A few weeks ago, I was at a social event and someone asked me ‘What do you do for a living?” This question may not seem tricky to you, but as a therapist who specializes in the treatment of pornography and sex addiction, this can be a boobytrap (no pun intended). There are the inevitable jokes of “I wish my spouse had that problem,” or “That must be fun,” followed by “Isn’t that just an excuse for cheating?”
Then there are the professional arguments as to whether sex addiction is truly an addiction. The American Psychological Association does not consider sex addiction a diagnosable disorder due to a lack of empirical evidence to support physical withdrawal symptoms from sex and/pornography. There is also an on-going debate over the language used to describe sex addiction; some professional groups refer to it as out of control sexual behavior, while others say compulsive sexual behavior. In my opinion, the most important place to spend my energy is with my clients. The individuals I work with report the inability to stop engaging in sexual behaviors that are severely distressing to them and damaging to their relationships. They often report feeling jittery, anxious, unsettled, depressed, and many experience insomnia, or racing and intrusive thoughts when they try to stop looking at pornography, engaging in compulsive masturbation, or seeking online contact with potential sexual partners.
According to the American Society for Addiction Medicine the Definition of Addiction is as follows:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death. (May 15, 2017. Retrieved from http://www.asam.org/quality-practice/definition-of-addiction.)
When I think about the behaviors of my clients who present with sex addiction, I can check off each of the above characteristics as present. Sex addicts report that they no longer get pleasure from their acting out behaviors, the arousal is mostly in the planning and fantasizing about the acts, and there is a strong need to relieve the anxiety and tension that build up despite deep shame and self-loathing about themselves afterwards.
The lack of pleasure or short-lived sense of pleasure derived from sexual behaviors by my clients is what separates them from individuals who are not addicts and engage in extramarital affairs, view pornography, or frequent massage parlors. At some point the pleasure turns to an innate need that cannot be dulled despite the negative consequences. Addictive behaviors escalate over time, because over time, the addict needs to access a higher level of the behavior (riskier behavior, more extreme pornography) to get the same hit.
A study out of the University of Cambridge conducted by Valerie Voon (2014) https://www.sciencedaily.com/releases/2014/07/140711153327.htm found that the parts of the brain activated by cocaine use are also activated in individuals who describe themselves as addicted to pornography. This study will hopefully lead to more research supporting the impact of pornography on the brain.
As with all problematic behaviors you must look at each individual and conduct a thorough assessment. The assessment protocol to determine if a sex addiction is present includes taking a thorough history of the client’s family life, work life, relationships, sexual experiences, and physical and mental health; speaking with the partner; and having the client complete a sexual addiction inventory. The Sexual Dependency Inventory is a validated measure that was created by the International Institute for Trauma and Addiction Professionals, which is the accrediting organization for sex addiction therapists, to determine if the client meets standardized criteria for sex addiction. But for me, the most important piece in making an assessment is understanding how much the behavior is negatively impacting the client’s life.
When clients meet the criteria for sex addiction it means their behavior is out of control and it has created significant negative consequences in their lives. However, characterizing their behavior as an addiction neither implies judgment nor excuses their behavior. It simply helps the client and therapist define the path to a better life. Every addict is responsible for their choices and behaviors. One of the most crucial parts of recovery from sex addiction is working a Twelve Step Program that is based upon taking responsibility for your behavior, making amends to those you have hurt, and paying it forward through service. These benefits can result from the diagnosis and treatment of a sex addiction without letting anyone “off the hook.”