Sex Addiction – The Ultimate Guide

The term “sex addiction” first appeared in mainstream media and popular theory in the 1970s. Indications suggest that it may have its origins in 12-step groups like Alcoholics Anonymous (AA) as group members tried to understand self-destructive actions.

Wherever the roots, classifying someone as a “sex addict” very quickly became a source of controversy, and it still is.

Sex is a normal human behavior, similar to eating and sleeping. However, it’s deeply impacted by cultural, religious and even political norms. Unfortunately, this opens individuals whose sexual conduct falls outside of generally accepted standards to needless labelling, judgment and even rejection.

So is sex addiction real, and if it is, can it be cured?

We’ll explore the answers in this article by detailing the facts and current findings and looking at opposing perspectives. Delving into statistics, causes and treatment will help you decide for yourself and see how you can help someone you care about, or see if you are an addict.

Remember, virtually all mental health conditions can be cured or controlled with the proper treatment and medication where applicable. Don’t allow fear, shame or other’s opinions to prevent you from reaching out if you suspect that you or a loved one is a sex addict.

What is sex addiction?

It can be described as an uncontrollable, and compulsive need to engage in sex acts to gain satisfaction or relief.

Also known as sexual dependency, hypersexuality, and compulsive sexual behavior disorder, the boundaries defining sex addiction are very vague and open to misinterpretation.

While sexual desires are perfectly normal, people who are addicted surrender all control to their urges. As a result, their daily lives gradually become consumed by thoughts of sex, perusing sexual partners or pleasures, having sex, and dealing with the aftermath.

In active addiction, sex isn’t intimate. It’s a means to relieve mounting internal pressure, anxiety, stress and even depression that in itself can become damaging. Internal pressure can be caused by external forces such as work, relationship issues and social circumstances that the individual can’t handle and seeks to escape.

Another angle is mere pleasure-seeking for the sake of it or thrill-seeking through risk-taking. It’s vital to understand that neither pleasure-seeking nor risk-taking equates to addiction. Whilst they may seem to be selfish pursuits that don’t draw social approval, they’re not wrongful behaviors. Addiction happens when the addict no longer has control over their actions.

A pattern of heightened sexual activity followed by feelings of self-retribution, remorse, and promises to change can set in. Each time the addict reneges and gives into new urges, they feel more out of control.

As with all addictions, acting out on impulses and urges brings short-term relief, but the effects soon wear off, triggering new compulsions. Over time the individual needs more and more to get the same “high” or effect.

There’s a gradual decline in quality of life and deterioration in close relationships, friendships and work associations. Eventually, fulfilling sexual urges takes precedence over family life, social engagements and work responsibilities.

At its peak, sex addiction can lead to people living a double life, lying at every turn and sooner or later losing their sense of identity. Unsurprisingly, they can fall out of college, find themselves jobless or lose valuable family ties, intimate relationships and long standing friendships.

Apart from this, overindulgence in sex acts can cause physical pain and injury and casual sex with multiple partners can encourage sexually transmitted diseases (STDs). At best, STDs are uncomfortable, embarrassing and compromise the immune system; at worst, they can cause infertility and even death if left untreated.

Fear and shame commonly lead to avoiding treatment.

Why Sex addiction isn’t a recognized condition

Because mind-altering substances don’t drive sex addiction, and sex is normal behavior, it’s not accepted as an addiction by most influential professional bodies.

The American Psychiatric Association (APA) excluded it under addictions in the current fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it’s listed for diagnosis under “other specified sexual dysfunction”.

Conversely, the World Health Organization (WHO) included it in the most recent International Classification of Diseases (ICD-11). It’s defined as an impulse disorder described as being – “characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior“.

The American Society of Addiction Medicine (ASAM) in 2011 redefined addiction as a chronic brain disorder. This was the first time they’d expanded the definition of addiction to reach beyond substances and include reward-seeking behaviors such as gambling and sex.

To date, no official US controlling body for sex and relationship therapy or psycho-sexual counselling has accepted sex addiction as a separate condition with distinct treatment protocols either. In fact, many practitioners strongly believe that diagnosing sex addiction is as harmful as gay conversion therapy.

