“Sex addiction” is a newfangled category that was invented in 1986 by prison addictionologist Patrick Carnes. The criteria for this disease are either hopelessly vague, moralistically specific, or subjectively applied—typically by anguished spouses, decency crusaders, or “addicts” themselves who are in genuine pain. The subjectivity and moralism around the diagnosis are one reason it isn't included in the DSM-V
As a psychotherapist and sex therapist for over thirty years, I just don’t see the value of the “sex addiction” diagnosis. It assumes that people who FEEL out of control ARE out of control. It assumes that the only kind of healthy sex is wholesome and intimate sex. It assumes that any self-destructive use of sexuality is pathological—while ignoring the fact that most of us periodically abuse every activity we really value, whether it’s working, eating, playing golf, reading romance novels, surfing the web, or volunteering at our Church.
And the sex addiction “treatment” can be a nightmare. Again, like the diagnosis, the standards and rationale are all over the map. Some programs insist that “sobriety” means no casual sex, while others ban pornography or even masturbation. Some sex addiction counselors are ignorant or judgmental about non-traditional activities like S/M, non-monogamy, internet role-play, swing clubs, even sex toys. Most sex addiction programs and counselors see no legitimate value whatsoever in massage parlors, escorts, or other commercial venues.
Millions of men and women are in real pain about sexuality out there: I’ve seen them in my office every single week since 1980, before “sex addiction” was even invented. I get hate mail whenever I write about this subject, and it always includes 'you've obviously never spoken to people in pain about their compulsive or destructive sexual behavior.' In response, I can only sigh: I’ve spent tens of thousands of hours working with people who could be (or are) labelled sex addicts. I don’t deny their suffering at all.
I just know there are better ways to conceptualize these peoples’ problems. That leads to better ways to treat them—because it aims toward more positive, more adult outcomes.
When sex addicts complete their treatment, they’re still addicts, facing a lifetime of recovery. When someone completes high-quality sex therapy, psychotherapy, or couples counseling—really completes it—they’ve changed. They still have their biography and vulnerabilities, but they’ve resolved the problems that brought them into therapy. They know that sex is not dangerous—it’s a grand opportunity for self-expression and celebration.
Later this week I’ll describe the specifics of an approach to sexual compulsivity and self-destructiveness that doesn’t depend on lifelong recovery.
Meanwhile, if you’re wondering about whether sex addiction exists, take the Sexual Addiction Screening Test. You’ll discover that you’re either a sex addict, or at risk of becoming one. The test primarily measures guilt, shame, secrecy, and experimentation—that is, standard American sexuality.