Sex addiction/compulsive sexual behavior

[cara susanna]

Is this a thing? I used to think that it wasn't but now I see articles saying that the criticism of the sex addiction diagnosis isn't supported by research. e.g., https://www.tandfonline.com/doi/full/10.1080/10720162.2015.1036184

Thanks! As you can tell, this is definitely not my area so I am hoping to hear some of the expertise on this board.

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[Fan_of_Meehl]

Is this a thing? I used to think that it wasn't but now I see articles saying that the criticism of the sex addiction diagnosis isn't supported by research. e.g., https://www.tandfonline.com/doi/full/10.1080/10720162.2015.1036184

Thanks! As you can tell, this is definitely not my area so I am hoping to hear some of the expertise on this board.

My recollection from reviewing the literature was that--after accounting for things like clinical depression and substance use--there was very little left in terms of meaningful variance to justify adding the conceptual construct of 'sexual addiction' to explain anything. I would assess for mood disorder, substance abuse, personality disorder pathology, etc. and diagnose/treat those according to prevailing CBT models of conceptualization and care. Of couse rule out mania.

 

[deleted343839]

The DSM-5 committee couldn't even reach agreement on hypersexuality as a disorder, much less "addiction." But the idea has gained traction among a lot of master's level therapists and pastoral counselors. And of course there are several 12-step communities that embrace the concept. But the credentialing for a "certified sex addiction therapist" is a pretty low bar. The sex addiction treatment I've seen in the community is pretty dismal stuff. The worst I've seen is a therapist encouraging one partner to use a tracking app to follow the whereabouts of the "addict" partner.

Obviously, people do engage in a range of sexual behaviors that might be problematic in some way. In my experience there are always better ways of conceptualizing these behaviors than "sex addiction," which is kind of a lazy catch-all term for behaviors that are much more diverse in terms of their functions and consequences. This article gives a nice overview from a clinical perspective: A Treatment-Oriented Typology of Self-Identified Hypersexuality Referrals

 

[Justanothergrad]

Of the folks I know who do sex research specifically, they don't find a strong supporting case for this beyond the realm of any other operant conditioned stimuli.

 

[erg923]

One time, when I was looking for a place as a graduate student, I saw a Craigslist ad titled. "Marine for sport ****ing"

First: Gross.

Second: Yea, I guess...barring more parsimonious explanations for said behavior. I'm not an expert on this.

Third: This is why I am vigilant with my children about socializing too much with "Lucy Morals" (male or female) during their preteen and teen years,

 

[Ryan2468]

So there’s a lot of debate between camps, but I tend to fall in the “compulsive sexual behaviors” camp (which is being added to the new ICD), rather than some bonafide addiction, as the cycle doesn’t look the same.

However, I am also big on being sure there’s actual functional impairment because you can get into a lot of cultural variability with what someone defines as “problematic sexual behaviors”. For instance, a client who is devout Catholic may see any sort of pornography and masturbation as sinful and thus feel shame and guilt (impairment?) whereas someone with no religious background may only see a problem if that use escalates RJ public places or in the workplace (still a values judgement).

At the end of the day, I actually think the argument is a moot point, since we should be focusing on helping clients meet their goals, if their goal is to focus on decreasing problematic sexual behaviors (as defined by them), I think we could go that route, unless we see it as potentially harmful.

There is currently some research being done looking at biological markers for “sex addiction” and I think all of this will gain traction once the above diagnosis is added to ICD.

 

[R. Matey]

So there’s a lot of debate between camps, but I tend to fall in the “compulsive sexual behaviors” camp (which is being added to the new ICD), rather than some bonafide addiction, as the cycle doesn’t look the same.

Got any citations for this? I'd like to read more about the debate.

 

[sfgucadoc]

Got any citations for this? I'd like to read more about the debate.

Here's a book by a colleague that lays this out pretty well. His focus is mainly on sex and drug-linked behavior (e.g., using meth while at a sex party, etc.) and how sexual health is generally ignored in CD treatment programs. We have a new grant to work on restructuring our CD program based on his work.

Amazon product

There's going to be a session on ICD 11 and compulsive sexual behavior at this year's Society for Addiction Psychology meeting in April. Should be interesting.

 

[Ollie123]

Addiction is very difficult to define. I don't question there are people for whom sexual behavior is a problem, but the extent to which this overlaps with drug addiction is not well established. This extends across all behavioral addictions quite frankly. Though oddly enough, most people don't question whether "gambling addiction" is a thing but do question many others (internet addiction, sex addiction). Fundamentally, there isn't any obvious reason to separate these. In some ways, the existence of "sex addiction" would actually be more logical (UR with clear physiological effects). I think the main reason gambling disorders have more street cred are just because more research has been done on them (which historically is likely due to the prevalence of the disorder, the nature of the problems it causes and the stigma surrounding sexual behavior...none of which have anything to do with nature itself).

That said, all psychopathology is messy. Those of you doing addiction work, how many "pure" cases do you see? Extraordinarily rare in my practice - I pretty much only saw them in forensic settings where it was arguable whether the person would have even met for a use disorder if not for societal consequences stemming from drug use. Evidence is even mixed with regards to whether drug addiction is fundamentally different in a manner driven by drugs themselves (see Carl Hart's writing, rat park studies however flawed they were, etc.).

My personal belief (and research program) is guided by the belief that all these "types of issues" are a constellation of impulse control, emotion dysregulation, cognitive deficits and other basic processes overlaid on physiological effects (from drugs or otherwise) and modulated by micro (family peer, etc.) and macro (legal, societal) environmental features. When you take a view like this, what is and isn't a disorder becomes arbitrary silliness we settle for because there are societal benefits to oversimplifying things in our current environment. We're a long ways from "carving nature at its joints." Doubt we'll get there in my lifetime, though hoping to move us closer.