Is Sex Addiction Just Sales Talk?

(August 24, 2006) -- It seems to have been no less an authority than Dr Alfred Kinsey himself, who sarcastically defined a nymphomaniac as "someone who has more sex than you."

For ages, doctors and psychologists have recognised that some people engage in sex unusually often, often to the detriment of themselves or of others. The situation has been given various names, and has attracted various responses, as we will discuss below. In the 1970's a psychologist of no great distinction renamed it "Sexual Addiction" and greatly publicised the phrase, which helped to sell his books on the subject. But this was no useful discovery, nor was it accompanied by any significant advances in treatment - merely renaming a problem rarely leads to a solution.

False theories of "sexual addiction"
This psychologist claimed that such promiscious people had become addicted to certain brain-chemical changes that occur during sex, much the same as a drug addict gets hooked on cocaine or heroin. There was no good evidence to support this theory, and no effective treatment arose from trying to block such chemical changes. There was no explanation of why some people would get hooked on the chemistry of sex, while the rest of us would just enjoy it without losing control. Based on his experience, he estimated that around 8% of all American men, and 3% of American women, were sexual addicts, which provided a dandy audience for his books and people who might be persuaded that they needed treatment.

The writings I have seen on "sex addiction" have been trivial and superficial, and wholly unhelpful. They write that addictive sex may lead to remorse, excuses, shame, exploitation, secretiveness, or hypocrisy - just like any other type of sex! They speak of compulsive masturbation, compulsive sex with prostitutes or with multiple partners, and indeed, any form of usual or deviant sexual behaviour which is unduly repeated. They claim that the condition is progressive and gets worse without treatment, even if it may remit for years at a time. Having examined some of the screening tests they recommend, I find that they include far too much normal and usual behaviour, which may be lucrative as a marketing tool, but is not helpful clinically or as a way to genuinely help people. It implies a long-term and intractable problem for something that can also be relatively short-lasting and more easily managed.

Men Behaving Badly?
The problem is that though sexual behaviour may, under various circumstances, be compulsive, it is not an addiction, and nobody has thought it useful to call every other form of compulsive behaviour "addictive". This name does not point us towards any specifically useful treatment. The concept is too often used by people who are simply behaving badly, as an excuse for not even trying to change their preferred style of behaviour. It also has the huge disadvantage that it is a name that assumes a single type of problem with a single type of cause, rather than recognising how many different disorders and illnesses may contribute towards this situation. I am not convinced that a Sexaholics Unanimous approach is the most useful way to try to understand, or to help, in these circumstances.

Other causes of hypersexuality
Far from adding to our understanding, the "sex addict" over-simplification has helped people to forget that there can be many other possible causes of troublesome increases in libido and sexual activity. One of the oldest and most eternally valid principles in medicine is that before you can plan an effective treatment, there has to be a comprehensive assessment and a sound diagnosis, not a rush to judgement.

It's worth understanding that someone may be labelled as a sex addict simply because they are more sexually active than the person applying the label, or because they enjoy themselves in ways the labeller doesn't appreciate. For a number of reasons one's libido, the level of sexual desire one experiences may be increased, by something as commonplace as being under extra stress, as sex is excellent recreation and usually induces enjoyment followed by relaxation. On the other hand, the primary problem may be a loss of impulse control, such as can follow some forms of brain injury or brain disease, in which the person is just much less able to control such desires as they may feel. It may be related to a form of epilepsy, or to something like Alzheimer's Disease.

It can occur during manic phases of Bipolar Disorder, or even in Depression (just as depression may include an increase or decrease in appetite for food, weight gain or loss). It can be part of a formal Obsessive-Compulsive Disorder. It is a common part of the Manic phase of Bipolar Disorder. Someone may even be of low libido and uninterested in sex while their mood is normal, only to become, as they grow manic, increasingly interested in sex, hopefully with their settled partner, but potentially of almost any kind and with almost anyone.

When is repeated sexual behaviour a problem?
Sexual behaviour becomes a problem when it is harmful and hurtful to the individual or others, and when it is repeated or engaged in inappropriately; when you feel out of control of what you are doing (not at the height of orgasm but when it comes to choosing what, when, where and with whom); and when you find yourself spending an inordinate amount of time thinking about what you have done and what you plan to do, to the extent that it interferes with your usual work and social life.

As with any other normal aspect of a fully rounded life, if your sexual activity has become so overwhelming that it is a preoccupation that takes precedence over your usual work and family or social duties, things have got out of proportion. Typical of many other self-defeating patterns of behaviour, the more you do it, the less you get whatever it was you were originally seeking by doing it. The Don Juan is like the unhappy millionaires I've known, who were sure that just another 10% further wealth would be completely satisfying, but could never meet that elusive and retreating target. At first it may seem to relieve stress, depression, anxiety or loneliness; soon it clearly only underlines and emphasises these uncomfortable states of mind.

OK, so, having been scornful about the fashionable term, what else might we call this problem? Sexual compulsiveness, perhaps, or sexually compulsive or obsessive behaviour? Recognising the compulsive aspect of such behaviour can be useful, as it can respond to medicines and psychological treatments adapted from treatments for other obsessive and compulsive disorders. Typical of compulsivity, one loses a sense of proportion, and finds it difficult to choose whether to continue or stop, even if risks are obvious.

Similarly, it is worth recognising this, not as part of the field of addictions, but as one of the Impulse Control Disorders. Others call it simply Hypersexuality, which is acceptable and accurate. Older terms which have been used include Erotomania, and Nymphomania or Satyriasis (of which, we'll hear more later).

When should you seek professional help?
As soon as you recognise the problem for what it is - by definition, the matter is beyond mere self-help, although your own full collaboration will be essential for successful expert treatment. What sort of treatment is likely to be used? Individual psychotherapy/serious counselling is surely needed, to help you understand and manage your sexual obsessions. Marriage/relationship counselling would be needed after you have begun to sort yourself out. Modern antidepressants of the SSRI family may help, both to attend to co-existing anxiety and depression, and they may reduce the power of the obsessiveness underlying the problem.

Problems caused by sexual compulsivity
There may be a wide range of negative effects from this primary problem. Obviously, depending on the type of indulgence chosen, you could run into serious problems with the law, run a major risk of pregnancies and of STIs and HIV, for yourself and your partners, and run up significant financial expenses. You are likely to neglect your marriage or primary relationship. Failure to concentrate on your work may risk the loss of a job.

Other terminology
Satyriasis is an old-fashioned term for the male variety of excessive sexual behaviour, named (perhaps unfairly to the animals) after the Satyr of Greek mythology, which was part man and part goat. Nymphomania was for long a preferred term for the female variety of this complaint. It was even included in the catalogue of pathology of the American Psychiatric Association, the DSM, until 1987! - Prof M.A. Simpson, Health24's Cybershrink

Last updated: 08/06

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