Sex Addiction Disorders

Sex addiction is the uncontrollable urge to behave sexually even though negative consequences may occur as a result of that behavior. Various organizations have been created to support sex addicts as well as their families in the treatment community. The Internet is a concern for therapists because it allows sex addicts to access pornography in an anonymous way. A study examining the behaviors of sex addicts is reported here, as is research conducted, which focuses on the sexual behaviors of college students. Concerns addressing the lives of clergy members and comparisons between behavioral dependencies, like gambling addictions, and substance dependencies are made here as well.

Keywords Keywords; Abstinence; Abuse; Addiction; Compulsion; Dependence; Disease; Disorder; Predisposition

Sex, Gender & Sexuality > Sex Addiction Disorders

Overview

Psychologist Patrick Carnes has spent years devoted to the research of sexual addiction and sexually compulsive behaviors. In 1983, he published a book entitled The Sexual Addiction. While many people were suffering from the disorder of sexual dependency at the time, the book did not sell. Once he changed the title to Out of the Shadows, however, society embraced the possibility that people could become addicted — compulsively seeking out a behavior rather than a substance. In 1987, Carnes and two colleagues founded the organization known as the National Council on Sexual Addiction and Compulsivity (NCSAC). In 2004, NCSAC changed its name to the Society for the Advancement of Sexual Health (SASH) to focus more broadly on sexual health issues. In the 2020s, SASH continued to operate amongst an ever-growing field of other sexual addition and advocacy groups, had an international membership and published a website focusing on the issues of out-of-control sexual behaviors. Carnes also established the International Institute for Trauma and Addiction Professionals (IITAP) and Gentle Path Press (drpatrickcarnes.com, 2018).

SexHelp.com (2023), an additional resource and advocacy organization created by Dr. Carnes, cites the following definition of sexual addiction:

The SASH website also included a listing of the following predictable consequences for sexually dependent people.

• Social: Addicts become lost in sexual preoccupation, which results in emotional distance from loved ones. Loss of friendship and family relationships may result.
• Emotional: Anxiety or extreme stress is common in sex addicts who live with the constant fear of discovery. Shame and guilt increase as the addict's lifestyle is often inconsistent with personal values, beliefs, and spirituality. Boredom, pronounced fatigue, and despair are inevitable as addiction progresses. The ultimate consequence may be suicide.
• Physical: Some of the diseases that may occur due to sexual addiction are genital injury, cervical cancer, HIV/AIDS, herpes, genital warts, and other sexually transmitted diseases. Sex addicts may place themselves in situations of potential harm, resulting in serious physical wounding or even death.
• Legal: Many types of sexual addiction result in violation of the law, such as sexual harassment, obscene phone calls, exhibitionism, voyeurism, prostitution, rape, incest, child molestation, and other illegal activities. Loss of professional status and professional licensure may result from sexual addiction.
• Financial/Occupational: Indebtedness may arise directly from the cost of prostitutes, cybersex, phone sex, and multiple affairs. Indirectly indebtedness can occur from legal fees, the cost of divorce or separation, decreased productivity, or job loss.
• Spiritual: Loneliness, resentment, self-pity, self-blame (SASH, 2014).

The sex addict, in theory, is no different from the cocaine addict or the alcoholic. He or she wakes up in the morning thinking about sex—finding sex, watching sex, or taking part in sexual acts—and these thoughts consume the addict until they are acted upon. While the cocaine addict or the alcoholic betrays the people in his or her life by lying, spending money the addict may not have, and possibly committing crimes in order to obtain that next fix, the sex addict betrays the people in his or her life in a way that most people can never understand. People have heard of the addictive nature of cocaine and alcohol, but sex as a compulsion? Even with people like Dr. Carnes promoting the reality of the disorder, a wife who has been betrayed may never welcome the psychology of compulsive tendencies. As such, society as a whole was slow to accept the concept.

Theoretical Explanations

The study of sexually compulsive behavior is not new. In fact, there are several theories that have been used to define or describe the disorder. For example, Kaplan's (1995) research identifies sexual desire as the center of the addiction in that the inability to regulate desire is the catalyst for the compulsivity. However, Quadland (1985) notes that much like rape, the condition of sexual addiction is one of control rather than desire. Dr. Carnes believes that the act of orgasm (ejaculation) releases mood-altering endorphins that sex addicts continually chase (1991). This theory is based on the concept of self-medication. Similar to chasing a euphoric high, Milkman and Sunderwirth (1983) identify that the gratifying effect of an orgasm on neurotransmitters (messengers within the brain) is habit-forming because the addict learns to depend on the increase or decrease of brain messages to actually regulate his or her mood (as cited in Guigliamo, 2006, pp. 361–362).

