For decades mental health professionals have been debating the question: Can a person be addicted to sex? Then the World Health Organization stepped into the fray last month — and didn’t totally answer the question.
WHO announced that compulsive sexual behavior disorder had been added to its updated listing, the International Classification of Diseases. In the ICD-11, it’s described as being “characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.”
The controversial decision was hailed by many supporters of the change as advancing the conversation surrounding problematic behavior that goes by many names: sex addiction; out-of-control sexual behavior; hypersexuality; and hypersexual behavior disorder. Yet while the inclusion of the disorder has been proposed, it’s not been accepted into the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Health Disorders.
So WHO’s decision made waves.
“I’m too old to dance on table tops,” says Robert Weiss, a sex addiction expert based in Santa Monica, California, and author of “Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction.” “But were it 30 years ago when I started in this field, that’s what I would have done. It’s incredibly important to have a diagnosis — it’s essential. Because without a diagnosis, you get moral judgment, you get religiously influenced clinical decisions and you get misdiagnosis.”
[See: What Only Your Partner Knows About Your Health.]
Others point out — as Weiss does himself — that WHO stopped short of calling the behavior disorder an addiction. However, most who support or oppose adding a diagnosis acknowledge that the WHO decision is significant and will only spur more conversation.
In its position statement on sex addiction, the American Association of Sexuality Educators, Counselors and Therapists “recognizes that people may experience significant physical, psychological, spiritual and sexual health consequences related to their sexual urges, thoughts or behaviors.” But it “does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder.”
WHO’s decision to add compulsive sexual behavior disorder to the ICD-11 is “getting ahead of the research,” says Michael Vigorito, a certified sex therapist in the District of Columbia and co-author of “Treating Out of Control Sexual Behavior — Rethinking Sex Addiction.” Vigorito helped draft AASECT’s position statement on sex addiction. Instead of creating a new diagnosis, he argues what’s needed is to treat other underlying psychiatric conditions like depression or problematic, harmful sexual behaviors, or paraphilias. “When you try to isolate this condition as a discreet disorder that fits the criteria of sex addiction, it doesn’t materialize in the research because most of those folks meet criteria for other established psychiatric disorders,” he asserts. “So once you treat that disorder, the sexual behavior problem will likely remit.”
Proponents of sex addiction therapy, however, contend that approach misses some people whose consensual sexual behaviors are disruptive to their lives and undermine their ability to function at home or work or in their social lives.
Most consensual sexual behaviors are not a cause for concern, experts say. “But if you come to me and tell me that you’re losing your marriage, you’re losing your family, you’re losing your job, you’re unable to get through college because you’re looking at porn instead of studying. If you tell me that the behavior engaged in is affecting your ability to function, then I’m looking at addiction or compulsion,” Weiss says. He adds that sex addiction is not about who you sleep with, who you’re attracted to sexually or what kind of sex you have. “It’s not like if I’m into leather, I’m a sex addict, but if I’m into vanilla sex I’m not. So it’s not about who or what,” he says. “It’s about how my sexual behavior is affecting my ability to function.”
But unlike with an addiction to, say, alcohol or drugs, where a person in recovery is advised not to drink or get high, experts who have conflicting opinions on the sex addiction debate agree that few people would be willing to give up sex entirely — and that they shouldn’t be expected to.
[See: 7 Health Risks of Binge Drinking You Can’t Ignore.]
Weiss suggests cognitive behavioral addiction treatment, therapy that’s used to treat other addictions. But his strategy in treating people with sex addiction focuses on containment and maintenance, and it varies by the person, where problems might range from infidelity in a monogamous, marital relationship or spending hours viewing porn while one is supposed to be working. “So we’re working with them on containing behaviors that are out of control — for them — that are going to ruin their marriage, their career” or other aspects of a person’s life, Weiss says. “We’re not saying that you’re not going to be sexual anymore. We’re saying now what sexual behaviors are affirming for your life, healthy for your life? … That’s where it is very individual.”
As Weiss notes on his website, the first step for treating a sex addiction is a thorough “bio-psycho-social assessment.” The evaluation involves looking at nearly every aspect of that person’s life, including one’s sex and relationship history. “Individuals are assessed not just for sexual addiction, but for other psychological issues (including other addictions), along with relationship, family, legal, work, social, recreational, and financial concerns that may need to be dealt with.”
After that, the focus is on a person’s behaviors and well-being. He also recommends going beyond one-on-one therapy to get support to change deeply rooted patterns of behavior. “Group therapy helps sex addicts learn that their problems are not unique, which goes a long way toward reducing the shame associated with their behaviors,” the website notes. Weiss also suggests joining a sex addiction support group, just as one might join Alcoholics Anonymous for alcohol addiction to get lifelong support, for what he sees as a chronic — lifelong — issue.
Others, like Vigorito, say the answer lies not in considering whether one might have a sex addiction, but rather in getting a better understanding of — and treating as necessary — what’s driving problematic behaviors. In some cases, it may be about evaluating attitudes that lead to thinking there’s a problem in the first place. “It could be around their negative moral judgment about either the sexual behaviors they’re engaging in or the sexual fantasies that turn them on; and that internal conflict is what they are describing as feeling out of control,” Vigorito says.
Those who do have a serious sexual problem that’s disrupting their life will benefit from digging deeper to understand what’s causing that. “I think most folks presenting with this issue likely would qualify for a psychiatric disorder that’s already recognized and researched and has evidence-based treatments for, such as major depressive disorder [or] anxiety disorder,” Vigorito says. “It could be a symptom of ADHD. We can then provide the treatment based on those disorders without becoming distracted that the symptom of that disorder is sexual.”
Whatever the cause — and however contentiously debated — experts at least agree it’s important to seek help. Nor is it about taking an all-or-nothing approach to sex — that’s either permissive of even behaviors that are self-destructive or hurt others, or that’s repressive.
[See: How to Find the Best Mental Health Professional for You.]
“Sexual health is a health domain on par with physical health, mental health and spiritual health,” Vigorito says. “So it is such an important aspect of people’s life satisfaction that to me my work is to help them integrate sexual pleasure into their life where it will contribute to their overall health and wellness.”
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Could You Have a Sex Addiction? originally appeared on usnews.com
