Does Sex Addiction Exist?

In the last three posts I’ve examined and critiqued the specific claims by the Center for Healthy Sex about the sex addiction diagnosis. It’s time to look at the broader picture. Is sex addiction a real diagnosis?

On the pro side, arguments are usually about the tremendous harm alleged sex addicts cause themselves and others through their compulsive acts, as well as the struggles these people have with changing their behaviour. To deny the diagnosis is akin to denying alcoholism, something that would leave suffering people out in the cold. Not to mention potentially contributing to the stigma of mental illness. On the anti side, arguments are usually about the sex addiction diagnosis as being more about the conservative, narrow judgements about what sexuality should be over helping people. To pathologise behaviour in this manner is to contribute to sex negativity of the broader culture. Not to mention the ridiculous ease at which people proclaim others to be sex addicts (especially cheating spouses).

Before going on, some relevant source materials. On the anti side, two posts by sex therapist Marty Klein. Also, an MP3 of a 30 minute debate between Benoit Denizet-Lewis on the pro side and Dan Savage on the anti side. Also, two roundups that have examined arguments by the above 3 people: Tracy Clark-Flory and Amanda Marcotte. The first leans somewhat towards the anti side, the second does this more solidly.

Here are some of my reactions to the issue when taken as a whole. In no particular order.

• As the anti side says, there’s a difference between x being a disease and x being a symptom of an underlying compulsion or self-destructive behaviour. Just because sex is the outlet does not necessarily qualify it as a unique condition. For instance, OCD can manifest in a number of ways but it would be weird to classify each behaviour as a separate condition. On the other hand, this could be applied to alcoholism as well. I think the difference is that alcoholism is associated with a specific neurological dependence. But I wouldn’t be surprised if we found such dependence in certain people who fall under a (sophisticated) definition of health addiction.
• A large proportion of treatments for and views of sex addiction are utterly puritanical. Or at the very least, they have a very cookie cutter 1950s view of sex. As Marty Klein says, there is no model at all of healthy S&M, healthy non-monogamy and so on. Such views do not appear to admit in principle that anyone engaging in sex work has a healthy sex life. It’s not just the website I looked at but a great deal of the other stuff I’ve seen. According to Marty Klein’s post, some programs require total “sobriety” including abstaining from masturbation(!). It’s not enough for the pro side to say “yes there are plenty of simplistic and puritanical views on sex addiction but we have a non-judgemental, sophisticated model”. The typical view of sex addiction appears to be the bad kind and this needs to be acknowledged and dealt with by the thoughtful pro side members.
• A particularly pernicious part of much talk of sex addiction is that it’s not mindful of the long history of mental illness being society’s way to control people and to express disapproval. Sure, it’s not clear how many from the pro side are imposing the sex addiction diagnosis on unwilling patients. But judging by some of the rhetoric I’d wager this is common enough to call for skepticism about the diagnosis.
• On the other hand, I’ve seen some on the anti side express some anti-expert, anti-intellectual attitudes when making their case. Some of the arguments stem around the idea that sex addiction is just a case of “poindexters trying to excuse what is obviously just bad behaviour (and bad choices) by turning it into a disease”. I don’t find this reliance on common sense any good. Appeals to folk wisdom do not get us anywhere and neither do “common-sense” notions of personal responsibility. These are denialist tactics.
• The pro side run up into anti-expert, anti-intellectual attitudes as well. The most serious is how common it is to find people performing armchair diagnosis on their partners, or even celebrities. From Klein’s post: “I saw a guy last fall in an even more extreme situation. His wife had caught him seeing out-of-town prostitutes. Not only did she decide he was a sex addict (and porn addict), she demanded he begin treatment at an in-patient facility.” You might think it’s unfair to have a go at members of the general public here. But I think these are just the harmful effects of general awareness of sex addiction in the public. It’s the way sex addiction is described in the media and pop culture that’s contributing to these.
• There is a lack of consensus science-based expert opinion about an adequate model for sex addiction. In a telling moment in his debate, Benoit Denizet-Lewis admits this to be true, but then says this is because there hasn’t been enough research. He continues (paraphrased): “have you tried getting government funding to study sex addiction?” The implication is that because it’s politically unpopular it’s being supressed. This is another denialist tactic. Even if Denizet-Lewis is not engaging in conspiracy theories (I don’t think he is and what he said might be true), the fact is that we don’t appear to have enough research. The pro side would be justified in making more modest claims in lobbying for research and suggesting its necessity. Unfortunately, a lot of the pro arguments act like the research has already been done.
• Finally, there is too much anecdotal evidence in these discussions. In the debate, Denizet-Lewis acknowledges that there are interventions where the [sex-negative] people in someone’s life think they’re a sex addict due to them being judgemental as opposed to the person having a problem. But he says about 5% of interventions are like that. To be charitable, let’s assume he meant “5%” as a stand in for “a small proportion”. Still, where’s the data? I think it would be a lot higher. Either way, we can’t argue using evidence that does not yet exist…

In conclusion, I think there is room for a sophisticated diagnosis of sex addiction within our society. But for this to happen, we need to get good evidence suitable for a model the experts can agree on and we need to expunge the unsophisticated, sex-negative version of sex addiction from the discourse. Until this is done, I think it’s doing more harm than good. So I’m also joining the anti camp (but leaving a window open conditional on the right developments). Until then, I still think a good framework to help whose sex lives have taken over their lives is one similar to Klein’s one. He treats “obsessive-compulsive disorder, bipolar disorder, post-traumatic stress disorder, depression, and a few other exotic states” especially when any of these manifest in sexual behaviours that cause suffering or harm to the patient.