How Real is Sex Addiction?

By Anna David 12/11/11

Newsweek says sex addiction is rampant, Salon insists it's a myth. What's the truth? Our resident expert tries to get to the bottom of this shadowy subject.

Image: addiction.jpg
Michael Fassbender plays a sex-obsessed suit in the hit movie "Shame' Photo via

You can’t turn on your television, click on a website or see a movie at the multiplex these days without tripping over sex addiction. From the brilliantly disturbing NC-17-rated Shame—with its attendant Oscar buzz and star-making performances—to Bad Sex, the Logo reality show about sex addicted liars, cheaters and misogynistic loners (Logo wording, not mine!) to the hype about the upcoming sex addict dramedy Thanks for Sharing, sex addiction has certainly become our cause du jour. It’s safe to say that when squeaky-clean Gwyneth Paltrow signs up to play a nymphoniac, the issue’s gone mainstream.

But how much of the noise about sex addiction is accurate and how much of it is pop culture hysteria? In other words, with Newsweek declaring sex addiction an epidemic and Salon countering with a piece that it’s not even real, what’s the real story? 

When I was about four years sober, I was diagnosed as a sex addict. Here's how it happened: I was in a therapy session one day that ended where it usually did: with the revelation that I had trouble with boundaries because I grew up in a family that also had trouble with them. My therapist—a lovely, brilliant woman who I am still in touch with today—recommended I deal with it by attending a weeklong retreat called “Survivors,” which was part of the program at The Meadows rehab in Wickenburg, Arizona. Survivors, she explained, was a requirement for everyone enrolled in their 28-day inpatient drug and alcohol rehab, though denizens of the outside world were also encouraged to attend. The name Survivors sounded a bit daunting but the site for it simply stated that it was a workshop that "investigates the origins of adult dysfunctional behaviors by exploring early childhood trauma that has led to various addictions, depression, eating disorders and painful relationships." Because a week in Arizona sounded nice, because of how much I trusted my therapist and because I’m always, arguably to a fault, looking for ways to try to improve myself, I signed up.

The only way to get the AMA to endorse addiction medicine as a new specialty was to exclude sex addiction altogether.

By the end of the week, my group leader had diagnosed me as a sex addict.

“Me—a sex addict?” I’d cried. “I don’t even have that much sex!”

“I realize that,” he’d responded, answer at the ready. “That’s because you’re partially a sexual anorexic.”

A sexual anorexic—a term that was new to me that week—is, for the uninitiated, “an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one’s life” (at least according to Patrick Carnes, a sex expert who had been, until 2004, the Clinical Director for Sexual Disorder Services at The Meadows). I told the counselor, Clint, that this wasn’t accurate either. “Oh yes it is,” he’d said. Which made me wonder: was I, to spin a line from When Harry Met Sally, not having sex with men without my knowledge?

What had happened between the first session—when Clint had told all 50 or so of us that we were suffering from Post-Traumatic Stress Disorder (PTSD) from our respective childhoods—and the last, when he’d singled me out as someone who “needed” to “immediately” sign up for their 28-day program?

In my opinion, a lot of silly stuff. There was a lot of hearing that we'd been terribly emotionally abused by our parents even if we felt we hadn't been, a lot of hitting of chairs with felt bats, a lot of throwing of Kleenex across the room (the chairs were meant to be the people who’d hurt us, I believe, and the Kleenex symbolic of us letting go of our issues), a lot of holding of stuffed animals that were supposed to symbolize our inner children (I recall the term “little Anna” being used more than once). Everyone else seemed to love it—tears were shed, epiphanies were reached, fences with family members who weren’t in the room were magically mended. Only I remained dry-eyed, feeling foolish.

We never really talked about sex but Clint asked us to fill out questionnaires about our sex lives and then drew conclusions from what we’d written. Why he determined that I was the one suffering from sex addiction—as opposed to say, the dental hygienist who’d lost her job because having sex with her coke-addicted, abusive boyfriend had caused her to test positive for cocaine—was never made clear. I asked him if it was because I talked about sex on TV and wrote about it in articles and he assured me it wasn't. I think it might have had to do with the fact that he theorized (incorrectly, as it turned out) that I had the spare $40,000 sitting around to pay for the month-long treatment The Meadows offered (and he insisted I needed).

So why do I tell you this embarrassing story about one of the more disturbing weeks of my life? Because sex addiction is, in my opinion, an extremely serious disease—one I learned a lot more about as I went to 12-step S meetings after my Meadows experience trying to see if I had it. After not relating at all in the SLAA meetings—I’d sit next to women who were counting how many days it had been since they’d publicly masturbated—I sought out a meeting for sexual anorexics. Listening to a group of people share about how they’d sometimes have trouble leaving the house for up to six months at a time, I counted the minutes until I could leave. I didn’t relate but I kept going, telling myself I must just be in denial—like any number of alcoholics I’d met who insisted they were fine. I was diagnosed with this, I kept thinking. I must have it. After six of the most depressing months of my life, I finally quit that 12-step program, and have felt relieved ever since. (I’m not saying the sex programs don’t help many people—I personally know some who have been transformed by them—but the pain of forcing yourself to go to a program because you’ve been told you should even though everything in you tells you it’s not for you is all too real.)

