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Is sex addiction a legitimate disorder?

July 8, 2013
by David J. Ley, PhD
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Sex addiction has been a powerful and enduring phenomenon of pop psychology, but its privileged status may be coming to an end. Since the early 1980s, the idea that sex can be addictive has become embedded in American popular culture and media, despite a consistent lack of scientific evidence or endorsement of the concept by behavioral health professionals. Sweeping changes in the social, healthcare and scientific communities signal that the field of sex addiction treatment might have to change quickly or face increasing marginalization.

Young counselors in the addiction, mental health and sexuality fields face a dilemma when it comes to sex addiction. On the one side, there is a powerful and vocal industry promulgating sex addiction and its treatment, with hundreds of self-help books, treatment programs and 12-Step groups supporting the idea that sex can be addictive and destructive. Conferences on the topic are well-attended, and professional organizations have certified hundreds of providers to treat sex addiction. In 2012, the American Society of Addiction Medicine (ASAM) included sexuality in its new definition of addiction, framing sex as a behavior that can become destructive and can affect the brain of sufferers.

The sex addiction industry has benefited from extremely effective and timely marketing efforts, though it prefers to term these “public education” campaigns. For several years, savvy sex addiction treatment providers used sex scandals in the media to further their agenda. Breaking news involving public figures caught with their pants down triggered press releases describing the dangers of sex addiction and implying that the “scandal du jour” might be the result of untreated sex addiction. These education efforts offered advice on seeking sex addiction treatment for oneself or loved ones.

Oftentimes, these scandals led to sex addiction therapists being invited to discuss the issue on national news and talk shows. Under such a media onslaught, it is no wonder that young therapists, not to mention the general public, are often confused as to whether sex addiction constitutes a legitimate disorder.

The wake-up call for young counselors comes when they see a patient and attempt to render a diagnosis of sex addiction. Simply put, there isn’t one. The American Psychiatric Association (APA) has played what I call the “hokey pokey dance” with sex addiction, including it in one edition of the DSM and removing it in the next. Since the DSM-IV, the only available, related diagnosis has been “sexual disorder not otherwise specified,” which includes language regarding clients who view sexual relationships as “conquests.”

This language harkens back to dark days when the condition was called Don Juanism in men and nymphomania in women. This long, often tragic, history is one reason for traditional mental health’s resistance to the concept of sex addiction. Carol Groneman’s excellent work The History of Nymphomania details the disturbing history of the use of the nymphomania diagnosis to suppress and pathologize female sexuality. Modern psychiatry is understandably loath to take up the issue without substantial scientific arguments, and evidence that this is not merely a moral debate.

Society’s acceptance of the concept of sex addiction has not swayed the APA or most other traditional institutions. For decades, sex addiction proponents have been challenged in the academic press to produce scientific research to back up their theories. Thirty years later, the sex addiction field has produced countless articles, but these articles are roundly criticized as subject to severe sample bias, based largely on anecdotal reports, with no “gold standard” studies employing randomized designs and control groups where sex addiction-specific approaches could be compared with traditional therapy techniques such as cognitive-behavioral therapies.

In early 2013, the APA completely rejected the concept of sex addiction, and the related concept of hypersexual disorder, in finalizing the newly released DSM-5. The majority of sex addiction clinicians saw this as merely another example of the degree to which they, and their patients, are misunderstood by the mental health system. Most sex addiction providers argue that the fact that sex addiction is not a recognized diagnosis has no impact on their practices, and that they will continue providing services the way they have for decades. The overwhelming majority of sex addiction treatment is provided outside traditional funding, usually on a self-pay basis.

 

Challenging the industry

In 2012, I published The Myth of Sex Addiction, the first book to challenge the sex addiction industry aggressively. The book followed my own attempt to answer this question: “Is sex addiction real, and if it’s not, does it matter?” Ultimately, I concluded that the sex addiction concept is subject to dangerous levels of moral and social bias. Numerous sex addiction therapists have acknowledged to me that their belief in sex addiction is more akin to a faith.

Patients and family members have shared with me that challenges to the validity of the sex addiction diagnosis often result in shaming and threats from their therapists. Patients who question the concept are told they are “in denial” about their addiction. Even therapists who use the sex addiction label in their work report that their own attempts to reform or modernize sex addiction theory or practices within their organizations have resulted in aggressive warnings to maintain the status quo.

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Although sexual dependency may be the time frame with regard to laughters on a lot of television programs and also inside publications and also films, the reality is which sexual dependency is really a condition that ruins people, romantic relationships, and also lives.www.marriagematerial.org

I work with sex addicts.

