Understanding sex addiction - a clinical reality
Sex addiction can be defined as the compulsive participation and/or engagement in sexual activity, despite the negative consequences associated with this. Internet sex addiction describes internet-based sexual activities that are deemed to be excessive. Reported problems in this area include damaging primary relationships through searching internet pornography, causing financial difficulties due to excessive spending, and resulting in loss of employment because of a sexual preoccupation.
The internet has revolutionised communication, shopping and education, generally in a socially acceptable way. Yet it has also made pornography freely accessible and facilitates off-line sexual liaisons between strangers. It is also estimated that over half of all spending on the internet is related to sex. This aspect of the internet has polarised the debate about its benefits and risks.
Overuse of pornography, infidelity and risky behaviours are the internet-related problems that are most frequently treated by mental health professionals. In general psychiatry, sex addiction is a rare problem but one that is taken extremely seriously.
In 2010, the BBC reported that 6% of the population were sex addicts, with 1 in 5 being women. Today, the media states that internet sex addiction is highly prevalent and on the rise, often creating unnecessary moral panic.
The media uses the behaviour of a select few to imply that internet sex addiction is a frightening and widespread problem, and whilst there is truth in the seriousness of this behaviour, such exposure runs the risk of oversimplifying what is actually a complex mental health condition.
Spotting the signs and symptoms
Studies suggest that sex addiction is not a stand-alone disorder, but rather behaviour arising in association with several other psychiatric disorders. Examples to look out for include:
- Obsessive compulsive disorder/impulse control disorder
- Other addictions such as substance misuse or gambling
- Eating disorders such as bulimia nervosa
Considering co-morbidities when assessing someone for sex addiction is imperative to ensure that a patient receives appropriate and successful treatment. For example, those with self-identified sexual addiction commonly describe having dissociative experiences and a tendency to seek out sexual experiences when they feel depressed or anxious.
It is also important to develop greater social context around the frequency of sex addiction known to clinicians, and the ease of diagnosing those who need support. Clinicians will often see distressed patients and families worried about internet sex, seeking psychiatric assessment and advice, who then do not proceed to engage with the correct treatment due to the shame and stigma associated with the condition.
Commonly, there is a 'crisis of disclosure':
- The individual's family or employer has discovered their use of the internet for sexual purposes
- Patients' reactions to their sex addition being discovered vary, which impacts on diagnosis and treatment
- Some patients present with depressive attitudes, perhaps asking why they do it
- Some patients request medication as a quick fix due to the shame of entering treatment
Diagnosing and treating sex addiction
It is proposed that the problems people experience with taking illicit drugs, for example, should be re-conceptualised as compulsive drug-seeking behaviour, rather than a neurochemical addiction. This leaves the door open for other subjective compulsive behaviours such as sex addiction, to be bracketed with more traditional addictions.
More recently, a wealth of research has developed the case for sex addiction to be conceptualised as a biopsychological process, which is shared by co-morbid conditions like the ones mentioned earlier in this article. Defining sex addiction in this way not only reduces social stigma but moves the concept of sex addiction from something that one does, to something one has, allowing for more robust management and treatment. This can include:
Despite no clear criteria being robustly defined for when sexual interest becomes excessive, the sexual addiction screening test (SAST) is a useful tool in helping to diagnose this mental health condition.
SAST was developed in co-operation with hospitals, treatment programmes, therapists, and community groups to provide a profile of responses which help to discriminate between addictive and non-addictive behaviour.
Psychiatric or psychological therapy
Cognitive behavioural therapy involves helping people to become more aware of their often dysfunctional and unhelpful thought patterns which can lead to maladaptive behaviours and negative emotions. It also attempts to help patients understand and adjust underlying belief patterns which maintain these dysfunctional thinking patterns and behaviours. By teaching people to challenge cognitions and modify their behaviour, this can then lead to a significant improvement in mood.
A 12-step model, such as the Priory Addiction Treatment Programme (ATP)
This is a good starting point in receiving sex addiction therapy. Whilst the Addiction Treatment Programme is based on abstinence for substance misuse disorders, in sex addiction it will help the individual to develop healthy patterns of loving and relating. Old habits are hard to break and establishing a period of abstinence from the harmful behaviour is usually required.
Priory offers a variety of services for a number of addictions, including compulsive sexual behaviour, within our nationwide network of hospitals and wellbeing centres.