No diagnostic proposal has yet been approved into any official government diagnostic manual either. Therefore, treatment mostly gets provided by professional counsellors who specialize in addiction. Diagnostic and treatment models are often based on research and publications from the International Institute for Trauma and Addiction Professionals (IITAP), founded by the renowned sex addiction counselor, Patrick Carnes.

Sex addiction statistics aren’t reliable

Reliable statistics on the pervasive nature of the issue are tricky because many professionals refuse to diagnose sex addiction. On the other hand, people falsely claim to be sex addicts to explain away sex crimes or infidelity.

Either way, we can safely assume that therapists and other mental health professionals’ statistics are understated, since most addicts won’t seek help. Hypersexuality carries a tremendous social stigma that often drives addicts and their families to ignore the problem and hope it will eventually disappear. As we know, deep-rooted problems become more entrenched over time; they don’t just vanish into thin air.

Another aspect that negatively influences stats is people seeking or getting coerced into counselling for sexual behavior that doesn’t fit their society’s standards. For example, someone who has multiple sexual relationships in a culture that values sex within marriage can get accused of having an addiction to sex. Family and social pressure can wrongfully lead to them believing that they have a problem.

Despite differing opinions, most professionals treating sex disorders concur that the issue is growing, and patients are getting younger due to online sex. Chatrooms, online dating, hookup apps, quick access to porn and greater social acceptance of these services has led to more people logging in.

Online activity can easily get hidden and happen in the privacy of the home. The ease of access makes it seem less shady, and hiding it from family adds to the thrill. Isolation caused by this behavior leads to social withdrawal and, over a long time, to profound loneliness that can fuel addiction.

Some recent statistics

Various research projects have tried to understand and clearly define sex addiction. Most of them are local and don’t cover global or even national behavior patterns, though. Consequently, they can’t be taken as the norm. On the other hand, they do give some insight into the world of sex addicts.

• 3 to 5% of adults in the USA have some kind of sex addiction
• Men displaying excessive sexual behavior are more inclined to anxiety and depression compared to the general population
• 90% to 95% of addicts are male
• 92% of people in treatment in the US in 2012 were white
• According to an academic article, Sex and Sexual Addiction in the United States of America
• 81% of patients had previously been abused sexually (81%), emotionally (97%), and physically (72%)
• 87% come from dysfunctional families with a history of addiction problems
• Sex addicts often have dual addictions: drug/alcohol addiction (43%), eating disorders (38%), compulsive spending (28%) and gambling addiction (5%)

What causes sex addiction?

Research evidence cannot point to any specific cause. Instead, it seems that a combination of factors can lead to addiction.

Featuring most prominently are other existing addictions, mental health issues and previous abuse. This triad of conditions regularly goes hand in hand across different mental health issues.

Homes, where addictions are a factor, are more inclined to be dysfunctional and abusive. Family members get exposed to a survival-based lifestyle rather than a nurturing one. The most common outcome is that they develop a distorted version of reality and have inadequate coping mechanisms leading to them turning to addictive behaviors for consolation.

Considering that there is a genetic link to addiction, predisposition and addicts are known to shift between addiction types, genetics can be a factor – mainly where dual addictions exist.

Mental health problems, including anxiety, depression, personality disorders and poor impulse control, can trigger sex addiction. Social isolation, low self-esteem and performance anxiety can also play a role.

Research indicates that children exposed to sex and pornography (without being abused) can fall into sex addiction. This is because an immature mind cannot healthily embrace sexuality, so perceptions, experiences and actions become distorted later.

Substance abuse is another driving factor with certain drugs, such as methamphetamine and cocaine, increasing sex drive while others lower inhibitions.

Some experts hypothesize that sex addiction may be caused by the same reward system and brain circuits that trigger substance abuse, but there’s no scientific evidence to prove this. What is known is that sex does trigger the brain’s reward system, it’s whether it can be the cause that’s an unknown.

