If Not Sex Addicted, Then What?

Sex Addiction Series #2

Posted Aug 25, 2020

The couple looked troubled. Everything that they thought they'd figured out, that had been explained by their pastor, no longer made sense. "OK, then, if it's not sex addiction, what is the problem?" A moment passed. Then another. "Well," I said, "for starters, it's worse than you think."

Source: Photo by Cottonbro from Pexels

Sex addiction, as a pseudoscientific concept, is very emotionally appealing. First, it definitely labels the objectionable sexual conduct as a disease and nothing but a disease; really, there's no need to look any further. But the reason I told my clients it's worse than what they thought is that it's not the so-called addict who has a problem. The problem is about them as a couple.

Look closely at this definition of sex addiction: “any sexually-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment.” Sex addiction is about "any sexually related behavior." Really? How about flirting? Engaging in private sexual fantasy? Trying to talk one too many times to your partner about how sexually unhappy you are? Any sexually related behavior, like shopping for (and staring at) carrots or melons.

You might object, "That's a bit overbroad isn't it?" Sure. Absolutely. Let's narrow it down: "...which interferes with normal living." There can be no ambiguity there because, across the U.S., we all agree with what normal sexuality is. Just kidding, no, we don't agree. Sex outside of wedlock? Being gay? Availing oneself of the services of sex workers? Erotica, porn, or just steamy romance novels? Some of us think masturbation is a normal human behavior even though only 95 percent of Americans do it. (Studies indicate that the remaining 5 percent are liars.) You see where this is going. So much for normal.

This "sexually-related behavior" must "cause severe stress on family, friends, loved ones, and one’s work environment." A nice touch here. This is almost like (and easily confused with) the descriptive criteria for mental illnesses in which the disorder must "cause clinically significant distress or impairment." In other words, if a behavior doesn't cause problems then it's most likely not a problem—at least for clinicians. But if Johnny (or Suzie) persists in masturbating (when we really want them not to) and mom and dad are really upset, then there you go. You have a bona fide case of sex addiction. Or do you? The difference for clinicians is that the distress has to occur in the patient and not in the people around them. Therapy Rule #17: The person with the pain is the person with the problem.

I've had men come into my office seemingly tormented with their sexual thoughts and behaviors. They say that they don't want to think or behave this way. That these thoughts and behaviors are destroying their marriages. I suggest a thought experiment. "What if you came home one day from work and your wife, dressed provocatively, greeted you at the door with a warm kiss and a loving smile. She then looks at you kindly and admits that she was a little stuck on what to get you for your birthday and that finally, in the end, she decided to bring over her hot girlfriend so the three of you could have a great time and, right now, the girlfriend is waiting in the bedroom."

Long pause. "I'd think it was a trick." OK, but let's say it wasn't, what would you do? Long pause, "Well, I wouldn't want to be rude, I mean, it was her idea and...." There it is. The thoughts of infidelity did bother him, but only if they bothered her. If those thoughts and the related behaviors were viewed more kindly then (poof!) no more distress. This is confusing to some because it means that in marriages with frisky partners like the one above, what was a sex addiction yesterday might become today, abracadabra, a consensual sexual adventure.

When I tell my clients that sex addiction isn't the problem and that the real problem is worse than they think, what I mean is that they have a problem not having realized a sustainable form of sexuality. Most often, this problem with how they're living takes one of three forms:

1. There are people who are in committed relationships with other people and the problem is their relationship—not sex addiction. This might include men who want sex more than their partners do, women who long ago lost all interest in the stable stick-in-the-mud to whom they are married, and men and women who find their partners nice, very nice but really boring.

2. Then there are those who are trying to live according to a form of spirituality that they consider more important than the people their spirituality is meant to serve. A simple case: The woman caught masturbating in the 1990s film, The Handmaid's Tale. She was taken up by force and held with her hands outstretched while attendants burned them. Obviously a sex addict. But then, so is the teenager who masturbated seven times yesterday. Or the husband who was caught looking at adult porn after he thought his wife had gone to sleep. Part of his therapy was confessing all this in church on Sunday.

