Sexual addiction is generally regarded in one of two ways—the first theory is that it is addiction, like that of drugs or alcohol, where a state of euphoria or a “high” is experienced; the other is that it is a type of obsessive-compulsive disorder. However it is defined, sex addiction is considered a progressive illness, meaning that the addictive behavior intensifies the longer it goes untreated. Experts believe an estimated three to six percent of Americans are battling some form of sexual compulsion.

Signs and symptoms of a sexual addict may start innocently enough with excessive masturbation, obsessive use of pornography, or partaking in sex phone services. As the disorder develops, the severity of the symptoms increases. Addicts may compulsively date, engage in unsafe sex, and may have multiple or extra-marital affairs. These acts may not only harm the individual’s health, but can negatively impact their relationships with loved ones.

In the most severe cases, a sex addict will engage in illegal acts such as voyeurism, prostitution, molestation, or even rape. Although not all sex addicts become sex offenders and vice versa, it is estimated that 55 percent of convicted sex offenders have a sexual addiction. Interestingly, a person with sexual addiction generally doesn’t receive pleasure or satisfaction from the sexual act. Instead, they often use sex as an escape from other problems such as stress, depression, or anxiety. Many sex addicts have experienced some form of sexual or verbal abuse in their lives that has contributed to their compulsion.

Even though research on sexual addiction is growing, there are skeptics who claim the condition is not a “real” addiction. Many critics believe sexual compulsion is a narcissistic act and a byproduct of society—nothing more. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has yet to include the diagnosis in its compendium of mental disorders although it does include a miscellaneous diagnosis for sexual disorders.

Treatment for sexual addiction may prove tricky at first because many individuals with this disorder feel embarrassed and shameful, making it difficult for them to acknowledge that they have a problem. Once an individual admits they have an addiction, their recovery follows a similar plan to those of other addictive and behavioral treatments. Patients are encouraged to become involved in group therapy, a 12-step program, and one-on-one therapy sessions with a psychologist or psychiatrist. Medication may also be prescribed. The goal behind the therapy is for the patient to learn how to control their compulsive behavior while maintaining a healthy sexual lifestyle.

Overcoming any type of addiction is highly challenging and sexual addiction is no exception. Under the guidance of a physician or clinical therapist and by having the willingness to change, any individual dealing with this addiction can be treated.

Patrick Carnes, in his groundbreaking book, Out of the Shadows: Understanding Sex Addiction, cites core belief systems shared by sex addicts. They are:

1. I am basically a bad, unworthy person.
2. No one would love me as I am.
3. My needs are never going to be met if I have to rely on others.
4. Sex is my most important need.

While these are the core dysfunctional beliefs, there are many more beliefs that keep the addictive cycle in place, including:

• I am unable to tolerate boredom; sexual acting out is a good way to fill in the time.
• If not distracted by sex, I am filled with an intolerable sense of emptiness.
• Men are more sex-driven than women. As a man, I need to discharge that drive, or I’ll go crazy.
• My sense of self is determined by how many women are attracted to me.
• The vicissitudes of life are either boring or unmanageable. There is no pleasure to be had in day-to-day life except for my "secret" world.
• Sex with my partner is a mechanical, deadening process which lacks spontaneity and excitement.
• If life does not provide excitement and high stimulation, then I’ll be bored and depressed forever.
• When I get an urge or impulse to act out sexually, I must succumb to that urge.
• In order for me to be a real man, I must have sex with as many women as I can. Furthermore, as the man, I am responsible for my partner’s pleasure through intercourse. Failing at intercourse is failing as a man.
• Engaging in cybersex is my only means of getting away from the stress and frustration of living.
• Sexuality is the only trustable means of relating to others.

Dysfunctional beliefs give rise to rationalization, minimalization, and justification. As the disease progresses, the sex addict starts to see the world and his place in it in a distorted way in order to protect his sexual acting out. His whole perspective becomes distorted to the point where he becomes increasingly out of touch with reality.

Sexual addiction is self-perpetuating. It feeds on itself because of ingrained core beliefs as well as each individual’s dysfunctional beliefs about sex. In order to change the addictive cycle, one must change the belief systems that underlie it.

Dorothy Hayden, LCSW has been specializing in treating sex addiction and chemical dependency for 15 years. She has training in sex addiction therapy, psychoanalysis, hypnosis and cognitive behavioral therapy. The full text of her writings on sex addiction can be found at www.sextreatment.com.

