Sexual Compulsion and Sex Addiction

In the 2005 mock documentary "I Am a Sex Addict," the protagonist sits dolefully in an anonymous 12-step meeting for people "addicted" to sex. He's ended up there after being unable to control a compulsion to seek out prostitutes when his intimate relationships faltered. "The more I indulged the addiction, the stronger it became," he says, confessing to the group that his sexual compulsions destroyed his marriage.

Based on the filmmaker's life, "I Am a Sex Addict" isn't a compelling movie, but the underlying message is powerful: Out-of-control sexual impulses can be as devastating as a drug habit. In this scenario, sex can overwhelm people's thoughts and lifestyle, ruining their careers, friendships, and closest relationships.

But having a sex addiction isn't as straightforward as having an addiction to nicotine or alcohol. You cant satisfy a sexual craving with a patch or a pill. On the other hand, if you have trouble controlling your sex drive, you shouldn't have to give up sex completely. If you feel like your sexual urges are threatening the rest of your life, the best thing you can do is get help and learn how to regain control.

A real addiction?

Many people are surprised to learn that compulsive sex isn't considered a true addiction. In fact, there isn't an official term for this behavior listed in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which describes all mental disorders with a diagnosis recognized by the American Psychiatric Association. Many experts currently prefer the term "compulsive sexual behavior" over "sex addiction" because it describes the problem more accurately.

The "addict" label is also overly simplistic, says Marty Klein, PhD, a sex therapist and author of multiple books on sexuality. As Klein explains, several different underlying psychological problems can trigger hypersexuality. A man who cruises for sex nearly every day might have obsessive compulsive disorder, or he might be using sex to ease feelings of depression and anxiety. (A similar pattern is often seen with compulsive eating, gambling, smoking, or drinking.)

According to Klein, calling sex an "addiction" tends to lead to a single type of treatment: 12-step programs. One such program, Sex Addicts Anonymous, now has more than 750 chapters worldwide. Such programs can help some people, he says, but it's a one-size-fits-all approach to a complicated problem. "You go through the same 12 steps no matter what," he says. "A lot of questions never get answered." (Twelve-step programs for any other problem behavior suffer from the same limitations.) Still, according to an article in the journal Psychiatry, such programs can be valuable because they offer fellowship and support -- as well as a sense of structure and accountability.

A matter of perspective

One crucial question continues to vex experts and patients alike: How much sex is too much? Most experts agree that there's no such thing unless it's harmful to you or someone else.

Some types of sexual acts, such as rape and child sexual abuse, are morally wrong and unacceptable in any circumstance. But while even "healthy" acts such as consensual adult sex or masturbation can become problematic if they cause you or others harm, the dividing line is far from clear, says Mike Miner, PhD, an associate professor at the University of Minnesota who studies the psychology of sexual behaviors.

Some people are troubled by sexual feelings that may seem harmless or mild to others. "A minister came to see me because he had what he called a 'Christian sex addiction,'" Miner says. The mans transgression? He was buying adult magazines once or twice each year.

In this case, the minister simply needed reassurance, not treatment. But what about someone whose life is in turmoil because he has to have sex several times a day, and sometimes more than that? As reported in a 2006 issue of the journal CNS Spectrums, men receiving treatment for compulsive sexual behavior are far more likely than other men to report having more than seven orgasms each week. But you can't tell if someone has a problem simply by counting orgasms, Miner says. Some men could have far more than seven orgasms a week without causing any problems for themselves or anyone else, he says.

"It's like beer," Miner says. "Some people can have 14 beers in a week without any trouble, but other people can't."

When sex goes too far

Miner and other experts try to use a different yardstick for measuring sexuality: Is it interfering with the rest of a person's life? "It's not a problem unless it keeps you from doing other things," Miner says. In fact, the need to engage in a behavior despite evidence of self harm is what many experts would call the definition of addiction.

For example, masturbation is completely normal and healthy unless it takes over a person's life or interferes with relationships. As reported in CNS Spectrums, a sexually compulsive person might masturbate five to 15 times a day, stopping only because of exhaustion or injury. And while a healthy couple might enjoy daily sex, sexually compulsive people might feel angry, depressed, or anxious any time they're not satisfied -- or because sex is dominating their lives.

