Diagnosis: The Signs and Symptoms of Sexual Addiction

According to our definition of sexual addiction, people can develop addictions to activities as well as substances. Professionals sometimes call these activity or behavioral addictions. As we have previously noted, sexual addiction is not yet a diagnostic term recognized by the American Psychiatric Association. The fact the APA does not yet recognize sexual addiction as a distinct diagnostic term does not diminish the reality of this troubling disorder.  At the time of publication (APA, 2013), the authors of the DSM-5 concluded that there was insufficient research evidence to establish diagnostic criteria. .  Although most closely resembling a behavioral addiction to gambling, the DSM-5 provides no "unspecified" category for "non-substance related disorders."   Therefore, clinicians must use other -unspecified diagnostic labels.  These include unspecified impulse control disorder, unspecified paraphilia (particularly for addiction to pornograpdy), and unspecified sexual dysfunction.  The later diagnosis is controversial because sexual addiction is not the same as a sexual dysfunction. A review of the available scientific literature is available online (Kafka, 2009).

It may be difficult to understand how someone might become addicted to an activity in the same way that people become addicted to drugs.   It is helpful to recognize that people do not actually become "addicted" to drugs or activities themselves.  Instead, people become "addicted" to the effect of those drugs and activities on the brain.  From this more accurate perspective, it becomes easier to understand how activities can become addictive. This is because certain activities have the same chemical effect in the brain as drugs. Therefore, some addictions occur because drugs are added to the body.  These drugs alter the brain's functioning.  Certain activities can achieve a similar effect.  These activities alter brain chemistry in a manner that is similar to alcohol or other drugs.  

Activities such as gambling, eating, and sex increase levels of dopamine in the brain in the same way that using cocaine or nicotine does. Dopamine is a neurotransmitter that causes pleasurable feelings. Due to the brain's reward system, people are more likely to repeat behaviors that result in the pleasurable release of Dopamine.

Of course, it is sensible to wonder, "When does a healthy activity like eating or sex become an addiction?" A simple way to distinguish between ordinary pleasurable activities and addiction is to review the definition of addiction. When a person continues to engage in a pleasurable activity even when negative consequences outweigh the benefits, we can begin to speak of an activity addiction. When an activity takes on a compulsive quality, we can speak of an activity addiction. However, professionals can best determine these sorts of distinctions.

Another confusing thing about sexual addiction is there may be different types of sexual addiction. This is similar to the way there are many types of drugs that can become addictive. Sexual addiction may include behaviors that many people would not consider especially sexual or enjoyable. This may include things like dominance, control, or abuse of a partner. Some types of sexual addiction involve partners. Other types of sexual addiction include solo activity such as masturbation to pornography. Some types of sexual addiction include high levels of fantasy, which may be more important than the activity itself. There may be a form of "keeping score" about the number of sexual conquests. Sexual activities may be limited to a very narrow range of activities. These activities can interfere with other more wholesome enjoyment of sex. For instance, heavy users of pornography, coupled with masturbation, may be unable to achieve an erection or orgasm with a partner. The collection of sexual paraphernalia, clothing or pornography can be extremely costly and secretive. This is similar to the expense of obtaining drugs or gambling. Sexual activity may be pursued in a purposeful, goal-oriented manner; e.g., going out to clubs during specific nights to pick up partners. Alternatively, it may be more impulsive; e.g., going out whenever sexual craving becomes strong.

Regardless of the specific form of sexual addiction, the pleasures of addicted sexual activity are short-lived. As momentary pleasure subsides, the pursuit begins again. This is similar to the pattern seen in other addictions. Pleasure eventually gives way to compulsions in an effort to reduce the tension associated with cravings.

Some people enjoy sexual activities that are not considered average or ordinary.  This does not necessarily indicate sexual addiction.  For instance, sexual activity may involve multiple partners or just one. There are also people who consensually engage in polyamory.  Polyamory refers to involvement with two or more partners (at the same time, or at different times). While these sexual behaviors may not follow cultural norms, they do not in themselves indicate an addiction. Conversely, there are many people who claim to be polyamorous, but who meet the criteria for sexual addiction.

Likewise, a high degree of interest or enjoyment of sex doesn't necessarily indicate sexual addiction.  There is quite a lot of variance among people with respect to sexual interest and appetite.  Sexual activity resembles addiction when it becomes the sole source of pleasure in life, or replaces other healthy interests (work, relationships, recreation, etc.). 

There may be many forms of sexual addiction.  This is similar to substances addictions.  There are different substances that can become addictive.  The sexual activity may include things we don't ordinarily associate with sexuality.  This may include things like dominance, control, or abuse of a partner. The activity may involve other people directly.  It might also be a solo activity.  If partners are involved, those partners may be sexually addicted themselves. On the other hand, these partners may have a healthy sexuality.

Locating sexual partners, while concealing the addictive nature of sexual involvement, may require significant deception.  It also reflects a degree of predatory behavior. Sexual activity might include high levels of fantasy, which may be more important than the activity itself. There may be a form of "keeping score" about the number of sexual conquests. Sexual activities may be limited to a very narrow range of activities.  These activities can interfere with other more wholesome enjoyment of sex.  For instance, heavy users of pornography, coupled with masturbation, may be unable to achieve an erection or orgasm with a partner. The collection of sexual paraphernalia, clothing or pornography can be extremely costly and secretive. This is similar to the expense of obtaining many drugs.  It also resembles the secrecy of covering up the extent of gambling involvement in gambling disorder.  Sexual activity may be pursued in a purposeful, goal-oriented manner; e.g., going out to clubs during specific nights to pick up partners.  Alternatively, it may be more impulsive; e.g., "cruising" whenever sexual cravings become strong.

Sexual addiction is often accompanied by shame and secrecy.  This makes research difficult.  Whatever the research reveals, it is not hard to imagine a person whose life is out of balance due to sexual pursuits.  The pleasure of the activity lasts only a little while. Then, more activity is sought. The activity does not foster healthy human relationships.  Rather, it replaces such relationships, or destroys them. Like all addictions, the negative consequences build up over time.  These may include infections; debt; legal troubles; or impaired health (from lack of sleep, poor self-care, being beaten up); loss of important relationships; loss of job, etc.  Risk factors for developing a sex addiction include being molested as a child; having bipolar disorder; and distress about one's sexual orientation.

If you wonder whether you or someone you love has a sexual addiction, get a professional evaluation. It is best to choose someone who specializes in addictive disorders. Some professionals are highly specialized. Their practice may be limited to certain types of addictions such as gambling addiction or sex addiction. Recovery can be more complicated than with drugs or alcohol. With alcohol and other drug addictions, abstinence is an achievable (and often desirable) recovery goal. Recovery from activity addictions is a bit more challenging because abstinence isn't possible or practical. For instance, it isn't possible to be abstinent from all food and still survive. It isn't practical (though possible) to completely refrain from sexual activity.

You can find more information about sexual addiction and sexual disorders in our article: What determines Healthy Sexuality?