As addressed in a recent Zee News article, for most people with sexual addiction, the behavior is not actually about the sex itself – but rather the way the behavior allows them to escape emotional pain or helps them escape an inability to form close personal bonds with others.

As a result of misconceptions about sexual addiction or feelings of shame, many people may not look for help from experts and treatment professionals. As the condition progresses, the person will need more intense forms of the behavior to get the same "rush" and remain powerless over their urges, despite the consequences.

Like other addictions, sexual addiction is linked with a person’s inability to experience and cope with negative emotions. Similar to people who abuse drugs or alcohol, a person may abuse sexual activity, masturbation, pornography or other sexual outlets to escape stressful emotions. The sexual activity may bring a temporary sense of control over these feelings, but in reality, each behavior associated with the addiction only worsens feelings of shame, guilt and isolation.

For people with sexual addiction, sexual behaviors may bring a sense of release or a short-term high, but the consequences are devastating to their spouse, children and careers. Research involving the causes and treatments for sexual addiction is rapidly increasing across the globe, and hypersexuality is under consideration for formal inclusion in the next version of the Diagnostic and Statistical Manual of Mental Disorders.

As stated in the Zee News article and many professional sources, people living with sexual addiction are living with deep levels of pain and need the help of experts to reach recovery.

Commonly reported feelings by people with sexual compulsivity and sexual addictions include anxiety toward personal relationships and deep fears about becoming emotionally close to people. A Massey University study strengthens this conclusion about sexual addiction, revealing that in surveys with more than 600 adults intimacy-related fears were repeatedly noted. The participants, who had problems with sexual addiction, also felt "threatened" by close personal relationships and went out of their way to keep people at an emotional distance.

Sexual addiction continues to gain recognition as celebrities come forward to share information about the problem, including golfer Tiger Woods. While treatment centers and research studies continue to increase nationwide and globally, experts still believe the problem is not viewed as seriously as conditions like drug or alcohol abuse, even though the consequences can be just as severe.

The phrase "sex addict" is now more than three decades old, typically accompanied by phrases like hypersexuality or sexual compulsivity. The complicated disorder of sexual addiction has received much less medical, psychological and scientific attention than it deserves, say many experts, because the problem affects millions of adults and can destroy careers, finances and families. People with sexual addiction may also be at higher risk for other conditions, like persistent depression.

An additional term used by experts to describe sexual addiction is "out-of-control sexual behaviors," or OOSCH. Because gaps exist in scientific research toward sexual addiction, so do gaps in treatment options, say psychologists and researchers.

Like other addictive behaviors, sexual addictions or hypersexuality can become more severe over time until the person loses their ability to control the behavior, despite the consequences. There is also a shame factor involved that prevents people from admitting the problem or seeking treatment – all related to misinformation about the causes and the nature of sexual addictions, say Massey University study researchers.

It is believed that around three to six percent of American adults are living with a form of sexual addiction or sexual compulsivity. Researchers hope that future studies will continue to change perceptions that people with sexual addictions are concerned or obsessed only with the act of sex, when in reality, they suffer from issues like low self-esteem and strong anxieties toward personal relationships.

Treatment can include residential programs, though few are currently in existence, or individual counseling by psychologists who specialize in sexual addictions. Several group-based counseling groups exist, such as Sex Addicts Anonymous, which help participants reach a level of sexual sobriety.

Newer approaches to studying sexual addictions and sexually dysfunctional behaviors are focusing more on the role of brain responses and reward circuits that seem to reinforce the behaviors, despite the destruction the behavior causes of the person’s family, relationship, career and finances.

For some people with sexual addictions, there’s an added element of risk or fear involved, especially when they are engaging in extramarital affairs. This added fear element may increase the response of dopamine and increase the strength of the addiction, according to a PsychCentral article by Dr. Athena Stake.

Author Patrick Carnes, Ph.D., addresses the growing interest in sexual addictions in his book “Out of the Shadows:  Understanding Sex Addiction,” stating that the brain science behind sexually addictive behavior continues to unfold and is also shedding new light on what constitutes a healthy sexual relationship. 

However, cultural norms have led the term sexual addiction to be used as an excuse for damaging, unhealthy behaviors.  This includes the use of the term sexual addiction toward relationships where sex has become an arena for relational power struggles, or its use to declare an expected “normal” behavior pattern of promiscuity for males. 

