The term sex addiction, also known as hypersexual disorder, is not listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, many people still consider it to be a very real disorder . According to the Psychology Today website, “Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual thoughts and acts. Like all addictions, its negative impact on the addict and on family members increases as the disorder progresses. Over time, the addict usually has to intensify the addictive behavior to achieve the same results” . This paper will focus on theories used to describe sexual addiction, types of sexual addictions, differences between male and female sex addicts, effective treatments, and areas requiring future research.
Even though sex addiction did not make it into the new DSM-5, the proposed criteria is worthy of examination. For at least six consecutive months, recurrent and intense sexual fantasies, sexual desires and behaviors must be associated with four or more of the following criteria: Excessive time thinking about sexual fantasies and urges, as well as by planning when one will engage in sexual behavior; repeatedly engaging in these sexual fantasies, urges, and behavior to deal with negative moods, such as anxiety, depression, irritability, or feeling bored; repeatedly engaging in sexual fantasies, urges, or behaviors to deal with stressful life situations; repeated but failed attempts to control or decrease these sexual fantasies, urges, and actions; and repeatedly taking part in sexual acts, while ignoring the risk for emotional and physical harm to oneself and other people. In addition to this, there is also significant personal distress or impairment in social, vocational, or other areas of functioning that is connected to the frequency and strength of sexual fantasies, urges, and actions. The person must be at least 18 years old and the sexual fantasies, desires, and actions cannot be the result of manic episodes, drugs, or other medications .
Some sexually related disorders that are in the DSM-5 have been considered sexual addictions by some experts, these disorders known as paraphilia . According to the DSM-5, paraphilias are any kind of intense and enduring sexual interest besides a sexual interest in general stimulation or fondling between normal, physically mature, consenting human beings. Meeting the diagnosis of Paraphilia is described as the following, “For a diagnosis of a paraphilic disorder (excluding certain age parameters and other factors in Criterion C) both Criterion A (in general persistent and troubling “fantasies, urges or behaviors over 6 months”) and Criterion B (broadly referring to stress and life “impairment” sequela due to the disorder and/or “acting on these sexual urges with a non-consenting person”) have to be met” (American Psychiatric Association, 2013).
However, paraphilia can be broken down into more distinct categories. These categories include Exhibitionism, which is described as a desire or actual behavior of exposing one’s genitals to an individual or group that does not expect this type of behavior. The exhibitionist gets aroused by performing sexual behaviors in front of other people. Fetishism is a type of disorder where one obtains sexual arousal through inanimate objects, i.e. women’s high heels, underwear, leather, belts. Another disorder, Frotteurism, is a disorder where one gets sexual pleasure by touching or rubbing one’s body against an individual, who has not given the proper consent. Voyeurism is a disorder in which somebody enjoys viewing another individual who is naked, in the act of taking off one’s clothes, or performing sexual behaviors that one wants to be private. However, the person being watched has not given consent to this viewing and may not ever know that he or she is getting watched .
Sexual masochism disorder, also known as S&M, is a disorder in which one wants to be a degraded, humiliated, beaten up, tied with ropes, hand cuffed, or subjected to other unusual acts of suffering, in order to obtain some type of sexual pleasure. Sexual sadism or Sexual Sadism Disorder is the flip side of sexual masochism disorder, this person desiring to be on the receiving end of sexual pleasure that is garnered through another person giving pain or humiliation .
Although many theories have been used to explain sex addiction, one thing that experts can agree on is that the sex addict’s thought process gets distorted. The individual starts to rationalize their actions and behaviors. Some people with sex addiction shift the responsibility for their behavior by blaming other people for their sexual actions. Many sex addicts are in denial that they have a problem with sexual addiction .
Sexual addiction is something that appears to progress, as one falls further and further into the addiction. In the initial stage, a person will start out viewing lot of pornography. This may turn into the individual taking part in online sex groups. This can worsen into an intense desire to go out and perform these acts in public, which can lead to risky sexual activity that poses a significant danger to the person, such as physical harm, disease, or other problems (Sex Addiction, 2015).
Attachment theory has also been used to explain the behaviors of males with sexual addiction. In one research study, subjects were given the “Sexual Addiction Screening Test and the Experiences in Close Relationships Revised” instrument. Study results showed that sexually addicted men had a greater likelihood of having an insecure attachment style in relationships. These subjects were also more likely to have elevated levels of anxiety. This research suggests that treatment for sexual addiction in males should focus on both addiction and insecurity in relationships .
Studies involving women studies have also examined the role of attachment theory. Females with sex addiction often tend to mimic dysfunctional attachment patterns from their past that get carried into future intimate partnerships. This insecure mother-child attachment in childhood seems to be a factor in women developing a sexual addiction. (Ferree, 2010).
However, female sex addicts show different tendencies than males. Unlike men, females suffering from sexual addictions are often relationship or love addicts. Sexual codependency is also more common in women. In females with sexual addiction, childhood trauma, such as sexual abuse, also appears to play a role in developing the addiction. These sexually addictive behaviors serve as replays of the childhood trauma. Hence, the sexual addiction serves as an escape from the pain of childhood traumas, the sex addict having a hard time in not engaging in the sexually addictive behaviors .
