How Real Is Sex Addiction?

by Ross Rosenberg, M.Ed., LCPC, CADC

The term "sex addiction" was coined by Patrick Carnes, who described it in his 1983 seminal book on the topic: "Out of the Shadows: Understanding Sexual Addiction." Carnes is largely responsible for legitimizing the study and treatment of sex addiction. Sex addiction is defined by The Society for the Advancement of Sexual Health, SASH (2007), as "a persistent and escalating pattern or patterns of sexual behaviors acted out despite increasingly negative consequences to self or others." Unlike alcohol or drug addiction, there is no formal diagnosis for Sex Addiction in the American Psychiatric Association's Diagnostic Statistic Manual (DSM IV-TR). The mental health and addictions' fields have been fraught with debate, disagreement, and to some, plain old stubbornness over whether to include sex addiction in the DSM. For example, according to Chester Schmidt (1992), Chair of the DSM-IV Sexual Disorder Work Group, there is "no scientific data to support a concept of sexual behavior that can be considered addictive." Schmidt believed that what is called sex addiction is more likely a symptom of other psychological problems like depression, obsessive-compulsive disorder, or bipolar disorder. According to John M. Grohol, Psy.D, "What is both amazing and a little disturbing, however, is to see entire professional societies, such as the Society for the Advancement of Sexual Health, spring up around a disorder that isn't even officially recognized as such." It is generally accepted that the prevalence of sex addiction is 3% to 8% of the American public. According to data collected by Patrick Carnes, many sex addicts also have other addictions. For example, in Carnes' research, of the individuals who were diagnosed with a sex addiction, 42% were chemically dependent, 38% had an eating disorder, 28% were compulsive workers (workaholics), 26% were compulsive spenders, and 5% were compulsive gamblers. Ruling out cross addictions is crucial in appropriately diagnosing, understanding and treating sex addiction. According to Benoit Denizet-Lewis, "believers in a sex-addiction diagnosis point out that for many years, doctors and psychiatrists similarly dismissed alcoholism, refusing to accept that it was a serious problem in itself, not merely a symptom of something else." Many practitioners in the sexual addiction field are hopeful that the DSM V, which is due out in May of 2013, will include a diagnostic category for sex addiction. The proposed sex addiction is "Hypersexual Disorder." According to Robert Weiss, a renowned sex addiction expert, the proposed Hypersexual Disorder diagnosis "is not an ideal description of a problem that more accurately involves the lengthy search and pursuit of love and sex, rather than the sex act itself" Nevertheless, having a sex addiction-related diagnosis in the DSM V would legitimize the under-recognized and under-treated disorder. Because sex is a part of normal human functioning, it is difficult and, at times, a scientific challenge to compare sexual and chemical addictions. Both "normal" and pathological (addictive) sexual patterns are open to diverse and often controversial definitions. Clearly, factors such as personality, psychopathology, gender, sexual preferences, culture, socio-economic status, and other "filters" have made a clear consensus on a definition of sexual addiction that much more challenging. Making matters even more complicated is the fact that the topic of sexual deviance and/or sexual pathology remains one of the most taboo topics in our society. Individuals with a sexual addiction are often the subject of ridicule and harsh judgment, whereas those suffering from drug/alcohol or other more accepted process addictions (i.e., gambling, spending, etc.) elicit more social acceptance. Another ironic twist is that the co-founder of Alcoholics Anonymous, Bill Wilson, was considered a sex addict. According to biographers and Alcohol Anonymous historians, Wilson was not only an alcoholic, but also a sex addict. Wilson was flirtatious, had multiple affairs, and according to biographer, Susan Cheever, "had an inability to regulate his behavior with women" and was "often accused of groping and unwelcome fondling," yet he was married to the same woman for 53 years. Until sex addiction is formally included in the DSM, we currently derive a "diagnosis" through assessment protocols specifically designed for this addiction. Such protocols are provided by specially trained qualified mental health practitioners. Clinicians, such as myself, utilize uniquely designed instruments that are created to collect relevant information necessary for a diagnostic conclusion. Information collected during the assessment includes: sexual history, drug/alcohol history, psychosocial assessment, mental health history, and other relevant information. Additionally, an assessment involves interviews with the client, affected partners (i.e., spouse, significant other, etc.) and, if possible, mental health providers who have or are providing services to the person being evaluated.

When a cross addiction is present, it is important to identify which addiction requires attention first. This is crucial when it is determined that the sex addict is also addicted to drugs or alcohol. In these cases, detoxification (detoxing) of the drug may require medical services in order to ensure that the client's physical health is not compromised. The experience of physical withdrawals can potentially create medical risks. As many practitioners and sex addicts know, despite a formal recognition of this disorder, it is indeed very real. Let the intellectuals battle out what is and is not a diagnosis. In the meantime, let's provide the much needed services to those who are suffering from this disorder.
Cheaver, S. (2005), "My Name Is Bill: Bill WilsonHis Life and the Creation of Alcoholics Anonymous". Washington Square Press, New York, NY. Denizet-Lewis, B. (2009), "America Anonymous: Eight Addicts in Search of a Life". Simon and Schuster, New York, NY. Grohol, J. (2008), "Is Sexual Addiction Real?". Psych Central. Retrieved on March 5, 2013 from http://psychcentral.com/blog/archives/2008/09/30/is-sexual-addiction-real/ Schmidt, C. W. (1992), "Changes in terminology for sexual disorders in DSM-IV". Psychiatric Medicine, 10, 247255. The Society for the Advancement of Sexual Health. (2007). Sexual Addiction. Retrieved on January 8, 2011 from http://sash.net. Weiss, R. (2012), "Sex addiction, hypersexuality and the DSM". Retrieved on March 5, 2013 from http://www.addictionpro.com.

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