Contrary to stereotyped beliefs, a person with a sexual addiction or sexually compulsive behavior does not typically seek the activity for sexual gratification – but rather as an escape from negative emotions or to avoid the possibility of facing an intimate, personal relationship with others. Like drugs or alcohol, sex becomes a temporary solution.

Sexual addiction rehabilitation centers and treatment facilities have also sharply increased in number during the past two to three years. Modeled after 12-Step global programs like Alcoholics Anonymous, new chapters of Sexaholics Anonymous and Sexual Recovery Anonymous are available in more and more states, and more celebrity profiles are beginning to include sexual addiction problems and recovery as a feature.

Research to date has struggled to keep up with these trends in the growing field of sexual addictions. Addiction, by definition, originated in terms of drug and alcohol abuse. It is defined as a disease that is chronic and involves a process where the brain experiences a reward from an addictive substance, is then motivated to seek it again, and can remember the process and desires to repeat it over and over.

Researchers have discovered that during addiction, the brain begins to release abnormal amounts of dopamine, prompted by the substance abuse. The addict often cannot control their impulses to seek the addictive substance. The addiction also becomes stronger and more disruptive as it continues.

In terms of sexual addiction, many mental health experts have called for a formal listing of sexually dysfunctional behaviors among conditions like substance abuse. The basis for sexual addictions, say many experts, seems rooted in similar patterns as substance addiction, including feelings of euphoria or escape, compulsive thoughts toward the behavior and actual brain changes that can occur when the person engages in the activity.

A 2005 article written by Dr. Judith Reisman on the way pornography changes the brain, and affects the mind and memory capacity, seems to encourage the recognition of sexual addictions as having a neuroscientific base. Reisman said pornography releases a powerful mixture of bodily chemicals, including neurotransmitters dopamine and serotonin – both related to well-being – and oxytocin and testosterone.
The effect of this chemical mix is a dopamine pattern a drug addict might experience, says Reisman. She also suggests that the moment a sexual addict views a pornographic image, an imprint is made on the brain, creating an actual “trail” that the brain will want to repeat.

Additional research from the University of Minnesota used MRI technology to determine that different types of brain activity seemed to be taking place for people with hyper sexuality, in comparison to people with obsessive compulsive disorders.
 

Some myths about females and sex addiction include that women can’t become sex addicts. This false belief can facilitate a sense of isolation and prevent them from finding help.

Another common myth is that for women, the addiction always revolves around emotional desperation. However, the sexual addiction can be about a desire to be stronger than negative feelings, such as those that can result from being a victim of abuse or neglect. Ultimately, a woman’s addiction to sex can be based in a desire for power.

It is also a false assumption that the effects of sexual addiction are not as severe on women as they are for men. Losing financial resources, personal relationships and low self-esteem can be just as powerful for female sexual addicts as men, in addition to other problems, like sexually transmitted diseases and pregnancy.

Many times, a female who is a sexual addict will use sex to keep a relationship going, even if it is not a healthy relationship. Some women who suffer from sexual addiction have not been part of a relationship that wasn’t rooted in sex, and may not know how to act in a healthy relationship if sex is not included.

The issue of sexual addiction and women can be further complicated by societal messages about what is acceptable for women, and the fact that these sexual norms can differ between men and women. Still, deciding if a woman’s sexual behaviors are problematic or addictive can be based on core issues like whether or not she can control the sexual actions, and if she maintains the behaviors even though they can lead to depression and serious life disruptions.

Like males with sexual addictions, women can also display an obsession toward how and when they will get their next “fix,” or spend abnormal amounts of time finding and thinking about partners. Sometimes, sexual compulsion in women looks like confidence or self-assuredness, but the behavior then becomes a repeated cycle and something she cannot control. Other manifestations include masturbation in public locations, having many sexual partners and an obsessive interest in pornographic material.

Additional symptoms, like overeating, depression or substance abuse can also point to an underlying problem with sexual addiction. Because the sexual behaviors and associated symptoms can cover up serious mental problems, women with sexual addictions can be particularly vulnerable to lifelong consequences. Professional therapy is recommended to lead female sexual addicts to recovery, before the addiction causes the destruction of family, career, finances and her future.
 

