What Is Sex Addiction?

Overview

Sex addiction refers to an intense fixation on sexual fantasies, urges or activities that are deemed to be uncontrollable. Sex addiction has also been referred to as compulsive sexual behaviour, problematic sexual behaviour, hypersexuality disorder, and sexual compulsivity/impulsivity.

Sex between partners is an aspect of life that individuals frequently engage in, as well as activities such as masturbation, phone sex, cybersex, pornography, multiple partners and many more. However, it is when these sexual thoughts become an overbearing compulsion that requires satisfaction to the point where it can consume an individual’s life that it is considered an addiction. The individual is stuck in a vicious cycle of sexual craving. Consequently, instead of feeling euphoric or pleasure, individuals are left feeling rather out-of-control, unsatisfied and emotionally distressed. This type of condition contributes to decreased quality of life and functional impairment as it hinders an individual’s ability to function adequately and can have devastating consequences in various domains of one’s life. With these real consequences individuals suffer, it is vital they receive the necessary support and care to best manage the condition.

Causes & risk factors of sex addiction

Researchers are unsure precisely what causes sex addiction. However, some common potential contributors include:

Genetics 

Research demonstrates that individuals are genetically predisposed (i.e., possess an elevated probability of developing a condition/disease based on their genes) to traits commonly associated with sex addiction. Examples of such traits include emotional dysregulation, impulsivity,  instant gratification, sensation-seeking behaviour, anxiety and depression.^1,2,3,4

Social isolation/withdrawal 

Social isolation or withdrawal from one’s friend groups and/or romantic relationships can prompt an individual to seek sexual gratification in unhealthy or even inappropriate ways.

Brain damage/dysfunction 

Neurological conditions that alter or damage certain brain areas responsible for sexual behaviour can increase one’s chances of developing a sexual disorder.⁵ Conditions such as dementia, traumatic brain injury and epilepsy, in particular, are thought to contribute towards greater sexuality.

Biochemical imbalances neurotransmitters 

Neurotransmitters are the body’s chemical messengers, notably dopamine, serotonin and endorphins, which play a critical role in sexual desires and behaviours. It is thought that individuals possess an intense craving for the endorphins rush, and only engaging in sexual activity can satisfy this.

Hormones 

Sex hormones, in particular testosterone and oestrogen, are thought to be elevated in those suffering from sex addiction, thereby increasing one’s libido.⁶ Such sex-related hormones increase one’s likelihood of engaging in sexual acts and increase their impulsivity.

Environments 

Early life events such as adverse childhood experiences, abuse, relationships and premature exposure to sexual content can feed into increased sexuality in individuals.⁷

Substance abuse 

Excessive use of substances such as cocaine, amphetamine and alcohol can increase one’s sexuality and fuel their needs and cravings for sexual gratification.⁸  

Mental health 

Addiction is more likely in individuals suffering from mental health conditions such as anxiety, depression, personality disorders and bipolar disorder. Hypersexuality can be a symptom of such mental health conditions or even a coping mechanism.⁹

Diagnosis of sex addiction

There is much controversy regarding the diagnosis of “sex addiction” following its exclusion from the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) published by the American Psychiatric Association (APA). Note that the DSM-5-TR is used by healthcare professionals worldwide to help with the assessment and diagnosis of mental health conditions. The reason for sex addiction’s exclusion was down to deficient evidence and the potential consequences of terming excessive sexual ideation and activity a “pathology” (i.e., a disease or disorder). As such, there is a lack of consensus on how the concept of sex addiction is thought about.

However, the eleventh edition of the International Classification of Diseases (ICD-11) does allow for the diagnosis of compulsive sexual behaviour disorder. Note that the ICD-11 is essentially a set of diagnosis codes for both medical diseases and mental health conditions maintained by the World Health Organisation (WHO), which serves to provide a global language for assessing and diagnosing diseases.

A general lack of consensus surrounding sexual disorders has severely restricted the diagnostic criteria for sex addiction, given that assessment and diagnosis of the condition are vague and subjective. Despite this, individuals who suspect they may have a sex addiction should still consult a medical healthcare professional and seek out the support they may require for such a condition.

Signs & symptoms of sex addiction

Again, given the lack of consensus regarding the diagnosis of “sex addiction” following its exclusion from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), there remains much controversy surrounding the exact criteria for sex addiction.