In some ways, people who lose control of their sex drives really do behave like addicts, Miner says. They certainly pursue their sexual outlets with all of the determination of a drug user looking for a fix.

But in many other ways, sex is far different from drugs or alcohol, Miner says. For one thing, just about everyone has strong sexual desires, not just the so-called "addicts." One of Miner's recent studies emphasized this point. He flashed a series of pictures -- some sexual, some not -- in front of men. Some of the men had problems with hyperactive sexuality, and the rest were "normal." Miner found that the normal men were just as interested in pictures of naked people as the "compulsive" men.

As Miner explains, the results might have been much different if he had been showing pictures of drug paraphernalia to a group of people dependent on drugs and people who were not. "It's really hard to fit sex into an addiction model," he says. While drug addicts really do need to get substances out of their lives completely, people stuck in sexual overdrive just need to learn how to slow down, he says. "Treatment is aimed toward controlling the behavior, not abstaining from sex," he says. This is similar to the approach with compulsive eating disorders -- you can't eliminate the problem or trigger from your life completely; you learn to live with it.

Getting help

People who are compelled to seek out sex often have one or more other problems, such as substance abuse, depression, or obsessive compulsive disorder. Some may have a history of being sexually abused. Sexual compulsion can also cause guilt, anxiety, and despair.

That's why treatment for sexually compulsive behavior that's disruptive to a patient's life needs to address the root of the problem, says Marty Klein. For example, antidepressants may be helpful for some people who seek out sex to relieve depression, he says. "If they get treatment, they may feel more alive, and they won't have to get that spike from sex."

Here are a few ways to find someone who can help:

• Talk to your primary care doctor about your problem, and ask for a referral to someone who specializes in treating compulsive sexual behaviors.
• Call your state licensing boards (or look up the directories online) for psychiatrists, psychologists, or therapists who specialize in treating sexual compulsions.
• You can also call local mental-health professionals and ask if they have credentials (such as a license in sex therapy) or experience in treating sexual compulsions.
• Many universities have psychology departments or psychiatric clinics (within the medical school) with experts who specialize in treating sexual compulsions.

Treatment options

Psychotherapy, cognitive behavioral therapy, and other psychological approaches -- either one-on-one or in groups -- can be extremely helpful. For example, cognitive behavioral therapy can help people find healthier ways to cope with anxiety or stress. Likewise, behavioral therapy can help people manage obsessive compulsive disorder, a common cause of excessive sexuality. Couples or family counseling is often necessary to help resolve the relationship problems that arise as a consequence of compulsive sexual behavior.

Surprisingly few studies have ever carefully investigated the best treatments for compulsive sexual behavior. Still, therapists and doctors have found several treatments. As reported in CNS Spectrums, fluoxetine (Prozac) and other antidepressants are thought to be helpful. Other possible medication options include the anti-anxiety drug buspirone (BuSpar), and naltrexone, a medication often prescribed to weaken drug addictions. Mood stabilizers such as valproic acid or lithium may be helpful when compulsive sexual behavior is part of a bipolar disorder.

It's worth noting that hormonal treatments ("chemical castration") often ordered for sex offenders aren't good options for people who are sexually compulsive. The hormones tend to erase desire completely instead of bringing it under control.

With help -- and real work and commitment -- many people can put sex back in its rightful place: An intoxicating part of life, not the entire reason for living.

References

Interview with Michael Miner, PhD, an associate professor at the University of Minnesota who studies the psychology of sexual behaviors

Interview with Marty Klein, PhD, a sex therapist and author of five books on sexuality

Mick TM and E Hollander. Impulsive-compulsive sexual behavior. CNS Spectrums. 2006. 11(12): 944-955.

American Psychological Association. Understanding compulsive sexual behavior.

Stanford University. OCD research: Behavior therapy. http://ocd.stanford.edu/treatment/psychotherapy.html

The Society for the Scientific Study of Sexuality. What Sexual Scientists Know: About Compulsive Sexual Behavior. http://www.sexscience.org/publications/index.php?category_id=440&subcategory_id=334

Fong, MD, Timothy W. Understanding and Managing Compulsive Sexual Behaviors. Psychiatry 2006 Vol. 3, Issue 11, November 2006. p51-58. http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article247.

IFC Films. I Am a Sex Addict. Press Kit. 2005.

Mayo Clinic. Compulsive Sexual Behavior.