Sex addiction: Explanation or excuse?
04:52 - Source: CNN

Editor’s Note: Ian Kerner is a licensed psychotherapist, certified sexuality counselor and New York Times best-selling author. Read more from him on his website, iankerner.com.

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The concept of sex addiction began gaining traction in the 1980s

Professionals are divided on whether it should be officially classified as an addiction

CNN  — 

From Anthony Weiner to Tiger Woods, there’s no shortage of so-called sex addicts these days. But is sex addiction a real condition?

Getting to the bottom of this question is the source of much controversy among therapists. On one end of the spectrum are sex therapists (myself included), who tend to doubt that sex can be addictive and view the label as potentially shaming.

On the other end are sex addiction therapists who believe that for a small group of people, sex and the behaviors surrounding it can be as destructive and addictive as any drug.

The concept of sex addiction gained traction in the 1980s, when Patrick Carnes published “Out of the Shadows,” one of the first books to identify compulsive sexual behavior, a problem he likened to an addiction.

Soon, treatment centers, 12-step programs and other resources grew around this new label, despite the fact that it has never been an accepted clinical diagnosis in the “Diagnostic and Statistical Manual of Mental Disorders,” which is widely viewed as the authoritative guide for psychiatric diagnosis and treatment.

“To me, ‘sex addiction’ is a cultural myth,” said psychotherapist Joe Kort. “Thirty years ago, we didn’t have a better way to describe people who worried that their sexual behavior was out of control, so it made sense to call it addiction. But it’s not an actual diagnosis.”

But should it be one? I asked several of my colleagues on both sides of the debate to weigh in on claims and myths surrounding sex addiction. Here’s what they said.

Is sex addictive?

This is perhaps one of the greatest controversies about sex addiction. Though some believe that sex can affect the brain in ways similar to drugs and alcohol – habituation, withdrawal, escalating risk-taking behaviors, alteration of brain structures – many proponents believe that sex addiction is more similar to a gambling addiction in that it involves a behavior, not a substance.

At present, gambling is the only addictive disorder in the American Psychiatric Association’s fifth edition of the “Diagnostic and Statistical Manual (DSM-5)” that would be considered a process or behavioral addiction.

And it may not even be the actual act of sex that’s the issue.

“It’s not about the kind of sex you have, who you have it with or even how often you have it,” explained certified sex addiction therapist Robert Weiss. “We don’t base the definition of alcoholism on the type of alcohol someone drinks. Like alcoholism, the sex addiction diagnosis is based on whether or not that individual’s behavior repeatedly creates profound problems and crisis in their day-to-day life functioning.”

Instead, Weiss sees sex addiction as a process addiction, in which the hunt for sex, whether that means searching for online porn or surfing for hookups on Tinder, creates in some people an anticipatory arousal that creates more of a rush than the act itself.

Yet some critics question whether there’s a concern at all. “Sex addiction has become the label du jour to explain why people without an understanding of their own desires now struggle and feel out of control in a world that’s increasingly sexually permissive,” said David Ley, a psychologist. “They tend to be people who grew up in religious households who have been taught that sex should make them feel guilty and ashamed.”

Indeed, for some, the label of sex addiction may simply be a response to that shame, said Michael Aaron, a sex therapist. “Many of the ‘sex addict’ clients I see aren’t addicts at all. They’ve been told by a partner or someone else that their behavior, like watching porn or having a high libido, is a problem.”

Other therapists fall somewhere in the middle. “I do believe that a subset of people struggle with out-of-control sexual behavior,” said sex therapist Douglas Braun-Harvey. “They may have sexual urges, thoughts and behaviors that are consensual but that they feel they can’t control. I view this a sexual health problem, though, not an addictive disorder.”

What does the research say?

It’s tempting to look to science to settle this debate, but research only seems to feed the both sides of the debate.

In a well-publicized 2015 study, a researcher at the University of California, Los Angeles, Nicole Prause, used EEG to measure brain activity in 122 men and women, some of whom reported having problems controlling their viewing of online pornography. After showing the volunteers a set of photographs, some of which were sexual in nature, she found that the pattern of brain responses in subjects with porn viewing problems was the opposite of that seen in all other proposed addictions, including cocaine, tobacco and gambling. This suggests that self-reported sex addicts don’t exhibit any different brain activity than people who just have high libidos.