A person who uses pornography is not necessarily a porn addict or sex addict. A person who has an affair or even a couple affairs does not necessarily have a sexual addiction. However, we must find some way of explaining that a person who loves his partner repeatedly cheats, despite his promises to himself (and perhaps to the partner) to be faithful. The term “sexual addiction” is a way of explaining such a compulsion.

Is Sexual Addiction an Addiction?

Is sexual addiction really an addiction? This is still a debate among medical and mental health professionals, and Sexual Addiction is not listed as a disorder in The Diagnostic and Statistical Manual IV of the American Psychiatric Association, although some of the concepts are listed under “Sexual Disorder NOS.” But for those who suffer and their loved ones, the diagnosis generally makes sense and gives some hope. After all, when there is a “label,” that also means that others have suffered and that there might be some pathway to healing. Many have, in fact, “recovery” from sexual addiction, and just like alcoholics in recovery can be found in 12 step fellowships, and become mentors or “sponsors” to others who are willing to seek recovery.

Signs of Sexual Addiction (from Carnes’ Don’t Call It Love, 1991)

One of the first authors on sexual addiction is Patrick Carnes, who is a psychologist with his own personal story of recovery. His signs of sexual addiction follow:

1. A pattern of out of control sexual behavior
2. Severe consequences due to sexual behavior
3. Inability to stop despite adverse consequences
4. Persistent pursuit of self-destructive or high-risk behavior
5. Ongoing desire or effort to limit sexual behavior
6. Sexual obsession and fantasy as a primary coping strategy
7. Increasing amounts of sexual experience because the current level of activity is no longer sufficient
8. Severe mood changes around sexual activity
9. Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experience

10.Neglect of important social, occupational, or    recreational activities because of sexual behavior

The Cycle of Sexual Addiction

Carnes in Out of the Shadows says there is a cycle to Sexual Addiction. This cycle starts with negative beliefs:

1. “I am basically a bad, unworthy person.”
2. “No one would love me as I am.”
3. “My needs are never going to be met if I have to depend on others.”
4. “Sex is my most important need.”

Then something happens to cause pain for the person, who does not have healthy ways of coping with the pain. Overwhelmed by the pain, he (could be “she”) is mentally preoccupied or “obsessed.” (Again, this is not OCD!) The person dissociates (unconsciously distances from his feelings), and a separation (according to Carnes) occurs between his mind and his emotional self. The person develops (unconsciously) an altered state of consciousness and euphoric fantasized experiences. The addict is disconnects from his emotions and becomes preoccupied with acting out behaviors. The addict is preoccupied with being sexual or romantic. This fantasy is an unconscious way to avoid real life. The addict becomes more and more focused on reaching a mood-altering high, even before acting out. The addict thinks about sex to produce a trance-like state of arousal in order to get rid of painful feelings or reality. 
 
The next stage of sexual addiction is the one most people recognize when they think of sexual addiction. This is the stage of “acting out” or “ritualization.” For example, the person develops a pattern such as cruising and then going to a strip show until his arousal is beyond his ability to stop. The ritual induces trance and separates the person from the reality of life (e.g., the spouse, his career, the reputation in the community).

Carnes calls the next stage “sexual compulsivity.” The addict acts out sexually and this, in fact, reduces tension. The person may now feel degraded, and this leads to shame and thus to the next stage, which is “despair.” Feelings of shame and often depression are too much to deal with, and the addict promises he won’t ever give into this pattern again. However, if he is an addict, this is more easily said than done, and the cycle starts again.

How Does Sexual Addiction Start?

Many of those who treat sexual addiction believe that there is a genetic component, in that it is found most often in families where there are other addictions or sexual addiction itself. It becomes a way to self-medicate.

A recent qualitative research study using in-depth interviews conducted with 14 men with problematic sexual behavior suggested that compulsive sexual behaviors may serve different psychological functions and needs for different people. The needs according to these men (and unfortunately only men were in this study, but women can also have sexual addiction) were:

• Narcissistic needs
• Desire for human affection or connection
• Compensation for feelings of low self-esteem
• Avoidance of disturbing feelings
• Reenactment of childhood deficits or trauma
• A means to cope with issues of sexual identity/orientation
• Need for power and control
• Libidinal and sexual needs

Treatment

Treatment begins with an intake, in which I ask lots of questions and take basic information, including assessing for other disorders such as depression, anxiety, attention deficit disorder, and other addictions. Your partner will also need to be involved in treatment, and I will ask to meet them early in your treatment, even if they are seeing someone else for treatment. I only see sex addicts when they are also attending a 12 step program for sexual addiction , because the support and insight which comes from these programs increases the speed and efficacy of our work together. Recovery is dependent on:

• your ability to accept the reality of the disease and its consequences,
• your commitment to change, 
• your willingness to surrender your need to control the compulsion,
• your willingness to learn from others,
• psychotherapy for sexual addiction which focuses on:
• early unmet needs (see my section on DNMS)
• any early traumas (see my section on EMDR)
• intimacy problems (being able to fully connect with others)
• coexisting disorders such as depression, ADHD, bipolar disorder, personality disorders, and any other addictions

Twelve Step Groups for Sexual Addiction

There are several 12 step programs for sexual addiction. These groups are free but accept donations.

I will give excerpts here from each:

Sexaholics Anonymous (SA) has a website: http://www.sa.org and sees lust as the central problem:

“We also see that lust is he driving force behind our sexual acting out, and true sobriety includes progressive victory over lust. These conclusions were forced upon us in the crucible of our experiences and recovery; we have no other options. But we have found that acceptance of these facts is the key to a happy and joyous freedom we could otherwise never know.”

Another program, Sex Addicts Anonymous (SAA) can be found at this website http://www.sexaa.org.

SAA sees compulsive behaviors as the major issue:

“The essence of all addiction is the addict’s experience of powerlessness over a compulsive behavior, resulting in their lives becoming unmanageable. The addict is out of control and experiences tremendous shame, pain, and self-loathing. The addict may wish to stop – yet repeatedly fails to do so. The unmanageability of addicts’ lives can be seen in the consequences they suffer: losing relationships, difficulties with work, arrests, financial troubles, a loss of interest in things not sexual, low self-esteem and despair.”

A third program, Sex Love Addicts Anonymous (SLAA) has this website: http://www.slaafws.org and sees sex and love addiction defined by each individual, so that different group members can have different sobriety “bottom lines.” The common focus is the willingness to stop acting out in ways that the individual has defined, and the common denominator is “obsessive/compulsive patterns.”

I should add that sexual addiction is not obsessive compulsive disorder (OCD), although some individuals have both sexual addiction and OCD or obsessive compulsive traits.

Basic Books on Sexual Addiction

Carnes, P. (1983). Out of the Shadows: Understanding Sexual Addiction. Minneapolis: CompCare.

Carnes, P. (1991). Don’t Call It Love: Recovery from Sexual Addiction. New York: Bantam Books.

Guigliamo, John (2006). Out of control sexual behavior: A qualitative investigation. Sexual Addiction & Compulsivity, 13Sexual Addiction & Compulsivity, 13, 361-375.

Sexual Addiction Therapy Group

• Support & group accountability
• Porn addiction included
• 12 step group also required for members
• Enhance awareness of triggers
• Early attachments connect to compulsion
• Review history of escalation in safety of group
• Self esteem renewed