My thoughts on Sex “Addiction” aka Compulsive Sexual Behavior aka Problematic Sexual Behavior.

I am an AASECT Certified Sex Therapist and used to be an IITAP Certified Sex Addiction Therapist. There were too many things about the IITAP sex addiction treatment model (there are other models) at the time that I went through the training (it may be different now) that I disagreed with. For this reason, I let that certification lapse. I would like to share some of my thoughts as someone who has been trained in both treatment approaches.

1. When someone is severely addicted to drugs and alcohol, they risk death if they quit cold turkey. This is not true for sex. No one has ever died from not having sex. Can people experience severe anxiety and distress if they are unable to have sex? Yes. But they do not experience the same physical dependence as those who are truly addicted to drugs and alcohol. People argue that this criteria alone isn't enough to rule it out as an addiction, but it is a difference I think is worth pointing out. 
2. Medical and mental health professionals have yet to put “sex addiction” in the Diagnostic and Statistical Manual of Mental Disorders (DSM V) or in the ICD-10. This is because there is not enough evidence of compulsive sexual behavior meeting the same criteria as drug and alcohol addiction. Others argue the reason it hasn't been included is political. 
3. For these reasons, models of treatment that replicate addiction treatment models are often ineffective, and worse, damaging to many individuals who participate in them. There are always exceptions to the rule, and in severe cases, some may benefit from treatment that is similar to addiction treatment.
4. Can sexual behavior become compulsive? Yes. Can it destroy relationships? Yes. Can someone feel like they are dependent on porn or sex? Yes.
5. It is important that someone who is well-versed in healthy sexuality is making a diagnosis of “sex addiction.” I have had several clients come see me who have previously been labeled as sex addicts by other professionals. While some of them do exhibit compulsive sexual behavior, I have found that others:
   • had sexual preferences that were outside the cultural norm
   • simply had higher sexual desire than their partner
   • had a history of childhood trauma that they were coping with in unhealthy ways as adults
   • are questioning their sexual orientation
   • did not actually wish to be monogamous, but had not been able to talk to their partner about their feelings
   • had a particular sexual fetish that their partner wasn’t comfortable with
   • were in sexless marriages with partners who had labled their partners as “sex addicts” because they were always complaining about wanting more sex
   • had had only one affair
   • were actually bipolar, depressed, or had ADHD and whose sexual behaviors were simply a symptom of another diagnosis.

           Conducting a SOLID DIFFERENTIAL DIAGNOSIS is ESSENTIAL!   Sadly, many clinicians are not trained on how to conduct a good differential diagnosis.

6. Do I believe that sex, porn, massage parlors, extramarital affairs, strip clubs, and use of escorts can become problematic? YES!
7. Do I sometimes recommend that my clients stop viewing pornography? YES! I actually think that many sexual dysfunctions (such as erectile dysfunction, delayed ejaculation, and rapid ejaculation) arise from over-porn use, especially among men.
8. The fact is, there is SO MUCH sexual behavior that is outside the cultural norm that is still perfectly healthy. There is also sexual behavior that we, as clinicians, consider unhealthy. Ultimately though, as long as there is no harm to self or others, mutual consent, and mutual pleasure, I view my role as helping each and every one of my clients determine what is healthy for them. That may look different than the next person who walks through my door.
9. Here are some questions to ask yourself when considering whether your behavior is unhealthy or compulsive:
10. Does my behavior involve mutual consent and mutual pleasure?
11. Am I breaking the law with my sexual behavior?
12. I am exploiting a vulnerable population or person through my sexual behavior?
13. I am breaking the assumptions of monogamy with my sexual behavior?
14. I am putting my primary partner’s sexual health at risk through outside sexual behavior?
15. Is my sexual behavior creating distress to myself or to my partner?
16. Do I feel dependent on a specific kind of stimulus for sexual arousal and wish I could get turned on in other ways?

To summarize, the language we use in assessing, diagnosing, and treating sexual issues is extremely important. The word “addiction” when applied to sexual behavior can create a perception that may further harm the individual, ignore true underlying pathology, and limit the range of what’s considered healthy when treating individuals who are suffering as a result of their sexual behavior.