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ОглавлениеGENERAL QUESTIONS ABOUT SEX ADDICTION
How common is sex addiction?
The Society for the Advancement of Sexual Health31 has estimated that 3–6 percent of the population of the United States suffers from sex addiction. This percentage is based on the number of people who present for treatment. Since addicts usually avoid treatment as long as they possibly can, the actual number may be significantly higher.
Some people try to emphasize the magnitude of sex addiction by quoting statistics that are much greater, but have little foundation in research. If we take the minimum of the best estimates we have, there are at least 9.5 million sex addicts in the United States—equal to the combined populations of the states of Alaska, Montana, North and South Dakota, Wyoming, Vermont, Delaware, and Rhode Island.
If we factor in the number of spouses/partners who have been wounded by sex addicts and the children of sex addicts who have been damaged, the numbers escalate considerably. Sex addiction is a huge problem in our society.
Is sex addiction a real disease?
As with alcohol and other drug addiction, sex addiction is generally treated using a “disease model.” However, like gambling addiction, it is a process or behavioral addiction that does not involve psychoactive substances. Whereas sex addiction causes changes in the brains of those afflicted with it, and its progression resembles a disease process, its classification as a disease continues to be controversial.
Accepting sex addiction as a disease may also give some sex addicts an excuse or rationalization for their behavior. Confronted with their sexual acting out they say, “I can’t help it, I have a disease.” Some partners of sex addicts think that referring to sex addiction as a disease minimizes addicts’ responsibility for their behavior. Although their compulsive behavior may be out of control, as stated earlier, sex addicts are always responsible for their behavior. It’s most accurate to consider sex addiction a disorder.
What are the criteria for diagnosis of sex addiction?
Currently there are no definitive diagnostic criteria for sex addiction. However, most sex addiction therapists look for the following in diagnosing sex addiction:
• Preoccupation with and frequent cravings for sex
• Obsessive thoughts about sexual fantasies to the point of excluding other thoughts
• Lack of interest in activities that once were important
• Desire to spend more time alone than interacting with others
• Engaging in excessive sexual behaviors despite efforts to stop and negative consequences associated with such behavior
• Neglecting obligations like work, school, or family in order to pursue sexual interests
• Feelings of irritability when not able to engage in sexual behavior
• Escalation of the scope of sexual behaviors or time spent pursuing and participating in sexual acting out
The presence of just a few of these is enough to indicate that a person should consider receiving treatment for sex addiction.
A recently developed screening tool called PATHOS32 is a brief questionnaire that health professionals can use to identify the presence of sex addiction. PATHOS is an acronym for six assessment questions:
P:Preoccupied—Do you often find yourself preoccupied with sexual thoughts?
A:Ashamed—Do you hide some of your sexual behavior from others?
T:Treatment—Have you ever sought therapy for sexual behavior you did not like?
H:Hurt others—Has anyone been hurt emotionally because of your sexual behavior?
O:Out of control—Do you feel controlled by your sexual desire?
S:Sad—When you have sex, do you feel depressed afterwards?
A positive response to just one of the six questions indicates a need for additional assessment with a sex addiction therapist. Answering yes to two or more is a strong indication that the person is a sex addict.
In Stop Sex Addiction33 I suggested a two-question assessment:
1. Have you engaged in sexual behavior that has harmed you or others?
2. Did you repeat that behavior?
Although not all who answer “yes” to both of these questions are sex addicts, when answering honestly, all sex addicts answer yes to both. How would you answer these questions?
Why is sex addiction not listed in the DSM-5?
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is the comprehensive classification and diagnostic manual published by the American Psychiatric Association. Sex addiction was listed in the third edition published in 1980 but was removed in the fourth edition published in 1994. In preparation for the publication of the fifth edition in 2013, a committee of academic and clinical experts debated whether to include sex addiction in some form. There were several hurdles to overcome. First, the DSM does not use the term addiction. Alcohol and other drug addiction is covered under the term substance use disorder. The committee grappled with terms for out-of-control sexual behavior and finally settled on “hypersexual disorder.” They conducted clinical trials in conjunction with several treatment centers trying to amass the data needed to have sex addiction included in the DSM-5. In the end, there was simply not enough data for it to be included.
