In recent years, the concept of "sex addiction" has gained significant attention in popular culture, primarily around the work of Patrick Carnes, who has merged the "sex addiction" world with the 12-step modalities and concepts in the early- to mid-1980s. Since this time, many individuals and therapists have embraced the idea that some people suffer from an uncontrollable urge to engage in sexual behaviors, labeling it as an addiction. However, it is essential to critically examine this notion and question whether "sex addiction" is a legitimate medical condition or a societal construct. While I will never say that, for some people, sexual behavior is hyper-focused on and these behaviors and choices a person makes, have never had negative impacts on their lives and the lives of the people close to them, the construct of "sex addiction" can cause potential harm by pathologizing normal human sexual behavior. This opinion blog is not to argue that some people have sexual behavior that has become problematic in their lives and cause real, evidenced, trauma and pain. It is truly the argument of how controllable it is that the various camps of sexologists fall into. Here are some challenges to the notion of "sex addiction," as crammed into the lenses of the "addiction model" that substances use:
Absence of Diagnostic Criteria: Unlike recognized psychiatric disorders such as substance abuse or gambling addiction, the label "sex addiction" lacks standardized diagnostic criteria (though, if we had to shove it into a type of addiction folder, "behavioral addiction" would be the best fit...but, even then, we do not have the unbiased scientific evidence for this yet). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the authoritative guide used by mental health professionals, does not include "sex addiction" as a formal diagnosis. The absence of clear diagnostic criteria demonstrates the lack of consensus within the scientific community regarding the existence of this condition. It is worth mentioning, though, that the ICD-10 (which is the international diagnosis authority, similar to the DSM-IV that we have here in the USA) includes "Compulsive Sexual Behavior Disorder" in their rankings, but it is still not touting the message of "uncontrollable."
Over-pathologizing of Normal Sexual Behavior: One of the main criticisms, and perhaps the most damaging overall, of the concept of "sex addiction" is its tendency to pathologize normal human sexual behavior. The spectrum of human sexuality is vast, and individual preferences and desires can vary significantly. Labeling consensual sexual behaviors as addictive undermines personal autonomy and reinforces societal stigma surrounding sexuality. Moreover, sexual desires can be influenced by various factors such as biology, culture, and personal experiences. It is crucial to recognize that engaging in frequent or diverse sexual activities does not necessarily indicate an addiction. Often this is showing up in the form of a partner not liking the same things as the labeled "addict," or it bringing up an insecurity their partner has about themselves or their sexual functioning/view of the world. This mismatch should never be used to label someone as an "addict," but I have seen it time and time again in my office. (Do not read this as a justification for, or excusing of, a person choosing to cross marital/relationship boundaries -- that is NOT the same thing!) The focus should be on promoting healthy attitudes, open communication, and consent, rather than pathologizing consensual sexual behavior.
Lack of Scientific Consensus: The scientific community, especially those of us who study and work in the clinical realms of human sexuality, remains divided on the existence of "sex addiction." Some studies have attempted to establish a link between compulsive sexual behaviors and addiction-like processes, but the research in this area is characterized by significant methodological limitations. For example, many studies rely on self-reported questionnaires and clinical samples, which can introduce biases and fail to provide a representative picture of the general population. Additionally, neuroscientific (studying of the brain) studies have not identified any specific brain abnormalities or neurochemical imbalances that are unique to individuals allegedly suffering from "sex addiction." In contrast, studies on substance addiction have consistently demonstrated neurobiological changes associated with drug use and withdrawal. This is not saying the "reward center" of the brain is not being activated when someone struggling with problematic sexual behavior is acting in their behaviors, but it is saying that there is no major differences between the brains of someone engaged in sexual behavior versus someone shooting up an illegal drug. People labeled with "sexual addiction" have the same brains as someone struggling with chemical addiction. The studies that I have seen that propose there is "sexual addiction," tend to be funded by (and thus biased) a religious sect or point of view, pushing for a specific religious-based agenda of what "health sex" is/should be. While most people would agree it is usually not a good idea to force someone to ascribe to a spiritual/religious belief, the same should be expected of science that is applied to ALL people: science and scientific study should never be influenced or biased by a specific religion. To be truly scientific, you want any study to be as neutral as possible and not try to sway, or fit, the outcomes/answers from a study to align with what someone wants/doesn't want. Basically, scientists doing research need to be prepared to find an answer that goes against their original hypothesis! If you are only finding answers that align with your beliefs, then there should be some further questioning/studies to go deeper into that. And sometimes the "it doesn't support what I wanted it to" or the "there were no findings to support that" is the answer -- and should spark further research into the "why" and perhaps make a person look at their own beliefs about the topic. Otherwise, you are creating an "echo chamber" to validate your personal, moral, and/or religious beliefs, not base it in science. (Which, yes, science often changes.) Which lead to the next point nicely....
Social and Cultural Factors: The concept of "sex addiction" is heavily influenced by social, religious, and cultural factors. In a society that often struggles with open discussions about sex (I'm lookin' at you, America), it is not surprising that individuals experiencing sexual guilt, shame, or dissatisfaction may seek to label their (or their partner's) behaviors as an addiction. By doing so, they can externalize (and sometimes avoid) responsibility, find a sense of relief from societal judgment, and/or push the focus away from their own insecurities on to someone/something else. And what does that really do but further perpetuate the real underlying problems within the self/relationship? Moreover, the diagnosis of "sex addiction" is predominantly based on subjective interpretations (what a specific person thinks) rather than objective (what is based in fact) criteria. What may be considered excessive or problematic sexual behavior in one culture or society may be perceived as normal in another. These cultural variations indicate that "sex addiction" is a socially constructed concept rather than a universally recognized medical condition.
Conclusion: While individuals may experience distress related to their sexual behaviors, it is important to challenge the idea of "sex addiction." The absence of diagnostic criteria, over-pathologizing of normal sexual behavior, lack of scientific consensus, and the influence of social and cultural factors all contribute to the argument that "sex addiction" is not a valid medical condition. Instead, society should prioritize comprehensive sex education, de-stigmatization, and support systems that promote healthy sexual relationships, consent, and communication. By moving away from the notion of "sex addiction," which shifts the focus away from something "uncontrollable," we can avoid the struggle of placing the accountability of hurtful boundary-crossing behaviors, secrecy of a "hidden life" outside of a primary relationship, and move people toward more honest, fulfilling, and consenting sexual experiences and lives.
No one is saying that sexual behaviors, attractions, and how they are chosen to be expressed never cause harm to others or are difficult to untangle from aspects of our lives, but by removing it from the "sex addiction" label, we're allowing people even more autonomy, freedom, and control over their sexual selves. If I am shown non-biased research that points to inarguable evidence of "sex addiction" being real, I will apply what I've written above and look into my own thoughts and beliefs; but as things stands, "sex addiction" labels only provide justifications to excuse hurtful choices, not based in the "six principles of sexual health," as proposed by Doug Braun-Harvey, LMFT (co-creator of the "Problematic Sexual Behavior" model and one Jessica uses in her work and frame of reference).