Article By Alex Manley
~ APRIL 2023 ~
When people talk about sexual urges, they often frame them in metaphorical terms.
They might describe themselves as “sex-starved” or call a horny person “thirsty as hell.” They might describe the pull of an attractive person as magnetic. And, of course, they could say, “I’m addicted to having sex.”
For some people, though, that talk is a bit less metaphorical, and a bit more real.
In the 21st century, it’s become more common to recognize certain substances’ addictive potentials. We now call alcohol addiction a disease, and increasingly, there’s recognition that substance abuse — whether of prescription drugs or illegal ones — is not a character failing, but due to the addictive properties of the substances themselves.
Yet when it comes to behavior, this gets a bit trickier. Gambling, for instance, is often considered to be something that can be addictive. But what about sex addiction? Can you be addicted to sex?
Though the phrase itself has become pretty popular, thanks in no small part to media coverage of high-profile cases, as it turns out, there is some controversy around the question of whether such a thing as sex addiction even exists. In order to get a better understanding of what the experts say, AskMen spoke to two sex doctors about the concept of sex addiction. Here’s what they had to say:
What Is Sex Addiction?
“First off, before defining ‘sex addiction,’ it’s important to know that many sex therapists emphatically state that sex is not addictive, and instead prefer the terms ‘compulsive sexual behaviors’ or ‘out-of-control-sexual behaviors,’” says Dr. Laurie Mintz, Ph.D., LELO sexpert and author of Becoming Cliterate and A Tired Woman’s Guide to Passionate Sex. “In other words, the field of sex therapy doesn’t recommend evaluating or treating sexual behavior problems through an addiction lens.”
“Sex addiction is not a recognized diagnosis in the DSM 5, or the recently updated DSM-5-TR,” agrees Dr. Kate Balestrieri, a licensed psychologist, certified sex therapist, and founder of Modern Intimacy. “The phrase ‘sex addiction’ is a colloquial term used to describe compulsive sexual behavior, recognized as compulsive sexual behavior disorder (CSBD) in the ICD-11.”
Mintz notes that the American Psychiatric Association, which publishes the DSM, “rejected the diagnosis of sex addiction, noting insufficient scientific evidence to support the notion that sex is addictive.”
As well, a BusinessWire article about a statement from the American Association for Sex Educators, Counselors, and Therapists — which Mintz calls “the major accrediting body in the U.S. for sex therapists,” cites Russell Stambaugh, Ph.D., DST, CSTS, one of the authors of said statement, as saying that “the best scientific studies do not currently support the theory that sex can be an addiction directly analogous to cocaine, heroin, alcohol or nicotine.”
So, essentially, “sex addiction” is a possibly significantly misleading name for a phenomenon that does indeed exist, but one that experts don’t classify as an addiction in the sense that we understand other addictions — an important distinction, because it changes how people think about the issue, as well as how it’s treated.
So if the real disorder isn’t sex addiction but something called “compulsive sexual behavior disorder,” what is compulsive sexual behavior disorder, exactly?
“CSBD reflects a pattern of being unable to control patterns of intense and repetitive sexual impulses and urges, which leads to repetitive sexual behavior,” says Balestrieri. “Despite negative consequences in a person’s life, or a lack of pleasure born out of their sexual efforts, repeated attempts to stop the behavior have not been effective.”
“Stated simply, we are talking about sexual behaviors that cause individuals significant negative physical, psychological, spiritual and/or sexual health consequences and, in some but actually less frequent cases, feel out of control,” says Mintz.
“CSBD can engender feelings of helplessness, powerlessness, fear or shame for those who experience it, similar to other chemical and behavioral addictions,” Balestrieri adds.
However, Balestrieri notes, “Feeling a moral judgment or recognizing a relational or identity conflict about one’s sexual behaviors is not the same as CSBD, and is not enough to warrant a diagnosis,” adding that CSBD “is generally considered a disorder of impulse control.”
How Common Are Sex Addiction Issues?
The prevalence of CSBD “is a difficult construct to appropriately measure, given the confounding variables of stigma around sex, the conflation of compulsivity and moral judgements about sex, and hesitance for many people to come forward for research and treatment,” says Balestrieri.
