Sexual Addiction

The Diagnostic and Statistical Manual for psychiatric disorders does not list sexual addiction as a specific disorder, but it has been generally recognized as a problem in the psychiatric and addiction literature for many decades.

Compulsive sexual activity meets the criteria for addiction when it involves a loss of control over the behavior and continuation of it despite negative consequences. The particular type of sexual activity may vary and include various behaviors.

Some of these behaviors, such as voyeurism and fetishism, are addressed as sexual disorders in the diagnostic manual, and there is some overlap between sexual addiction and other sexual disorders.

The prevalence of sexual addiction in the general population is thought to be between 3 and 6 percent and is more common in men than in women. Sexual addiction often coexists with substance addiction, particularly to cocaine. The prevalence of sexual addiction may be as high as 70 percent in cocaine addicts entering treatment. When unrecognized and untreated, it is a common cause of relapse of the cocaine addiction.

Sexual abuse or inappropriately seductive relationships with adults are common findings in the childhood histories of sex addicts. Sexual abuse damages a child's sense of self and the ability to self-regulate painful emotional states. It also predisposes the child to view sexual activity as a coping strategy. Women with addiction to alcohol or drugs have a higher incidence of sexual addiction than other women, and the prevalence of sexual abuse experienced in the past by women addicts who are in treatment centers has been estimated at about 80 percent.

Treatment of sexual addiction involves a combination of approaches. Twelve-step recovery groups are available and provide useful support. Sex Addicts Anonymous is one such group. Although these groups are generally closed to the public, participation can be gained through referral from a treatment center or a personal interview. Cognitive behavioral psychotherapy is particularly helpful, assisting the individual in identifying core beliefs and basic assumptions that underlie behavioral choices and allowing for conscious changes in behavior. Psychodynamically based psychotherapy is often useful in identifying and addressing the developmental problems that occurred in a person's childhood as a result of abuse.

Elizabeth Connell Henderson, M.D.