The simple truth is that sex addiction exists, just like alcoholism, drug addiction, compulsive gambling, compulsive shopping, eating disorders, and other addictive/compulsive issues. Moreover, the people who are suffering from sexual addiction deserve informed, empathetic, and properly directed treatment just like any other person who is dealing with a destructive addiction or compulsion..
For the doubters out there, below is the latest research-based facts on the etiology, neurobiology, and effective treatment of sexual addiction, along with a brief statement on a few issues that I believe the clinical community needs to address and overcome.
The Etiology of Sexual Addiction
Sadly, sex addicts (like addicts of all stripes) are usually survivors of profound and chronic early-life trauma (link is external) – neglect, emotional abuse, physical abuse, and sexual abuse (link is external) (both overt and covert (link is external)). Oftentimes these survivors begin to self-medicate their emotional discomfort relatively early in life, usually during adolescence but sometimes even before. This process of self-soothing typically involves alcohol and/or drugs. However, many people also learn (or are taught) that they can self-soothe with sexual behaviors (including sexual fantasy and masturbation), sometimes by eroticizing and reenacting an aspect of their trauma (particularly if/when part of their abuse was sexual). While distracting in the moment, over time these behaviors tend to exacerbate preexisting feelings of shame and emotional discomfort, thus creating an even greater need for emotional self-soothing, escape, and dissociation.
This survival practice of abusing alcohol, drugs, and/or sexual arousal to self-soothe the pain of early-life trauma often carries forward into adulthood. As adults, these deeply shamed survivors may find themselves mired in an addictive cycle of self-hatred and shame buffered by sexual fantasy and sexual behavior, all utilized to self-soothe and distract from internal emptiness and the fear of becoming emotionally vulnerable. This is the most common etiology of sexual addiction – how and why it manifests. Essentially, when people consistently and impulsively use sex (or alcohol, drugs, gambling, eating, spending, etc.) as a way to avoid uncomfortable emotional states, they are quite likely to qualify as addicts and to experience the negative life consequences that typically ensue. Even when deeply committed to another person, sex addicts under emotional stress will time and time again choose the emotional intensity of sexual fantasy, pursuit, and behaviors as a way to self-soothe and self-regulate, rather than risking the pain that emotional vulnerability and intimacy brought them when they were young.
The Neurobiology of Sexual Addiction
With current brain imaging technology we can look at the brains of self-reported sex addicts to see if they react differently than the brains of non-addicts to arousing sexual stimuli. Moreover, we can compare the brain responses of sex addicts to the brain responses of other addicts (in particular substance abusers). Numerous studies of this nature have been published in the last two years. The best of this research (link is external) has been conducted by Dr. Valerie Voon at Cambridge University (UK). Unsurprisingly to me, Dr. Voon has found that the brains of self-reported sex addicts respond in very different ways to sexual stimuli (porn) than the brains of non-addicted people. Moreover, the brain response of sex addicts exposed to sexual stimuli mirrors the brain response of drug addicts when exposed to drug-related stimuli. (You can see and hear Dr. Voon speaking about her work in this short video (link is external)). These recent findings, when coupled with earlier research (discussed in detail in this article (link is external)), strongly suggest that sexual addiction manifests in the human brain in profoundly similar ways to more commonly accepted forms of addiction, most notably substance abuse.
Sexual Addiction Treatment: Myth vs. Reality
Sexual addiction treatment involves the use of motivational interviewing, cognitive/behavioral, task-oriented, and psychodynamic methodologies to help clients alleviate the patterns of problematic sexual behavior that have led to their lives becoming dysfunctional. Prior to any clinical intervention, clients receive extensive assessment, typically using sophisticated, normed, psychometrically validated instruments. Thus, clients do not receive addiction treatment simply because they say they are a sex addict or because their sexual behavior does not meet some arbitrary cultural or religious norm.
Initial treatment goals (beyond assessment) are most often focused on short-term and long-term sexual behavioral change in order to prevent further harm and consequences. Frankly, by the time most sex addicts reach out for help they’ve experienced multiple and profound negative life consequences directly related to their sexual behavior – relationship losses, trouble at work or in school, STDs given and/or received, arrest, financial losses, public humiliation, and more. So obviously behavior change is an early priority. Down the road, for clients who remain in our care, sex addiction treatment specialists are trained to move into more dynamic and trauma-informed methods of treatment, but only after the client has developed the ego strength and social support needed to halt his or her destructive patterns of compulsive sexual behavior.
Properly trained sex addiction treatment specialists do not diagnose sex addiction based on how often or in what ways a client is sexual, just as a substance abuse treatment specialist would not try to diagnose alcoholism based on how often or what brand of booze a client drinks. Sex addiction is also not diagnosed based on collateral information brought in by understandably hurt and angry spouses. Furthermore, and most importantly, we do not diagnose a person as sexually addicted based on ego-dystonic (unwanted) sexual orientation, gender identity, and/or fetish arousal patterns. So, once again, sexual addiction is not based on who or what it is that turns a person on. Instead, sexual addiction is defined by out-of-control behaviors that are causing negative consequences in the client’s life.