Taylor, a 31-year-old in Los Angeles who asked that only her first name be used for privacy, started having casual sex several times a week in college. Her friends warned her she could be a sex addict. At age 21, she was a victim of revenge porn, which her therapist considered evidence that her friends’ sex addiction theory had merit. “I thought it was all my fault,” she said. “That's when I surrendered and accepted the ‘diagnosis’ of sex and love addict.”
For four years, Taylor attended volunteer-run Sex and Love Addicts Anonymous (SLAA) meetings, which follow the 12-step model of Alcoholics Anonymous. Members suggested she had repressed childhood sexual trauma and urged her to be celibate for a year. Once she’d made it nine months, she followed the other women in the group's example and committed to only having sex within monogamous relationships. Whenever she felt desire, she said, "I berated myself and dragged myself to a meeting in fear of falling back into ‘old habits.' I felt like a zombie." Over time, Taylor wondered why she was being encouraged to think of sex like a disease. At meetings, she asked, “Who decides how much sex is too much? How do we know if we're addicts?"
After receiving unsatisfying responses, Taylor saw a sex therapist. "Is it possible that you're not a sex addict, and maybe you're just a woman who enjoys sex in a society that shames women for enjoying sex?” he asked. She cried with relief on his couch.
Sex addiction has never been a formal diagnosis. Though treatment centers and books like Patrick Carnes’s 1983 Out of the Shadows: Understanding Sexual Addiction have popularized the term, the mental health field is increasingly critical of it, based on research suggesting that sex does not affect the brain like an addictive substance. A 2016 study by sex researcher Nicole Prause in PLOS One, for example, found that people who engaged in risky sexual behaviors were more sensitive to genital stimulation, not desensitized, as the sex "addiction" model would predict.
The American Psychiatric Association repeatedly rejects proposals to add sex addiction or “hypersexual disorder” to the Diagnostic and Statistical Manual. In the 2018 edition of the International Classification of Diseases, the World Health Organization also rejected the label of sex addiction and instead included "compulsive sexual behavior disorder." Many psychologists favor the latter label because it describes a behavioral pattern, not an addiction, and focuses on treating the underlying issues rather than directly changing sexual behavior itself.
Before he was trained as a sex therapist, psychotherapist Joe Kort adopted a sex addiction treatment model due to sex-negative cultural messages he’d received earlier in his life and career. But as he saw this approach repeatedly fail, he abandoned it. “The training is loaded with addiction and trauma information and education, but not sexuality,” he said. Kort feels the term is over-applied to people simply because they enjoy sex without emotional attachment. “The sex addiction therapist misunderstands sexual health and imposes their own bias and moral beliefs onto what could be completely natural for the client,” he said.
LGBTQ people may be more frequently mislabeled as sex addicts, says Prause. A 2014 review in Current Sexual Health Reports found a lack of scientific evidence for porn addiction—which is often studied for sex addiction research because it’s easier to show people images of sex than to sexually stimulate them—and pointed out that a disproportionate number of those who report it are LGBTQ people with religious conflicts. “Assessments claiming to help diagnose ‘sex addiction’ are well-replicated to discriminate against gay men,” said Prause. “Questionnaires identify more gay men as having a problem than is statistically reasonable. I think the overrepresentation of homosexual men in sex addiction centers is strong evidence that the diagnosis is primarily used for social control of sexuality, rather than treating any actual disease that should affect all men equally.”
Sex workers are also pathologized. Daniella Valenti, a 32-year-old legal sex worker in Hawaii and Nevada, was put into therapy by an anti-trafficking program and diagnosed with sex addiction. “Sex is my job, and I am super safe with it. I'm not addicted to anything, and I'm not a danger to myself or anyone else. I don't display any type of compulsive behavior," she said. “I think my psychologist was judging me for enjoying sex work and labeling it as a disorder because it's a reality he didn't want to accept."
Prause said issues involving sexual behavior should be addressed individually, rather than grouped together as an addiction. “If you are failing to consistently use condoms when you should, there are excellent empirically supported interventions to improve condom use,” she said. “If you are engaging in sex outside your monogamy agreement with a partner, there are excellent empirically supported interventions to treat infidelity that include risk reduction. If you are having sex to deal with depression, there are dozens of excellent empirically supported treatments for depression."
Nevertheless, some women believe in the value of the sex addiction model. Erica Garza, author of Getting Off: One Woman's Journey Through Sex and Porn Addiction, said SLAA meetings—which prompted her to give up sex, porn, and masturbation for various periods of time—and other sex addiction treatments helped her replace her compulsions with healthier behavioral patterns. “I'm less likely to seek out the shame-and-pleasure combo I was hooked on," she said. "I have revised my learned beliefs that sex is something dirty and bad [...] so that I can engage in healthy, honest, safe, yet still open-minded sex.”
Alexandra Katehakis, sex therapist and Clinical Director for the Center for Healthy Sex, argued that sex addiction is real, pointing to a study in JAMA Network Open showing that 8.6 percent of Americans report “clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behaviors.” She isn’t against alternative labels like compulsive sexual behavior, but she believes they are separate from sex addiction. Sex addiction is characterized by feelings of withdrawal when someone ceases certain sexual behaviors, desensitization, and always seeking the next “high,” according to her approach, while sexual compulsivity is more about problems with impulse control.
If someone thinks they’re a sex addict because of a conservative upbringing or gender norms, Katehakis won't treat them for sex addiction. But if their sexual behavior causes harm or feels out of control to them, she will use cognitive behavioral therapy to help them stop whatever behaviors they feel are destructive. “Both sides have to be careful about either minimizing the problem, or making something into a problem that’s not really a problem,” she said.
Today, Taylor has a happy sex life that has included an open relationship and multiple casual partners. The solution to using sex to cope with anxiety and depression was not to have less sex, but to begin seeing a therapist and learning to communicate with others about her mental health and reduce shame around sex. “My relationship to sex is beautiful because it's so authentic, but most important, because it's mine,” she said. “I have the kind of sex that I want to have, with men that I want to have sex with, as little or as often as I please, and I don't see any need to explain it to anyone who doesn't understand.”