3. Finally, there are those people with personality disorders, sadly, who are simply incapable of love and for whom intimacy is a unicorn: absolutely nonexistent. Titillation, the arousal to physical stimuli, is their dialysis keeping them going. They are addicted to sex but only in the same way diabetics are addicted to insulin.

Treating any of these with the sex addiction model puts money in the hands of quacks and hopelessness in the hearts of people who really are looking for some compassionate help.

What a great read

Submitted by Ekim on August 26, 2020 - 7:47am

Thanks for posting.

I enjoyed every paragraph - all resonated with me.

I'm wondering where the 'anti' comments are!

The Emperor's New Clothes

Submitted by Steven Ing on August 26, 2020 - 11:17am

Hi Ekim. I suspect that their silence is the best defense against drawing any more attention to the fact that their business model is a scam.

I wholeheartedly disagree

Submitted by Robyn on August 29, 2020 - 2:30pm

This is highly damaging and unfounded. This is so sad and wrong. Please read carefully the works of Patrick Carnes and educate yourself on this very real addiction because you are perpetuating unhealthy addictive behavior that truly can harm people’s lives and destroy their families.

Done & done!

Submitted by Steven Ing on August 29, 2020 - 2:43pm

Thank you Robyn for sharing your thoughts. I have read Mr. Carnes' first book and I have educated myself about this not "very real addiction". Perhaps you could help me with sharing some of your reasoning about why you think as you do or how you disagree with what I'm saying. Funny though, isn't it, that after years of study, those writing the DSM have concluded sex addiction doesn't exist so...maybe you might consider the possibility that you could be wrong? I've been wrong so many times and so many of those times I was quite sure I was right. I'm sure you know what I'm talking about. Maybe this is one of those times? I'd love to hear your reasoning about sex becoming an addiction and why that's the best model for helping when sexual behavior is the presenting problem.

Anonymous wrote:

Submitted by Anon on August 29, 2020 - 10:24pm

Anonymous wrote:

...educate yourself on this very real addiction because you are perpetuating unhealthy addictive behavior that truly can harm people’s lives and destroy their families.

You made that up. Not calling a problematic behavior an addiction isn't the same as saying it isn't a problem that requires attention, or that as you absurdly imply, that it means it's fully supported, not a problem at all and therefore "perpetuated".

Are you saying that if anything is a problem, you have to call it an addiction, otherwise it's not a problem and you are perpetuating it?

wrote:

Submitted by Anon on August 29, 2020 - 10:16pm

wrote:

This is confusing to some because it means that in marriages with frisky partners like the one above, what was a sex addiction yesterday might become today, abracadabra, a consensual sexual adventure.

Good point. I think it squares with articles which suggest that religious people claim more sex addiction. If you try to live by unrealistic restrictions of thoughts and actions, you would logically see the inability to live within those restrictions as an "addiction".

One wife might see her husband's viewing of porn as an "addiction" even if he has all the sex with her that she wants. In the meantime, a woman in menopause who's sick and tired of sex might think of her husband's viewing of porn as a "welcomed relief" that he's not pestering her for sex all the time or going out and having an affair instead.

such an interesting conversation

Submitted by Steven Ing on August 30, 2020 - 12:58pm

I wish we could all be in a room talking about this. How seldom it is that these important conversations take place. I still think that the sex addiction industry is mostly about money and religion and so far no one has made a different argument. This silence seems to support that view.

Haha..ha.

Submitted by Kat on August 31, 2020 - 2:00am

wrote:

I wish we could all be in a room talking about this.

