Sex and Porn Addictions: Misconceptions and Bias

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I’ve spent the past 25 years providing clinical treatment to sex addicts and their families, while also training therapists and documenting the clinical evolution of this increasingly common issue. Throughout this time I have been constantly surprised by a small but vocal group of misguided and/or under-informed professionals who doggedly insist that sexual addiction is not a real disorder. And this denial continues despite an increasing array of neurobiological and social science research that clearly supports the concept of sexual addiction.

Much of this research is summarized in Harvard professor Martin Kafka’s 2010 position paper arguing in favor of Hypersexual Disorder (as he prefers to label the issue) as an official diagnosis in the American Psychiatric Association’s diagnostic bible, the DSM-5. Numerous other studies supporting sexual addiction—available here, here, here, here, here, here, here, and here, to cite but a few—have been published since Kafka’s summary. Moreover, anyone who’d like an up-close and personal look at sexual addiction can simply go to an open meeting (where everyone is welcome) of any 12 step sexual recovery group (SAA, SCA, SA, SLAA) to hear people talk about their addiction and the problems it has created.

Still, despite the obvious clinical realities and mounting scientific evidence, sex addiction deniers are as vociferous as ever. This small but noisy subset of clinicians fervently clings to their badly outdated 1970s ethos: “Do it because it feels good. And if it feels good, it can’t possibly be a problem. Ever. For anyone.”

Much like those who think that our increasing weather and eco-instability problems are random events unrelated to human activity, these misguided “sexologists” appear to have chosen willful ignorance over facts and reality. For instance, therapists have known for decades that early-life trauma and attachment concerns can and often do lead to adult addictions and adult intimacy disorders, but the sex addiction deniers say, “Not so.” More recently, therapists all over the country (and around the world) have anecdotally reported an evolving clientele of young adults self-identifying with porn-related compulsivity/addiction (related to the unfettered 24/7 availability of digital pornography), but the sex addiction deniers say, “Not so, they’re just kids trying to get comfortable with their sexual desires.” And so it goes.

Sadly, these “sexual health” professionals choose to bolster their misguided arguments with poorly conducted and generally refuted research, coupled with confusing statements conflating the term “sex addiction” with phrases like “sex negative” and “1950s sexual conservatism.” Basically, sex addiction deniers seem to think that sex addiction treatment forces preconceived moral, cultural, and/or religious values onto vulnerable people who are already tortured by sexual shame. However, that’s not the type of care that properly trained sex addiction therapists actually provide. Not at all.

Unfortunately, thanks in large part to these aging ideas and voices, America does not yet have a formal diagnosis for sexual addiction. (Notably, the World Health Organization’s diagnostic manual, the ICD-10, used pretty much everywhere but in the US, will likely include sex addiction with its next set of updates.) So individuals with substance abuse and gambling issues can be “officially” diagnosed and treated. The APA has even recognized internet gaming as a valid problem worthy of official investigation. But people who are compulsive with pornography and other sexual behaviors are inexplicably left in the dark. At times, this causes those who are already hurting and feeling crazy because they just can’t seem to stop masturbating to porn or hooking up via sex apps to feel even worse. And without an official label and directions for treatment, some sex addicts won’t pursue the excellent help that’s actually available. As such, they end up hopeless, discouraged, and depressed because they feel as if there are no answers.

Interestingly, even Psychology Today lags behind when it comes to sexual addiction, as their editors routinely reject, with one recent exception, any article that even mentions the problem as a treatable disorder. This frustrating stance recently pushed approximately a thousand psychotherapists to formally petition the magazine (click here or here to read the petition), asking the editors to reconsider their outdated position, noting that it serves neither the profession nor the individuals dealing with this disorder.

Given the undeniable clinical evidence and the increasing body of research backing it up, one wonders why some people are so intractably resistant to the idea of sexual addiction. Maybe we’re just caught in an argument about nomenclature. After all, for whatever reason the psychiatric community (as represented by the APA) seems to not like the word addiction. To this end, the APA has almost completely eliminated that term from the DSM-5, choosing instead to call alcoholism and drug addiction substance use disorders and gambling addiction gambling disorder. Oddly, the APA has altered the lexicon in this way even though the vast majority of people dealing with these issues are perfectly OK self-identifying as addicted and seeking help based on that label/diagnosis.

So now we are left with a confusing mish-mash of colloquial labels to describe the unfortunate individuals dealing with an ongoing, out-of-control pattern of sexual behaviors—sexual addiction, sexual compulsivity, hypersexuality, and hypersexual behavior, to name but a few. For what it’s worth, after treating this population for decades, I prefer the term sexual addiction. It’s not a pretty term, but it’s accurate. By any commonly used diagnostic criteria we are absolutely dealing with an addiction, so let’s call it an addiction. Moreover, the people who are suffering from this issue tend to identify with this label more than any other.

It is an unfortunate fact of human sexuality treatment that American professionals with differing opinions have chosen to build walls rather than windows. The sexology field and the sexual addiction field have so much they could learn from each other, yet ideological barriers have prevented our working together and developing common ground and a common language inclusive of all of our philosophies, experiences, and research.  Well, I believe the time has come for us to stop throwing intellectual rocks at one another and to start working together. If we don’t do this, then how can we ever put resolution of our clients’ challenges first? It seems to me that only by moving beyond labels and preconceived notions as a field will we be able to steer our fellow humans onto the best healing pathway for their specific needs. That day can’t arrive soon enough for me and many of my clients.

 

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