Furthermore, research has looked at early environmental experiences as the cause of sexually addictive behaviors. Creeden (2004) points to trauma theory as a potential explanation. Trauma theory posits that adults who experienced childhood trauma look toward sexual compulsiveness to dissociate from feeling helpless or out of control because of earlier experiences. More specifically, Schwartz et al. (1995) looked at adults who had been victimized sexually as children and noted a correlation between their victimization and their resulting compulsive behaviors. Conversely, earlier research identified narcissism as the root of compulsive behavior. In fact, Kohut (1977) noted that a cycle exists for the sex addict who tries to increase his or her self-esteem by gaining the approval of others. Once sex addicts act out, they feel empty and full of shame, which causes them to chase approval again (as cited in Guigliamo, 2006, p. 362).

Characteristics of the Sex Addict

Since sexual addiction was so misunderstood, Guigliamo (2006) conducted a study in order to humanize its effects. The researcher studied 14 men who identified themselves as being sexually addicted (p. 361). In the course of the study, Guigliamo interviewed participants to learn directly about their loss of control over their sexual behavior. Guigliamo's study was limited to participants who were 18 years of age or older and who did not identify themselves as having sex with adolescents or children (p. 363). Each of the interviews lasted between 60 and 90 minutes, and participants gave consent to being audiotaped during the interview. Guigliamo noted that the purpose of the study was to "understand the affective and motivational aspects of repetitive uncontrollable sexual behavior" (p. 364). The behaviors respondents discussed were grouped into the eight categories listed below, with a combination of categories often resulting:

1. Narcissistic Needs — To supplement self-esteem, sexual conquests, and external validation were employed to meet emotional and psychological needs.

2. Desire for Human Affection or Connection — More than half of the informants reported a history of having problems sustaining long-term intimate relationships, and about half of the informants expressed an inability to experience any emotional intimacy.

3. Compensation for Feelings of Low Self-Esteem — Low self-esteem and self-loathing were also mentioned by nine of the informants.

4. Avoidance of Disturbing Feelings — Nine of the informants reported using sexual activities to avoid or escape from negative feelings such as loneliness, boredom, and sadness … and to escape painful feelings.

5. Reenactment of Childhood Deficits or Trauma — Five of the informants believed that they were emotionally abused as children. All but one informant reported parental neglect. Some type of childhood sexual abuse was reported by 9 of the informants. Ten respondents reported incest, and six involved sexual activities with siblings.

6. A Means to Cope with Issues of Sexual Identity/Orientation — Four of the six gay men in this study reported that their entrance into sexually addictive behaviors was related to coping and understanding their sexual orientation. The men described a sense of fear, isolation, and alienation, as well as a lack of guidance and support as they struggled through childhood and adolescence, searching for their identity as sexual people.

7. Need for Power and Control — Investigation is essential to assess if the need for control is a result of early feelings of powerlessness that later resulted in habitual sexual aggression or if the feelings of powerlessness progressed over the course of repeated problematic sexual activities.

8. Libidinal and Sexual Needs — Only two of the informants explained their problematic sexual behaviors in terms of strong libidinal needs (p. 365–367).

Essentially, Guigliamo was able to point toward various theoretical models based on his experiment. What should be clear is that the behaviors resulting from sexual compulsion or sex addiction are not primarily based on issues related to sex itself. The acts of having sex, trying to find sex, or even thinking about sex are means of escape from life, just as having a drink, thinking about drinking, or trying to find the next drink helps the alcoholic escape. What is disturbing is that all but one of the respondents in this study stated that they had been neglected as children and that 9 of the 14 respondents reported childhood sexual abuse. Bancroft & Vukadinovic (2004) identified similar results for 9 out of the 31 study participants they interviewed. Furthermore, Guigliamo noted that "[a]lmost all of the informants in this study who stated that their sexually addictive behaviors began in their early adolescence or teenage years also reported incest prior to the age of 14" (p. 368).

Guigliamo noted that while the number of participants here seems low (n = 14), the data retrieved from the study was of a qualitative nature (subjective according to the participants' interview responses), which made the study valuable regardless of the sample size. Furthermore, five subjects were randomly chosen for follow-up interviews following the completion of the study. The purpose of that second interview was for participants to "review and give feedback regarding the accuracy of the recording and interpretation of the data that they gave," thus strengthening the research conclusions (p. 371). In addition, Guigliamo noted the limitation of such a small sample did make the results of the study unavailable for generalization purposes. Indeed, the sexual behaviors of 14 men cannot be representative of the entire population of men, even of those who also view themselves as being sexually addicted (p. 369).

