It is not easy to talk about a subject like this, but the hardest thing of all is for a person to admit that he or she has a sex addiction. That is why my clients most often come with questions about relationships or about problems in the family. And even after several sessions, once trust has grown between me and the client, very few are the first to speak about problems in their sex life or about the loss of control over their own body. My colleagues know that a client very often hides the real request; I call it "a screen request", and a professional spots the "screen" fairly quickly. In this article I want to open up the subject of sex addiction a little. Why it can be a problem, what may lie behind that problem and, above all, how to resolve it!
Sex addiction
There is no way of saying exactly how many people suffer from sex addiction. This is mainly because of the great sense of shame felt by those affected and their tendency to deny the addictive behaviour. It often takes them years to recognise their problem and to seek professional help, and the need for sexual gratification is so strong that they spend most of their time focused on satisfying it. Other everyday matters, such as work or a partnership, suffer and are increasingly neglected.
Doctors prefer to speak of hypersexuality, even though the term "sex addiction" has become widely accepted. You will often hear the term "nymphomania" for sex addiction in women; "satyriasis", for sex addiction in men, is heard less often.
The calm and free attitude of modern society towards sex has made this problem considerably sharper. A person who is supposed to be ready at any moment is under constant pressure, not only at work but in bed as well. He makes up for it by withdrawing into a world dominated by masturbation and anonymous sex.
So it is no surprise that one of the main symptoms of hypersexuality is an addiction to internet porn. According to an American study, 8.5 per cent of users spent at least eleven hours a week on a porn site; this is called cybersex addiction. Sex has become a consumer product and is flourishing in the porn industry.
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Loss of control over sexual desire
Excessive sexual activity can conceal a sex addiction. What is typical of it is the absence of control over one's own sexual behaviour. Negative, sometimes serious consequences are left out of account. As the addiction grows, the feeling of pleasure becomes weaker and in time disappears altogether. Such people tend to be led along in sexual acts, and feelings of guilt and shame follow
People with a sex addiction do not simply have a lot of sex. They have lost control over their sexual behaviour. Further symptoms:
- very frequent changes of sexual partner (promiscuity),
- excessive masturbation (masturbation),
- excessive consumption of pornography, cyber or telephone sex,
- an increasing number of visits to prostitutes,
- no serious relationships,
- compulsive acting out of sexual fantasies.
So-called paraphilic sexual disorders, the paraphilias (fetishism, sexual sadism or masochism, for example), can also become addictive.
Hidden behaviour with serious consequences
Those affected lose more and more control over their sexual behaviour and, as a result, the negative consequences grow. Uncontrolled sexual behaviour is for the most part hidden. It may involve creating situations that hold potential danger for oneself or for others, as well as financial, professional and social problems (in a partnership, for example). Unprotected sexual behaviour can also lead to sexually transmitted diseases.
People with a sex addiction feel less and less satisfaction from their sexual activity and often feel helpless or inadequate because of the lack of control they experience. The level of suffering rises. The addiction takes up more and more space and time in your life, until it may become the only thing there. Criminal behaviour (in the sense of a sexual offence, for example) can also be a serious manifestation of sex addiction.
How does sex addiction come about?
Exactly how sex addiction develops is not known. The following factors, however, may play a part:
- metabolic disturbances (the hormones dopamine and serotonin in particular),
- low self-esteem,
- the experience of sexual violence or other traumatic experience,
- problems in relationships and attachment,
- internet pornography and cybersex as possible secondary triggers (a high potential for addiction), and also
- stress, life crises.
Sexuality is experienced as a short-lived release from negative feelings and thoughts, from a sense of inadequacy and loneliness. Step by step, sexual behaviour becomes the most frequently used reward strategy. Such behaviour increases over time and is placed above all the rest. Other ways of coping with stress lose their rewarding character in favour of sexual activity.
Sex addiction often begins in childhood
Sex addiction often develops in adolescence. At the start there is a constant preoccupation with sexual thoughts and stimuli. This leads to ritualised sexual behaviour. You begin to "reward" yourself with sex.
Over time a feeling of despair sets in, and it becomes harder and harder to control your behaviour. Isolation follows. Relationships are spoiled. Despair, in turn, leads to stronger sexual desire by way of compensation.
Even though the strong emotional intensity of the first sexual experience is often the trigger, the reason a sex addiction develops usually lies much further back, in childhood. Almost all of those affected were subjected in childhood to violence in one form or another: physical, sexual or psychological. Often there is already a predisposition to addiction in the family, alcoholism for example. The cause may also lie in a particularly strict or prudish upbringing in which the subject of sex was forbidden.
Diagnosing sex addiction
The focus in diagnosis is on taking the medical history (the anamnesis). The main attention goes to the themes of sexuality, and also to sexual development and relationships. There are special psychological self-assessment tests (the Sexual Addiction Screening Test / SAST, for example, or the Hypersexual Behaviour Inventory / HBI). All the same, the test results normally have to be assessed by a specialist for their clinical significance. No psychological test, however, makes it possible to arrive at a diagnosis. Tests circulating on the internet should be questioned as to whether they are serious, though they can serve as a guide to possibly seeking professional help.
Personally, I believe that the most important test is the opinion of the person seeking help, someone who has either seen this addiction in themselves or listened to the opinion of those close to them.
In the ICD-10 diagnostic manual, different diagnoses are assigned to sex addiction depending on its form and severity, among them:
- excessive sexual drive
- Obsessive-compulsive disorder
- unspecified sexual dysfunction
- unspecified abnormal habits and impulse control disorder.
The paraphilias (these involve sexual arousal from atypical items, situations and/or objects of arousal, such as children, corpses or animals. Some kinds of sexual activity that seem unusual to other people or to a doctor are not paraphilias merely because they are unusual) are set out separately in ICD-10. For a diagnosis to be made, the symptoms have to last at least six months and to cause serious difficulty and suffering in everyday life. Physical and other psychiatric causes (mania or emotionally unstable personality disorder / borderline type, for example) or neurological ones (brain damage, for example) also have to be taken into account. The risk of a further mental disorder (an anxiety disorder, depression or an eating disorder, for example) or of another addiction, as well as of pathological gambling, is raised for those affected.
Help with sex addiction
The treatment options for sex addiction include:
- Psychotherapy (individual, group, couples or family therapy)
- Medication (antidepressants that work against depression, for example)
In psychotherapy or sex therapy, alternative forms of behaviour are explored, among other things. Usually a sex addiction is an attempt to solve a non-sexual problem in life. So the work is also about that underlying subject.
Attending self-help groups (Sex Addicts Anonymous, for example) may also prove useful. If uncontrolled sexual acts lead to sexual offences, drugs that suppress the sex drive are used as well.
What can I do on my own?
Admitting the problem is the first and most important step. Usually, though, this is very hard. Distorted ideas about oneself and self-justification make it difficult to admit the problem. Feelings of shame and guilt do not make the task easier either. All the same, try to get help quickly. Professional helpers do not blame, are not surprised and do not judge.
What can partners do?
Partners should be alert to possible signs of co-dependence.
Try to keep control over your partner's sexual behaviour, not to deny the sex addiction and not to allow:
- Sex without desire,
- Sex as a reward,
- Sex despite pain.
Do not be afraid to ask for support if you are suffering from your partner's behaviour.
A healthy attitude towards sex
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