A "Sex Addict" By Any Other Name Hurts the Same

Much like alcoholism decades ago, acceptance and understanding of sex addiction is gradually increasing.  This happens whenever..… 

     ….. a politician or celebrity admits to a history of multiple affairs;

     …..a successful career is suddenly terminated amid whispers of astoundingly inappropriate sexual behavior;

     .....a respected marriage ends in divorce because one spouse was leading a sexual double life.

It's becoming almost universally accepted that compulsive sexual behavior can literally devastate the lives of people who are fundamentally moral, thoughtful and committed.  For example, easy and anonymous access to hardcore pornography, cybersex and other forms of secretive sexual gratification can carry some caring and competent people into a downward spiral of lust that is capable of eroding their deepest principle, clouding their best judgment and destroying their most cherished relationships.

The old jokes (“That’s the addiction I want to have!”) are slowly being replaced by sincere discussions about what makes so many people fall off the sexual cliff.  Because of this gradually improving public awareness, it's becoming more likely than ever that a person caught in an ultimately unsatisfying cycle of sexual behavior may utter a simple but profound sentence: “I think I may be a sex addict.”  This humbling admission can be one of the most important moments in a person's life and mark the start of a journey to healing and happiness. 

But many other people in similar situations can’t or won’t say those words even in the face of potentially devastating and lasting consequences to their personal reputation, professional career, emotional well-being and family lives.  Their reluctance often stems from their belief that the word “addict” is too shameful, too harsh or just doesn’t fit.

  • The stigma and shame may cause some people to think of the worst extremes of sexual behavior, even though an extremely wide variety of behaviors can cause a person to realize that a problem exists.
  • Some skeptics may suspect that the word “addict” excuses responsibility for bad behavior, even though in reality it is an admission of the need to fully address the problem.
  • There can be a mistaken belief that a “sex addict” has to stop having sex, which is not the definition of sexual sobriety.  Although some behaviors have to stop, the ultimate result is to achieve a healthy and balanced approach to sexual desire.

For all of these reasons and more, a person first facing the possibility of being a sex addict is likely to negotiate for an alternative explanation that seems easier to swallow and requires less effort to change.  But isn't the impassioned protest that "I may have some problems but I'm not a sex addict!" just the kind of denial that proves the problem?  The answer may not be so simple.  

The reality is that several other reasons are capable of explaining why someone would engage in inappropriate sexual behavior over and over again.  However, it will soon be evident that none of these other conclusions are very comfortable to face or easy to treat.  

In order to understand these distinctions it is first necessary to clear away any confusion regarding what does NOT constitute sexual addiction.  The next step will be to consider what other categories are capable of sufficiently explaining the kind of behavior that is under question.  The answer may disappoint a person looking for a convenient explanation for the mess he or she has created.  

Many myths and accusations tend to swirl around the concept of sex addiction, obscuring the characteristics that really matter.  A few points of clarification can threfore be very helpful. 

1. Sex addiction is not the same as really, really, REALLY liking sex.  There is a lot of variation in the frequency and variety of sexual stimulation people seek.  Some don’t experience significant sexual desire for weeks, months or longer, while others are willing and able to be aroused whenever an appropriate opportunity is available. 

People express their sexuality in many different ways and for many different purposes.  Sexual energy can be used to: 

  • enhance emotional intimacy with a partner; 
  • relieve stress and escape from the cares of the day; 
  • experience an exhilarating sense of excitement, novelty, and freedom;
  • revel in the delight of desiring and being desired;
  • connect with and explore the profound psychological aspects of the physical self;
  • bring the blessing of a new life into being, and so on. 

All of these sexual desires and motivations have both highly conscious and deeply unconscious roots.  Like fingerprints, our sexual drives and erotic templates are a mix of both the common and the unique.  People are into all kinds of different things. There is no single measure of "normal" sexual expression. 

     Here's the Truth Behind the Myth…..…..

