For several decades, sex addition has been accepted as a disorder within the fields of marriage and family therapy, clinical social work, behavioral analysis, and clinical psychology. The fact that sex addiction was excluded from the DSM-4 and the recently released DSM-5, leaves open the debate over whether problematic sexual behavior is actually an addiction, or even a disorder at all.
There is considerable evidence to the addictive nature of problematic sexual behavior, such as the fact that eighty-three percent of those in treatment report comorbid addictions such as drug, alcohol, gambling, compulsive working, hypochondria, and eating-disorders. Like these addiction, sex addiction defies self-control, even given aversive consequences such as loss of friends and family, employment and other financial problems, and arrest. Indeed, the obsessive quality of problematic sexual behavior points to obsession, as is the case in any addiction.
Diagnosis of sex addiction typically includes: a semi-structured interview, one to three self-report screenings, and collateral assessment information collected from family and or friends. A medical screen should also be conducted, to rule out possible medical causes of the behavior, such as hormonal imbalances, excessive use of drugs to treat erectile disfunction, and steroid use. The clinician pays careful attention to behaviors such as minimization, avoidance, emotional detachment, inconsistent responses, and should be mindful of the possibility of faking the disorder as a means of escape from the repercussions of common or garden infidelity.
It is true, as with other addictions, that the sexually addicted client cannot be helped until he or she asks for help. Assessment includes valuation of the client’s readiness for and commitment to recovery, as well as the level of care required, and it is also a time to consider participants for the intervention team. These may include family, friends, and sometimes an employer and co-workers.
Once assessment has been completed, the intervention team members are prepared for what’s to come. This includes the establishment of guidelines and boundaries, which are typically put into writing to be presented to the client. Breaking through denial and addressing the pain associated with extreme shame, are typically two early considerations in treatment. When shame does not occur, it may indicate a much higher level of denial, or it could point to differential pathology such as narcissism or sociopathy. Intervention also includes setting sexual boundaries, and affect regulation, which involves teaching the client how to regulate his or her affect to preclude sexually inappropriate behavior.
Once these have been accomplished the underlying psychological problems are reviewed through various therapeutic means such as cognitive behavior therapy (CBT, acceptance and commitment therapy (ACT), or traditional psychoanalysis. Typical underlying problems encountered by sexually addicted clients include fears of failure, an inner believe that he or she is unlovable, and or fears of rejection, often co-occurring with an obsessive need for attention or approval. A twelve-step program is another approach that may benefit those with a spiritual foundation. A 2014 comparative meta-analysis (Miller & Moyers) revealed similar outcomes across program approaches for alcohol addiction treatment across intervention and fifteen-month follow-up, however, no such comparison has been conducted specifically for sex addiction.
Couples therapy is advisable once the primary client is stable. For a discussion of couples therapy, see the article 'The Forgiveness Connection' in this blog.
