people who experience it.

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