Further Insights

College Students

Dodge, Reece, Cole, and Sandfort (2004) attempted to determine if "an association exists between sexual compulsivity and participation in sexual behaviors that are high risk in terms of HIV/STI infection" (p. 345). The researchers used a sample of college students for their study because that population had not been a focus of sexual addiction research in previous studies. In addition, they wanted to consider the reliability of the Sexual Compulsivity Scale (SCS) in reference to their participants. Dodge et al. gave the SCS (a questionnaire) to 876 heterosexual college students who responded to questions anonymously (p. 345). Almost half of the study participants were in exclusive relationships. Another fifth were in relationships in which exclusivity was not a condition, and the remaining third of the participants reported not being sexually active at the time the study was conducted (p. 346).

In addition to collecting demographic information, Dodge et al. created subscales of sexual behaviors to determine which participants (if any) were behaving in sexually compulsive ways and, if so, if those same participants were also performing risky sexual acts. The sexual behavior subscales are shown below (p. 345).

• Partner sex activities;
• Solo sex activities;
• Public sex activities, and
• Frequencies of protected and unprotected anal, vaginal, and oral sex (leading to possible HIV/STI infection) (Dodge et al., 2004, p. 345).

When assessing the SCS scores, Dodge and colleagues determined that the respondents who identified participating in broader ranges of partner sex acts had higher compulsivity scores. Furthermore, a "significant relationship between solo sex activities and sexual compulsivity" was also noted, as was a link between higher compulsivity scores and public sexual activities (p. 346). Looking at gender distribution, more men than women reported being in nonexclusive relationships; that group was also significantly more likely to have higher compulsivity scores when compared to those participants who were in exclusive relationships (primarily women) and those who were not sexually active at the time of the study (p. 347).

Summarizing their findings, Dodge and colleagues noted an additional gender difference:

In other words, the male respondents had higher compulsivity scores when compared to women, as did the younger respondents in the group. Higher compulsivity scores were also correlated to risky sexual behaviors for both genders; that is, both men and women with high SCS scores also participated in risky (unprotected) sexual activity.

Dodge and his colleagues made the following points with regard to limitations within their study. First, "our findings are based on a convenience sample that cannot be considered representative" (p. 348). In other words, any results reported cannot be interpreted as universal for all college students. "Although we found support for construct validity of the SCS in our sample, it is not clear whether the scale distinctly measures sexual compulsivity or taps into other constructs, such as sexual desire and sexual exploration" (Dodge et al., 2004, p. 348). While credit should be given to these researchers for offering limitations, it should be clear what reference they are making with regard to sexual desire and sexual exploration.

It is possible that not all responses provided by the sample were truthful. Furthermore, honest responses may be tied to uncertainty about one's addiction/dependency status. In other words, it is possible that subjects responded to questions about being out of control without realizing that being out of control was atypical. What is clear is that the subjects in this group who behaved in sexually compulsive ways did not protect themselves from sexually transmitted diseases or viruses. It is possible that for this group, the compulsion to have sex was more of a priority than having safe sex. That is the case for heroin addicts who share needles; the need to get high outweighs the need to remain healthy by always using new needles.

The Clergy

According to Frykholm (2007), clergymen may be a population that many people do not consider vulnerable to sexual addiction. To be clear, members of the clergy accused of pedophilia are not necessarily sex addicts. Sex offenders are usually of the mind that controlling their victims is the gain, the "high." Sexual addicts find some other gratification from the experience of searching for and/or having sex. They gain an endorphin rush or the removal of self-loathing for a period of time during or after the chase.

Frykholm discusses a former seminary student, Mark Laaser, who had researched sexual addictions within the field of ministry:

Laaser, author of the book Healing the Wounds of Sexual Addiction, was the president of Faithful and True Ministries. Based on his own experiences as well as the research he conducted after his removal from the ministry, Laaser noted a difference among the sex addicts with whom he was currently working when he compared them to those he had served in the past. He blamed the difference on pornography and the Internet. For example, Laaser noted that when he first started working in the area of sexual addiction, "nearly all his clients had a history of trauma; for them, sexual addiction was a way of coping with or masking severe emotional pain. Today that is seldom the case: people who have problems with pornography look more like the general population" (Frykholm, 2007, p. 20–21).

Laaser identified three characteristics that were representative of sexual addicts within the clergy: 1) they were lonely, 2) they were angry, and 3) they were bored. These characteristics are those that were fostered by the job itself. For example, Laaser noted that for clergy, "their jobs make high demands, they work in large part independently … [and] are often isolated and work in contexts where they have few if any peers. Friendships, too, may be rare for pastors. While they are caregivers themselves, pastors may not have care extended to them" (Frykholm, 2007, p. 21). It would be difficult to exhaust emotional support all day when nobody returns the favor. Anger and other emotions are usually what most addicts try to avoid, thus turning to substances or behaviors instead.

