Frequently Asked Questions

Addictions are diseases of escape and avoidance from internal distress and the difficulties of life. Any behavior used to produce gratification and escape painful feelings can be engaged in compulsively and develop into an addictive disorder. There are both substance addictions (alcohol, drugs, etc.) and process addictions (gambling, shopping, sex, etc.).

The Society for the Advancement of Sexual Health has defined sex addiction as a “persistent and escalating pattern or patterns of sexual behaviors acted out despite increasingly negative consequences.” Sexual acting out behaviors are used to manage painful affect and often the anxiety and stress of unresolved trauma or abuse.

Examples of such behavior include: pornography, compulsive masturbation, cyber sex or phone sex, use of prostitutes, multiple anonymous partners, voyeurism or exhibitionism.

Whatever the specific behavior, the defining feature of sexual addiction is the addict’s inability to control or stop the behavior, and escalating use despite significant negative consequences such as loss of relationships, career, money, reputation, disease, arrest.

Diagnostic criteria indicating the presence of sexual addiction in one’s life include the following:

• Recurrent failure to resist sexual impulses to engage in specific sexual behaviors.
• Frequently engaging in such behaviors to a greater extent or for a longer time than intended.
• Persistent desire or unsuccessful efforts to stop, reduce, or control the behavior.
• Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experiences.
• Preoccupation with sexual behavior or preparatory activities.
• Frequently engaging in the behavior when expected to fulfill occupational, academic, domestic or social obligations.
• Continuation of the behavior despite persistent or recurrent social, financial, psychological or physical problems that are caused or exacerbated by the behavior.
• Needing to increase the intensity, frequency, number or risk level of behaviors in order to achieve the desired effect.
• Giving up or limiting social, occupational, or recreational activities because of the behavior
• Distress, anxiety, restlessness or irritability if unable to engage in the behavior.

Three or more of the ten criteria usually indicate the presence of sexual addiction and the need for professional consultation.

Sexual anorexia is an obsessive state in which the physical, mental and emotional tasks of avoiding sex dominate one’s life. Like self-starvation, sexual deprivation can make one feel powerful and defended against all hurts. Sexual anorexia is about much more than simply not being sexual: it is about compulsive avoidance.

• Recurrent patterns of resistance or aversion to any sexual activity, initiative or behavior.
• Extreme efforts to avoid sexual contact, including self-mutilation, distortions of body appearance.
• Rigid and judgmental attitudes toward one’s own sexuality or the sexuality of others.
• Extreme shame and self-loathing about sexual experiences and one’s sexual attributes.
• Sexual aversion affects work, hobbies, friends, family and primary relationship.
• Preoccupation or obsession with avoiding contact or preoccupation with the sexual intentions of others.
• Despair about sexual functioning.
• Avoidance of intimacy or relationships because of fear of sexual contact.
• Distress, anxiety or irritability because of sexual contact or the potential for such contact.
• Persisting in extreme avoidance activities even though it is self-destructive or harmful to relationships.

Recent research indicates that there are over twenty million sex addicts in the United States. These are men and women, straight, gay, bisexual, from all socioeconomic levels for whom sex is no longer a pleasurable experience, but rather a consuming, voracious craving. The fastest growing area of sexual addiction is internet porn. Research also demonstrates that the escalation rate of the addiction is exponentially faster when the internet is involved. Patrick Carnes, Ph.D., has referred to online sexual activity as the “crack cocaine of sex addiction.”

Fortunately, in recent years the therapeutic community has learned a great deal about sexual addiction and its progression, its causes and consequences. Growing numbers of clinicians are specializing in this area and have undergone training with Patrick Carnes, Ph.D., and have become Certified Sexual Addiction Therapists (CSAT). This state of the art training program is sponsored by the International Institute of Trauma and Addiction Professionals (IITAP). Additionally, there are a growing number of Twelve Step programs for sexual recovery, based on the model pioneered by Alcoholics Anonymous. For most persons, a combination of Twelve Step work and psychotherapy works best.

Many of the same clinicians who work with addicts are also trained to work with partners. Co-Sex Addicts Anonymous (COSA) is a Twelve Step program designed especially for partners of sex addicts and can be a significant source of support and encouragement. In the absence of COSA, ALANON can be a valuable resource as well.