Compulsive Sexual Behavior
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Compulsive Sexual Behavior or ‘Sex Addiction’ as it has been referenced….
The label of ‘sex addiction’ is a controversial topic. That label alone can spark frustration & ire amongst general/couples therapists & sex therapists.
The area of contention is ‘by definition, can it be called an addiction?’ If we follow the DSM’s definition, the answer would be no as it currently remains unclassified. If we place ‘sex addiction’ in say the same category as a substance use disorder, there are 2 criteria of note: tolerance & withdrawal. These 2 criteria are not met with regard to compulsive sexual behavior.
Tolerance
Tolerance implies that the sexual behavior has to start as pleasurable and then over time ceases to become pleasurable without an increased dose or frequency. I have yet to meet a client with compulsive sexual behavior that ceases to find sex pleasurable or needs increased frequency to find it pleasurable. “Sexual pleasure never stops being pleasurable and people don’t need to have more sex to achieve the same pleasure” (Neves, 2020, p. 6).
Withdrawal
As far as I have researched, withdrawal has never been observed in sexual behaviors because our bodies are naturally designed to sustain the brain chemical involved in the pleasure experience of sex and the orgasms (Neves, 2020).
Compulsivity on the other hand….
Berlin and Hollander (2008) define compulsivity as the tendency to perform behaviors prematurely and without foresight for the purpose to increase arousal. It is the tendency to repeat the same, often purposeless acts, which are sometimes associated with the undesirable consequences for the purpose of relief or tension. Think of it as a compulsion aims to reduce unpleasant emotions. Almost like an escape. With that release, the stress and anxiety that one feels is alleviated at the moment of the compulsive behavior.
The ICD-11 Definition of Compulsive Sexual Behavior:
Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.
Did you catch that last bit? Revel in that for a second….
If the distress is entirely related to moral judgements of others, this does not meet the criteria for compulsive sexual behavior. Let’s keep that in mind….
Why does the word you use matter?
With many clients, the compulsive sexual behavior is a coping mechanism for a deeper existential injury created earlier in life. For instance, imagine the woman that seduced men simply because she could, regardless of if she was in a committed relationship. With further inquiry, we learn that in her youth she experienced multiple sexual traumas and was placed in a space of submission to men with no agency, power or control. When she details her emotions as she seduces men, the common theme is feeling a sense of power over them. When we look at her behavior from this context, this is not someone that is addicted to sex. This is someone that is processing prior trauma and reclaiming power through seducing men. In sex therapy, we acquire that understanding and learn other methods by which to meet her needs.
The psychological treatment would start with complex trauma therapy, not a 12-step addiction protocol. The difference may seem subtle and insignificant, but the psychological treatment varies between the two drastically. Many 12-step protocol therapies place the client in a position of examining all of the things that are ‘wrong’ with them and are heavily focused on abstaining. Well, I can not imagine a sexual, sentient being abstaining from sex for forever. It almost seems ridiculous as sex is natural and abstaining from what is natural seems punishingly unrealistic. However if we process the underlying trauma and assist the client in creating meaning, oftentimes the compulsive behavior subsides on its own.
Compulsivity can not thrive where there is meaning or purpose in one’s life.
Are all areas of your life being embraced (social, relational, familial, authenticity, your personal values)? As an existential sex therapist, treatment for sexual compulsivity always entails finding meaning in the behaviors but also how to add more meaning to your life to fulfill your needs and align with your authenticity.
“ Sexual compulsivity thrives in deprivation. It
tries to compensate for something important that you’re not getting. One
way to look at it is with your pie of life. Often, many people live a life with
one or two slices of their pie, and perhaps a few crumbs from missing slices.
That is dissatisfying and keeps you wanting something more. You have the
right to have your full pie, consistently. So let’s look at the slices that you do
have, and those that you need to add for a fuller, delicious pie’”
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Neves, S. (2020). Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians (1st ed.). Routledge. https://doi.org/10.4324/9781003029502
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