Nevertheless, some symptoms that an individual with sex addiction may experience include:

• Chronic, obsessive sexual thoughts, fantasies and ideations.
• Uncontrollable preoccupation with sexual relations.
• Lying to mask and cover sexual tendencies – the secrecy of behaviours.
• Impulsivity in engaging in sexual behaviours.
• Inability to stop or control sexual behaviours.
• Behaviour that escalates into reckless sexual activity.
• Feeling remorse, guilt or shame after sexual activity.
• Feeling dissatisfied and unfulfilled after sexual activity.
• Unsuccessful attempts at stopping or decreasing sexual behaviours.
• Preoccupation with having sex, notably at the expense of being able to conduct normal daily affairs (e.g., relationships, finances, work, emotions and health).
• Fixation and spending excessive amounts of time planning sexual activities.
• Frequent engagement in habitual masturbation and self-pleasure.
• Frequent use of sexual services – e.g., phone sex, cybersex, viewing pornography, attending strip clubs, paying for sexual encounters, one-night stands, and having multiple partners.

Please note that this is not an exhaustive or comprehensive list of signs and symptoms of sex addiction. An individual may experience symptoms not listed here. It should also be noted that sex is a normal and healthy aspect of life. It is only when behaviour is considered to be problematic, unhealthy, excessive or at the expense of normal functioning that it is a cause for concern.

Management & treatment of sex addiction

Currently, there is no ‘magic bullet’ or direct course of treatment for sex addiction. Nevertheless, there are measures one can undertake and integrate into one's lifestyle to best manage and treat one's condition and to alleviate the hindrance the condition may cause the individual.

How feasible and effective the following treatment options are for each individual will naturally differ; therefore, it is critical that individuals collaborate with their healthcare professionals to find a tailored treatment plan that works for them and yields a result they are happy with.

Treatment options are divided into their respective category and are listed below:

Inpatient therapy

This is a form of intensive 24/7 residential rehabilitation. As part of this programme, the individual leaves their everyday lifestyle to go into a rehab centre for around 30 days with hopes of helping the individual regain control over their sexual impulses and desires and begin the path to recovery in resuming their normal life with a healthier relationship towards sex.  

In the centre, access to sex and romantic engagements of any kind is stripped away from the individual, therefore prohibiting them from acting upon and fulfilling their cravings and compulsions for sexual gratification.

Because of this, inpatient therapy is a more intense treatment option, and individuals are provided with in-depth individual and group therapy sessions to help them achieve the following:

• Better understand their condition – Where it may have arisen from, what impact it has on them and those around them,
• Challenge their unhealthy sex cognitions and compulsions – This serves to dampen the obsession-compulsion cycle they are a part of and set the ground for a healthier relationship with sex.
• Resist cravings and adopt alternative coping strategies to deal with the challenges of temptation – Promotes mindfulness and calming activities.
• At some centres, family therapy may also be available to help the individual and those closest to them recover and cope with any damage and struggles they may be facing as a result of sex addiction.

Inpatient therapy works to remove an individual from their current environment and submerge them in a centre full of support to teach them restraint, promote a healthier relationship with sex, and equip individuals with the strength and tools they need to cope in their everyday lives.

Outpatient therapy

Similar to inpatient therapy, outpatient therapy serves the same purpose in exploring one’s relationship with sex and how it became unhealthy, teaching the individual how to move forward in a sustainable manner. The key difference is that with outpatient care, the individual can still maintain their lifestyle and freedom. Whilst care isn’t offered 24/7, the individual attends regular group and individual therapy sessions.

The limitation of this treatment option is that the individual still has access to engage in their sexual behaviours. Therefore, it often requires great strength, willingness and resilience from the individual to (1) enter the programme willingly because they recognise they need help and are open to receiving it, and (2) the drive to resist temptation and stay on course with their treatment.

Overall, outpatient therapy works to support an individual by teaching them restraint, improving their relationship towards sex, and equipping them with the strength they need to cope back long-term in their everyday life.

Psychotherapy

Psychotherapy entails various specific therapies one can undergo. Psychotherapy or “talk therapy” helps people deal with their emotional responses by directing the session towards their specific sexual obsessions and compulsions. A healthcare professional talks the individual through various strategies to help them better understand and manage their disorder whilst simultaneously setting practical tasks and goals to exercise.

There are different approaches towards psychotherapy¹⁰ the most common include:

Cognitive behavioural therapy (CBT) 

Cognitive behavioural therapy works by cognitively reframing how you perceive and think about sex so that it no longer causes you to give in and act on destructive sexual desires. CBT provides different ways of thinking, behaving, and reacting to situations to help individuals feel more in control when it comes to sex.