Regardless of its lack of inclusion in the DSM-5, those who struggle with problematic sexual behavior, those whose lives are negatively impacted by sexual acting out, and those of us who strive to help them have no doubt that sex addiction is a very real disorder.
What is the difference between sex addiction and love addiction?
Sex addiction and love addiction are both disorders of intimacy. Sex addicts tend to be more interested in specific sexual acts where love addicts are more interested in having a relationship with others. Some love addicts and some sex addicts will engage in sexual behaviors with multiple partners. And some sex and love addicts never engage in sexual behaviors with others. Dr. Brenda Schaeffer has written the seminal work on love addiction: Is It Love or Is It Addiction?34 I would encourage you to read it for a fuller explanation.
Love addicts look for the next relationship that is going to fill the void in their lives. They are continuously searching for an ideal person that will make their life more meaningful—that they think will make them whole. As they focus on their intended target, they may be very charming and solicitous. But when love addicts are successful in their quest they typically find that the person they pursued is not the right person for them after all, and begin their search all over again. Often, love addicts will not end that relationship so as to avoid being alone, continuing it as they seek a new ideal partner.
Also, some sex addicts choose to describe their addiction as love addiction in an effort to minimize their shame and the greater stigma associated with sex addiction.
What is the difference between sex addiction and being polyamorous?
Polyamorous means “many loves.” Although I (Milton) do not believe polyamory is healthy, a chief difference between it and sex addiction is in the presence or absence of honesty. Those who practice true polyamory believe in openness and transparency, including the knowledge and consent of all partners involved. Obviously, this is not the case with sex addiction, where so much of the relevant behavior is secretive and cloaked in dishonesty.
Using the label of polyamory in the attempt to dress up or rationalize sex addiction does not lessen its destructive impact on oneself or others.
Is there a relationship Between IQ and sex addiction?
There have been no published studies that indicate a relationship between a person’s level of intelligence and sex addiction. In our practices, we see sex addicts with a wide range of intelligence from those who appear to have low IQs to extremely intelligent persons who have earned multiple graduate degrees. Sex addiction does not discriminate with regard to intelligence.
Is there a relationship between wealth and sex addiction?
Sex addiction does not discriminate with regard to socioeconomic status. That being said, wealthy sex addicts often maintain the belief that, because they have incomes that set them apart from the majority of people, they are not like “ordinary people,” and that their wealth makes them somehow “superior.” This narcissism and grandiosity can drive the expectation that they should have whatever they want; whatever gives them pleasure. When this dynamic is extended to sex, the likelihood that someone will become caught up in sex addiction is increased.
What makes it so difficult for people with sex addiction to ask for help, even when they obviously need it?
Shame, guilt, embarrassment, denial, and minimization are the greatest hindrances to seeking help for both sex addicts and their partners. The shame is often so great that many people suffering from sex addiction will never seek help until they feel as though they have no choice. When people admit they have a problem and need help, they need to take responsibility for it and actually do something about it. This is extremely scary and emotionally painful, so it’s no surprise that most people avoid it for as long as they can. As more brave people step forward with the willingness to talk about their recovery and healing from sex addiction—both addicts and their partners—more of those who are suffering with this disorder will mobilize the courage to seek help.
What is the difference between guilt and shame?
Guilt is the emotional experience people have when they believe or recognize they have done something “wrong.” Feeling guilt because of poor decisions you have made and because of the trail of pain and destruction you created in your sex addiction is healthy.
Guilt is an important emotion to have in recovery because it is closely related to remorse. There are people who are incapable of feeling guilt because they suffer from antisocial personality disorder sometimes referred to as sociopathy. They lack the ability to feel remorse or to express empathy. Be grateful if you feel guilt for how you have harmed yourself and others.
Shame is more characterological. Shame results from feeling there is something wrong, not just with one’s actions, but with who one is as a person. It is the belief that one is somehow inherently defective. Whereas guilt produces remorse and regret, shame results in self-loathing. Put another way, guilt is an acknowledgment of having done something that is “bad.” Shame is a judgment that “I am a bad person.” Guilt is helpful to recovery. Shame undercuts recovery.