So what is and isn’t real in terms of sex addiction and its ancillary terms? While reputable publications claim that sex addiction isn’t real—touting the fact that it was rejected from the Diagnostic and Statistical Manual of Mental Disorders (otherwise known as the DSM) as proof—the truth is far more complicated. Essentially, as Cupid’s Poisoned Arrow author Marnia Robinson explained in a recent Psychology Today post, the only way to get the AMA to endorse addiction medicine as a new specialty was to exclude sex addiction altogether. “You don’t want to sacrifice the good for the perfect,” says Dr. David E. Smith, the Alternate Delegate to the American Medical Association’s House of Delegates in 1992, when the decision was made. “Our big battle was to get addiction accepted as a medical specialty and to have smoking included in that.”

Smith, who started the Haight Ashbury Free Clinic in 1967 and currently chairs the Adolescent Addiction Medicine program at Newport Academy, very much believes sex addiction is real but says that the fight that tobacco companies were putting up meant that negotiating was a necessity. “When we said smoking was addictive, they countered with, ‘You call everything addicting: surfboarding, sex…’” Smith recalls. “We would have fed into the tobacco industry’s well-funded fight to get addiction medicine thrown out altogether [if we hadn’t done it this way].”

As for sex addiction and the DSM, Smith has his theories. “I think that the politics behind the resistance is that they don’t want, in situation like what happened with Jerry Sandusky, for him to be able to use sex addiction as an excuse. There’s also the insurance company battle—if sex addiction is accepted as an addiction, insurance companies are going to have to pay for its treatment.”

None of this bargaining and compromise comes as a surprise to sex addiction experts. “What goes on in the medical community is almost as political as what goes on in Congress,” notes Robyn Cirillo, a psychotherapist for over 30 years who practices in New York and specializes in trauma. Adds Alexandra Katehakis, the Clinical Director for The Center for Healthy Sex and the author of Erotic Intelligence (which lays out a healthy model of sexuality for sex addicts), “Clinicians always see what’s going on at the forefront before researchers catch up to it.” In other words, in the current day and age—when psychiatrists have become little more than medication dispensers who charge astronomical amounts to not even talk to their patients—it’s the therapists that are actually seeing sex addiction play out in the field.

The dangers of this political power play and the lack of understanding among the decision-makers are all too real. “The same thing happened with eating disorders,” Katehakis says. “For a long time, people said food couldn’t be an addiction—until the recent Yale University study proved that it is. But in the meantime, millions of people suffered and died from obesity.” Cirillo adds, “Alcoholism and homosexuality used to be thought of as things you should be able to control with your own willpower—alcoholism finally got put in the DSM just as homosexuality was taken out. But this was in the 1970s! Why did it take so long?”

 “Saying that sex addiction isn’t real is like saying that the world is flat,” says Shame director Steve McQueen.

When people therefore posit that sex addiction isn’t real—as David Ley, a clinical psychologist in New Mexico and the author of the upcoming book The Myth of Sex Addiction—has, it’s skewing facts and adding unnecessary complications to an already complicated issue. “Saying that sex addiction isn’t real is like saying that the world is flat,” says Shame director Steve McQueen, who, along with his co-writer Abi Morgan, interviewed numerous clinicians and sex addicts as research for the film. What surprised him the most as he talked to the people he ultimately based his film on was that “when people imagine sex addicts, they picture freaks but these were normal, everyday people—albeit people who suffered from immense self-loathing and shame.” (The movie title is no accident.)

Self-loathing and shame aren't new emotions to drug addicts and alcoholics—some of whom, in sobriety, discover they're addicted to sex (or food or gambling or fill in the blank with anything addictive). “I’ve never treated anyone who didn’t have a dual addiction,” says Dr. Paul Hokemeyer, a marriage and family therapist who specializes in relationships and addiction. Katehakis seconds this, adding, “People often have co-occurring issues.” While the sex-addiction-is-fake camp use this fact as part of their argument, it’s probably more helpful to advise sober people to be on the lookout for any potential obsessive or compulsive sexual behaviors that are making their lives unmanageable than to label them pejoratively as people with “major mental-health problems.” The good news, according to Katehakis, is that those suffering from sex addiction don’t always need to work a secondary program. “Many people who start applying the principles of recovery to their lives begin applying them to all areas of their lives,” she says. Still, she cautions, “Sex addicts often have high levels of compartmentalization so denial is possible.”

Still, when taking stock of sex addiction—on both the personal and clinical level—it’s important to stick to the facts. While the constant parade of sex scandals can certainly help edify the public about sex addiction (as Katehakis says, “Usually where there’s smoke there’s fire so if somebody is doing something once, they’ve probably done it twice or three times and can’t stop doing it”), tossing around labels willy-nilly doesn’t help anyone. “Sex addiction isn’t like diabetes,” Cirillo says. “A doctor can’t do a blood test and tell you whether or not you have it. Like with other addictions, it’s self-diagnosed. And when clinicians diagnose people, it’s dangerous because it scares them and is very shame inducing. The best we can do is educate people so that they know what is and isn’t proper therapy.”

If only she'd been around at The Meadows.

Anna David is the Executive Editor of The Fix and the author of the books Party Girl, BoughtReality Matters and Falling For MeShe's written about Tom Sizemore, Nic Sheff, and gambling addiction, among other topics, for The Fix.

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Anna David is the New York Times-bestselling author of multiple books about overcoming difficulties and coming out on the other side: the novels Party Girl (HarperCollins, 2007) and Bought (HarperCollins, 2009), the non-fiction books Reality Matters (HarperCollins, 2010), Falling for Me (HarperCollins, 2011), By Some Miracle I Made It Out of There (Simon & Schuster, 2013) and True Tales of Lust and Love and the Kindle Singles Animal Attraction (Amazon, 2012) and They Like Me, They Really Like Me (Amazon, 2013). Find Anna on LinkedIn and Twitter.