What is Sex Addiction?

Reviewed by Joseph Goldberg, MD

You've probably heard of sex addiction, but you might be surprised to know that there's debate about whether it's truly an addiction, and that it's not even all about sex.

"That's a common misconception," says Rory Reid, PhD, LCSW, a research psychologist at UCLA's Semel Institute for Neuroscience and Human Behavior. "It is no more about sex than an eating disorder is about food or pathological gambling is about money."

Sex addicts, in other words, are not simply people who crave lots of sex. Instead, they have underlying problems -- stress, anxiety, depression, shame -- that drive their often risky sexual behavior.

"Those are some of the core issues that you start to see when you treat someone with sex addiction," says John O'Neill, LCSW, LCDC, CAS, CART, a certified addiction counselor at the Menninger Clinic in Houston. "You can't miss those pieces."

Sex addiction won't be in the upcoming edition of the DSM-5, which is used to diagnose mental disorders.

That doesn't mean that it's not a very real problem.

"People are going to seek help, and there doesn't need to be diagnosable condition for them to get help," Reid says. "If they are suffering, we want to help them."

Reid and many other experts prefer the term "hypersexual disorder," rather than "sex addiction."

By either name, it's about people who keep engaging in sexual behaviors that are damaging them and/or their families.

As examples, Reid cites men who spend half their income on prostitutes, and office workers who surf the web for porn despite warnings that they'll lose their job if they keep it up.

"Who does that? Somebody with a problem," Reid says.

That problem puts so much at risk: their personal lives, their social lives, their jobs, and, with the threat of HIV/AIDS and other sexually transmitted diseases, their health.

Despite the danger, they return to the same behaviors over and over, whether it's Internet porn, soliciting sex workers, ceaselessly seeking affairs, masturbating or exposing themselves in public, or any number of other acts.

"I see in them an inability to stop what they're doing," O'Neill says. "They're preoccupied; their brain just keeps going back to it. It often leads to loneliness and isolation. There's such intense shame and pain."

Frequently, a crisis convinces them to seek treatment, Reid says. They're caught in the act by a spouse, fired from their job, or arrested for soliciting sex from prostitutes. For some people, the crisis brings relief from distress caused by their behavior and constant fear of being discovered. "The world comes crashing down," says Reid, "and some say, 'I'm glad that I got caught.'"

There are no reliable estimates of how many people have the disorder. Some studies suggest that it's more common in men, and gay men in particular, than women.

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