Pandemic: With a mask on? And six feet apart, of course--haaaaha!
Me: getting back to the subject--just my opinion...sex is a touchy subject, and is mostly subjective (with the exception of a few common/cultural norms, and biological facts). When anyone--especially those whose opinions hold weight spiritually and/or behaviorally--starts to label your preferences, feelings, thoughts, or opinions in this area as anything other than the 'norm' then something fundamental begins to change not just about what you like, but about who you are. I appreciate your stance on the subject---it's liberating. And I agree to a point: while I call it 'being in my vagina', others might put it more discretely as 'being in the bedroom'--and I believe that that is personal and private. Bringing any issues in this arena to a trusted authority should be treated with respect and objectivity (compassion also helps), but I suspect that sometimes ideology, cultural biases (the term of the times), and personal agendas get in the way. But maybe also confusion? Or, for lack of a better grasp on this gray area, maybe just a lack of a better way to handle something that is problematic to a relationship but not necessarily to that individual. It seems a whole lot 'easier' to lable polyamory a lifestyle choice rather than an unwillingness to commit to your best friend ...who you like to sleep with (but maybe not your life-partner). Or maybe say 'sex addiction'... Which feels even worse because now you're in the realm of impulse control and that's scary...when maybe you're (indiscriminately? Are they really random? Are you having extended, emotionally involved affairs?) sleeping with people outside of your relationship because you want to...you just don't want the negative repercussions of what that would mean for the relationship you're not completely ready to relinquish. And that's where the agenda comes in: who're are you going to for help and what do they believe? If the goal is to save your relationship and you're seeking help toward that end, then which part of you will be addressed? What you want, or what what you'll have to give up. You want the relationship, give up the extra sex (or the escapism/borderline voyeuristic, unrealistic and potentially damaging porn addiction), and save the relationship. Simple. But humans ask questions (why did this happen?), usually for prevention's sake--so maybe it's easier to say: impulse control, addiction, 'got caught up', than it is to say--'that's an excellent question. An even better question would be why is your partner's vagina not something you feel like you can commit to anymore? Or why do you feel the need to escape your own bedroom to be in someone else's?' Labeling an addiction is a tricky business--science has defined physiological symptoms to this endeavor, but it's also aknowledged that it has a social aspect to it, parts that enable and encourage behavior. So what seems like a 'simple' fix--lable this particular behavior as something 'extreme and hard to control' and then address it within those parameters--seems like deflection without the real application of the symptoms--your physiology has not changed in response to this changed behavior, your relationship has. But back to my point: I agree with you, to a point. You're a lot more accepting of the possibilities... I guess, willing to do the emotionally work. All I would need to know in this particular situation are the following: is this a scientifically proven disorder? And Do I get my 'original' partner/relationship back (or better)?

wrote:

Submitted by Anon on August 31, 2020 - 11:01am

wrote:

An even better question would be why is your partner's vagina not something you feel like you can commit to anymore? Or why do you feel the need to escape your own bedroom to be in someone else's?'

It's a little hard to follow your lenghty post, but this part seems judgmental. People in open relationships often aren't insisting on monogamous commitment. To them, it's like asking, why do you need more than one child -- is it because you have difficulty committing to just one child? Just like many people had multiple lovers while dating in college, people in open and polyamorous relationships are not "escaping the bedroom of their partner", they are adding to the fun with more than just the bedroom. And in some relationships, they both even enjoy telling each other about the adventures they had with other people, and enjoy hearing it. They take joy in hearing that their partner had sexual fun, regardless of whom it was with. The problem is, you would seem to start asking questions as if that is not possible and that no person would ever think that way, and you'd be wrong right from the start. Or you'd say there's something "wrong" with a person who thinks that way.

The problem with your questions is that they have already made a judgment in the very premise of the questions.

Less Broken than They Say We Are

Submitted by Steven Ing on August 31, 2020 - 12:05pm

Hi Anon. I agreed that it was hard to follow the post you responded to. If I may, I'd like to take the conversation from the edges of polyamory to a more common scenario that also applies. The questions you're asking also apply to sexual fantasies in traditional arrangements: "But WHY do you need to do that?" Even though as kids we could allow ourselves to openly play make-believe and start wars between "Cowboys and Indians," or start crimes as in "Cops & Robbers," we struggle with the exact same behavior of make-believe in our adult relationships. Some think this too is a precursor to full sexual addiction and that our capacity to think these thoughts is full of danger despite suffering no ill from our childhood habits of playing with ideas like severe anti-social behaviors or xenophobia and racism.

Conversation with Masks

Submitted by Steven Ing on August 31, 2020 - 11:58am

Hi Cat. I'm not sure if I follow you in what you said but it sounds like you're asking if addiction is a scientifically proven disorder. If that's what you're asking then the answer is a definitive "NO." I find these email conversations rewarding but thinking of masks brings up the metaphor of how much masking we use to talk about sexuality. I think this is because this topic is so unsafe. My unsafe conclusion is that most of what some call "sex addiction" of the individual is actually a relationship issue exacerbated by individuals' behaviors and beliefs.