An interesting discovery Laaser made when conducting a study with Delmonico in 2002 was that "sexually addicted clergy were far more likely than the general population to be addicted also to work. Work had become not only a calling but an escape from other life problems" (Frykholm, 2007, p. 21). Indeed, it is rare to find a minister who is not available to his or her congregation at all hours of the night, seven days a week. Laaser believed that the screening process for hiring clergy needed to become stricter and that warning signs needed to be addressed before addictive behaviors took control of those who are trusted the most. For example, potential sex addicts within the clergy tend to work as though nothing else matters (the workaholic). They also appear to be superior to most (rather than being vulnerable like everyone else). While these characteristics tend to define an effective minister, they also define a potential addict (Frykholm, 2007).

The Internet & Pornography

According to Schneider (2004), sexual addiction has changed since the 1990s. "Today an increasing number of sex addicts are caught up in the web of cybersex, devoting endless hours to accessing Internet pornography sites and chat rooms and having real-time sexual encounters online … For many, the Internet serves as a gateway to live sexual encounters" (p. 5). Furthermore, Hall (2006) points out that the lure of the Internet is twofold: it is easily accessible, and the people using it are anonymous. This makes the hunt for sex easy. People can do it at work, at home, or in cafes while pretending to be productive. The most common online sexual activity is viewing pornography (Hall, 2006), which is both produced and consumed in the United States more than in any other country. This accessibility both promotes and encourages sexual activity. For those who lack the ability to control their sexual impulses, the Internet is a perfect way to feed their addiction, and the problem has only grown as the twenty-first century progressed. According to the Mayo Clinic, 4.7 million adults in the United States spend more than 11 hours per week looking at pornography on the Internet (Gleeson, 2022).

Viewpoints

According to Dr. Jerome Jaffe (1990), categorizing behaviors like sex, eating, gambling, or shopping addictions together with substance addictions is not an effective way to look at either abusive tendency:

Citing one of the mantras of Alcoholics Anonymous, Jaffe fears that labeling behavioral addictions as such may cause the assumption that a sex (behavior) addict is as powerless over having sex as an alcoholic is of having his next drink (p. 1426). Furthermore, placing together behaviors and dependencies implies that the same treatments should be available to, offered to, and promise relief from all of the above, which is not the case (1427). Twelve-step programs offer treatment for many disorders. However, abstinence is not the goal of sex addiction treatment. Behaving appropriately (in thought and action) with regard to sex and intimacy is the goal of treatment, just as the goal of treatment for an eating disorder includes teaching healthy eating habits rather than teaching how to never eat again. Jaffe's point has merit and highlights a more achievable goal for sex addicts.

So too, does Keane's (2004) counterpoint. Keane posits that while not necessarily neat little packages of dependency,

Indeed, many addicts are viewed as being immoral and weak of will. Having a theoretical model that encompasses the various dependencies may help reduce the assertion that addicts are bad people simply because research and science are behind the assertion.

In 2022, the Mayo Clinic estimated that between 6 and 8 percent of adults in the United States were addicted to sex. The Internet and introduction of apps that facilitated casual sexual encounters were expected to increase those numbers as sexual material became even more available. In the 2020s, research also continued into the underlying causes of sexual addiction from a genetic viewpoint, as well as environmental impacts (Gleeson, 2022). Following the COVID-19 pandemic, researchers looked into its effect on sexual addiction. Predictably, they found that during the pandemic, sex addicts continued their consumption of material on the Internet and virtual pornography while all but abandoning in-person encounters due to fears of illness. The ability of sex addicts to cease a behavior so abruptly called for further research into sex addiction (Rosenberg, 2022).

Conclusion

Opinions on this issue are vast. Nevertheless, it is important to look closely at the point Dr. Jaffe tried to make. Being addicted to sex is not the same as being addicted to heroin. For instance, drug addictions change the physiology of the brain as a result of its prolonged exposure to chemicals that were never intended to be ingested. Sexual addiction, on the other hand, may cause an increase in chemical production in the brain during the hunt for sex, the secrecy of that hunt, or even within and after the act of orgasm. That chemical increase in the brain (of endorphins or other neurotransmitters) is not the same as the introduction of an outside source (e.g., heroin) to a brain that does not produce it. The repeated increase of chemicals already produced by the brain may cause brain chemistry to change, but not in the same way that drug dependency does. While the dependent nature of the addictions is the same — the addict "has to have" the substance — the physical damage experienced by the brain from exposure to chemical substances is a complication not found in behavioral addictions.

Terms & Concepts

Abstinence: Restraining from a behavior or activity.

Abuse: Using something in a harmful (often habitual) or illegal way.

Addiction: Physiological or psychological dependence on a drug or behavior.

Compulsion: The inability to resist a desire to do something.

Dependence: The physical, psychological, or physiological need to use a drug or substance or to behave in certain ways despite negative consequences.

Disease: A condition resulting in symptoms that are pathological in nature.

Disorder: A condition that involves a disturbance of the normal mind or body functions.

Predisposition: A susceptibility to an illness, disease or behavior based on genetic factors.

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