Let’s talk about “sex addiction”

I often get asked about my thoughts on sex addiction. This is a term that you may have associated with yourself, or someone you care about. 

There is no widely accepted definition of sex addiction. It is not a recognized diagnosis in either the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which most American mental health professionals use, or the International Classification of Diseases (ICD-11) from the World Health Organization. The latter includes “compulsive sexual behavior disorder” as an impulse control disorder, which is different from an addiction, and says the disorder is “characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.” The DSM does not take a stance, leaving practitioners to make their own judgments on treatment.

Thus, when we talk about sex addiction, we are generally referring to a behavior pattern that has either been labeled by the person experiencing it, or someone in their life.  It is not a clinical diagnosis.

Why I personally don’t use the term addiction

Many mental health professionals feel that using the term addiction helps build a treatment plan and gives the afflicted person the opportunity to find a support community that can reduce shame. 

Others avoid the term because it can make sex seem unhealthy and may restrict a complete understanding of the reasons behind the behavior. They focus on improving overall sexual health and well-being through insight into the dynamics that contribute to a perceived lack of control. 

I am not a mental health professional.  I help people build skills that empower them in their sexuality. 

When building skills, I focus on helping my clients develop an understanding of themselves, their values, and their desires.  Then I support them in aligning their behavior with their values. 

We can call the troubling behavior whatever serves those goals.

Whatever we call it, the concerns are real

Regardless of the debate about whether sex can be addictive, sex can absolutely cause problems.  When it is uncontrolled, it can get in the way of other activities that we want to or should be engaging in.  It may make us neglect work, family, or other obligations, harming relationships and potentially income. It can also cause distress to the person experiencing it, a feeling that they wish to alleviate. So addressing sexual behavior that is leading to problems is a very real concern.

How I approach it

I take a sex-positive approach, which says that sex is part of being human, and having a healthy and fulfilling sex life is integral to being our whole selves. Giving sex up altogether will never be my solution, no matter how detrimental the current behaviors might be, because I do not believe that abstinence is any healthier. I believe there is always another way.

We cannot control what turns us on. Our eroticism will evolve over time, but at any given point, what arouses us just is.  However, we can control the activities we engage in when we want to feel turned on, and what we do when we are already aroused. 

Shame is intimately tied to what inhibits us in sex, and also what stimulates us.  Shame and guilt (whose definitions different people distinguish in a variety of ways but which are always intertwined) are tied to taboo or things that you think are prohibited, and these are widely accepted as cornerstones of sexual turn ons. So if the label of addiction increases shame, it risks only amplifying the sexual intensity.  

I can help you build skills to reduce shame and find acceptance of yourself. I can also help you explore your own values around sex, distinguishing them from what you have been taught. And I can support you as you decide which activities you want to engage in, and how to channel your desires in alternative ways if you are looking to shift your behavior. 

I can help you use those skills to have a sex life that you feel great about.  

What does the research say about sex addiction?

Evidence-based research is inconclusive on whether you can be addicted to sex. In 2020, Joshua Grubbs and colleagues reviewed 25 years of published studies on compulsive sexual behaviors. Their conclusion was that methodologically rigorous research has yet to be done on how to treat these behaviors effectively. 

Nicole Prause and colleagues have argued that studies have failed to find a connection between sex and key addiction markers in the brain. They point to lack of research findings on the responsiveness of glutamate neurons, which are involved in reward and learning, as well as the sensitivity of dopamine pathways, which cause cravings and compulsion, both of which change in other types of addiction.

Per Görts and colleagues found a difference in a reward-related brain region on the right side, called the posterior cingulate cortex, when they compared men diagnosed with compulsive sexual behavior disorder to others who had not been diagnosed. The researchers note that the role of this part of the brain hasn’t yet been studied sufficiently, but say that it is linked to habits, impulse control, reward processing, and how sensitive we are to stimuli.

Valerie Voon and colleagues found three brain regions that are more active in drug addicts are also activated in people with compulsive sexual behavior: the ventral striatum, dorsal anterior cingulate, and amygdala.  These brain areas responded when the participants were shown pornography, a parallel with drug addicts when they see their drug of choice. These brain regions are involved in anticipating and processing rewards, as well as processing events and emotions. However, Dr. Voon has said that the findings do not prove that the individuals are addicted. 

Another really interesting study by Dr. Grubbs found that how religious someone is and how much moral disapproval they feel about porn use are the greatest predictors of whether they call themselves a sex addict. It didn’t actually matter how much porn the person watched or how much control they demonstrated over their behavior, only what they had been taught about how acceptable it is.

---

In my coaching practice, I help women explore their desires without judgment so they can feel connected, confident, and in charge of their own pleasure. If this article speaks to you, I would be happy to arrange a conversation.

Ready to start?