Recently it has become more commonplace to have clients come into my office and state that they have a sex addiction. Often when asked how this was diagnosed they respond that their spouse or other family member told them or they read a book and self-diagnosed. Sometimes when examined more closely, the client does not have a sexual problem at all, just a higher than average sex drive well as living in a sex negative environment.
Many sexologists are beginning to speak out about the attitude that promotes the current level of misunderstanding about problematic sexual behavior. Many practitioners would condone a client who watched 3 hours of reality shows on prime time as normal, while someone who views an hour or two of porn on the internet as an addict. Could both people be spending their leisure time more productively? Absolutely, however if both are able to be productive in their jobs and relationships, then why would some view the latter as problematic?
No one denies that sex, like many other things, can become compulsive, problematic behavior. As some would say, sex is like Jell-O in the refrigerator, it takes on the flavor of whatever you put with it. Sex can be sacred, loving, kind, healing and fun if that is the focus. It can also be hurtful, coercive, demeaning, or wounding.
There are several problems with the diagnosis of sexual addiction. The first is that no such diagnosis appears anywhere in the commonly used diagnosis processes. When dealing with issues of chemical abuse, therapists do not use the word "addiction", but rather "dependency". In 1964, the World Health Organization declared the term "addiction" to be clinically invalid and recommended the term "dependence" which can exist in varying degrees of severity and does not rely on the disease model of sick or well.
Another problem is that those from the addiction model view point have rather unclear definitions even within their diagnosing methods. Dr. Patrick Carnes who is the founder of the sex addiction movement has a questionnaire frequently used to determine if one is a "sex addict". It asks questions such as "Do you often find yourself preoccupied with sexual thoughts?" and "Do you feel that your sexual behavior is not normal?" These types of questions do not take into account that healthy sexual expression encompasses a wide range of forms, functions and frequency. Sexual behavior, thoughts, and feelings exist on a continuum rather than a definite point.
Part of the reason that the sexual addiction movement is so popular is that it takes away personal responsibility for sexual choices. A person can blame their addiction for their behavior instead of having to face themselves. Our sexuality is not always pretty, perfect, or easy to understand. The lack of proper sex education or ability to discuss sexual issues openly feeds the shame and public ignorance about sexuality. This makes it easy to spread dangerous lies about sex and allows people to continue to harbor ignorance about issues such as masturbation even though no medical society in the world has ever proven that masturbation is harmful.
Human sexuality is complex and requires being comfortable with uncertainty. Those in the sex addiction field would like people to fear their sexuality, be powerless over it, and lack the tools to understand how to deal with any compulsive or destructive behaviors. Treating clients with problematic sexual behaviors requires an understanding of human behavior, the wide range of healthy sexual expression, and a belief that people are strong enough to handle the complex issues of their own sexuality, for better or worse.
