Am I a sex addict, or just promiscuous?
Doctors with the American Psychiatric Association are considering the validity of this very question as they prepare the DSM-V, slated for publication in 2012. Because the word "addiction" doesn't appear in DSM-IV -- "dependence" or "abuse" are the preferred terms in reference to compulsive habitual behavior -- sex addiction would appear in the DSM-V under the moniker "hyper sexual disorder," according to Dr. Robert Weiss, founding director of The Sexual Recovery Institute and director of Sexual Disorders Services at The Ranch Treatment Center and Promises Treatment Centers.
Sex addiction is defined as "any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one's work environment," according to Patrick Carnes, the author of the pioneering 1983 book "Out of the Shadows: Understanding Sexual Addiction" and creator of the websiteSexHelp. But not everyone is buying this vague, perhaps outdated definition. With celebrities like Russel Brand, Lindsay Lohan, David Duchovny and Tiger Woods making headlines with confessions of sexual compulsion, critics wonder, is sex addiction a legitimate psychiatric disorder or an excuse for bad behavior?
In researching this article many of my peers, mostly city-dwellers in their mid-20s and 30s, seem particularly glib on the subject. "I've actually considered scoping the SAA (Sex Addicts Anonymous) meetings for horny hotties," says Jack*, an attractive 28-year-old New Yorker who works in graphic arts. "Could you imagine 'Hump For the Cure' t-shirts?" jokes Lee, a 37-year-old private chef in Atlanta. "But seriously, when I go out, it's with one intention: to hook up. I don't think that makes me a sex addict." When I press Lee further, asking if alcohol and drugs go hand-in-hand with hooking up, he tells me, "Of course!"
Inadvertently, Lee makes a good point. State-altering substances and sex -- or the lure of it, anyway -- are both staples of nightlife, suggesting that sex addiction is only part of person's greater pathology. Because people are so complex, a good shrink will usually use the "mixed bag" approach in diagnosis. Respectively, people who exhibit sexual compulsion are often also diagnosed with substance dependency, bipolar disorder or various types of personality disorders. For this reason, it's hard to isolate sex addiction as a condition that progresses physiologically, one vital criterion for inclusion in the DSM, based largely on a medical or physiological model. For example, anorexia nervosa is recognized as a psychiatric disorder due to the physiological and medical conditions that arise from the compulsion not to eat. However, to diagnose anorexia nervosa solely on physiological and medical criteria seems reductive, especially given the amount of research citing the psychosocial causes of the condition.
Within the medical model, there's a case to be made for the hyper sexual diagnosis. Brain plasticity, the widely-accepted belief that the brain can change and develop at any age and, in doing so, shape our personality, supports the claim that hypersexuality can progress physiologically. When people give into compulsions, pleasure centers in the brain release euphoric chemicals like serotonin and dopamine. Repeated release of neural chemicals flooding the brain creates physical dependency. As the addict pursues compulsive behavior, these neural pathways get reinforced -- making sexual behavior as addictive as street drugs. In addition, the risks of STIs and STDs among sexual compulsives stand to be higher than the risks of non-hypersexuals. More than that, the mind-body connection is perhaps in one of its most heightened states when people are engaged in the sexual act.
With diagnosis comes treatment. Brain plasticity suggests relief for people wanting to break the cycle of sexual compulsive behavior, in that just as these neural pathways are created, they can be re-routed with behavioral therapy and/or medication.
Curious to see what your sexual habits say about you? Take the Sexual Addiction Screening Test or SAST, an assessment tool that has been used since 1983 to help determine if sex addiction is a problem. Or, consider these confessions of people who self-identify as sex addicts:
- An attorney in San Francisco, Roberta, 31, calls herself a sexual compulsive. She describes the rush she feels when seeking out a sexual conquest. "What turns me on more than sex is the seduction, the anticipation, the danger of picking up a man and seeing where it will lead, which most of the time, is his bed."
- A 37-year-old New York waiter, Glenn, admits to dozens of one-night-stands per month, and, though the lifestyle leaves him depressed and "feeing alone," he continues to live it. "I can't stand to think of a woman after I've slept with her. I like to erase the whole memory and move on to the next. This makes me sound cruel, but I'm actually a nice guy."
- Shelia, 30, a single New York grad-student, complains to her friends about not having a boyfriend but continues to sleep with unavailable men. "It's like moth to the flame. I continually become involved with men who don't give me what I really want. Rather than break things off, I'll become super sexual with them, which makes me feel like an idiot. I know I'm acting something out here."
- Clair, 29, works in retail in New York and can't stand to go home alone. "I once had sex with my cab driver because the guy I was with earlier had dissed me. That's pretty pathetic and could have been really dangerous."
An advocate for the inclusion of hyper sexual disorder in the DSM-V, Dr. Weiss explains, "When persistent emotional and psychiatric problems lack a formal name or diagnosis, they can quickly become the stuff of subjective moral judgment." Moral objection to research into human sexuality is nothing new. As a culture, we're caught in a messy cycle of denying, exploiting, and enjoying our sexuality. Attempts to fully examine sexuality -- its variations and taboos will always make some people blush. A shame, considering that sex education has only saved lives and significantly improved the way we experience ourselves.
*Names have been changed to protect the identities of people mentioned in this article.