- The concept of sex addiction has been vigorously debated but is not clinically endorsed.
- Twelve-step programs for sex addiction may exacerbate distress, shame, and depression.
- People struggling with unwanted sexual behavior can benefit from erotic awareness and sexology-informed treatment.
The notion of "sex addiction" and "porn addiction" has been debated and rejected by scientific communities worldwide because of the lack of evidence supporting it. A study published in December 2020 made a ground-breaking independent review finding that the research methodology for "sex addiction" and "porn addiction" over the last 25 years was poor, further questioning the validity of the conceptualization of "sex addiction."
The ICD-11 from the World Health Organization (WHO) only endorsed "compulsive sexual behaviors disorder" (CSBD) as an impulse control condition, not an addiction. The WHO states that CSBD is different than "sex addiction," and these two terms should not be interchangeable.
This is important because clinicians offer treatments that are congruent with what they label the condition they are attempting to treat. A therapist believing in "sex addiction" is more likely to offer treatment through the primary lens of addiction, despite the science not supporting it. Clients may be misunderstood in treatment because their sexual behavior struggles might be seen through the therapist’s window of morality rather than through the evidence-based knowledge of modern clinical sexology.
Despite the ICD-11 classification, there are still fierce disagreements and much confusion amongst clinicians. What is important to me is to alert the public affected by sexual compulsivity that they have choices about their psychological treatments.
If you struggle with unwanted and repetitive sexual behaviors that cause distress, please know that a "sex addiction" treatment and 12-step support groups are not the only choices, and they are not the scientifically approved ones.
People's Experiences with "Sex Addiction" Treatment Programs
Since the podcast with Dr. Kort, I have unfortunately received many calls and emails from people in the UK and Europe telling me about being traumatized by 12-step support group programs and by their "sex addiction" treatments. It is heartbreaking to hear that many people who originally struggled with sexual behaviors ended up feeling worse after their programs. The common self-report from the victims of such treatments is feeling more shamed and more depressed about themselves and their sexuality than before. It is the dark, unspoken side of the "sex addiction" movement.
I've heard many accounts of clients’ experiences:
"My therapist beat my sexuality out of me."
"I learned to lie better because I knew my therapist wouldn’t approve of my sexual desire."
"My sponsor told me I had an unrepairable spiritual disease because I didn’t agree with some of the 12 steps."
"My sponsor told me to break up friendships because they questioned my attendance at the fellowship meetings, and he thought they were a bad influence on me."
"My wife beat me after discovering I was still masturbating, and my therapist condoned the physical violence and told me it was my fault for cheating."
"My therapist told me to pray to stay strong and beat my sexual addiction even though I repeatedly told them I wasn’t religious, and I didn’t want to pray. They often responded that the refusal to do as they say was me being in denial, defensive, and self-harming."
"My sponsor told me that having sexual thoughts and fantasies was bad, but I found it impossible not to have spontaneous sexual thoughts. I began to believe I was really broken; my sponsor agreed."
Distinguishing Between Preference and Pathology
Many sexual practices that are non-monogamous or unusual may actually be functional and harmless as long as they are consensual but may be misunderstood by therapists who have poor knowledge of contemporary sexology and therefore might unduly pathologize their clients, which creates more harm for them.
I've heard on numerous occasions that people practicing BDSM (Bondage and Discipline, Dominance and Submission, Sadism and Masochism) were told that they were "addicted to BDSM," which is grossly inaccurate. Many were told to be afraid of their sexual thoughts and fantasies as they were "triggers" to avoid when, in fact, these were normal processes and responses to common sexual stimuli. A majority were told that watching pornography was bad because it was like a drug, a piece of advice that is not clinically supported.
All of the misinformation mentioned above—and more—perpetuated by the "sex addiction" movement encourages people to be erotically avoidant, thus creating more problems for them. The "sex addiction" ideology imposes sex-negative (and religious) morals onto a vulnerable population, shaming them for their sexual desire, arousal, and behaviors, which is unsettling because it is close to "conversion therapy."
"Conversion therapy" is the religious practice underpinned by the belief that sexual behaviors must conform to a strict concept of heteronormativity. Sexual behaviors outside of that heteronormative ideology are deemed a "disease" that must be changed. In its original form, "conversion therapy" is typically a practice attempting to "cure" homosexuality. "Conversion therapy" is considered unethical in the UK and in the process of being banned because of the significant harm that it inflicts on people.
As you can imagine, heterosexual people who do not conform to strict heteronormativity may also be vulnerable to a type of "conversion therapy" disguised as "sex addiction."
People struggling with their unwanted sexual behaviors actually need the opposite interventions. They need help to face their erotic world, being fully erotically aware whilst learning to manage their emotions. They need support in examining the functions of their sexual behaviors and what the underlying precipitating and maintaining issues are instead of staying focused on stopping the symptoms. With thorough erotic awareness, and a sexology-informed treatment, sexual compulsivity dilutes, and people can start to make the right choices for themselves and the partners they choose to commit to.
Psychological treatment is not supposed to induce shame and depression. I have heard many people tell me that after "sex addiction" 12-step programs and/or therapy, they felt suicidal for the first time in their lives. Some became acutely fearful of their erotic world, fantasies, and ability to relate to others, freezing in sexual situations. To me, this is not a good outcome of therapy or support groups. Many of these people would not speak up about their experiences themselves because of shame.
There are many unheard voices who are alerting us of the great potential of harm; I think it is important that clinicians continue the conversation Dr. Kort and I are having because, after all, we all have to be held accountable for the therapy we offer, and all of us must uphold our first ethical pledge: First, do no harm.