It was

Submitted by Kat on August 31, 2020 - 12:52pm

My post was hard to follow (sorry about that) I was a little all over the place; there's a lot to unpack, and your responses helped:
1. Judgment: it's there, and that's why I suspect it's so hard to talk about sex. Judgment is supposed to be objective and sex is not
2. Relationships have their contracts (between the people in them--like those in both monogamous and Polyamourous relarionships), that sometimes change over time and there's a level of rejection that's involved when that change happens (if the change was unexpected, or not in the agreement). I can't speak for Polyamourous relationships, I was only imagining a scenario where a monogamous relationship may morph into one. But I can speak on an affair, and on your partner not being able to "answer for" what happened. In that case it does depend on who you go to for help, what you believe, and what (or who) you want to save. Sometimes being given a lable (even infidelity--though that is the truth, and it is what it is, is more than enough to deal with and unpack. Any more labels like sex addiction or pork addiction and I would either ask more questions (or check out). Not saying it's unheard of, just saying on a personal level --as stated in the previous post: I would ask is this real, and what has changed?
3. Strategy and saving the marriage vs. Saving yourself: there was a mention of playing out fantasies, etc. and I don't think there's anything wrong with that (no judgment here), but I'm talking about marriage counseling and being on the same page--it' s one thing to discuss your fantasies with your partner (and a trusted third party when things are ok, or maybe there's a lull; it's another to heal from infidelity and try to address underlying issues).
4. What does any of this have to do with sex addiction? It's possible that serial infidelity can be attributed to sex addiction and I'm saying I don't buy it.

Deepest Sympathies

Submitted by Steven Ing on August 31, 2020 - 3:25pm

Hi Kat! I think part of what's still hard to follow is that our culture hasn't developed the basic language to communicate on this issue. We're like nonmechanics trying to tell shop mechanics what's wrong with our cars. If I could pull a bit on one of your threads it would be that of "relationships have their contracts." I too use that term "contract" or "agreements" or "how it works in your relationship" to refer to a couple's understanding of how sex works or should work. It's funny that our courts have no problem treating matrimony as a contract but so many of us cringe at the idea because it doesn't fell right somehow, as if our relationship were business. But we do nevertheless make deals and sadly, when it comes to sex, it seems that the deals are always implicit (unspoken) and never really clear. Consider the couple who have the following exchange:
He: I'm glad we're talking about a long term committed relationship.
She: Me too!
He: I do have one question though....
She: Yes?
He: Under what conditions would we have sex?
She: Easy. Whenever we both want to.
He: I'm not sure that'll work.
She: Beg pardon? Making someone have sex when they don't want to is rape.
He: Agreed. However, I want to be in a relationship where I have a reasonable expectation that my sexual needs can be met. I don't want sex to become part of a power play.
She: And?
He: Maybe we should agree to have sex whenever the other person initiates it?
She: Hmmmm.

In this scenario, the "sexual contract" is about clarifying our expectations and we're negotiating the agreement. What sense would it make for anyone to commit to getting all of their sexual needs met in a relationship where their partner is not committed to meeting those needs? The sad part is that none of us are educated to have any version of this conversation about our "contract."

Recently Diagnosed

Submitted by James on August 31, 2020 - 3:20pm

In my last session, my (new) therapist said I was a sex addict. Even though my sexual impulses have *not* caused severe stress to anyone. Since I struggle to function normally without sex, he says its akin to going through withdraw. I always felt that if my wife was as into sex as much as I was, we wouldn't have a problem!

Thanks for you article. It is something I need to put more thought into and I will bring this up with him this week.

Time for a New Therapist

Submitted by steven ing on August 31, 2020 - 5:46pm

James, thank you for sharing what you're going through. I'm planning on talking a bit about your situation in my next installment in this series but, until then, please take a look at my TEDx Talk, "Magic Sex Number." (If you can't find it easily just go to my website for a link.)