There is some evidence that social circles can trigger hypersexuality. Someone who moves in company or has a partner that’s preoccupied with sex can fall in line. Other underlying mental or emotional issues will have to be present, though, especially around low self-esteem or the desire to control.

Finally, some mental illnesses and neurological disorders can cause hypersexuality – bipolar disorder, epilepsy, dementia and specific head injuries among them. A medical diagnosis is essential in these instances, and treatment options are available.

Signs that you have a sex addiction

The most defining feature of sex addiction is a mental fixation on sex and continually perusing ways and opportunities to have sex. Relentless thought patterns eventually take over completely, placing the importance of sex above everything and everyone else.

Even though these thoughts might get kept secret from others initially, your behavior will belie any denial as you start acting out. Signs can include –

• Sexual preoccupation to the exclusion of all other activities
• Constantly talking about sex and relating sex to unobvious matters
• A very high sex drive and constant sexual urges beyond what is determined to be healthy
• Inappropriate or risky sexual behavior, such as sex in public or having unprotected sex
• Having sex with multiple partners (although this isn’t always the case)
• Having vivid sexual fantasies that can be very time consuming
• Being driven to act out on day-dreams to get relief (often followed by regret)
• Engaging in sex outside of a committed relationship
• Pressurizing a partner for sex more often than what’s reasonable
• Accessing sex chat lines, online sex sites, pornography, etc. to fulfill fantasies
• Finding habitual sexual relief in masturbation when alone
• Turning to sex to avoid emotions or to find consolation
• Chronic lying to family, friends and employers to cover up sexual activities
• Gradual loss of control over thoughts about sex and sexual behavior
• A decline in self-confidence, self-esteem and ability to socialize in a healthy way
• Experiencing negative consequences, like divorce or job loss, but still chasing sex
• Feeling deep remorse or self-retribution, but being unable to stop
• Withdrawal: although characteristic of substance addiction, sex addicts can experience withdrawal symptoms too when they reduce sexual activity. Symptoms include –
  • Anxiety
  • Cravings
  • Depression
  • Guilt and shame
  • Restlessness

Sex addiction can have similar effects on the brain to those caused by substance addiction. When anyone satisfies a desire or need essential to survival or reproduction, dopamine gets released, creating a sense of pleasure or euphoria. This reinforces the expectation of reward and, in so doing, encourages the desire to engage in the same behavior.

This chemical reaction in the brain is why sex addicts can also experience withdrawal symptoms when they abstain from sexual activity.

An addict’s inner world becomes smaller and smaller as it becomes dominated by sex. Accordingly, everyone around them will begin to suffer as they renege on their responsibilities, let people down, and become more detached. Driven by addiction, they might not care what the effects of their actions are on others.

How to treat sex addiction

Since it’s not recognized as an addiction, compulsive sexual behavior might get overlooked unless you approach a therapist specializing in this kind of diagnosis and treatment. It’s crucial to find a healthcare professional who’s experienced in treating sexual disorders.

Lack of professional recognition means that treatment isn’t covered by health insurance, although some medicine classifications can be.

Inpatient treatment is seldom an option unless there are other addictions, health complications, or mental health conditions present that would benefit from 24-hour care. Although this reality can seem overwhelming to someone whose obsession is out of control, medications can treat underlying disorders.

Medication

Serotonergic drugs used to treat depression and anxiety disorders prove to decrease compulsive urges associated with sex addiction in some patients. Taken in the proper prescribed doses, they’re generally safe and well-tolerated. Mild side effects can manifest in the first few weeks of taking them, but they usually go away. Adverse symptoms can include headache, nausea, insomnia, decreased libido or delayed orgasm.

Mood stabilizers also decrease impulsive behaviors in hyper-sexuality in some cases. Most commonly used as a treatment for Bipolar Disorder, many sex addicts can benefit too. Side effects are mostly mild in well-monitored doses and can include sleepiness or an upset stomach.

Naltrexone reduces the effects of narcotic substances and decreases sexual urges and arousal. It’s given to sex offenders to encourage celibacy and abstinence from all sexual activity. In men, anti-androgens have the same effect by decreasing the male hormone testosterone and acting as a blocker.