The attempt to blame ongoing sexual shenanigans on a "strong libido” can serve to deflect attention away from the presence of other possible personality deficits.  Chronic lust can obscure the fact that a person may not possess all of the skills necessary to be well-rounded adult, such as the ability to:

  • competently convey a wide range of appropriate emotional expression; 
  • experience healthy emotional intimacy with a primary partner;
  • effectively manage inevitable relationship conflicts;
  • capably cope with the expected and unexpected stresses of life;
  • articulate rather than merely act upon feelings;
  • act with appreciation of the causes and consequences of behavior;
  • develop and maintain healthy limits and boundaries; 
  • enjoy affirming forms of physical and emotional pleasure, and so on.

Relying on intense sexual preoccupation to compensate for the absence of these attributes is a terrible investment of energy.  It should come as no surprise that the eventual result is a level of emotional isolation that is one of the inevitable characteristics of sexual addiction.   

2. Sex addiction is an inappropriate explanation for differences in sexual desire within a relationship.  Sometimes a person who has a relatively lower level of sexual desire may feel like a partner with a higher sexual appetite is showing symptoms of sex addiction.  It’s not enough to say “He’s a sex addict: he wants to have sex with me all the time”.  

This conflict is beautifully expressed in the famous “split-screen” scene from the movie “Annie Hall” in which Diane Keaton and Woody Allen tell their therapists how often they have sex with each other.  She says “Constantly!  I’d say three times a week” while his reply is “Hardly ever.  Maybe three times a week.”  

Some people who engage in ongoing sexual deception claim it is at least partly the result of "a relationship problem" with their spouse or partner.  The reality is that lots of couples encounter deeply troubling conflicts without using them to justify secretive sexual behavior. Of course, a conflicting level of sexual desire can often contribute to and/or reflect other problems in a relationship.  This can be difficult for a couple to address without defensiveness, shame, misunderstanding and defense mechanisms that obscure rather than clarify the issue. The danger is when labels such as “sex addict” and “cold as ice” turn into weapons. 

     Here's The Truth Behind The Myth……….

An incessant desire or demand for exceptionally frequent sex in an intimate relationship can certainly be included as one of a collection of indicators that suggest the possibility that a person may be operating with some degree of sexual compulsion or addiction.  Regardless of any relationship problems that may need to be addressed as a couple, when such sexual desire repeatedly spills outside the relationship, it's reasonable to suspect that a pattern of sexual dependence is either emerging or escalating.  

3. Sex addiction isn’t the only reason a person repeatedly has affairs, keeps blowing the mortgage on prostitutes or chronically masturbates to porn for hours on end.  All of these behaviors can certainly cause shatteringly negative consequences, but they do not necessarily mean that compulsion is the core problem.

Sex addicts aren't the only one with the capacity to engage in sexual behavior that is misguided, immoral, destructive, callous, and deceptive.  Many people seem content, capable and even dedicated to operating with a selfish disregard for anything other than personal pleasure.

     Here's The Truth Behind the Myth..........

It's clearly the case that one characteristic of truly addictive sexual behavior is its capability to operate without regard for ethical, legal, logical or moral constraints.  Addiction erases such limits and boundaries, which is why a sexually addicted individual can engage in thoughts, words or actions that can be profoundly disturbing to others (and even to the addict once the fever has broken).

So why in the world would a person continually engage in sexual behavior that is so fundamentally flawed and inherently unhealthy?  What categories can contain this kind of lifestyle?

Four choices are available, and all of them have the ability to seriously impair the quality of life a person can ever expect to experience unless they are openly addressed in an honest and sustained manner.  It may be surprising which answer offers the most hope.

The first two alternatives are that a person who repetitively seeks intense sexual gratification in the face of enormous personal risk either(1) lacks a steady moral compass or (2) has developed some degree of sexual addiction, compulsion or obsession (all three words mean just about the same thing).

There are two other categories to consider, including the fact that (3) some people are simply ignorant about how to  manage their lives with appropriate sexual boundaries in the first place, generally because they grew up without sufficiently healthy caretakers to model this behavior. The final possibility is (4) the presence of a serious mental illness or other significant impairment that inhibits restrained sexual behavior.  

Therefore, a person who repeatedly engages in a pattern of sexual behavior that violates commitments and has the potential for profoundly negative consequences either:

  • doesn't know any better,
  • is ethically challenged,
  • has a psychiatric illness, or
  • lacks sufficient self-control.

