Most people have heard of the term ‘sex addiction’, it has been around since the 80’s and it is associated with sensational stories of celebrities booking themselves into a ‘sex addiction’ clinic after being caught for bad sexual behaviours, some of whom have committed sexual offences.
The psychoanalytic profession observed sexual behaviours that feel and look out of control coining terms such as ‘nymphomania’ for female behaviours and ‘satyriasis’ for male behaviours. Although psychoanalysts misunderstood human sexuality, they were curious about it.
A few decades later, in the early 80’s, the term ‘sex addiction’ took off. It was in the particular backdrop of the AIDS epidemic, a dark time when the entire world was afraid of sex because we didn’t understand the virus. Gay men were mostly pathologised because they were the ones most affected by the virus but also because their freedom of sexual expression became more visible when ‘homosexuality’ stopped being a criminal offence.
I don’t blame the experts calling sexual compulsivity an addiction in the early 80’s because these behaviours definitely look and feel like an addiction: a strong urge resulting in repetitive and unwanted sexual behaviours that they feel unable to control. At the time, the field of sexology was almost non-existent and we simply didn’t have any other frame of reference, apart from the addiction model. Before science, we thought the Earth was flat because, from our human experience of living on the planet, it looks and feels like it is flat, until science disproved it.
As soon as the term ‘sex addiction’ was invented, the entirety of the clinical thinking was pushed into the same framework of other known addictions such as alcohol and drugs, and experts tried very hard to make all their conceptualisations fit with the known addiction model. This is when the field of ‘sex addiction’ started to go wrong: unlike psychoanalysts, there was no more curiosity and no more questions, because the certainty of the addiction-thinking set in. The questions: ‘could it be something else?’ ‘could we have different conceptualisations?’ became forbidden, and clinical discussions were shut down. Clients and clinicians could only rely on the one ‘sex addiction’ model invented by a handful of experts, made from anecdotes and personal opinions, and no scientific backing.
The term ‘sex addiction’ became popular because those two words evoke emotive stories, and it was an easy fit for many people struggling with their heartbreak about sexual behaviours: ‘my partner cheated on me, he must be a sex addict’, ‘my partner enjoys looking at other people in the streets, she must be a sex addict’, ‘my partner wears revealing clothes, she must be a sex addict’, ‘my colleague doesn’t want a wife or children, he must be a sex addict’. The fear of sex because of the AIDS epidemic and the emotive popularisation of the term flourished worldwide, unquestioned and unchallenged.
Sex addiction trainings flourished too, teaching clinicians worldwide how to diagnose ‘sex addiction’ based on anecdotes, personal beliefs and a major lack of understanding of gender, sex and relationship diversities. Therapists are trained in offering interventions that are primarily addiction-oriented helping their clients stop their so-called ‘sex addiction’.
The tradition of addiction treatments is to recommend 12-step programmes, which may work very well for alcohol and drugs but is questionable for ‘sex addiction’ because there are so many sex-negative teachings that are incongruent with contemporary sexology. For example, the opinion of SAA and SLAA is that ‘sex addiction’ is a progressive disease which may lead to sexual offending, and it is a character defect. This has never been endorsed by science. The ‘sex addiction’ movement deemed a vast amount of normative and functional sexual behaviours as ‘unhealthy’, and puts them together with sexual offending behaviours, which sends grossly inaccurate information to their followers. The ‘sex addiction’ field (both 12-step programmes and ‘sex addiction’ therapists) pepper their treatment methods with overt or covert religiosity, promoting the power of prayers. Prayers are not used in any other psychotherapy treatments for depression, anxiety, eating disorders, trauma, OCD, self-harm, and so on, but it is prevalent in ‘sex addiction’ treatments.
Scientific data has not been able to confirm the existence of ‘sex addiction’, which is why both WHO and the DSM-5 consistently reject the conceptualisation of ‘sex addiction’.
The last ten years, the field of sexology has grown fast and has been offering much research looking into sexual compulsivity. The results are clear: scientific data has not been able to confirm the existence of ‘sex addiction’, which is why both WHO and the DSM-5 consistently reject the conceptualisation of ‘sex addiction’. In 2018, the ICD-11 (WHO) who came up with ‘compulsive sexual behaviour disorder’ which clearly states that it is not an addiction disorder but an impulse control disorder, which requires a different treatment from an addiction-oriented one.
Now, the ‘sex addiction’ thinking is still strong, but it is no longer about the debate towards clinical excellence, there is no curiosity and there is no willingness to change. The ‘sex addiction’ thinking has become a movement, much like a religion, ignoring science.
Clinicians need to take more responsibility for their interventions and recommendations as it can be harmful to treat clients with ‘sex addiction’ therapy for a problem that is not an addiction.
In the UK, psychotherapy and counselling trainings allocate very little time for understanding gender, sex and relationship diversities and if they do they perpetuate the misinformation of ‘sex addiction’. Most therapists offering ‘sex addiction’ treatments are from the field of sex therapy, as even amongst sex therapists the understanding of sexual compulsivity is still poor, and the teaching of ‘sex addiction’ is still popular because it hasn’t been updated with contemporary sexology.
Amongst sex researchers and sexology scientists worldwide, the language of ‘sex addiction’ is disappearing fast, but amongst counsellors, psychotherapists and sex therapists the term is still used widely. It is time for our profession to follow the scientific path of contemporary sexology because we have a duty to continue to be curious for clinical excellence and, ultimately, for the safe and ethical service of our clients.
Find out more about how you work with clients who feel that their sexual behaviour is out of control with our Online Diploma in Compulsive Sexual Behaviour.