Social-Cognitive Learning Theory, established by Albert Bandura, can be used to describe how sexual addiction develops. The theory says that individuals’ personalities are shaped by other people’s actions plus individuals’ own learning expectations. Bandura’s Theory states that personality consists of behaviors, cognitions, and environment. The interplay of these parts is known as Reciprocal Determinism. It explains how a person’s environment, personal characteristics, and actions determine how somebody will behave in the future (Cicarelli & White, 2011). For example, a 40-year old man goes to see a prostitute at a hotel (environment) and likes it when he is able to have rough sex with her (personal characteristics). When he has sex with her (behavior), he always has an orgasm, the pleasurable environment encouraging him to engage in this behavior in the future (part of his environment). Most likely, the male will keep visiting prostitutes unless it becomes non-pleasurable or another negative event happens.
Social Learning Theory also incorporates the concepts of self-efficacy and self-esteem. Self-Efficacy is defined as our perceptions of how effective we will be in accomplishing future goals in particular circumstances. Perceptions of efficacy are high or low . If an individual expects his sexual performance with a new person to be bad and boring, his self-efficacy will be low. After a few sexual encounters, which are boring and bad, the person expects the sex to stay that way, one’s self-efficacy quite low. Hence, this can make a person more likely to engage in a type of sexual addiction where one is watching pornography to get sexual excitement. In pornography, no other person is involved and it is safer than looking bad and boring.
Self-esteem focuses on one’s sense of self-worth and personal value. How we judge our beliefs, behaviors, and actions dictate the quality of our self-esteem. Do we like how we look, interact with individuals, and feel deserving of intimacy? If yes, then our self-esteem in probably healthy. One’s level of self-esteem influences how an individual acts and feels, contributing to one’s sex life, which can include sexual addictive behavior.
Decreased feelings of self-esteem has been suggested in sex addiction research. A study involving 187 college students examined how self-forgiveness, shame, and guilt were related to hypersexual behavior. The study’s method and procedure was as follows, “After indicating consent online, participants were asked to describe an offense that had occurred in the past month that involved violating their own sexual values. Participants then completed an online questionnaire, which included measures of self-forgiveness, shame/guilt, and hypersexual behavior. Participants completed the measures of self-forgiveness and shame/guilt in relation to the particular offense they described.” . Results of the study showed that the more shame and guilt one felt and less self-forgiveness, the higher the levels of hypersexual behavior. These results suggest that self-esteem may also be linked to hypersexual behavior .
While there is a scarcity of controlled studies in sexual addiction, uncontrolled and case studies have highlighted some positive treatment methods. Individual therapy, motivational interviewing, cognitive behavioral approaches, dialectical behavioral techniques, relapse prevention strategies, insight-oriented therapy, family therapy, and drug therapy have shown to reduce or eliminate sexual addiction symptoms when treating some sex addicts .
As far as drug therapy, the follow passage shows evidence of its effectiveness “Anti-anxiety agents, other than selective serotonin reuptake inhibitors and serotonin/ norepinephrine reuptake inhibitors, may be helpful in sex addiction patients whose sexual acting out is triggered by anxiety. Benzodiazepines need to be judiciously prescribed in the sex addiction population because of their tendency towards multiple addictions, while in our clinical experience, nonaddictive anxiolytics such as buspirone may be useful” (Rosenberg & Carnes, 2014, p. 88). Antipsychotics have also been used, these drugs decreasing sexual arousal, desire, and climax.
Group therapy has also shown some effectiveness with sexual addiction. While individual therapy is still paramount to treating sexual addiction, group work has shown some positive benefits in helping people overcome their addictions. One advantage is that group therapy appears to get to the bottom of the guilt and isolation that many people feel over having a sexual addiction, especially when it comes to watching pornography. With a here and now focus, which is at the core of Existentialism, group therapy also helps people develop empathy and emotional cohesiveness between individuals in the group. This helps people feel a sense of belonging. The group creates the atmosphere of being in the real world, which can help addicts try to offer each other solutions, understanding, and a sense of connectedness .
In spite of sexual addiction or hypersexual behavior not being in the DSM-5, research suggests that it is a valid disorder that causes significant distress and impairment in the individual who is suffering from it. Sexual addiction is characterized by persistent sexual fantasies, behaviors, and desires that cause significant distress and impairment. Paraphilias have also been classified as sexual addictions, including exhibitionism. Women often present sexual addiction symptoms differently than men, women’s sexual addictive behavior seeming to arise from childhood traumas.
Theories such as Social Learning Theory and Attachment Theory can be used to understand why sexual addictions develop and how a sex addict can be treated effectively. While controlled research studies that examine sex addiction are lacking, some treatments have shown positive results. Group work that is aligned with existentialism has shown success, as well as certain drugs such as anti-anxiety drugs, benzodiazepines, and anti-psychotics drugs. Avenues of future research on sexual addiction are open. Sexual addiction studies with LGBT population are sparse, sexual addiction studies needed to see if any difference exists between this group and their heterosexual counterparts. Research studies that assess any differences between various age groups are also needed. More information in these areas can lead to greater understanding pertaining to sexual addiction and its treatment.