Addictions

Submitted by Bill on August 31, 2020 - 3:54pm

Some healthcare professionals use the term ‘food addiction’ despite not having a formal diagnosis in DSM-5. It might not be clinically correct, but people know what's meant when a morbidly obese person is said to have a food addiction. The same goes for sex addiction. It's a real problem for some people and others might be using the term 'sexual addiction' as a cover for socially unacceptable promiscuity. Compulsive gambling often gets labeled as an addiction.

"Addiction - A biopsychosocial disorder characterized by compulsively seeking to achieve a desired effect (such as intoxication) despite harm and adverse consequences to self and others." Excessive eating, excessive gambling and excessive sex all seem to meet the threshold if the person with the problem feels out of control. So what if the American Psychiatric Association hasn't gotten around to adding it to their list.

What Do Words Matter?

Submitted by Steven Ing on August 31, 2020 - 5:53pm

Thank you Bill for you honest questioning. What a world it would be if we could all learn to question like this! So, what does it matter whether we use the term "sex addiction" or not because, as you say, we all know what we mean. First, we don't all know what we mean because, Bill, the term makes no sense as it is currently used. The term (and the concept) have no traction in science. Lastly, the conceptualization of any problem (including a client's presentation of one) largely determines what sort of thinking goes into solving it. Some states still allow for "conversion therapy" for treating the so-called "illness" of homosexuality and this is a spot-on example of how conceptualizing a problem as "the client's sex problem" obscures the larger problem of relationship dysfunction (Hi parents!) and irrational thinking. I hope this makes sense to you but, please, if it doesn't, feel free to weigh in again.

Chasing the Dragon

Submitted by Bill on August 31, 2020 - 7:39pm

We all understand physical addictions like heroin or alcohol, because of the need to detox to get clean. But, non-substance addictive behaviors are a different story. Internet gaming disorder has been included in the DSM-5 as a condition requiring further study. The topics of addictions relating to sex, exercise and shopping were discussed but not included as it was concluded that there is insufficient peer-reviewed evidence to establish the diagnostic criteria.

Gambling Addiction got on to the list because of the considerable amount of research had been conducted into pathological gambling, As far as I know it's still the only non-substance addictive behavior that has qualified. But, that doesn't mean that sex addiction doesn't exist. It simply means more research is needed. All addictions have one thing in common. The addict gets a head rush or high from engaging in the activity. They keep going back for more. Most of us can shop, eat, drink, gamble, use recreational drugs and have sex in moderation without going off the deep end. Some people need help.

Should Hypersexual Disorder be Classified as an Addiction? The case is getting stronger not weaker. Research investigating neurobiological pathways relating to hypersexual behavior is at an early stage. Good science takes time.

Gambling, Shambling

Submitted by Steven Ing on August 31, 2020 - 7:58pm

Good to hear from you Bill. I agree "Good science takes time." That's why we should wait for it. Whether we're talking about the Clorox Cure for Corona, or Conversion Therapy, or sex addiction, science will show the way but we have to...Wait. For. It. For true believers though, the absence of evidence is not a problem because we just have to have faith. Think of Jack Nicholson's character in "As Good as It Gets," who compulsively scalds his hands in the hottest possible water using a fresh, clean, luscious bar of unused (virginal!) bar of soap. Does he have a soap addiction? No, but don't try to tell that to true believers as further study is needed.

Soap

Submitted by Bill on September 1, 2020 - 8:39am

"Addiction - A biopsychosocial disorder characterized by compulsively seeking to achieve a desired effect (such as intoxication) despite harm and adverse consequences to self and others."

Obsessive-compulsive behaviors aren't going to meet the definition of an addiction. Melvin Udall, the character played by
Jack Nicholson, would receive a different diagnosis than an addiction. The American Psychiatric Association opened themselves up to a lot of new issues when they concluded that a person can be addicted to gambling. It's inevitable that sex addiction will be added to the DSM. Both gambling and sex involve activating the reward mechanisms in the brain. Excessive hand washing is about activating the fear mechanisms.

"Diagnostic classification systems, such as the DSM, do not include sexual addiction as a diagnosis because there is currently "insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders"."

