In his 27 years as a sex therapist, Doug Braun Harvey has seen his fair share of men who come in already knowing their diagnoses. There was the man who could only get it up while watching porn. The guy with a fetish he obsessively watched online, but hid from his partner. The man who masturbated so compulsively there wasn't anything left for partnered sex. By the time they found Harvey, they all made the same confession: They were sex addicts.
The problem, Harvey told me, is that none of those men are sex addicts. Because sex addiction doesn't exist.
Harvey, along with thousands of other members of the American Association of Sexuality Educators, Counselors, and Therapists (AASECT), issued a statement last week outright denouncing the diagnoses of sex and porn addiction. "From a scientific perspective," the statement read, "sex addiction is not real."
The idea of "sex addiction" first originated as a spin-off from other well-defined addictions. As the legend goes, a group of Alcoholics Anonymous members banded together in 1979 to apply the 12-step method of recovery to their issues with infidelity, pornography, and unfettered sexual desires. Today, there are hundreds of sex addiction self-help groups—Sex Addicts Anonymous, Sexaholics Anonymous, and Porn Addicts Anonymous, to name a few—along with rehab facilities catering to people who feel their sexual behavior is out of control.
But Harvey and other experts point out that there's nothing in the scientific literature to suggest that these problems—which range from watching too much porn to continuously cheating on partners—can be neatly categorized as an "addiction" to sex, and the oversimplified treatment model ignores the real reasons people are struggling with their sexual behavior.
"Sex addiction is truly a social phenomenon, not a clinical or medical one," says David Ley, a clinical psychologist based in New Mexico and the author of The Myth of Sex Addiction. "Most people who self-identify as sex addicts do so because they or their spouse read an article or saw a talk show about sex addiction."
Of the little research that's been done, very little of it suggests that self-identified sex addicts have anything in common with those who have other types of well-researched addictions. One study, published in the journal Socioaffective Neuroscience & Psychology, tested the neural response to sexual stimuli in people who self-identified as having issues with sexual compulsions. In previous research of drug addicts' brains, heroin users exhibited an increased neural response to images associated with heroin than to neutral images. But in the study of sex addicts, researchers found that brain activity was more or less the same as that of non-sex-addicts. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders rejected the addition of "sex addiction," citing the lack of adequate scientific research.
Other research has suggested that sex addiction is a behavioral addiction, like gambling, rather than chemical one, like alcoholism. Both types of addiction affect the brain similarly, by stimulating the dopaminergic system, though this happens less directly with behaviors than it does with substances. Even still, the "sex addict" categorization lumps together many types of disparate behaviors (like having cybersex, excessive masturbation, obsessive dating, or practicing unsafe sex, all of which are signs of a "sex addiction," according to online diagnostic tools) and fails to take into account the underlying issues causing those behaviors. Sex addiction, in other words, has become shorthand for "bad sexual behavior," rather than describing a true addiction to one unique behavior.
Harvey says he understands why men who are struggling with sex issues find it convenient to label their problems as sex addiction. "In my work, we call that an eroticectomy," he says—essentially, a way to neatly remove the problem with surgical precision.
But the reality is that a diagnosis of sex addiction often mutes the real problem, and that can come at a steep cost. One study of people in treatment for sex addiction showed that 92 percent were dealing with a mental health disorder, like anxiety, depression, or schizophrenia. Instead of pursuing treatment options for those disorders, or untangling the ways their mental health issues were affecting their sex lives, they were participating in therapies to learn how to avoid pornography or masturbate less.
It's also worth pointing out that sex addiction is almost exclusively a men's issue—90 percent of self-identifying sex addicts are men—and gay or bisexual men are three times more likely to be diagnosed as sex addicts than heterosexual men, according to Ley. The entire concept of sex addiction is laden with value judgments, he said, including how much sex is excessive and at what point a person should feel ashamed of their sexual desires.
Ley tells the story of one client, an 18-year-old boy, who came to see him because he was concerned he might be addicted to masturbation. "Turned out, he was only masturbating about once a week, but because he'd been taught that any masturbation was immoral and unhealthy and dangerous, he was terrified," Ley says. "He went online and was diagnosed by sex addiction therapists and online group discussions."
The executive director of Sex Addicts Anonymous, who refers to himself only as "Joe H.," says his group wasn't bothered by the AASECT statement. "Professional opinions are outside issues and we have no opinion on outside issues," he wrote in an email.
But Harvey, Ley, and other experts in the field hope that the statement can provoke a change in how people with sexual behavior issues seek treatment.
"There's absolutely no research showing that sex addiction treatment actually works, or works better than treatment with a regular therapist," Ley says. "But they serve a purpose—where men who get in trouble for sexual behaviors can 'go away' with the public appearance that they are committed to 'getting better.' Unfortunately, these patients are often deeply exploited, leaving treatment owing many thousands of dollars, and usually still struggling with the real psychiatric or social issues."