To be blunt, such a person is either ignorant, unethical,  impaired, or addicted (and these categories are not mutually exclusive).

All of a sudden, "addict" doesn't sound so bad, does it?

While these words may seem offensive, so is the behavior that leads to their use.  Too often a person adamantly refuses to accept a conclusion without carefully considering the alternative explanations that may be equally painful to acknowledge. While it's understandable to seek an answer that avoids intense discomfort, it's not helpful to enable this type of emotional evasion at such a pivotal time in a person's life. 

The bottom line is that a person who engages in ongoing destructive or deceptive sexual actions has a significant problem that must be acknowledged no matter what the reason is or what other issues are present.   

Therefore, regardless of whether the label "addiction” seems warranted, issues such as recurrent anonymous sexual encounters, chronic masturbation, extensive online pornography use, frequent affairs, repeatedly paying for sex and other unhealthy patterns of sexual activity are extremely serious behaviors that need to be addressed in a forthright manner.

The goals associated with any problem are at least partially determined by the way that problem is assessed. In other words, what you do about something is influenced by what you call it. Each of the four explanations listed above has specific implications for the type of approach that will likely bring about the best outcome for everyone involved. The particular steps that will be useful to take for each category are beyond the scope of this article and are best addressed in consultation with a qualified counselor and other supportive and informed resources.

A professional who is being asked to guide an individual or couple though difficult areas they are unfamiliar with and which will impact them on a deep personal level for years to come should be able to provide an accurate assessment and competent counseling without preconceived notions about what will emerge. This is not as simple as it may seem.  People have a natural tendency to interpret situations from their particular theoretical, philosophical or ideological perspective.  It’s easy to think you are being objective about a situation when you don’t perceive or fully appreciate the limitations of your own framework.  (As the old saying goes, fish don’t notice the water they swim in.)  To be able to transcend rather than be limited by these preconceptions is the mark of a truly balanced, fair and objective approach.

I’m very comfortable reaching the conclusion that a client does not have a problem with sexual addiction as long as he or she is willing to consider that this may in fact be the underlying source of the problem. Whichever category emerges as the primary focus, such understanding and acceptance often emerge in stages, not always because a person is trying to be deceptive but because of an inherent degree of self-delusion that stems from shame, fear and the inherent fragmentation of awareness that comes from a long pattern of leading a sexual double life. Because of the above, it may take more than one discussion to come to a conclusion on the matter.

This rather lengthy article has presented a way to conceive of chronic sexual indiscretions that includes but is not limited to the addiction model.  There are additional components of this topic that are important to examine in much closer detail, especially in the context of each unique individual situation that presents itself.  

I invite and welcome contact from any person ready to carry this conversation forward.

Comments

Anonymous sexual encounters, masturbation, online pornography use, and paying for sex are behaviors that are not ignorant, unethical, impaired, or addictive just because you think someone does them too frequently. Some people are hurting themselves or those around them with sex, but advocates of a "sex addiction" diagnosis can't seem to define the term without throwing in everything about normal human sexuality that they don't like. Playing on Americans' sexual shame is a license to print money, but it's not serious or ethical psychology. If you really want to help, start by defining your terms in a way that at least tries to separate serious problems from fun that middle class white culture disapproves of. Better yet, reflect upon why advocates of a "sex addiction" diagnosis consistently fail to do that.

Alex, thanks for your comment and sorry it took me so long to publish it -- I didn't check the queue for awhile.  I sure don't think that acknowledging the existence of sex addiction/compulsivity has much of anything to do with the behavior itself but in the unmanageability of it.  Anonymous sex, hardcore porn, long jack sessions, hitting up hookers, etc. is personal choice.  Lying about those things may come from shame, but doing so in a relationship where another person depends on the truth simply isn't ethical.  Perhaps there is impairment going on (bipolar disorder is a classic example).  People who are esentially narcissistic are capable of lying about any or all of their sexual behavior to get away with it.  None of this means an addictive process is going on.  That's only one possible explanation.  Feel free and write back and we can knock it around some more. 

