When Is Sexual Behavior Out of Control?

Source: medscape.com 7/31/24

A 25-year-old man comes in with a pulled muscle. You ask if he has anything else to discuss. Sheepishly, he says he is concerned about his use of pornography. 

A 45-year-old woman struggling with depression finds herself persistently seeking sex outside the bounds of her long-term relationship. Her partner is threatening to leave. She is devastated and tells you she doesn’t understand her own behavior. 

Do these patients have some form of sex addiction? How should a primary care clinician intervene? Is a referral to a 12-step program for sex addiction the right choice? What other options exist? Is a diagnosis — let alone treatment — possible or appropriate? 

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I’m no expert…but it seems that often, “sexual addiction” is actually “sexual dissatisfaction”. Then again, in many cases it may not even be exclusively about sex at all. There could be other factors…perhaps a lack of fulfilling intimacy, ongoing stress from work, unresolved childhood trauma, social anxiety, etc. that impacts an individual’s thoughts and behaviors regarding any particular aspect of themselves.

It’s easy/lazy to just say “this behavior is some form of addiction”, because the concept of “addiction” is much more politically/socially acceptable than, say, a complicated mess of deep-seated, multifaceted psychological issues compounded over time by genetics, environment, and life experiences.

Something else to consider is the bias of whoever makes the diagnosis…for example, what, exactly, would they personally believe qualifies as an “addiction” or “compulsive” behavior in regards to sexual activity, and to what extent would they allow their personal beliefs to guide their “treatment” of their patients. Suppose, for example, that the clinician is deeply religious, and therefore may consider any form of self-stimulation as a “sin”…would they then consider a patient to have a “sexual addiction” because said patient masturbates several times a day (or at all, for that matter).

Attempting to resolve serious, complicated issues with convenient “one size fits all” solutions, I believe, will inevitably be more damaging to anyone who buys into the idea that there is a simple, expedient answer to all of their problems/societal ills.

It’s not how much sex you have, or what kind, it’s what the sex does for you.

The addiction isn’t the problem, it’s the solution! Fixing the problem with, whatever works. Could be booze, meth, gambling, food, Social Media, video games, sex, religion, anything that works so well you can’t live without it. Nobody ever thinks they will become addicted, and will demand that aren’t no matter what!

Off and on for years, I would hook up through Craigslist once or twice a week, sometimes more. Turns out I had a loneliness problem, and a hook up solution! It wasn’t about sex, it was about not being alone, at least for awhile.

I also had a job where I was a one man mission critical department. Per the HR findings, I worked over 6,000 hours in 18 months and had been in the office for at least a few hours a day for around 500 consecutive days, despite being on “vacation” multiple times. They were really mad about that for some reason.

Anything can be a “fix” so long as it makes the bad go away! I was always looking for new and better ways to make the bad go away, but always ended up with a bottle in my hand sooner or later.

The focus of my comment below is not meant to be political, but to focus on how the state does nothing to attempt to reduce and prevent violent sexual behavior.

The person in the governor position in the state where I reside stated a few years ago once the state adopts a no exception abortion ban, the state would ensure there would be no more rapes in the state. Since then I heard that more than 25,000 rapes have been reported. Sexual behavior is out of control in the state and the state does nothing to focus on prevention and instead just makes life miserable for the pregnant rape victim and just makes sentences after the fact longer. My last sex treatment provider expressed his opinion to the treatment group that the focus should be on prevention or at least a reduction of sexual crimes.

The question of sex and / or porn compulsion and addiction (or none of the above) is currently in debate and under much study among mental health professionals and experts. Just because it was never looked at a certain way by the American Psychological Association in the past, does not mean it will not be classified differently in the future. We learn more about humans all the time; I shudder to think of the ways mental health professionals treated mental health disorders a few short decades ago, and those people were experts with studies to support their claims at that time too.
 
Behavioral issues are being more understood all the time with ties to brain development, brain activity, chemical rewards, associations with other mental health disorders, etc. Yes there are well regarded experts on all sides of this issue, and not every single one of them who considers sex / porn addiction as real is a religious zealot, homophobe, or carceral feminist (gotta love the labels).
 
If you do not struggle with sex or porn compulsive issues, good for you, but it is a disservice to those who do struggle to discount and diminish their issues and declare what their problem is or isn’t the result of – although we all do like to play armchair quarterback from the cheap seats. To all of us who are or love someone with such problems, and there are many on this forum alone, I know your struggles and pain are real and you are not alone.

This is a pretty good take on the “sex addiction” addiction. It’s a little milder and less directly critical of those models than how researchers like Dr. David Ley would express it. They don’t delve into how “addiction” theory has been hijacked by religious fanatics to achieve their other social entrepreneurial goals but it’s a pretty good, if limited, take on the subject.

They also allude to and exclude from consideration for a CSBD diagnosis “paraphilias,” (I’m pretty sure I know which paraphilia they’re thinking of, here) and they ascribe to it “non-consensuality,” defacto, out of the box, but they pretty much have to do that in the present climate of fear that operates in academia today where researchers, even the giants in the field, are scared s***less about losing their funding, their jobs or, worse, getting adverse publicity that brings them into view of insane members of the public.

Still, all in all, this expresses, as best as I can tell, the scientific consensus on the “sex addiction” movement, if a bit too mildly.