This week's segment of CBS Doc Dot Com examines sexual addiction, a subject about which I learned absolutely nothing in medical school and have not learned much more since. In researching the topic over the past week, I began to understand that it is extremely controversial, with experts not even agreeing about whether sexual addiction is a true addiction.
When most people hear the term, they usually think they know what's meant by sexual addiction. They may think of someone (usually a man) who has an incessant need to make sexual conquests, sometimes despite his own best intentions. But even back in the days when Sam Malone got this diagnosis on the old TV show "Cheers," it was clear that a real definition was lacking. In 1998, two researchers published an article entitled "Sexual addiction: many conceptions, minimal data." As Erick Janssen, Ph.D., Director of Education & Research Training at The Kinsey Institute, explained to me in an email: "We do not have a generally accepted definition of 'sex addiction.' It was originally approached as involving some kind of 'inability to adequately control sexual behavior,' but this is, as you can tell, not a very objective definition. According to some, sexual addiction seems in the eye of the beholder, or in the eyes of his or her therapist."
For one side of the definitional argument, I spoke to addictions treatment specialist Mavis Humes Baird, who is convinced that sexual addiction is a true disorder because people are in the throes of an impulse they can't control, that there are underlying changes in the brain that cannot be addressed by psychotherapy alone. She told me, "for example, if one of the partners in a couple is having affairs and they're not a sex addict, marriage counseling or family therapy is very effective. But if they're a sex addict, all the therapy in the world getting at problems in the relationship won't touch the addiction. One of the primary referral sources for sex addiction is couples counselors who have been doing attachment work with couples for years with the addiction going on unaffected and sometimes kept secret for all those years. You can't treat the sex problems between the partners until the addiction is treated. And that's done by a combination of specific treatment protocols, and 12-step program involvement, and sometimes medication."
But Ms. Baird also told me it's not listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and that there's a struggle about whether it will be included in the next edition. One crucial repercussion of not being listed in the DSM-IV is that the exclusion makes it more difficult for patients to receive reimbursement for treatment. Some researchers hypothesize that sexual addiction, substance abuse, and gambling share neurochemical changes in the brain--underlying problems with brain wiring and nerve transmitters such as dopamine. For many of those researchers, it would seem to follow that treatment should be covered as other addictions are.
On the other side of the definitional aisle is Dr. Herbert Kleber, Professor of Psychiatry at Columbia University Medical Center, where he is the Director of the Division on Substance Abuse. When I asked him about sexual addiction, he said: "Is it an addiction? I'm convinced gambling is an addiction but am agnostic about sexual addiction. Once you let one of them in the door do you let in shopaholics, kleptomaniacs, etcetera? Where do you draw the line?"
Dr. Janssen echoed Dr. Kleber's skepticism, telling me: "There are no reliable prevalence statistics on sexual addiction. That is, it has not been measured in representative samples of men and women. A few studies in non-representative samples have concluded that it could involve 5-10 percent of the adult population. Most sex researchers prefer to not use that term, instead relying on terms like 'sexual compulsivity' or 'sexual impulsivity' to reflect people's experiences and actual behaviors." Dr. Kleber and his colleagues wrote a classic article in which they argued that drug dependence was a "chronic medical illness" and not just a "social problem." The implication was that you could no more "snap out of" drug dependence than diabetes, asthma, or high blood pressure.
But Dr. Kleber is not convinced that what he calls "controversial addictions" to sex, the Internet, food, and shopping are true addictions. "We don't know enough about what goes on in the brain with these disorders. Do we include all of them, some of them? At this point, the jury is out."
Whatever the jury ends up saying about disease classification and underlying brain biology, one thing seems clear to me: for people suffering from this problem - and for their loved ones - the pain and the need for help are quite real. This is a disorder that desperately needs more research.
For an overview interview with Mavis Humes Baird on the subject of sexual addiction, click here.
For an interview with Ms, Baird about the relationship between Internet pornography and sexual addiction, click here.
For an interview with a self-described recovering sex addict, click here.
For an interesting WebMD article on the subject, click here.
For a good review of the concepts of sexual addiction, sexual compulsivity, and sexual impulsivity, click here: