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.