Pre-exposure prophylaxis antiviral drugs are used to prevent HIV infection in people who are negative but run a risk of contracting the disease. They don’t treat sex addiction but instead offer protection to addicts prone to high-risk behavior. Overall, they get tolerated well in most patients with only mild side effects in most. There have been instances of minor kidney failure as well as bone loss in some people. Prescriptions, therefore, will only be written where the risk of HIV infection outweighs the danger of any potential side effects.

One on one therapy options

Therapy is the most effective way to treat addiction as long as the addict is committed to recovery. All sexual activity is behavioral, making acceptance and willingness essential to change.

Whether therapy gets provided by a sex therapist, psychologist or psychiatrist, their input alone cannot bring about healing. The most successful treatment happens when the patient gels with the therapist, and they work in tandem to resolve often complicated problems.

Trust, honesty and openness are critical elements for an addict to understand themselves, regain their self-esteem and learn how to lead a healthy and balanced life once again.

There can never be a one-size-fits-all approach when treating the human mind because underlying causes differ, as do personalities.

More than one therapy type can be recommended after a thorough assessment, and medication may be prescribed if necessary.

Therapies can include –

Psychodynamic therapy takes a long-term approach to treatment. It’s derived from psychoanalysis and allows patients to openly discuss anything that’s on their mind to uncover thoughts and behaviors that contribute to their distress. The aim is to explore the connection between the unconscious mind and actions in daily life. This kind of therapy can continue for years, and research shows that people continue to improve over time.

Cognitive-behavioral therapy takes a short-term approach to identify thought patterns that negatively impact decisions and behavior. Its success is attributed to the belief that it identifies personal views about the self or external harmful and distressing situations. The approach is structured and focuses on addressing emotional challenges.

Behavioral therapy focuses on ways to change patterns of behavior and reactions to internal or external triggers.  There are various approaches, including –

• Aversion therapy where unwanted behaviors are associated with uncomfortable or unwanted experiences to bring about gradual change.
• Systematic desensitization combines gradual exposure to fears with relaxation exercises. Over time fear-driven reactions and behaviors get replaced with relaxation responses.
• Flooding takes a different approach to fears and involves immediately facing them head-on and working through the effects to change perceptions and reactions.

Dialectical behavioral therapy takes a four-step approach: skills training group, individual therapy, phone coaching and consultation team. It’s designed to teach mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation.

Eye movement desensitization and reprocessing works well in cases that involve past traumatic experiences. It’s a relatively new, non-traditional treatment that takes an 8-stage approach that consists of reliving traumatic events in small doses while the therapist directs eye movement. The aim is to encourage the recollection of distressing events while diverting attention. This makes them less emotionally upsetting.

Other therapies

Counsellors or therapists can run group therapy sessions for sex addiction to teach specific social skills and boost engagement. Addicts are encouraged to get involved and offered a safe space in which to share and learn. These environments help addicts realize that they’re not alone in what they’re experiencing.

Support groups offer peer-support and are run by addicts in recovery. Many of them adopt an adapted version of the 12-step program started by Alcoholics Anonymous almost a century ago. Despite the program’s age, it’s not outdated as it works on spiritual principles that, with minor revisions, remain timeless. Peer support mostly gets recommended to run parallel with professional therapy and counselling.

How to help someone with a sex addiction

One of the most critical aspects of helping someone with sex addiction is to accept that they have a medical condition wholly. It’s very easy to judge sexual behavior in particular because it’s such a sensitive subject. Any coercion into treatment backed by judgement will inevitably lead to disappointment on both sides.

Recovery from all addictions is a slow process that happens over years rather than months. Abstinence is only the first step and doesn’t imply recovery; however, it’s crucial to recovery.

Relapse is generally only a hair’s breadth away for any addict in early recovery, and family and friends must consider this. Everyone supporting the addict must ensure that they don’t themselves partake in things that can be a trigger in the addict’s presence. For example, watching a porn movie.