What is being done to educate the general public about sex addiction?
This book and the many other books written over the past few decades are part of the education process. Organizations like the Society for the Advancement of Sexual Health (SASH)35 seek to bring awareness of the scope of sex addiction. Additionally, our websites36 contain a great deal of material about sex addiction, the trauma of partners of sex addicts, and treatment for both addicts and partners, as well as hope for the future.
How could I have participated in behaviors that are so contrary to my faith and values?
Sex addicts who have a strong personal faith fight with their conscience much of the time. After each acting-out episode, they are filled with regret, remorse, and self-loathing. They make deals with themselves that they will never do those behaviors again. They pray and make promises they intend to honor. But, much more often than not, they end up breaking those promises and return to engaging in the same and sometimes more extreme behaviors.
Engaging in behaviors that are inconsistent with your beliefs does not nullify your faith. If it were a matter of personal faith and/or personal strength or willpower, many people would simply stop all acting out permanently. However, faith, strength, and willpower have little to do with what happens once the addictive process begins and brain chemistry changes as people become progressively caught in the obsessive-compulsive grip of sexual acting out. The only thing that explains why people continue to engage in behaviors they desperately want to stop is that they are addicted.
A significant number of those I (Milton) work with are clergy from various faith perspectives. Without exception, each of these men are in great mental anguish knowing that their acting-out behaviors stand in opposition to everything they believe. In their desire to change, all of them increased their spiritual disciplines and prayer life. Still, they acted out—not because their faith was not strong enough, but because of their untreated sex addiction.
How does sex addiction affect a person’s self-esteem?
Sex addicts who are active in their addiction often have significant problems with their self-esteem. Outwardly, they may present a persona of confidence and superiority. They may look like they succeed in every other area of life.
Their self-esteem suffers because:
• They are participating in behaviors they loathe in others.
• They recognize (at least deep down) that their behavior is not only harming themselves but others.
• They realize their many attempts to stop have been unsuccessful.
• They must live in a shadow world to keep others from knowing about their behavior.
• They habitually lie to those who mean the most to them and must continue their duplicity in order to keep their behavior hidden.
If I become successful at not acting out, will I still always be a sex addict?
Sex addiction must be treated for life. As with other forms of addiction, we speak of sex addicts as “recovering” rather than being “recovered.” A person who is recovering recognizes the importance of remaining vigilant and continuing to practice taking care of oneself mentally, emotionally, physically, and spiritually throughout life in order to keep the addiction at bay. Those who believe they have recovered frequently become complacent and run the risk of returning to their problematic sexual behaviors.
There is an acknowledgment in the terms “sex addiction” and “sex addict” that this is a disorder to take seriously and needs thoughtful and ongoing recovery efforts. But, beyond the addict and his partner, such terms may stop being helpful and become pejorative. In some contexts, talking about behavior may be more useful. If a sex addict has the need to talk about the damage he has caused in his addiction, he can speak about his behaviors and how he has hurt others.
It needs to be stressed that a person always maintains a right to privacy. What and with whom one shares are strictly up to each individual. There is no obligation to tell the public, casual friends, or even close friends about one’s addiction. The exception to this is when a sex addict gets into a committed relationship. Partners have a right to know about the past, as well as current struggles of someone with whom they are considering entering a relationship.
31 www.sash.net.
32 P. J. Carnes, B. A. Green, L. J. Merlo, A. Polles, S. Carnes, and M. S. Gold, “PATHOS: A Brief Screening Application for Assessing Sexual Addiction,” Journal of Addiction Medicine 6, no. 1 (2012): 29–34, doi: 10.1097/ADM.0b013e3182251a28.
33 Milton Magness, Stop Sex Addiction: Real Hope, True Freedom for Sex Addicts and Partners (Las Vegas: Central Recovery Press, 2013).
34 Brenda Schaeffer, Is It Love or Is It Addiction? (Center City, MN: Hazelden, 2009).
35 www.sash.net.
