Here’s why sex addiction can be a problematic label.
You may think you're a sex addict.
I have lots of clients who approach me because they are worried that they are sex (or porn) addicts. They are usually in distress, have possibly engaged in activities with problematic legal, health or relationship consequences and they want to change things. Maybe they’ve tried to make changes and nothing has worked.
Often they come in feeling like there is something wrong with them and may have self-diagnosed themselves as a sex addict. Traditionally, the label sex addict has been used to explain problematic sexual behaviors using the same disease model often used for substances like meth, cocaine, and alcohol. In past years, 12 step groups for sex addiction were created and offered support for problematic sexual behaviors. For some individuals, viewing their sexual behavior through this lens and seeking the support of a 12 step group has been helpful in changing behaviors and feeling like their sex lives are less problematic and distressing.
Shortcomings of the sex addiction model.
In working with men around problematic sexual behaviors, I've often noticed a sense of powerlessness and feelings of shame. They've taken on a label, “I’m a sex addict,” and it can feel as if this is a permanent condition that they’ll never be able to get over or that they will always have to fight. Sex becomes a minefield and something to dread. There is a struggle to feel good about sex and a feeling that sex just gets them into trouble and causes problems. It can be a narrow and inflexible way to live. It also can lead to viewing sex as something pathological.
I see a big shortcoming of this model in that sex doesn’t work like other substances. Sex (when it is consensual) is a healthy and meaningful way of connecting with another. There is no useful definition of what kind of sex is pathological or how much sex is too much sex. The same amount of porn use or number of sex partners can be healthy for one person and problematic for another.
There is a bigger problem with this model: there isn't enough data to support it as an addiction or that treating it as an addiction is effective. In fact, the principle resource for diagnosing mental health issues, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), does not list sex addiction as a disorder and the primary association for sex therapy, the American Association of Sexuality Educators, Counselors and Therapists (AASECT), has issued a statement about why viewing sex as an addiction is problematic.
A different way to look at this: the out of control sexual behavior (OCSB) model.
Just because sex doesn’t fit well in the addiction model doesn’t mean that it can’t be problematic. For many men, their sexual behaviors have serious consequences on their relationships, their jobs, and their health. It can feel like this is a part of their life that doesn’t feel in control.
The out of control sexual behavior (OCSB) model offers a way to honestly assess what is working and what isn’t working in your sex life. Rather than view yourself as powerless, it helps to create a path for moving toward a healthier life. What feels out of control and what can you do about it?
What can you do with the OCSB framework?
How might you feel “in control” of your sex life? What would sex look like in order to feel like it was a healthy part of your identity? There are a number of ways to explore what healthy sexuality would look like and you can read more about this here. As you consider this you might notice that there are areas that feel easy to change, areas where you feel ambivalent about making changes, and areas where you may not want to change or need some support to make change happen.
Once you think about what healthy sexual behavior would look like, what can you do next? Simply changing a behavior usually isn’t enough. Typically out of control behaviors are motivated by painful experiences such as depression, anxiety, shame, and past traumas, as well as problematic beliefs and thoughts. In other words, out of control sexual behaviors are usually attempts to not feel pain. If you stop the behavior, you’ll need to find another way to deal with the pain. That’s where therapy can help.
How to move forward.
If you have sexual behaviors that feel problematic and out of control, being honest about what motivates your behavior (your thoughts, feelings, painful memories, etc) is an important step in making change happen. Working with a therapist can also be a good strategy for identifying healthy coping skills, addressing the underlying issues, and getting support to make real change happen. Ultimately, it is possible to create a sex life that feels happy and healthy and in control.