Looking for signs of sex addiction? If your sexual behaviour is impacting on your ability to function in your daily life, you might be a sex addict
WORDS Yasmina Floyer
The truth is that sex addiction is not officially recognised as a medical diagnosis, even today. With opinion on the subject mixed, I catch up with Silva Neves, an award-winning psychosexual and relationship psychotherapist, trauma psychotherapist and the author of books including Compulsive Sexual Behaviours, A Psycho-Sexual Treatment Guide for Clinicians (Routledge, £29.99).
He tells me that debate surrounding whether sex addiction is a genuine addiction has been ongoing since the term landed into clinical discourse in the early 80’s. ‘It has been especially heavily critiqued in the last 20 years as our knowledge of sexology has grown, and the debate is mostly about moral and religious biases vs evidence-based science,’ Neves says. He explains that with all the research that has been conducted in this field so far, there isn’t any clear scientific evidence that ‘sex addiction’ exists. Despite this, there are still numerous clinicians that promote ‘sex addiction’.
Shame and stigma
The term ‘addiction’ itself is not only reductive, then, but it also creates a stigma that breeds shame, which is a moral based judgement rather than a clinical one. Given that broadly speaking, sex is still perceived as taboo, it means that shameful connotations relating to sexual behaviours that some may be struggling with are extremely diminishing, and may inhibit those who need support from seeking it. It is no surprise then when Neves says that some of the prominent therapists who promote treatment for sex addiction also tend to have religious and moral biases.
But in a world that claims you can become addicted to almost anything, it is important to understand what an addiction actually is. Neves says the addiction field notoriously diagnose pretty much anything as an addiction because it is their primary lens. ‘Shopping addiction, internet addiction, cheese addiction, caffeine addiction, and so on, yet none of these have been scientifically validated as addictive.’
Indeed, addiction is a clinical disorder with strict standards of measurement, which is why it is important that we understand the distinction between an addiction and a compulsion. ‘To put it in simple terms, an addiction is a disease affecting neurological functioning. A compulsion is a coping strategy to soothe unpleasant emotions,’ Neves explains.
‘People who start taking drugs or drinking alcohol may well start those as a coping strategy to soothe unpleasant emotions, but because those substances cannot be sustained by the brain, it has to adapt to those substances. When the addiction takes hold neurologically, it becomes an independent disorder, which means that people who are addicted to those substances need to be carefully helped in coming off this dependency. A compulsion, however, stays as a coping strategy and does not become a neurological impairment.’
‘From the sexology lens, the idea that sex is addictive doesn’t make any scientific sense,’ he says. ‘Scientifically, it is known that we cannot be addicted to an innate primary drive. As humans we develop a natural sex drive (primary), but we don’t develop a natural gambling drive or cocaine drive.’
In this way, gambling, cocaine, and other secondary reward drives are not the same as sex or anything involving sexual activities, including watching porn and masturbating. ‘The body of research on pornography has not found any causation, meaning that, as far as we know scientifically, porn does not cause mental or sexual health problems.’
‘One of the main features of people feeling “out of control” is called “moral incongruence”, which means it’s not what people think they “should” do.’
‘Feeling out of control’
Since many therapists (and the media) tend to confuse causation and correlation, this has led to much misinformation about porn or so-called ‘porn addiction’.
‘Applying an addiction treatment to primary drive behaviours not only doesn’t work, but it can actually cause significant harm,’ Neves explains. ‘One of the main features of people feeling “out of control” with sexual behaviours and porn watching is what is called “moral incongruence”, which means people have sexual behaviours that do not align with what they think they “should’ do. It means that shame is the hallmark of people who feel “out of control” with their sexual behaviours, yet shame is often not considered in sex addiction assessments.’
This is such an important distinction to highlight, since the way that we may feel about something, especially when our attitudes are partly informed by upbringing and social conditioning, may not necessarily reflect the reality of the situation. What this means is that just because we may feel shame surrounding something doesn’t necessarily mean that we are right to do so.
Compulsive or completely normal?
Neves describes that the more moral incongruence people feel, the more they are likely to feel out of control. But ‘feeling’ and ‘being’ out of control are not the same thing, and what one perceives problematic is subjective and depends on the person’s moral congruence. He shares that a major problem with the ‘sex addiction’ narrative is that it unduly pathologises sexual behaviours that are outside of heteronormative and mononormative (the norms of monogamy) behaviours.