This issue is more than just curiosity as children and teens who receive too much sexual content exposure are more likely to develop compulsive sexual behaviors. The average American child is first exposed to pornographic images at the age of 11. In a recent study, it was determined that the majority of adolescents look at pornography while they are doing their homework.

The danger that exists is that children have greater access to pornography and sexual interaction online. And, without parents guiding them through dangerous territories, curiosity can win out. What the children are viewing now, however, can impact them 10 or 20 years down the line.

According to “Virtual Addiction” author, David Greenfield, the next generation is experimenting sooner and exploring sexual acts they would not have known even existed had they not witnessed them through pornographic channels. There seem to be no limits to what is available online and children are not wired to handle that level of stimulation.

Children exposed to pornography may develop believing that it is normal to have multiple partners and engage in violent or extreme forms of sex. Pornography does not share the consequences of these actions and the results can be hard lessons for these kids to learn.
 

Interestingly, sexual compulsivity is not usually related to the act of sex, but instead reflects problems with intimate relationships. Many people with this addiction are also likely to suffer from depression, causing researchers to take a closer look at the connection between emotional illness and sexual addiction.

People with sexual compulsivity may have sexual behaviors that disrupt their daily life and cause anxiety for their family or challenges in the workplace. Despite the cost, people addicted to sex will do what they have to in order to get their next “high.”

According to the society for the Advancement of Sexual Health, around three to five percent of adults in the U.S. are believed to have an addiction to sex. Because many people do not openly discuss the problem, the number may actually be greater.

Complicating the diagnosis is the fact that the disorder is not yet recognized formally in the Diagnostic and Statistical manual of Mental Disorders. A true definition of sexual compulsivity or addiction varies from expert to expert, and several types of actions can fit under the larger label of addiction to sex, such as sex with multiple people, overuse of pornography or obsessive levels of masturbation.

Indiana University researchers at the Kinsey Institute for Research in Gender and Reproduction said in a study conducted in 2004 that many people who struggle with sexually compulsive behaviors tended to revert to sexual actions when they felt emotionally low or were in a depressed state.

A 2007 article written by Stephen Brockway, M.D., also supports the idea that sexual addiction is linked with the underlying illness of depression. Dr. Brockway outlines several types of depression that can be linked with sexual compulsivity.
One is a depression rooted in low self-esteem or feelings of shame, marked by bouts of extreme depression when a relationship ends. The feelings of shame that follow a sexual act for people living with sexual compulsions can be strong, even to the point where some addicts have considered suicide. Many report that their behaviors reflect a need to escape negative emotions and that they feel trapped in a cycle.

Another type of depression that may occur with sexual compulsivity is for the person addicted to sex who has almost no work-life balance, and seeks the sexual actions as a way to vent these frustrations. Dr. Brockway suggests that the depression will at some point outweigh an addiction to work and sex, and that treatment should involve helping the person find ways to better care for themselves and their needs.

Connections between depression and sexual behavior indicate there may be several types of emotional illness that can manifest as sexual compulsions. Counselors and therapists may want to first try to identify the underlying mental illness and assess the severity of the associated depression.

If sexual addiction is a way of outwardly expressing pain, according to expert theories, then effective recovery must involve resolving serious or lifelong emotional problems.

• mental obsession or excessive preoccupation with sexual ideas, feelings and behavior

• compulsion — engaging in sexual behavior as if driven to do so often despite negative feelings about it

• progression of life’s unmanageability

• feelings of being out of control yet continuing despite a desire not to

• continuing despite negative consequences

• experiencing distress when not engaged in the behaviors

Types of Compulsive Sexual Behavior

Some people with sexual compulsivity also consider themselves to be ‘relationship addicts’ or ‘love addicts’. Typically, these individuals experience various types of distress including the following:

• feelings of dependency

• fear of rejection and abandonment

• relationship-seeking with poorly chosen or incompatible partners

• a felt inability to tolerate solitude and loneliness

• unwanted sex to obtain intimacy

• impulsive partnering

• quick commitments

• serial relationships

• intense anxiety when independent of relationships

• low self-esteem

• fantasies of being rescued or rescuing others

• unrealistic expectations of partners

It is common for relationship or love addicts to have co-occurring mental health problems that contribute to sexual compulsivity and complicate recovery efforts. These problems cover a range of mental health concerns such as:

