When people ask me what I do, I tell them that I am a psychologist.  When they ask me what I specialize in, I smile and say that I am a Certified sex addiction therapist (CSAT) and treat sex addiction.  I know what will come next, especially if I am speaking with a man.  Usually a smile and then:  “Aren’t all men sex addicts”?  It is then that I am reminded that many or most people have no real idea of what “sex addiction” actually looks like.

As of today, the term “sex addiction” is not recognized as a disorder in the DSM (Diagnostic Statistical Manual – V) which is the taxonomic and diagnostic tool published by the American Psychiatric Association.  That doesn’t mean it doesn’t ‘exist’ – after all, addiction to alcohol wasn’t included as a disorder by the APA in the DSM until 1956  Before that time, abuse of alcohol was considered more of a moral problem.  It seems there are plenty of people who don’t think that engaging in sexual behaviors (process of engaging in a behavior) as addictive as taking or ingesting a substance.

After working for years with men and women who have compulsive sexual behaviors, I wouldn’t tell them that!

After years of training (as a CSAT) and through working with hundreds of folks addicted to substances or a process (sex, love, gambling, working, food) there seem to be shared behavioral characteristics:

1. Loss of control – more time spent engaging in addictive behavior
2. Compulsive behavior – more time spent in out of control behavior
3. Efforts to stop – several to many unsuccessful attempts to curb or stop the behavior
4. Loss of time – Significant amounts of time lost doing and/or recovering from the behavior
5. Inability to fulfill obligations in one or more areas of life, e.g. work, school, family or friends
6. Continuation despite consequences – Failure to stop the behavior even though you have problems because of it (social, legal, financial, physical)
7. Escalation – Need to make behavior more intense, more frequent, or more risky
8. Losses – Losing, limiting, or sacrificing valued parts of life such as hobbies, family, relationships, and work
9. Withdrawal – Stopping behavior causes considerable distress, anxiety, restlessness, irritability, or physical discomfort

I have often been asked at what frequency is “normal” to have sex or to masturbate.  I try to explain that many professionals in the sex addiction treatment community veer away from quantitative recommendations of behavior (e.g. masturbation 5 times a week) and the focus has turned to determining if there is: loss of control, obsessive thoughts of the behavior, increased time engaging in behaviors, consequences due to the behavior and a noticeable withdrawal when initially stopping the behaviors.

It’s a common assumption that the “shame” or immorality of an act, (for example) behaviors like voyeurism or fetishes. naturally indicates a sex addiction.  This isn’t always so.  While a sexual behavior may be illegal due to it’s being non-consensual, e.g. voyeurism, it’s immorality or illegality is not thought to make it addictive per se.

Are those behaviors getting him in trouble at work?  For example, someone who stays up after their spouse goes to bed to watch hours of porn and thus,  he is tired, unfocused and unproductive at work. That same individual may also isolate from friends, spouses, and children. He will likely try to stop the behavior by several means, promises to his self, trying to eliminate his ‘exposure’.  Some men I work with masturbate throughout their work day, up to 3 – 4 times a day.  They are shocked at their own behavior and didn’t notice when it increased so much.

Another popular conception is that unusual or “creepy” behaviors, for example voyeurism, fetishes of objects/body parts,  or transvestism (cross-dressing) are sex addictions.  The short answer is that they can be, but aren’t necessarily so as they have to have the features listed above to be considered addictive.  Behaviors like voyeurism or fetishes, cross-dressing are captured under the term “paraphilia” which is a  condition characterized by abnormal or atypical sexual desires.   Whether those behaviors are “addictive” are less the concern as the behavior is harmful to others and will result in harmful consequences.  A ‘foot fetish’ and transvestism may be atypical or unusual but rarely are harmful in and of themselves.  Any of the above behaviors can be addictive but may not necessarily be so.

Most typically, my clients’ reported distressing behaviors are mild to severe addiction to watching pornography (up to several hours a day), using sex/dating apps, inappropriate flirting, scanning/objectifying others and extra-marital affairs.  Porn viewing alone can have very negative consequences, mainly erectile dysfunction, decreased interest in sex with partners, and a sense of shame or isolation.   Many will say porn was their “gate-way” drug which over time needed to increase in intensity to achieve the same “high” as before.