What you Should know About Sex Addiction

Sex addiction can be defined as sexual behavior that a person feels they have no control over, that leads to psychological distress, and can result in impairment to social, occupational, or other types of functioning.¹ Some current psychiatric studies have concluded that sexual addiction is driven by either pleasure-seeking or as a way to reduce anxiety.¹ These studies also show that behaviors associated with sexual addiction are commonly triggered by states of mind such as depression or sadness and that the actions often result in feelings of shame.¹

Whether or not you can actually be addicted to sex is a controversial issue among professionals in the mental health field. This lack of agreement among professionals led the American Psychiatric Association (APA), the organization that creates the diagnostic manual for mental health professionals, to leave sexual addiction out of the most current Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Sex addiction also varies between groups of people. For example, sex addiction among gay and bisexual men can be hard to define because people in this group tend to have more sexual partners. Society tends to paint a picture of fear and confusion around the sexual lives of gay and bisexual men and women, however, research finds that people with paraphilias are significantly more likely to be heterosexual.²

What we do currently know about the potential for sex addiction includes:

• Sex addiction may be a result of certain neurotransmitters functioning abnormally. A case study for this indicates that when a person is treated for Parkinson’s disease (a condition marked by low dopamine levels) with dopamine-increasing protocols, hypersexual behavior increases. While research is not available to help differentiate hypersexual behavior from compulsive or addictive sexual behavior, the correlation is interesting enough to prompt further study.³
• The symptoms of sex addiction are similar to impulse control disorders and substance abuse disorders, both of which can be very disruptive and distressing.¹
• It is estimated that 5 to 6% of people fit the criteria for the sexual type of an impulse control disorder (DSM-IV); this would mean that more people have an addiction to sex than have a gambling addiction, bipolar disorder, or schizophrenia.³
• Behaviors associated with sex addictions can have devastating effects on the person acting out the behavior, the family and friends of the person, and on society as a whole.

There are several factors that may increase the chances that you will struggle with a sex addiction at some point in your life. It is important to understand that the presence of one or more of these risk factors does not mean that you will become addicted to sex, nor does it mean that if these risk factors are absent, you will not become addicted to sex.

Some of the theories about why you may become addicted to sex include:⁴

• Endocrine dysfunctions.
• Imprinting hypothesis.
• Courtship disorder.
• Traumatic experiences as a child, including sexual abuse.
• Early substance use.
• Impulse inhibition problems.
• Peer and family influences.
• Traumatic head injury.
• Genetics.

The research into how sexual disorders emerge is still evolving and though we know more than we did before, there is still much to discover.

A small amount of research does exist on the neurobiology of sex addiction, however. One study looked at the brains of men with pedophilia and found that their brains were actually different than men who were nonsexual offenders.⁵ In fact, there were differences in the fibers that connected areas of the brain to sexual cues. And other studies have found that some people with stroke and multiple sclerosis have high rates of sexual behaviors as a result of these brain conditions.⁴

Still other factors that may increase the chances of having a sex addiction include:^1,4

• Being male.
• Being in late adolescence to mid-20s.
• Having low levels of serotonin.
• Experiencing childhood sexual abuse.
• Having one or more parents who were addicted to substances or to sex.
• Having pre-existing mental health diagnoses, such as impulse control disorder, conduct disorder, anxiety disorder, depression, or bipolar disorder.
• Having certain medical conditions that may cause hypersexuality, including injuries or disorders of the brain’s frontal lobe, such as tumors, lesions, seizure disorders, or dementia—all of which may contribute to reduced inhibitions.

Sexually deviant behavior is often grouped into non-paraphilic and paraphilic addictions. Non-paraphilic behaviors refer to sexual fantasies or behaviors that a society deems “normal”, whereas paraphilic behaviors refers to those fantasies and behaviors that are outside of what is considered normal or acceptable by society. Some examples include:^1,4

• Non-paraphilic behaviors:
  • Masturbation
  • Use of pornography
  • Promiscuity
  • Extramarital affairs
  • Frequenting strip clubs
  • Paying for a prostitute or working in prostitution
• Paraphilic behaviors:
  • Exhibitionism: the act of exposing oneself in public.
  • Voyeurism: the act of watching people during intimate acts such as undressing, bathing, or having sex.
  • Frotteurism: the act of rubbing your genitals or other sexual body parts on an unsuspecting and non-consenting individual.
  • Sadism: deriving sexual pleasure from someone’s pain.
  • Masochism: deriving pleasure from being physically harmed.
  • Pedophilia: a sexual attraction to children.

Mental and Emotional Side Effects

Because sex addiction shares many of the same characteristics as other addictions recognized by the DSM-5, the criteria for disordered behavior is the same. Below are some of the mental and emotional side effects that are possible to experience when you have a sexual addiction.

Mental and emotional effects of sex addiction may include:⁴

• Less time spent doing hobbies or hanging out with friends and loved ones.
• Loss of productivity at work and at home due to the distraction of the sexual addiction.
• Financial problems related to overspending in an attempt to satisfy the sexual addiction.
• Loss of employment due to absences, accessing restricted content on the job, workplace sexual harassment, or any other problem related to sexual addiction.
• Increased chance that substances will be abused.

