As soon as you Google “compulsive sexual behaviours”, “sex addiction” pops up, almost everywhere. But these terms do not share the same meaning.
Compulsive sexual behaviours vs sex addiction
Sex addiction is not a new concept. It dates all the way back to ancient Rome and second century Greece, where records show “excessive sexuality”. The term became popularised in the 80’s by Patrick Carnes with his revolutionary book, “Out of the Shadows”. This became a ‘trend’ when visiting the “sex addiction clinic” grew popular among celebrities.
Sex addiction has no real definition and, most importantly, it’s not clinically endorsed. Many people may struggle with their sexual behaviours, but this is not enough to have its own diagnostic category. Sex addiction is a psychological disorder; sometimes treated as “impulse control” or “behavioural addiction”.
In 2018, WHO released the proposal for the 11th edition of the International Classification of Diseases (ICD-11), the first revision of the global standard diagnostic catalogue since 1990.
Inside ICD-11, it classified “excessive sexual drive” as a real disorder, calling it compulsive sexual behaviour and included it in the mental health disorders. This was a big milestone in the mental health community. Compulsive sexual behaviour went under the umbrella term of “impulse control disorders”, because researches showed that there is no real addiction in the behaviours.
Criteria to diagnose compulsive sexual behaviour disorder
- There is a persistent pattern of failure to control intense and repetitive sexual urges, that lead to repetitive sexual behaviours.
- Sexual activity becomes their primary focus, to the point where they neglect responsibilities, social interaction, health and personal care to the point of causing problems.
- They failed multiple times trying to stop - the struggle must go on for at least 6 months.
- The behaviour should persist despite negative consequences and they should get little or no pleasure out of it.
- They must identify very significant marks of distress and destruction in their lives, as a result of a compulsive sexual behaviour.
- There shouldn’t be a moral judgement or disapproval. It shouldn’t be the view of a partner/society; the individual should realise they have a problem.
How to treat it
Anyone who meets the criteria could be diagnosed with compulsive sexual behaviour disorder. People meeting only some of them, may struggle to keep things together. When I offer them treatments, I make it clear that they don’t have a compulsive sexual behaviour disorder, but a sexual behaviour problem.
The treatment for compulsive sexual behaviour disorder is never about the symptoms, but about finding what the underlying issue is. Often it could be a childhood trauma, linked to sex and/or relationships (eg. parents divorce, sexual/violence abuse, or even moving home multiple times as a child). It is important to find and treat the trauma, not the compulsive sexual behaviour itself.
Usually, the first 2 to 5 sessions focuses on exploring the erotic mind: many sexual behaviours are not real problems, they are normal parts of the erotic template, that just don’t match with the relationships a person is into. In fact, people who have committed to a monogamous relationship might have a very high sex drive - this is an erotic conflict. This means there is a mismatch in the relationship and the erotic world. But again, it’s not an issue or a disorder. When you begin to enjoy having a lot of sex (or using toys, for example), this is not compulsive and it’s not a threat in your life.
Pornography and compulsive sexual behaviours
I get asked a lot about the connection between pornography and compulsive sexual behaviour. Taking morality out of it, there has been a vast amount of research in sexual medicine and sexology about the effect of pornography on the brain; the result is that there is not enough evidence, proving pornography addictive or effecting the brain; it is just as safe as watching other genres of films. It is important to remember porn is adult entertainment and not for the eyes of children (this would be abuse).
It’s true that you can feel strong sexual pleasure from pornography, and that’s why a lot of people use porn to masturbate. Masturbating and orgasms are also great for our health. Porn, masturbation and sex can become an anxiety reliever; people may use it to relieve stress and depression. But it’s important to remember that this alone should not be used as a stress reliever.
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Using porn as the only way to experience pleasure might indicate a digi-sexuality, a kind of sexuality of its own that is emerging in the last decades. If a person experiences pleasure only through porn and not by another person but, at the same time they want to have sex with people, pornography is not the issue. This could mean that this person is experiencing a lot of anxiety; the only treatment for this is to try being comfortable with themselves.
If you have any issues with your sexual behaviours, don’t panic: most likely you are not in a disorder area. Make sure to go and see a therapist that deals with compulsive sexual behaviours and not sex addiction. During your first session, it’s very important that you interview them on their beliefs about compulsive sexual behaviours; if they mention sex addiction,find someone else. Linking compulsive sexual behaviours with sex addiction can only increase the shame and does not solve the issue.
Finally, there is no right or wrong way to be sexual. Each of us feels differently about our sexuality, and we choose to express it in different ways. We just need to discover what best suits our erotic template.