Sex Addiction Label: Helpful or Not?

It is important to note that there is no sex addiction diagnosis in the DSM V (the Diagnostic and Statistical Manual used to identify and describe psychiatric diagnosis). There is however a sex addiction label which has gained more attention in recent years. There is much discussion and at times argument, as to if sex addiction is a condition at all. For the purpose of this discussion, it will be assumed that sex addiction is a legitimate condition that many struggle with.

Benefits of the Sex Addiction label may be:

  1. There is an identifiable condition to name when a person has struggled with sexual acting out
  2. There are behaviors and symptoms connected to the sex addict label to help identify what a person may struggle with
  3. The “addiction” part of the label can be a way to identify a person’s loss of control over his behaviors (However even if there is a loss of control, he is still 100% culpable for all of his behaviors).
  4. There are many 12 step, inpatient, IOP, individual therapists and other support groups to support people who identify with the label of sex addiction
  5. Many people address their shame by joining a recovery community and sharing their problems with their support groups
  6. There is an increasing amount of material available about sex addiction and different specific behaviors and problems within sex addiction

Some of the drawbacks to the label of Sex Addiction may include:

  1. A person rationalizing his infidelity or offensive sexual behavior through identifying as a sex addict
  2. A person who has been unfaithful to his spouse/partner may take on the label by his or her spouse out of guilt
  3. A person can be mislabeled if their sexual acting out is really an episodic period in their lives, but not long term and enduring (i.e as part of exploring one’s sexual identity)
  4. A person becomes over-identified with the label, which can be stigmatizing and shameful
    There may be an over-focus on the label, without addressing the specific sexual behaviors or problems, and the underlying issues beneath this (often trauma based)
  5. In the absence of a discussion about and understanding of what healthy sexuality is, sexuality can be pathologized

In the future, the label of Sex Addiction may change or be done away with. What is more important than the label itself, is that the behaviors and underlying issues are addressed, and a person is able to be supported in their healing. At its best, the label of Sex Addiction is used to help a person receive the help and support that he or she needs.


By Elijah Bedrosian, LPC

Sex Addiction: What You Need to Know

Rick Isenberg, M.D. and Medical Director for Psychological Counseling Services, discusses sex addiction and what we need to know in this Triune Therapy audio interview.

[su_button url=”” target=”blank” style=”flat” background=”#003a54″ size=”7″ wide=”yes”]LISTEN TO THE INTERVIEW HERE[/su_button]

More on Rick Isenberg, MD HERE.

Overview and Presentations of Sexual Addiction

In the human experience, sexual expression takes a myriad of forms, limited only by the bounds of imagination. As the field of human sexuality progresses, more and more sexual behaviours have been catalogued and acknowledged as normal variants. As myriad as the range of sexual behaviours are the various manifestations of sexual addiction. Addiction, with its obsession, compulsion, tolerance, cravings and withdrawal, may distort any form of human sexual and romantic expression, and turn what is potentially joyful and intimate into something compulsive and problematic.

Much work has been done to understand the various manifestations of sexual addiction. It is apparent that certain behaviours present in clusters that may accompany specific forms of psychopathology. In this chapter, we review the various common presentations of the disorder, considering first those medical and psychological disorders that present similarly and must be ruled out before making the diagnosis of sexual addiction.

Differential Diagnosis of Sexual Addiction

In the field of mental health, despite our reliance on the Diagnostic and Statistical Manual (DSM) (American Psychiatric Association, 2013), not everything that quacks like a duck is truly a duck. We learn from our colleagues in medicine that a practitioner must always consider a differential diagnosis before making and acting upon a diagnosis. We have come to understand that when presented with depression, for instance, we must rule out hypothyroidism, syphilis, Lyme disease, post-concussion syndrome and drug effects, among many other disorders. So it is, too, with patients presenting with problematic, compulsive sexual behaviour. Especially in light of the shame, discrimination and contempt showered by our society on men and women with sexual addiction, we as clinicians must be discerning in our application of the label. Not all that quacks like a sexual addict is a sexual addict.

Definition of Sexual Addiction

In keeping with the nomenclature applied to substance use disorders and gambling disorder, Carnes has proposed ten criteria for the diagnosis of sexual addiction, which include elements of obsession, compulsion, risk-taking, tolerance, withdrawal, cravings, unsuccessful efforts to stop and social impairment. It is important to recognize that there are conditions that present with only some of the diagnostic criteria that must be separated from the rubric of sexual addiction, and other medical and psychological disorders that largely mimic sexual addiction and must be excluded before a diagnosis is made. We next explore these ‘rule out’ conditions.

Medical Conditions that May Mimic Sexual Addiction

Hypersexual behaviour has been associated with a range of neurological and psychiatric disorders. Before making a diagnosis of sexual addiction, consideration must be given to these medical disorders that are associated with sexual behaviour that is compulsive, inappropriate, uncharacteristic or excessive: Traumatic Brain Injury, Stroke and Neurosurgical Injury, Dementia, Autism Spectrum Disorder, Parkinson’s Disease, Bipolar Disorder, and Substance Abuse. The diagnosis of sexual addiction should not be made when these disorders are present without extensive consideration.

Non-Pathological Behaviours

In this discussion of conditions subject to misdiagnosis as sexual addiction, it is important to emphasize that the concept of healthy sexuality may include sexual behaviours that are frequent or different from the norms of the prevailing culture (such as homosexuality, BDSM, polyamory, etc). The clinician would do a disservice by reflexively labelling such behaviour as addictive. Such behaviors would not qualify as addictions unless all the criteria of obsession, compulsion, risk-taking, tolerance, withdrawal, cravings, unsuccessful efforts to stop and social impairment are present.

