A while back a listener asked us to do a podcast to help people who were worrying that they might be a sex addict. MJ decided to do an interview with their friend Dominic Davies – the head of Pink Therapy – who has a critical perspective, and lots of expertise, about sex addiction.
MJ and Dominic did a YouTube video on this topic back in 2016 which you can see here if you want more about this topic. In the podcast Dominic updated MJ on where the diagnostic terms relating to sex addiction were at, why he is still cautious about using the term, why it should be ‘principles’ instead of ‘act’ focused, and what people can do if they are concerned about their sexual desires or behaviours.
Diagnosing sex addiction
Of the two main manuals that psychiatrists and other practitioners use, the American one – the DSM-5 – ruled out including sex addiction last time it was revised due to the lack of evidence supporting its existing. The World Health Organisation ICD-11 includes ‘Compulsive Sexual Behavior Disorder’ but makes it clear that this should not be used if people’s distress about their sexual behaviours are due to moral conflict or being disapproved of or social rejection.
You can’t be diagnosed a sex addict because other people are uncomfortable with your sexual desires or behaviours, because you self-identify that way (perhaps to justify non-consensual behaivour), or because there’s cultural disapproval about your amount – or type – of sexual desires or behaviours.
There’s more about all of this in David Ley’s article in Psychology Today here.
Why be cautious?
Along with the lack of evidence for sex addiction, a lot of past attempts to diagnose it have been based on a ‘Goldilocks’ amount of sexual desire/behaviour ‘normal’ people should have, when we know that people can be perfectly happy and healthy with anything from no sexual desire, attraction or contact, to high levels of sexual desire, attraction and/or contact.
Also many of the behaviours said to indicate sex addiction have been those that are particularly common amongst gay and bisexual men – meaning that it has been a way to pathologise homosexuality now that is no longer considered a ‘disorder’ (it was in the ICD until 1992). Solo sex, sex work, non-monogamy, and BDSM are often included in lists of behaviours that might indicate sex addiction – again suggesting that these activities are somehow more questionable than hetero PIV sex.
Acts vs. principles
Braun-Harvey and Vigorito argue that we should move away from acts-based diagnoses of sex addiction, to a principle-based approach to working with ‘dysregulated sexual behaviour’. Basically we could see it as a problem (compulsion or dysregulation) if a person’s sexual behaviour wasn’t meeting any of the following core principles of sexual health, according to the WHO:
- Protected from STI’s and unintended pregnancy
- Shared Values
This could apply to any kind of sex equally – solo, partnered, group, vanilla, kinky, etc.
What to do if you’re concerned
Dominic spoke on the podcast about how having solo/partnered sex, viewing porn, or fantasising can all become problematic for people if we’re not doing them ethically and/or if they’re only giving us short-term relief or pleasure but causing problems for us longer term because we don’t feel good about them or they’re getting in the way of the rest of our life. This is similar to the issues there can be if we’re relating to alcohol, TV viewing, dating, gaming, work, exercise, or anything else in this kind of way.
Using sex to soothe distressed feelings isn’t wrong, most of us use sex and/or self-pleasure to help us feel better. But if you’re spending all day doing that when you have other more urgent things to do, then it might be worth seeking help to work on what’s causing the distressed feelings and treat the underlying cause.
Sex – like many things – can be a way of distracting/soothing ourselves from an underlying issue like anxiety or depression. In those cases addressing the underlying problem should be the focus of therapy rather than the sex as such.
What else might be underneath? Sometimes its trauma – especially traumatic events in childhood. We recommend Alex Iantaffi’s excellent podcast on developmental trauma to explore whether this possibility might apply to you here.
Often people who feel out of control around sex have a lot of sexual shame and have erotic conflicts where their values and what turns them on are in conflict. They may be aroused by dressing in latex or leather and their partner is more conventional in their tastes, or they enjoy pain or feeling submissive or powerful but this conflicts with ideas about sex needs to be loving and tender. They may be predisposed to non-monogamy, but their values tells them monogamy is the only valid option and they constantly find themselves being unfaithful. In these cases a chance to explore their erotic templates and their values can be really helpful.
With any of these examples – other problems, trauma, and shame – a good practitioner can help you to explore these things. Dominic suggested avoiding sex addict therapists and groups – due too all the problems with this idea – but searching for a Pink Therapist with expertise, or otherwise shopping around for a good therapist with expertise around sex. Check out our podcasts on going to therapy.
Dominic also recommended this website for the up-to-date sexual science: RealYourBrainOnPorn.com
© Meg-John Barker and Justin Hancock, 2020