Acceptance and commitment therapy (ACT) 

Acceptance and commitment therapy is an action-oriented approach to psychotherapy that uses alternative strategies, in particular mindfulness and goal setting, to develop and expand psychological flexibility. ACT works by helping the individual to change the relationship with their thoughts as opposed to changing the thoughts themselves.

Psychodynamic therapy 

Psychodynamic therapy looks at how one’s childhood experiences and thoughts that are locked away in one's unconscious mind affect one's current thinking, feelings, behaviours, and relationships.

Couples/marriage counselling

This is particularly helpful in the context of sex addiction. If one partner is affected by the addiction, then this form of therapy works with the couple to promote a healthier relationship between them.¹¹ Such counselling helps the couple navigate all they have been through in terms of how one’s excessive sexual behaviour has affected their relationship and how the couple can move forward together in a healthier manner.

Medication

There is no medication to directly treat sex addiction, but a medical healthcare professional may choose to prescribe medication targeted at treating other co-morbid (i.e., co-occurring) conditions such as depression, anxiety or even bipolar disorder, amongst many others.

Examples of such medications that can be prescribed include:

Anti-depressant medication 

Anti-depressant medications can help those suffering from depression manage their condition.12 Anti-depressants take many forms; however, the modern antidepressants are selective serotonin reuptake inhibitors (SSRIs) and selective-norepinephrine reuptake inhibitors (SNRIs), which work by increasing the levels of two key neurotransmitters, serotonin and norepinephrine, thereby promoting chemical messaging in the brain.

Anti-anxiety medication 

Anti-anxiety medication can help those suffering from an anxiety disorder manage their condition.¹³ A common anti-anxiety medication is called benzodiazepines, which effectively alleviates anxiety symptoms at a faster rate compared to anti-depressant medication.¹⁴

Mood stabilisers/anticonvulsants 

Commonly used to treat bipolar disorder, mood stabilising and anti-convulsant (i.e., anti-seizure) medications help individuals manage their condition.^15,16 

Examples of other medications that don’t target a comorbid disorder but could have effects that benefit those with sex addiction include:

Anti-androgens medication 

Anti-androgen drugs work by blocking the androgen hormone, testosterone, to curb sexual cravings.¹⁷ A commonly prescribed anti-androgen is spironolactone.

Anti-psychotic medication

Anti-psychotic drugs work by blocking the effect of dopamine (an excitatory chemical messenger) in the brain.²⁸

Naltrexone 

Naltrexone is commonly used to treat alcoholism and opioid addiction, but it can be prescribed to decrease sexually compulsive behaviours.

Medication has the potential to bring a lot of positive change into a person’s life and help alleviate the severity of some of the symptoms they face. However, side effects are also a consequence of being on medication so this should be taken into consideration when evaluating the effectiveness of taking medication. It is crucial to consult a healthcare professional and keep them updated on any changes or issues experienced whilst on these drugs to ensure they are working as effectively as they can.

Self-help support groups

There is an ever-growing number of support groups that assist individuals on the road to recovery. It should be noted that members are not necessarily required to abstain completely from sex but instead engage in healthier, non-destructive sexual behaviours.

Such groups are vital in helping individuals feel less alone and promoting a solid support system the individual can turn to in instances where they slip up or are having a difficult time controlling their addiction.

Examples of such support groups in the UK include Sexual Addicts Anonymous and Sex and Love Addicts Anonymous.

FAQs

When should I see a doctor?

A doctor and healthcare professional should be consulted if

• You suspect that you may have a sex addiction and wish to obtain a diagnosis.
• You are experiencing symptoms that are disruptive to your lifestyle and are impeding your ability to function adequately day-to-day.
• You wish to make amendments to your treatment plan or have any issues with your current plan.
• If you have any worries or concerns that you wish to seek medical advice about.

Summary

Sex addiction describes an intense, uncontrollable fixation on sexual fantasies, urges or activities. Whilst sex is a healthy, normal human activity, excessive or dangerous sexual thoughts and behaviours underlie sex addiction. It is when these sexual thoughts become an overbearing compulsion that requires satisfaction to the point where it consumes an individual’s life that the condition is considered an addiction.

Given that there is no clear-cut diagnosis for the condition, there are various signs and symptoms one can display. The symptoms can be rather debilitating and impede an individual’s ability to function adequately. They can have devastating consequences in one’s life. In line with these real consequences individuals suffer, they must receive the necessary support and care to best manage the condition.

There are various treatment options available, including therapy, medication, and self-help support groups. A healthcare professional should be consulted to work out an optimal treatment plan that works for the individual. Ultimately, with the right understanding and treatment, individuals with sex addiction can cure or learn to manage their symptoms to live a truly fulfilling life.