I’m a Board Certified Sex Therapist, Licensed Mental Health Counselor, and Certified Addictions Professional. I’ve been in the field of psychotherapy for more than 20 years. I’ve written a book – Addict America: The Lost Connection – in which I discuss how addictive thinking and behavior affects our brains and leads to a disconnection from each other and our spiritual Connections. So far, my book has resonated with everyone who read it and my therapy practice is full. I also have my own training programs so I can pass along the knowledge and expertise I have gathered over the years.

In short, I’m a competent and experienced professional.

I therefore do not take it well when I read that use of the term “sex addiction” is an excuse to get away with bad behavior, that sex addiction is a way to promote bigotry and sex-negative beliefs, or that sex addiction lacks any credence among the psychotherapeutic community.

When one reviews the history of addiction just over the past 100 years, it can be seen that alcoholism was not perceived as an addiction but rather a moral failing until the middle of the last century, give or take. In the 80s, cocaine was all the rage because it did not have the physiological withdrawal effects that alcohol and heroin did, so was not believed to be addictive. Now sex addiction is in the news thanks to the internet and the ways in which our personal and societal buttons get pushed around anything to do with sex.

Several years ago, I worked with a sex addict and his wife. The couple were Orthodox Jews, which was relevant in that their community was stringently opposed to homosexuality. This man’s addictive behavior involved acting out with other men, although he maintained that he was heterosexual. He also happened to be a licensed psychologist. He had also made a name for himself by treating sex addicts. When his wife shared with me that he was behaving unethically and was being sued, I decided to Google him. I was incredibly dismayed to see that he had a whole program for men who had sex with men and wanted to stop because they did not want to identify as homosexual. He was basically promoting reparation therapy. By the way, although he was himself in therapy, he was still acting out. He was denying his addictive behavior, denying his homosexual behavior (whatever its origin) and also denying the effects on his wife.

So I get it. I get that people use sex addiction to try to weasel out of bad behavior. I get that religion can get tied up in the process -both with causing shame for the addict and also in being used as a way to miraculously stop the behavior. I get that people can twist up the concept of sex addiction to suit whatever agenda they are promoting, as when some anti-sex addiction psychologists and others jump on the Duchovny/Woods/Weiner bandwagon to get their names in the media.

But here’s my real problem: Every time a sex addict reads that sex addiction is a myth, or that sex addiction is just an excuse because he/she cannot control themselves or make good decisions, that sex addict is harmed. Just as in medicine, we are ethically bound to cause no harm. That is why the American Psychological Association and now some states have prohibited orientation reparation programs. They cause harm.

The short definition of addiction, any addiction, is “obsessive, compulsive, out-of-control behavior done in spite of negative consequences to self or others.” It doesn’t matter the behavior. It can be using alcohol or drugs or it can be gambling, shopping or sex. This definition sums up the definition for addictive disorders in the DSM 5, which although it specifies particular substances, is still specifying behavior, not physiological effects of any drug.

So sex addiction isn’t even about sex. It is about particular behaviors that have become associated in the brain with heightened pleasure and, more importantly, relief of emotional pain. It is about the immense power of the limbic system to overrule the executive functioning of the cortex, making a mockery of the idea of sound decision-making. Just as the law admits that an intoxicated individual cannot consent to sexual relations, so can we acknowledge that an individual under the influence of dopamine, endorphins, and other brain chemicals is not able to make good decisions.

A person who is able to stand up and say “Hi, I’m John and I’m a sex addict” is not taking the easy way out or making excuses for his behavior. He is taking responsibility for his life and his recovery and beginning the most difficult journey of his life. Recovery is a long and arduous process made up of daily decisions that require changes in every aspect of the person’s life.

When I work with sex addicts, our goals are for the addicts to live fulfilling lives, to learn to be present and Connected, which includes healthy sexual intimacy in whatever form that takes for the individual. There is no condemnation of any sexual behavior and no imposition of any religious dogma. There is only healing from past trauma, self exploration, and answering the question “Is this for my addiction or is this for my recovery” when making choices throughout the day.

I applaud everyone who struggles with addiction and finds the courage to take that first step, whether it is calling a therapist, going to a meeting, or picking up a book. I can promise that one day you will thank your Higher Power for your addiction, because it brought you to where you are and you would not have gotten there without it. To get there, you made the tough choices and chose your priorities. You discovered the meaning of life. For those who are in that place, you are beacons for us all.

Be In Light

I could not agree more with Dr. Ley on this issue. I used to work a treatment center that promotes treatment of sex addiction and I often wondered how a natural human behavior could be consdered a disorder or an addiction.

If is truly not an addiction, this does not mean that certain sexual behaviors canot be destructive, excessive, and unhealthy. The same is true of eating and food. Lives and relationships can be destroyed by certain sexual behaviors, whether the behavior is infidelity, viewing pornography, etc. There are indeed natural consequences for sexual behaviors. Humans need to be held accountable for how our sexual behaviors impact others. This does not mean that a person is disordered or addicted.

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