People struggling with sexual behavioral disorders may also internalize feelings of guilt and shame because of the way the world views addiction. Because of this, if you have a sexual addiction, you may also feel:⁴

• Abnormal.
• Sick.
• Guilty.
• Ashamed.
• Regretful.
• Depressed.
• Uncomfortable.
• Numb.
• Hollow.
• Empty.

You may experience psychiatric problems too, most commonly depression, anxiety, and attention deficit hyperactivity disorder (ADHD).⁶ Your treating clinicians will need to assess for these things and treat them concurrently with your sex addiction.

These side effects may develop early, late, or not at all and may range from moderate to severe. If you or a loved one can identify with at least 3 of these side effects, it may be time to seek help for a sexual addiction.

How it Impacts Relationships

An addiction to sex does not only affect the person who is addicted. In fact, it can have a far-reaching impact on the people that an addicted person loves the most. These side effects often affect the healthy functioning of relationships. They can also leave the addicted person isolated because of the harmful emotional damage they can inflict on loved ones.

Some relational side effects of sex addiction include:

• Loss of trust because of lies, deceit, and denial of hurtful things being done.
• Difficulty in achieving real intimacy, either because of violations of trust that have occurred or because sexual partners are looked at more as objects than as individuals.
• Failed relationships due to infidelity, lies, or lack of trust.
• The chance that sexual addiction will lead to legal problems if the behaviors escalate to illegal activities, such as child pornography, soliciting sex, exposing yourself, rape, or any other violation of the law.

If you are a loved one who has been affected by the actions of someone with a sex addiction, couples or relationship counseling may help you and your loved one heal some of the wounds that have been caused. However, a person who is not willing to first seek out their own help for sex addiction is not a good candidate for couples counseling since the underlying issues will remain and potentially cause future damage.

The Physical Consequences

In addition to the mental, emotional, and relational side effects of sex addiction, there can also be physical side effects for the person who is addicted and, potentially, that person’s partner.

The physical side effects of sex addiction include:⁴

• Increased likelihood of contracting a sexually transmitted disease (STD).
• Physical injury to the genitals from aggressive or excessive sexual behaviors.

These side effects can be serious and could even threaten your health and longevity. If you are addicted to sex or are in a relationship with someone who is addicted to sex, making an appointment with a health professional to check on your sexual health may be an important step to take in the process of recovery. Many STDs can be cured if they are caught early. Some STDs, such as herpes, HPV, and HIV/AIDS, do not currently have a cure, but early intervention is still the key to mitigating your long-term risk of infection.

Treatment Options for Sex Addiction

Finding a treatment program for sex addiction can be a difficult task. Because the APA has not recognized sex addiction as a diagnosable disorder, professionals who deal with sexual addiction have been placed in a difficult position regarding the diagnosing and treatment of them. Without set criteria there is no diagnosis, and without a diagnosis, there is no investment in finding evidence-based treatment to tackle the problem. Without a diagnosis or an evidence-based treatment, there is no approved funding for facilities that provide sexual addiction services and no reimbursement to insured consumers.

There are professionals, however, who have vast experience treating sexual addictions, and these professionals will likely recognize the following common signs and symptoms associated with sex addiction:^1,3,4

• Repeatedly engaging in sexual behaviors, despite negative consequences.
• Lack of control over the problematic sexual behaviors.
• An overwhelming urge and tension that is present prior to initiating the sexual behavior.
• Pleasant feelings or feelings of release experienced during the sexual behavior.
• Engaging in the sexual behaviors and/or the feelings experienced after engaging in the behaviors are distressing to the individual.

These criteria parallel much of the criteria for a substance use disorder too, and many behavioral health treatment programs, dual-diagnosis facilities, and programs that provide medication-assisted therapy for addictions may prove invaluable as you begin your recovery. These programs tend to be readily available and are typically covered by insurance.

Cognitive Behavioral Therapy (CBT) and psychodynamic therapy have both shown promising results for those going through a sexual addiction recovery program:⁴

• Cognitive Behavioral Therapy (CBT) helps a person to identify thoughts, feelings, and behaviors that are potential driving forces behind dysfunctional patterns of behavior.
• Psychodynamic Therapy helps a person uncover both the conscious and the unconscious factors that are driving patterns of thought and behavior in a person’s life.

Dual-diagnosis programs could also be helpful, since it is not uncommon for someone to be addicted to sex and to also have an addiction to drugs and alcohol. It is also not uncommon for those addicted to sex to have an underlying and co-morbid mental health issue, such as depression, anxiety, or bipolar disorder. In fact, it is estimated that more than 40% of those addicted to sex also have some other underlying issue.¹ Treating both the addiction to sex and any underlying mental health or substance abuse issue will be important to maintaining long-term sobriety and relief from addiction.

Medication-assisted therapy while in treatment may also be helpful in attaining and maintaining sobriety. While the FDA has not approved any medication for the treatment of sex addiction, there are some studies that have shown certain SSRIs (antidepressants) and opioid antagonists, such as naltrexone, to be successful in treating the cravings and impulses related to sex addiction.