Gambling addicts existed before the American Psychiatric Association decided to add pathological gambling to the DSM. Hypersexual Disorder is a real thing. It's difficult to give a legit diagnosis because the documentation hasn't caught up with what therapists are actual seeing in their offices. Denying that sex addiction exists until it shows up on the DSM doesn't seem like a reasonable approach. A better approach would be to start by reading the study: "Should Hypersexual Disorder be Classified as an Addiction?"
(Ariel Kor, Yehuda Fogel, Rory C. Reid, and Marc N. Potenza)
The issue isn't whether sex addiction exists, but how to deal with it.

Anonymous wrote:

Submitted by Anon on September 1, 2020 - 9:57am

Anonymous wrote:

Denying that sex addiction exists until it shows up on the DSM doesn't seem like a reasonable approach. A better approach would be to start by reading the study: "Should Hypersexual Disorder be Classified as an Addiction?"

Your approach isn't any more persuasive. Anybody can quote lots of studies arguing the other side. Why don't you address it more directly rather than copying and pasting links, which anybody here can do for 100 of pages? Give us a scenario of someone who you think would definitely have HSD that would not depend on the circumstances he's in (such as being labeled as such because his partner is less interesed in sex, etc.).

(Ariel Kor, Yehuda Fogel, Rory C. Reid, and Marc N. Potenza)
The issue isn't whether sex addiction exists, but how to deal with it.[/quote]

Who's a Sex Addict Now?

Submitted by Steven Ing on September 1, 2020 - 11:50am

Hi Anon et al. As the old saw goes, "Define "sex addict," easy, right (?), "Anyone who wants sex more than I do." Somehow our thinking about that most intimate part of ourselves has become that it can only be understood with more studies. Reason, as a tool of science, indeed, the primary tool, seems to have been tossed aside.

Anecdotal examples

Submitted by Bill on September 1, 2020 - 12:25pm

"Give us a scenario of someone who you think would definitely have HSD that would not depend on the circumstances he's in (such as being labeled as such because his partner is less interesed in sex, etc.)."

Thanks for reading and responding to my comment. I have zero examples of sexual addiction. I don't know any addicts. I'm confident that drug addiction exists, but I couldn't provide any examples for you. The goal of my comment wasn't to persuade you that sex addiction exists. I'm skeptical of compulsive gambling getting labeled as an addiction, but it's on the list. I haven't read any comment here that explains why pathological gambling is different than sex addiction. A compulsive, or pathological, gambler is someone who is unable to resist his or her impulses. Sounds a lot like a person that engages in a lot of risky sex behavior. I'm not trying to persuade anyone. Maybe a simple acknowledgement that gambling shouldn't have been added to the list of addictions would be nice.

Consider It Done!

Submitted by Steven Ing on September 1, 2020 - 2:26pm

Hi Bill, thank you so much for your patience here. I really wasn't hearing what you just explained. I DO agree with you about pathological gambling. My own feelings and thoughts in this matter have been greatly influenced by Gabor Mate's view that early childhood trauma results in a child turning to self-soothing behaviors. Left untreated, the child's self-soothing becomes compulsive. OUR mistake is that we get myopic about the compulsion while we ignore the feelings and the unresolved trauma. Gambling, smoking, shopping, religiosity, etc., really anything can become compulsive self-soothing. Even this model isn't close to an entire explanation by any means when we consider the impact of variables of ignorance, irrational thinking, and organic brain damage. Thanks again for your patience in pursuing this conversation. You were right.

Scenario

Submitted by Bill on September 1, 2020 - 1:05pm

One of the above comments asked that I provide a scenario where a person displayed signs of a sexual addict. How about a United States Senator that has a layover in Minneapolis on his way home to Idaho. Instead of sitting in the waiting area like most people, the senator gets arrested for soliciting sex with a man in the men's room. There's a Wikipedia page devoted to the story: "Larry Craig scandal". He was charged with lewd conduct and pleaded guilty to a lesser charge of disorderly conduct.

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About the Author

Steven Ing has been a Marriage and Family Therapist for 30 years and is the author of two books on sexuality, We’re All Like This and Get Busy Living.

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