“Earlier studies suggest a prevalence around 3-6% in the general population,” she notes. “Generally, more men seek out treatment, but it is not clear if that is related to organic differences in prevalence, or social stigma further targeting women’s sexuality, resulting in additional shame that prevents women from seeking treatment.”
“In one study of US adults, about 10% of men and 7% of women endorsed distress or impairment in sexual self-control,” says Mintz. “One study of college and university students found up to 18% reported symptoms of hypersexual behavior disorder while another study of college students only found 2% meet criteria for compulsive sexual behavior.”
When it comes to feeling like you’re addicted to porn, she added, “one study found that about 9% of individuals who try are unsuccessful in giving up porn and about 8 to 17% of porn users might be classified as compulsive users.”
“As you can see, we don’t really have accurate numbers at this time,” says Mintz. “However, we do know that people regularly seek services because they think they are a porn or sex addict. Interestingly, the belief itself might be part of the problem.”
Essentially, Mintz notes, if you perceive your own sexual behavior as something you’re addicted to — due to, for example, “moral disapproval and religiosity,” you may experience significantly more distress than someone else with the exact same behavior patterns but who doesn’t perceive them negatively. Thus, even someone who doesn’t spend much time watching porn or engage in many hookups may see themselves as porn or sex addicts even if their behavior doesn’t match that of an ‘out-of-control’ person.
Signs You May Have Compulsive Sex Issues
“People often struggle with controlling their sexual behavior (e.g. masturbation, partnered sex, viewing pornography, paying for sex) like any other pleasurable activity,” says Mintz. “A smaller portion of people feel their sexual behavior is out of control.”
She notes that people might be concerned about their sexual control when:
- “Their sexual behavior is paired with drugs and alcohol
- They judge their sexual desires and activity as immoral or shameful.
- They repeatedly experience negative consequences (e.g., sexually transmitted infections, unintended pregnancy, or relationship conflicts from infidelity).
- They miss important obligations due to sexual behavior (e.g., miss work or school because they are engaging in solo or partnered sex).
- Sexual behaviors interfere with one’s ability to form or sustain healthy sexual and emotional relationships (e.g., consistently staying home to masturbate to porn rather than go on dates or out with friends, pattern of dishonoring sexual agreements)
- They make promises to change their sexual behavior but don’t”
Ultimately, “CSBD may be something to consider if you feel your sexual behavior is out of control, and is causing negative consequences in your life,” notes Balestrieri, but particularly if “you have a desire to stop and have not been successful in your efforts.”
In order to determine whether that’s you or not, she says, “You might take an inventory of whether your sexual urges or behavior has resulted in you neglecting important areas of your life, such as your physical health and wellbeing, your professional responsibilities, or parenting.”
She says you could ask yourself questions like:
- “Has it resulted in legal infractions or had a damaging effect on your relationship?
- Have you lost the pleasure of sex, and feel governed by the ritual of seeking it out?
- Have you sought out more intense or more frequent sexual activity, or kinds of sexual behavior that challenge your own values or do not fit your own erotic interests?
- Have you tried to stop, and have been unsuccessful?
- Do you feel emotionally hungover after engaging in sexual behavior?”
What to Do If You Think You Have CSBD
If your relationship with sex “feels problematic,” Balestrieri notes, it might not be a bad idea to work with a professional on this issue.
“They can help you explore your relationship with sex, your concerns about your behavior and help you reduce shame and create a blueprint for a relationship with sex that is thriving and exciting, while minimizing any out-of-control or problematic sexual behavior.”
However, unsurprising given the controversy around CSBD, not all professionals will approach the situation the same way. Mintz suggests seeking counseling from “a certified or trained sex therapist,” and also suggests avoiding people who call themselves “sex addiction counselors,” as this may be an indication that they are working within an addiction-based framework. She mentions trying out AASECT and SSTAR’s sites to find someone to work with.
While the experts don’t agree that sex addiction exists per se, Balestrieri notes that this doesn’t mean addiction-style treatment can’t help some people who struggle with CSBD.
“There are also 12-step meetings for folks who identify with the addiction model and want support as they gain traction in reshaping their relationship with sex,” she says. “Therapy groups and other community involvement can be a welcome support system as well. It can feel lonely to be at odds with your sexuality, or to face any negative consequences that have transpired.
You are not alone and being a part of a community can be a strong protective factor in your healing.”
A version of this article originally appeared here on askmen.com