‘Typically, people who have fetishes, kinks, are polyamorous, choose to be sex workers, who enjoy watching porn a lot, who go to sex clubs frequently, and people with a high sex drive could be diagnosed as a “sex addict” when those behaviours could be completely harmless, and even meaningfully normative for those in the queer community for example.’
So, how can we tell when sexual behaviour becomes compulsive?
‘The most important sign to look out for is when the sexual behaviour or watching porn causes significant impairment in someone’s life — which is not the same as feeling guilty for doing those behaviours. We are talking about not being able to manage life as a result of those repetitive sexual behaviours. Someone who watches porn all night long, for example, then doesn’t turn up to work the next day because they can’t get up, potentially damaging their career.’
Other features of compulsive behaviour include the fact that it must be happening on a repetitive basis, not just an occasional porn binge, or if someone spends more money that they can’t afford paying for sex in a repetitive manner, resulting in major debts.
‘It is not about the number of times people watch porn, or how many people they have sex with. It is about the significant impairment.’ If someone feels bad and believes they are out of control with their porn watching or sexual behaviours due to external judgement, however, this does not make it a compulsion, since those feelings can be linked to misplaced shame.
As someone who lives with OCD, I wonder if there are conditions that can complicate treatment of or indeed trigger compulsive sexual behaviours?
‘Yes. Compulsive sexual behaviours are a repetitive coping strategy to a chronic stress. The chronic stress can be anything from one hating your job, or significant financial stress, or feeling too much of the daily grind without much joy. The body of research points to compulsive sexual behaviours being a symptom to depression, as a means to “self-medicate”.’
‘It’s not about the number of times people watch porn, or how many people they have sex with. It’s about impairment.’’
Self-soothing behaviours
Neves goes on to tell me that this form of self-soothing via sexual compulsive behaviours can also present in those experiencing post-traumatic stress, since for many people, sexual behaviours may be the only resource they have to manage these disturbances.
‘For this reason it is very important not to go for an abstinence-based addiction method to treat compulsive sexual behaviours, because abstinence could be taking away the one resource people have to mitigate their depression or post-trauma stress symptoms, which means that it can make people worse as full-blown depression or PTSD can emerge as a result.’
By working in a way that recognises compulsive sex behaviours agnostic of any negative social stigma and shame requires treatments for compulsive sexual behaviours to be based on ‘sexology’, which Neves defines as an understanding the sexual behaviours, including what is normative, and being informed by sexual diversity knowledge including being kink-informed.
This inclusive outlook fosters a sex-positive approach and enables a treatment that integrates multiple therapeutic modalities because the source of underlying disturbances the compulsive sexual behaviours are attempting to soothe can be very diverse.
‘I help people explore their erotic mind, not to find the problems but to examine what their turn-ons are, their sexual pleasures and so on. The chances are the behaviours they exhibit may be compulsive, but they may also match their turn-ons.’
This is why Neves highlights the importance of erotic awareness, so as not to make people’s turn-ons part of the problem. ‘Erotic awareness is a great antidote to compulsive sexual behaviours, as often people report that they don’t know why they do what they do, which signals unawareness.
‘Once we have a pretty good idea of what their erotic mind is made of, we don’t attempt to change it because the goal of the treatment of compulsive sexual behaviours is to stop the compulsion, not to make someone monogamous if there aren’t — or vanilla.’
The goal then becomes helping people to reconstruct a life and a sense of self with better erotic and relational awareness so that they can have a fantastic, diverse sex life that fits with who they genuinely are and keep thriving in their intimate relationships.
Moving away from the reductive lens of addiction to a more inclusive and sex-positive approach made possible through knowledge of sexology, enables practitioners such as Neves to honour the erotic mind. It’s an intention that is, thankfully, a million miles away from the salacious clickbait about sex addiction that persists to this day.
Silva Neves is an award-winning, UKCP-registered psychosexual and relationship psychotherapist, and a trauma psychotherapist. He is the author of three books: Compulsive Sexual Behaviours, A Psycho-Sexual Treatment Guide for Clinicians; Sexology: The Basics; and Sexual Diversity. He is on the editorial board of the international journal Sexual and Relationship Therapy. www.silvaneves.co.uk