The Clinical Presentations of Sexual Addiction

In recent years, multiple typologies have been proposed for sexual addiction.

The most extensive characterization of the phenotypes of sexual addiction has been performed using latent profile analysis of a large database of patient self-reported data obtained through use of the Sexual Dependency Inventory (SDI-4.0).

As described by Carnes, close to two hundred different sexual behaviours have been catalogued as part of the development of the SDI. Using the statistical technique of factor analysis, these behaviours are found to cluster in distinct types, each with characteristic acting-out behavioural patterns. In the derivation of the SDI-4.0, 20 behavioural clusters were identified. It is common for sexual addicts to endorse behaviours in multiple categories. Details are provided in the book chapter.

These behavioral clusters include:

  • Fantasy Sex
  • Pornography Use
  • Phone Sex
  • Use of Inanimate Objects
  • Anonymous Sex
  • Conquest and Seduction
  • Group Sex
  • Relationship Addiction
  • Humiliation & Domination
  • Pain-Exchange Sex
  • Paying for Sex
  • Power Exchange Sex
  • Intrusive Sex
  • Voyeurism & Covert Intrusions
  • Exhibitionism
  • Exploitation of Trust
  • Sexual Exploitation of Children
  • Production of Pornography
  • Compulsive Sexuality with Drug Use


Sexual addiction presents in a myriad of ways with recognizable clusters of behaviour. The clinician facing a client with problematic, compulsive or excessive sexual behaviours must be mindful of the medical and psychological conditions which resemble sexual addiction and must be differentiated, with appropriate specific treatment provided. Multicultural sensitivity is necessary, especially when working with sexual minorities.

By Ralph Earle (PhD, ABPP) and Rick Isenberg (MD, CSAT)

How Does a Sex Addiction Expert Teach HIS Kids to Avoid Porn?

by Mark Bell LMFT, CSAT, PCS Staff Therapist

I’m a father of 5 young boys, ages 2-10 years old, and work as a sex addiction therapist. In this post, I’d like to share three strategies for addressing sexual matters, including pornography.

Maybe because of my profession, I find myself more and more aware of what my kids are confronted with regarding modern sexuality and pornography. Over the course of my career, I have worked with a diverse clientele possessing an assortment of sexual and emotional issues. This has made me even more mindful of my stewardship as a father to protect my sons’ potential by teaching them the important lessons of personal purity, integrity, healthy sexual awareness, and respect for womanhood.

My wife and I have implemented three strategies for addressing sexual matters, including pornography.

  1. Planned Interviews

One strategy is folded into a monthly father and son interview with me and each of my boys to discuss their spiritual, relational, physical, and intellectual well-being. We pray, we talk, I ask questions, I advise, I listen, I inquire some more, and above all I try to stay curious and inquisitive about each of these domains in their lives. And of course I ask them why it is important to be aware of inappropriate pictures, images, media, peer interactions, and conversations. I affirm what they say and try to add a little something extra that they may have missed or didn’t think to say. One cannot reiterate it too much.

  1. Spontaneous Conversations

The other strategy we use is to take advantage moments that arise at any given time and place (regardless of what else is going on) to ask and inform them about what they just saw, heard, or were exposed to. For example, my wife and I were watching a news show about a week ago while the boys were running around the house playing basketball on a number of our door-mounted indoor hoops (better than video games and the microwave timer is a great game clock!). During this news show our oldest son took a break to sit down with us and overheard the reporter describe how children can be easily kidnapped. He seemed intrigued and confused. My wife quite naturally proceeded to inquire of him if he knew why some adults would steal children. “No”, he said. She then proceeded to explain that many kids are stolen for sexual purposes and even used in child pornography, which she explained was forcing sexual activity on children that is filmed, put online, and watched by other adults who want to see it. My wife was quite direct and clear, and he was, of course, disturbed by this concept (as we all should be!). Naturally this was not our first sexual conversation with him. If it had been I imagine he would have been even more distressed and confused. However, he was able to hear and comprehend this because he has heard us talk about the harmful impact of pornography a number of times as well as our view of healthy sexuality. Our desire is to take advantage of the moments that naturally present themselves, to make them into empowering conversations instead of solely relying on structured, formal teaching opportunities.

  1. Resources for Parents

I would like to add that another part of parenting our boys around healthy sexuality is reading books that address these issues directly. One of those books we are using this summer is Good Pictures Bad Pictures: Porn-Proofing Today’s Young Kids. My wife and I have looked forward to reading and using this book due to the positive word of mouth by friends, social media connections, and my professional colleagues. In fact, a number of peers in my professional community of IITAP (International Institute of Trauma and Addiction Professionals) have referenced and recommended this book on our professional listserve. The buzz and endorsement from professionals and friends was a good sign of its broad appeal and benefit to families.

The Results

As we have utilized these three strategies, we have seen our sons’ emotional and sexual intelligence grow appropriately and confidently. The message we want them to hear (and we believe they are already understanding this more and more) is that using pornography is a form of unhealthy sexuality that most often results in making a person more selfish, dishonest, isolated, unhappy, less empathetic and more disrespectful towards others, particularly females. We strive for our sons to understand that respect for others begins with respect for themselves. What they watch, what they say, what they listen to, what they do, and who they associate with largely influences who they become, how they feel, and what they desire. This is what my fatherly role and professional experience has inspired me to instill in my boys.

*Originally published on Protect Young Minds on June 25, 2015

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