Hey GREAT discussion Mark and Bill!  I echo Bill's comments in his thanks to you for your perspective!  I wish more would take the time to comment on all the wonderful blogs out there on this topic!  Now, what I find utterly fascinating is that we (humans) are not the only member of the animal kingdom who experience or suffer from addiction/compulsions...whatever the heck you choose to label it.  Bill, as you know I use horses in work with kids, parents and individuals.  These animals are just fascinating and extremely effective in assisting with healing from a large number of human "afflictions".  And the mind blowing thing about horses is that they too can manifest obsessive/compulsive behaviors.   Case in point.......years ago we inherited a thorobred horse who had been confined to a 12x12 stall most of her life.  As a result she coped with that confinement by placing her upper teeth on parts of her stall and sucking in large amounts of oxygen.  This became a compulsive behavior that existed sometimes minute by minute.  You could observe and 2-3 minutes tell she was getting a high. This is called cribbing (mood alteration) and increased during her confinement (toleration and dependence).  When she came to live with us and could be turned out to pasture, the behavior continued in spite of having acres and acres to graze on lush grasses.  She would cribb on tree limbs, fence and even the withers of other horses!  It didn't take long for her to experience isolation from the other horses who avoided being the recipients of teeth on their body.  Fortunately we were able to apply a device known as a cribbing collar which made it difficult for her to continue this behavior however when the collar was removed she would resort back to the behavior.  The results of this compulsive behavior were damage to her teeth and our fences!  Visitors to the farm were heard to comment, "that horse is crazy!"  and "why can't she stop that?"  One even commented, "she is just doing it for attention".....comments that mirror those often heard in regards to human addiction/compulsivity.  Veterinary medicine and in particular, neuro-bioligical research has outpaced human medicine due to the lack of restriction and regulation based on moral objections or fear.  As a result the science has been able to verify outcomes in their research and study the role the brain plays in this behavior.  Effective medicines are now available to treat this problem with most favorable outcomes.  BTW, the horses brain is roughly the same size of the human brain but underdeveloped in the prefrontal cortex (hence the propensity to hyper-reactivity).  Now all this to say that I find it very reassuring that we are not alone in this universe in having to deal compulsive/addictive behaviors be it sex, work, gambling, eating, etc.  Please excuse me while I exit to go engage in the compulsive behavior of riding my horse.

I vigorously object to your use of the word "addiction."  I think that this is a misplaced label, adapted and coopted primarily by the religious right to demonize any sexual activity or desire outside of the missionary position in a dark room at night within a legally-sanctioned marriage.   Addiction also suggests an organic dependency rather than a psychological one. "Compulsion" is a more apropriate term.

Secondly, your four sources,

  • doesn't know any better,
  • is ethically challenged,
  • has a psychiatric illness, or
  • lacks sufficient self-control

are too judgmental, compartmentalized, and dependent upon psychological/psychiatric jargon and thought systems.  You omit the non-judgmental effects of poor self-esteem, social persecution, and simple libido, all of which are factors in gay society, for one.  I object to any and all compulsions falling under the rubric of "psychiatric illness."

I should think that you need to consider one other factor, and that is the manic, sorcerer's-apprentice nature of present-day consumerist and capitalist society, which incessantly demands participation and indulgence of its intended marks.   One would have to have the iron will of a proven saint to resist the constant bombardment of sexual come-ons in the current age.  This should not be viewed solely as "lacking sufficient self-control."

Mark, I greatly appreciate that you took the time to share your thoughts.  

I'm glad your objection to the term "addiction" isn't based on any denial that there exists a level of out-of-control sexual behavor that has devastating consequences.  As you surely know, there used to be a significant section of the professional psychology and sexology community that was extremely reluctant to acknowledge any such concept, no matter whether it was called sexual compulsivity, sexual addiction, problematic hypersexuality, out-of-control sexual behavior, or any other term.   So much of this reluctance was based on a sincere concern that such labels would subtly or overtly pathologize many of the wonderfully diverse expressions of sexuality that humans are capable of enjoying.  