If the person has admitted they’ve got a problem, it makes the situation much more straightforward. If not, and they’re in denial, your first hurdle is convincing them they need professional help. Almost all addicts genuinely believe they’ve got the situation under control, especially if their lives are continuing normally.

If you want to confront them or do an intervention, you must prepare upfront by writing your observations down and what you want to change. It’s always best to do it one-on-one, but if anyone will join you, ensure that the meeting doesn’t descend into a blame and interrogation session.

Choose a time when everyone is calm to approach the addict. Assure them that you’re acting in their best interests and not only yours. Decide who will speak first and make sure the addict also has an opportunity to get heard.

Honestly, tell them how you feel and how you want to help them. Have treatment options readily at hand so they can consider them right away.

Never set dire ultimatums unless you’re willing to carry them out. Do, however, set very clear boundaries and stick to them. Enabling someone you care about happens very quickly as you try to spare them from the harsh consequences of their actions. Situations like that easily descend into manipulation and even abuse.

Be willing to offer support if they’re ready to go for treatment. If not, you must put your own needs first. Go for counselling yourself and join support groups for family and friends of addicts. As you get stronger, consider whether it’s in your best interests to keep the addict in your life while they’re in active addiction.

Treatment centers

Private rehabilitation centers are the only places that will admit sex addicts for treatment, and it’s seldom that insurance will cover the costs. Where dual addictions are present, the prime reason for admission can be to treat the other, and sex addiction can get listed as secondary.

Most centers will recommend outpatient treatment, though. Outpatient treatment involves a full assessment and a comprehensive medical examination to diagnose and treat health conditions.

Patients get a detailed recovery plan and are referred to therapists, psychologists, psychiatrists and medical doctors who will manage treatment and make further recommendations.

Another option is to find a suitable sex treatment professional in private practice who can devise a recovery plan and make the necessary referrals to relevant healthcare specialists.

Helpful telephone numbers

• Sex Addicts Anonymous: 1-800-477-8191
• Sex and Love Addicts Anonymous: contact online
• Sexual Recovery Anonymous: (646) 450-9690
• Sexual Compulsives Anonymous: contact online
• National Suicide Prevention Lifeline: 1-800-273-8255 (24 hours a day, 365 days a year)

Books worth reading

All books listed are available on amazon.com –

• Living With A Sex Addict: The basics from crisis to recovery – Linda Hatch
• Help Her Heal: An empathy workbook for sex addicts to help their partners heal – Caro Juergensen
• Letters To A Sex Addict: The journey through grief and betrayal – Wendy Conquest
• I Just Wanted Love: recovery of a codependent, sex and love addict – D. J. Burr
• Diary Of A Former Sex Addict – Porsche Day

Conclusion

At its core, sex addiction has little to do with sex. It’s about fulfilling unmet needs and finding consolation. These needs are usually rooted in inadequate coping mechanisms or an inability to express wants and needs and ask for help.

While sex only offers temporary relief, it does activate the brain’s reward system leading the individual to rely on it. Unfortunately, this reliance creates a constant drive to get more.

While genetic and hormonal factors likely play a role, hypersexuality is mostly triggered by mental health problems that need to be addressed to break the addiction. Existing dual addictions or specific medical conditions can lead to sex addiction too.

Compulsive sexual behavior mustn’t get confused with promiscuity. A promiscuous person might have issues such as co-dependency or low self-esteem, but they’re still in control of themselves and their daily life.

Sex addicts, on the other hand, have lost control. Every conscious moment is spent thinking about sex or engaging in sexual activities. There’s no room for anyone or anything else in their lives.

Their lives are all about them getting what they need in the moment with no thought of consequences for themselves or anyone else. To cope, they project a false image, lie, cheat and manipulate.

They will rationalize their behaviour to themselves and anyone who confronts them, and for the most part, they really believe they are in control.

However, without acknowledging the problem and seeking professional intervention, sex addicts are doomed to a life of self-destruction. In contrast, through accepting that there’s a problem and getting the right help and support, sex addicts can lead a healthy and balanced life.