Sexual addictive behavior, sexual compulsive behavior,
sexual dependent behavior and hypersexuality are all terms referring to
pathological sexual acting-out with associated denial of negative consequences
and /or loss of control of such behavior.
Note it is not the type of behavior, its object, its frequency, or its
social acceptability that determines whether a pattern of sexual behavior qualifies
as sexual addiction; rather it is how this behavior pattern relates to and
affects an individual’s life negatively.
Most “sex addicts” act-out against their own ethics and
principles. Like most addictions, it
continues to escalate to where many ultimately suffer legal consequences. Hence, some addicts do commit sexual
offending behavior, but all sex offenders are not addicts. More common negative consequences are massive
losses of time, loss of career and marriage, loss of integrity with associated
profound shame, and strong feelings of isolation and loneliness. Ultimately, many become deeply depressed and
suicidal, feeling there is nowhere to turn for help.
For the past ten years, as Medical Director of the Del Amo
Hospital Sexual Addiction Recovery Program, I have had the privilege to work
with hundreds of men and women caught in this devastating behavior.
Because the sex addict becomes increasingly attached to
fantasy, relationships in the real world become less important and often ignored. The most common sexual addictive behavior
today is cybersex, with many addicts losing their jobs viewing pornography on
the job or performing poorly due to the vast hours spent compulsively on home
computer pornography. Many professionals
have been caught up in the intensity of the “web” which can provide unlimited
anonymous, accessible, and affordable pornography of any type.
Sexual addiction was dropped from the DSM-IV apparently because
it was felt that no solid research supported its existence. In March of this year, a major symposium at
Vanderbilt University sponsored by the American Foundation of Addiction
Research, began the task of designing a diagnostic and interview instrument to
be used over the next three years to substantiate this diagnosis for
consideration in the DSM-V. The name for
the diagnosis is yet to be determined, but it will not be sexual addiction
because the term itself has too much controversy.
Meanwhile, we must prepare to treat these people as they
present to us. Currently, the addiction
model seems to work the best in providing guidelines and support for ongoing
recovery. There are four different 12
Step Recovery Meetings for sex addiction: SA (Sexaholics Anonymous), SAA (Sex
Addicts Anonymous), SLAA (Sex and Love Addicts Anonymous) and SCA (Sexual Compulsives
Anonymous). There are also two 12 Step
Meetings for partners of sex addicts who are often the most devastated when
they find their trusted partner has been living a secret life: S-Anon family Groups
(S-ANON) and Codependents of Sex Addicts (COSA). Individual therapy along with 12 Step
meetings can be very helpful, especially in working through past abuse,
especially sexual, which is very high in sex addicts. SSRIs, although not a silver bullet, can improve
mood, allow more access to feelings and in some cases reduce sexual drive. However, it is important to be cautious as
excessive masturbation can increase on SSRIs because of the increased orgasmic threshold
side effect. As the therapist, you can
be of immense support in not shaming or trivializing the behavior, but
promoting re-connection to self and others who really care, establishing
integrity and self-esteem, and cognitive restructuring. Patients are profoundly grateful when they
learn to trust again and reclaim their lives.