The Problem with “Sex Addiction”

The Telegraph’s Web site recently ran an article by Dr. David Ley with the provocative title Why There’s No Such Thing as Sex Addiction:

[T]here’s no standard definition of sex addiction. It hasn’t been recognised as a bona fide disease by the Diagnostic and Statistical Manual of Mental Disorders, the medical profession’s bible when it comes to mental health, so, instead, there are a dozen or so competing definitions and no two psychotherapists who apply the concept in the same way. A diagnosis is based on a therapist’s own idea of what constitutes an excessive amount of sex. But the mistake all these “experts” make is to try to apply the characteristics of drug and alcohol addiction to sex, claiming too much sex works like a drug, causing cravings, withdrawals, tolerance (the need for increasingly powerful “hits”) and a downward spiral in which sex “takes over their life”.

There are many embedded moral concepts in these definitions, all of which suggest that sex is dangerous, shouldn’t be “enjoyed too much” and that something that creates imbalance in a person’s life is inherently unhealthy.

When I first started hearing about the notion of “sex addiction,” it struck me very strongly as a way of pathologizing any kind of sex that was not perceived as “normal.” The term was invented by a guy named Patrick Carnes, who wrote a book () and then went on to make a very lucrative career from “treating” sexual “addiction”. He has developed a sexual addiction screening test which consists of 52 yes or no questions, with even a single “yes” answer sufficient for a possible diagnosis of addiction. Among the questions:

11. Do you feel that your sexual behavior is not normal?
16. Are any of your sexual activities against the law?
18. Do you hide some of your sexual behaviors from others?
44. Have you maintained multiple romantic or sexual relationships at the same time?
46. Have you regularly engaged in sadomasochistic behavior?

The problems with these questions, and others like them, is that they really have nothing to do with whether or not sexual behavior is an “addiction;” instead, they start with the assumption that there is a “normal” set of sexual behaviors, that set of “normal” behaviors aligns with conservative social norms, and that anything outside this range of “normal” behaviors must be destructive.

Nearly all people can answer “yes” to at least one of these questions, at least in the United States. Many states outlaw oral sex, anal sex, and/or use of sex toys. Few of us talk about all of our sexual activities with everyone we meet. Polyamory and BDSM are both sexual activities which are quite popular and which have never been shown, when practiced between consenting adults, to be indicative of any sexual dysfunction.

These problems highlight one of the biggest issues around the notion of sex “addiction”–the pathologizing of any sexual activity that is not perceived as normal. When one reads Carnes’ questionnaire, it soon becomes obvious that it is a reworking of conservative religious morality with a veneer of psychological legitimacy tacked on.


Now, to be fair, Patrick Carnes may have invented the term “sexual addiction,” but that doesn’t mean that others who subscribe to his ideas agree with his definition. It’s by no means my assertion that everyone in the sex addiction industry assumes that having oral sex in Florida (where it is illegal) or tying up your partner with silk scarves automatically makes you a sex addict.

But that’s another of the many problems with the notion of sex addiction; there’s no rigorous diagnostic criteria. Ultimately, sex addiction is diagnosed by therapists who seem to apply a principle of “I know it when I see it.”

Part of that comes from sloppiness in language. In the popular vernacular, the word “addiction” is generally believed to mean “something you can’t stop yourself from doing.” But “addiction” actually has a very specific medical definition, and it’s difficult to argue that sex rises to that definition. More properly, something one can’t stop from doing is termed a “compulsion.”


I’m not trying to argue that there are no people who have destructive sexual habits or practices. Nor am I saying that there’s no such thing as people who sexual dysfunctions are both uncontrollable and harmful to others. What I am saying is that calling such things “addictions” is misleading and harmful.

The word “addiction” carries an emotional charge. We all have associations with it; alcoholics who beat their families in a drunken rage, heroin addicts dying in inner-city streets. And these emotional associations, flawed as they are, help shape our emotional response to the idea of “sex addiction.” Calling destructive, uncontrollable sexual behaviors “sex compulsions” simply doesn’t carry that emotional charge.

It’s not just a semantic quibble, though. The word “addiction” also carries assumptions about how to deal with it. If you have a drug or alcohol addiction, you can go into a rehab treatment program where you go through a process of detoxification and then receive counseling and support such as a 12-step program, right? And since sex can be an addiction just like drugs can be an addiction,it makes sense that the same treatment process for drug addiction must also work for sex addiction, right?

This assumption has fueled a multimillion-dollar industry in treating presumed sex addiction, and in the process given a number of celebrities who like having sex behind their partners’ backs a socially accepted excuse for their behavior, but it has never been shown to my knowledge that the same approaches that deal with drug dependency actually work on behavioral compulsions. Nor is there any real reason to believe that they would; factors such as physiological dependence simply don’t exist with behavioral compulsions.


The range of human sexual expression is wide. People make conventional and unconventional choices about sex, just as they do about money, work, hobbies, and everything else. Some of those choices are destructive or ill-conceived, just as they are with money and so on.

What concerns me is the notion that destructive choices about sex being assumed to be the result of some sort of nebulously-defined “addiction” (rather than, say, poor communication, or faulty assumptions about sex, or a conflict between a person’s sexual identity and his or her religious values or upbringing, or a simple unwillingness to take responsibility for the consequences of sexual decisions, or any of a thousand other things), and the eagerness on the part of some therapists and “experts” to say that any sexual practice that’s not in keeping with conservative religious ideals must be a sign of a pathology.

Are there people who genuinely struggle with sexual compulsions that cause them harm and that they can not control? You bet there are. I do not see, however, how pathologizing large swaths of the American public, or treating supposed sexual addiction the same way one might treat a heroin addiction, or offering the notion of sex addiction as a get-out-of-responsibility-free card whenever a star celebrity is caught in an embarrassing sexual situation, helps these people or anyone else.

Except perhaps the folks who sell books and offer expensive treatment programs for an addiction that’s never even been defined and has no accepted diagnostic criteria in the first place.

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2 Responses to The Problem with “Sex Addiction”

  1. What a wonderful read!

    I am a qualified counselor working in the relationship, addiction and BDSM arena, as well as a ProDomme. What has been written here is a must for everyone who has ever questioned anyone’s sexual behaviour – including their own. There is too much prejudice, lack of understanding and intolerance out there though ignorance and personal or political agendas.

    Thank you

    Catherine

  2. Claire says:

    I think you make a lot of valid points that I agree with AND I think that sexual addiction that has the same dysfunctional neurological reward circuitry as other addictions like gambling (behavioral example) does exist. I’d love to read your thoughts in reaction to this article:
    http://goodmenproject.com/featured-content/did-addiction-politics-leave-us-stranded-on-a-slippery-slope/

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