You've probably heard of sex addiction, but you might be surprised to know that there's debate about whether it's truly an addiction, and that it's not even all about sex.
"That's a common misconception," says Rory Reid, PhD, LCSW, a research psychologist at UCLA's Semel Institute for Neuroscience and Human Behavior. "It is no more about sex than an eating disorder is about food or pathological gambling is about money."
Sex addicts, in other words, are not simply people who crave lots of sex. Instead, they have underlying problems -- stress, anxiety, depression, shame -- that drive their often risky sexual behavior.
"Those are some of the core issues that you start to see when you treat someone with sex addiction," says John O'Neill, LCSW, LCDC, CAS, CART, a certified addiction counselor at the Menninger Clinic in Houston. "You can't miss those pieces."
What Is Sex Addiction?
Sex addiction won't be in the upcoming edition of the DSM-5, which is used to diagnose mental disorders.
That doesn't mean that it's not a very real problem.
"People are going to seek help, and there doesn't need to be diagnosable condition for them to get help," Reid says. "If they are suffering, we want to help them."
Reid and many other experts prefer the term "hypersexual disorder," rather than "sex addiction."
By either name, it's about people who keep engaging in sexual behaviors that are damaging them and/or their families.
As examples, Reid cites men who spend half their income on prostitutes, and office workers who surf the web for porn despite warnings that they'll lose their job if they keep it up.
"Who does that? Somebody with a problem," Reid says.
That problem puts so much at risk: their personal lives, their social lives, their jobs, and, with the threat of HIV/AIDS and other sexually transmitted diseases, their health.
Despite the danger, they return to the same behaviors over and over, whether it's Internet porn, soliciting sex workers, ceaselessly seeking affairs, masturbating or exposing themselves in public, or any number of other acts.
"I see in them an inability to stop what they're doing," O'Neill says. "They're preoccupied; their brain just keeps going back to it. It often leads to loneliness and isolation. There's such intense shame and pain."
Frequently, a crisis convinces them to seek treatment, Reid says. They're caught in the act by a spouse, fired from their job, or arrested for soliciting sex from prostitutes. For some people, the crisis brings relief from distress caused by their behavior and constant fear of being discovered. "The world comes crashing down," says Reid, "and some say, 'I'm glad that I got caught.'"
Addiction or Not?
There are no reliable estimates of how many people have the disorder. Some studies suggest that it's more common in men, and gay men in particular, than women.
The causes are also unknown, or how similar it is to other addictions. That's one reason that Reid prefers the term hypersexual disorder (HD).
"We don't know if the [brain] mechanisms associated with HD behavior operate the same ways as a substance disorder or pathological gambling," Reid says.
Reid says HD behavior can appear similar to those associated with obsessive compulsive disorder. It also could be tied to abnormal levels of the brain chemical dopamine or serotonin. Or, problems related to attention, impulse control, or emotional regulation could also be involved.
"There are so many models or theories that we can look at to help us understand HD," Reid says. "An addiction model is just one of them."
Treating Hypersexual Disorder
There isn't much research on what treatments work best. Reid encourages his patients to challenge the thoughts that lead to their risky behavior.
"If a patient says he has a craving and he can't control it, I confront the 'can't,'" Reid says. "I ask, 'What's going to happen if you don't satisfy that craving? Is your penis going to fall off? No.' I try to get the patient to see things more realistically."
One-on-one counseling, support groups, and having a plan are key.
"You want to make connections with other people who are also struggling, and you have to know who you are going to call, what you are going to do, and how you are going to attend to your feelings," O'Neill says. "If they're willing to really follow through, work with their families and their support networks, in my experience, people can get significantly better and stay in recovery."
In some cases, medications used to treat obsessive-compulsive disorder or impulse control disorders may be used to curb the compulsive nature of the sex addiction.
Matt McMillen - WebMD