• Personality Disorders
• Depressive Disorders
• Anxiety Disorders
• Trauma histories
• Eating Disorders
• Substance Disorders

Other Types of Sexual Compulsivity

Unlike compulsive relationship-seeking, other sexual compulsivity can occur without interpersonal intimacy. These types of sexual compulsivity may involve:

• excessive masturbation
• pornography
• fetishes
• prostitution
• sex clubs
• sex with strangers
• one-night-stands
• sex with acquaintances with whom there is little or no intimacy
• sexual activity with a particular partner over a period of time with whom there are no other interactions

In the extreme, sexual compulsivity can involve aggression, emotional and psychological victimization, domination, submission, incest and other forms of arousal and behavior with unusual objects or rituals. Some sexually compulsive behaviors such as these have potential and even severe legal consequences. Those that do not have legal implications may, however, be prohibited by usual social and cultural norms.

Co-Occurring Disorders

The co-occurring, or dual disorders that can include sexual compulsivity, are varied. Sexual compulsivity may develop as a result of an untreated mental health problem or may cause other clinically significant problems to develop. Some of the most common co-occurring issues are mood and anxiety problems.

Mood and Anxiety Disorders

People with Mood Disorders and Anxiety Disorders may engage in sexually compulsive behavior to alter uncomfortable or distressful feelings. Others may act out in sexually compulsive ways because symptoms of their mood or anxiety disorders cause a loss of inhibition and judgment. Some types of mental health problems that involve mood and anxiety symptoms and may co-occur with sexual compulsivity are:

• clinical depression such as Depressive Disorder and Major Depression
• Bipolar Disorder
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder

Additionally, sexual compulsivity is characterized by periods of feeling empty, alienated, let down, depressed, ashamed and guilty. Such feelings can, over a period of time, cause clinically significant depressive symptoms and anxiety to develop and require additional treatment.

Personality Disorders

People with sexual compulsivity have recurring and dysfunctional relationships in which there are patterns of coping with life stress and interacting with others that are problematic. Some, however, have distinct diagnoses called Personality Disorders that share some of the same characteristics found in sexual compulsivity. The symptoms of Personality Disorders can predispose one to sexual compulsivity and other problematic sexual behavior. Some of these disorders are:

• Narcissistic Personality Disorder
• Borderline Personality Disorder
• Dependent Personality Disorder
• Antisocial Personality Disorder

Detachment from Others

Some of the characteristics of Personality Disorders that may be directly related to sexual compulsivity are found in individuals who violate laws and the rights of others or who do not form close relationships in which there is a deep regard for the well-being of others and mutual nurturance. These personality characteristics include:

• recurrent disregard of laws
• recurrent disregard of social norms
• lack of empathy for others
• lack of remorse
• need for power
• need for control
• aggression

Enmeshment with Others

Conversely, some with Personality Disorders are at the other extreme of relationship difficulties. These individuals may engage in sexual compulsivity due to dysfunctional relationship patterns in which they are overly involved, or enmeshed, with others and require excessive nurturance and attention. They experience the following:

• a need to cling to others
• an unstable self-image
• an excessive need for validation and approval
• insecurity
• intense anxiety
• a lack of independent living skills
• feelings of incompetency
• feelings of inadequacy
• fear of abandonment
• preoccupation with approval
• severe distress when experiencing conflict or disagreement
• severe distress when intimacy increases
• severe distress went intimacy decreases
• intense strivings for attention

Other Co-occurring Issues

Many other mental health issues can co-occur with sexual compulsivity. Among these are addictions to substances or activities and having experienced traumatic events such as physical, sexual and emotional abuse. Sexual compulsivity for individuals with these issues is typically a dysfunctional way to cope with one’s own intimacy problems. Efforts to become intimate are often complicated by the inability to maintain stable and close relationships and difficulty tolerating true intimacy. Many who are affected by addiction and/or trauma in their early development will not have learned how to have healthy and intimate relationships.

Recovery

Recovery for those with sexual compulsivity often requires a dual approach. Sexual behavior itself is addressed much as any other addiction through education, counseling and self-help groups designed to support individuals with problematic sexual behaviors to abstain from them. Abstinence from sexual compulsivity is enhanced by co-occurring treatment that targets mental health symptoms, patterns of dysfunctional coping and unhealthy relationships. This type of dual approach is highly effective in helping those with sexually compulsive behaviors achieve and sustain a lasting recovery.