It seems to be me that this ice has melted a great deal over the last few years.  Whatever the phenomenom is called, there are less and less informed professionals willing to argue that some people experience a tremendously difficult challenge not behaving sexually in a way that brings the many layers of destruction I referenced in this article. 

I'm very comfortable using the term "compulsivity" in place of "addiction", but I tend to primarily utilize the addiction framework because of neurologically-driven data indicating the functional equivalence between most substance and process addictions.  It seems to be that brain science has pretty much put the issue to rest other than nuances of nomenclature.  

For example, the type of sexual behavior referenced in this article is consisitent with any addictive disorder, including:

·        a “high” from the behavior (mood alteration);

·        a progressive need for more frequent or intense stimulation (tolerance);

·        strong desire for the mood altering behavior (craving);

·        increased reliance on the behavior in order to function (dependence);

·        discomfort and reduced functioning in its absence (withdrawal);

·        an inability to manage the results of the behavior (loss of control);

·        an inability to stop thinking about the behavior (obsession);

·        engaging in the behavior despite attempts not to do so (compulsion);

·        a gradual alteration in personality (personality change)

·        increasing secrecy and social withdrawal (isolation).

I'm continually fascinated by the view, which you raised, that some elements of the religious right use the 'addiction' label to pathologize diverse sexual experiences.  I'm not saying that many such people don't carry strongly negative opinions toward diverse sexual expression.  However, my experience is that they frame these objections more along moral lines rather than using the concept of addiction.  In fact, I just received commentary from a therapist who often works with staunch members of the religious right.  Her view is that these folks are generally not  very supportive of the addiction model because of a mistaken assumption that it removes reponsibiity from the person.

To your point that the four categories I posit all carry a negative connotation, that's basically on purpose.  To restate one of my primary themes, some people do such a good job rejecting the possibility that they are out of control that they don't consider the equally painful alternatives, and I don't want to make this easy for them to do.  

The terms do each carry judgments, but I'm not sure that's the same as being judgmental.  I agree with your point that they are compartmentalized, and Imade a slight reference to the fact that these are not mutually exclusive categories.  

I appreciate but don't agree with your contention that "self-esteem, social persecution, and simple libido" can be sufficient drivers for a person to sincerely but unsuccessfully try to discontinue the kind of behaviors this article describes.  

As a kink-aware and gay-affirmative psychotherapist, I'm keenly aware of the need to contextualize behavior within cultural frameworks.  However, when I have a long-term gay relationship on the verge of dissolution because it has emerged that one partner has engaged in thousands of secretive, anonymous sexual encounters despite a desire not to do so, then something is going on beyond "self-esteem, social persecution of simple libido". 

I'm also fascinated and would love to hear more about your view that compulsions should not be considered as appropriate for psychiatric classification, if I read your comment correctly.

The bottom line is that if I am engaging in sexual behavior that causes some significant degree of damage along emotional, legal, financial, and/or relational dimensions, AND if I sincerely commit to operating with different boundaries in these areas, AND I know that there will be devastating consequences to me and to people I love if this behavior continues, AND I have tried as assiduously as possible to change these patterns, AND I have been ultimately unsuccessful in achieving this outcome........what do you call me?

And brother I am right with you on your beautifully expressed comments about the extreme toxicity of our cultural milieu. 

So thanks again for writing.

Thanks for your detailed reply.  By your accounting, sexual compulsion is much more severe than my own personal experience of it.  I find a great deal of social/consumer pressure to constantly indulge in sexual thought and activity even though I try to insulate myself from it.  I liken this to the allure of the casino--another "vice" I avoid by simply not allowing myself to gamble, because I know where it leads with myself--i.e. I have little self-control after a certain point.  I don't consider myself a problem gambler because I can be in a casino and not feel some uncontrollable urge. "Gambling addiction" is spoken of as well, and I can see that the compulsivity of that habit could be utterly self destructive, too.  I am not a psychologist or social worker, and I don't (dys)function on denial.  My appraisal of someone calling themselves a "sex addict" is that it excuses them from taking responsibility with it, but having said that I'm also not a hard-core religious rightwinger.   I also don't want you to think that my critique of your paper is intended as anything but constructive.

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