One of the difficulties I see for those suffering from compulsive sexual behavior is that the lack of agreement in the field of addiction and sex therapy adds to the stigma of the issue. This lack of agreement may be confusing or discourage those seeking help.
Levine's Study on Sex Addiction
The object of a study conducted by S.B. Levine (2010) was to clarify the concept of sexual addiction: how it is defined, its causes and symptoms, and how it is potentially diagnosed and treated. He believes that sex addiction is a confusing topic because of the social stigma and taboos surrounding sexuality. In addition, there is not a consensus in the field of psychology as to whether sexual addiction should be considered its own category of behavioral disorder: is it the underlying symptom of a greater behavioral disorder, or merely a personal lifestyle choice/behavior? As a result of this lack of agreement, sexual addiction has not been categorized as a unique psychiatric disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The clinical model holds that sexual addiction, to be considered an addiction, must be based on compulsive sexual behaviors that harm self or others. These behaviors are frequent, often performed in secret, and continue despite negative consequences because the individual may not be able to stop the behavior, despite attempting to do so (as a previous stated goal). In order to explore this behavior as an addiction, he compares and contrasts sexual addiction to substance addictions (e.g., alcohol and drug addictions), impulse control disorder, compulsive disorder, and relationship disorder. While some differences exist, he also finds that there are some similarities between sexual addiction and these recognized disorders, especially in the patterns of behavior, conditioned thinking, and neurobiology.
In the same study, S.B. Levine (2010) analyzed the sexual activity of 30 men who presented their problem as sexual addiction to the author in his clinical practice over a five-year period. Although the identified behavior, motivations, and emotional issues surrounding their sexual behaviors varied greatly, 28 out of the 30 men reported having violated the “publicly endorsed conservative norm of monogamy [to which they also identified as having subscribed], which insists on no designed, chosen, repeated sexual excitement with another real or virtual person” (Levine, 2012, p. 271). Because the wide spectrum of patterns differed so greatly among the participants, the results were by no means definitive. For example, infidelity within a monogamous relationship, partner distress, or even engaging in specific sexual activities such as viewing pornography on the internet or visiting strip clubs are not alone sufficient for determining sexual addiction. However, there was a stronger correlation in those identified with sexual addiction in suffering from other psychological issues (e.g. unresolved childhood issues, middle-aged boredom with life, feeling overly constrained in their relationship, inability to tolerate difficult emotions and situations, etc.). Some limitations of the study include a biased selection consisting of highly-educated and affluent white men, most of whom were married, and all but one heterosexual. It is possible that younger, gay/bisexual, less-educated, and less-affluent individuals might have resulted in different findings.
Concluding Thoughts on Sex Addiction Therapy vs. Compulsive Sexual Behavior Therapy
A difficulty for me as a sex therapist is how to communicate my approach to working with compulsive sexual behavior that does not alienate those who identify with the Sex Addiction model, while still providing an alternative to those for whom the Sex Addiction model does not resonate. As a result, I believe more education and outreach is needed in order for our society to better understand, relate to, and support those struggling with Out of Control Sexual Behavior–an endeavor to which I am glad to add my voice.
References
Levine, S. B. (2010). What is sexual addiction? Journal of Sex & Marital Therapy, 36, 261-275. doi:10.1080/00926231003719681