I always know someone took an online “sex addiction test,” when their first words to me are “I’m a sex addict.”
I want to correct them by saying, “It isn’t an addiction but it may be a compulsion!” Instead, I say, “Tell me more about yourself,” and open a line of questioning that delves into their sex history since puberty, their mental health status, their upbringing, any traumas they have had, their intimate relationships, and their patterns of both partnered and solo sex, past and present.
In almost every case, they have a self-made sexual compulsion. Today I’m going to unpack the difference between a “sexual addiction” and a “sexual compulsion,” and what kind of work it takes to free yourself.
Sex Addiction Is Controversial
The term “sex addiction” was first coined by Patrick Carnes in 1983. He later created an online test to self-diagnose sex addiction. That quiz is notorious for misrepresenting *all* masturbation and porn viewing as symptomatic of a sex addiction. It doesn’t distinguish between people with high libido and low libido, or liberal vs. conservative values regarding sex.
Someone who knows the difference between compulsions and addictions might easily get the idea that this test is designed to make people feel hopeless and funnel them directly into addiction counseling. But is addiction counseling the best option for most people?
Crucially, addiction counseling doesn’t always explore the root causes of your compulsion. Nor does it account for co-existing mental issues or trauma that make some of us particularly vulnerable to obsessions and compulsions. Meanwhile, the diagnosis of sex addiction has been firmly rejected by psychiatrists and certified sexologists. Instead, we use the term sexual compulsion.
Let’s look at some statistics.
Comparing Sex Addiction to Compulsions
According to AddictionHelp.com, which endorses sexual addiction counseling, “The average time in recovery from sex addiction was 3.4 years, ranging from two months to 14 years.” They also note that “Research on the relapse rate of sex addicts is sparse. However, according to research from Arizona Community Physicians, 64% of sex addicts with at least 5 years in recovery reported having had a significant slip or relapse, in many cases well after the first year or two.”
My clinical experience couldn’t be more different. While most clients do “slip” during the first months of therapy, no one has reported a relapse during treatment or after it has ended. I don’t claim a 100% cure rate. That’s unrealistic. I assume if people did relapse, they tried another counselor. But I can say with confidence that 90%+ of patients who worked with me fully recovered.
Utah State University published its research, reporting that “a randomized clinical trial, based on acceptance and commitment therapy [ed., ACT], resulted in a 92 percent reduction of pornography viewing following 12 treatment sessions,” (the typical 3-month course of therapy). 54 percent of their subjects stopped watching porn “completely.” (Note: everyone in this trial belonged to the LDS Church. Using a self-selected sample means these statistics may not apply to the general population.)
These results line up with my clinical experience. I’ve had clients achieve their goal in 2 months and clients who took 6 months. Three to fourteen years of treatment astonishes me, as does their failure rate. Naturally, this makes me wonder if a focus on correcting a sex compulsion is more effective than trying to cure a “sex addiction.”
Why Sex Therapists Say Compulsion Instead of Addiction
Sex therapists look for the red flags that make people vulnerable to compulsions. Pre-existing sex trauma is a big red flag. Religious trauma may set someone up to become compulsive. We also take a more generous view of sex, understanding that it is normal for someone with high libido to physically need frequent sexual release, whereas someone with low libido won’t have the same kind of urgency about sex or masturbation.
While the sex addiction movement makes it sound like masturbation and porn are symptoms of addiction, sex therapists consider masturbation and porn to be harmless normal activities in adulthood. We don’t assume that any two people who masturbate five times a day are identical. For some, it’s their physiological norm to be horny and need relief a LOT. For others, it’s a compulsion driven by their ego state.
The questions we ask center on their emotional attitudes towards self-pleasure and porn. Are they feeling guilty or ashamed of their sex habits? Do they hate themselves for it? Do they repress their needs to control them? Ironically and tragically, the more they hate themselves for masturbating or watching porn, the more likely they are to be vulnerable to compulsions. It’s not just the highs of compulsion that trap them. It’s their psychological state, before, during, and after.
In my experience, four primary forces cause compulsions.
Four Driving Forces in Sexual Compulsions
Sexual Repression
We don’t use that term much anymore, but it was popular in the 1960s-70s. It remains accurate too. The more you repress your natural biological needs, the uglier the results. Sexual repression raises stress, increases vulnerability to compulsions, disrupts your ego, and can trigger medical diseases and disorders.
Frequent (minimum three times a week) masturbation is medically proven to reduce the toll of stress on the body and mind. The problem is that it has to be happy masturbation that leaves a person feeling content. Most people with compulsions end up feeling more stressed out than relieved because they have deeply repressed shame and guilt about doing it.
The Shame Trap
As detailed in my previous blog, Living With a Fetish, the “shame trap” is a never-ending loop of self-destructive sexual behavior. You repress your natural sexual desires; you become stressed out; you develop a compulsion or mental problem in response to the stress. Instead of getting satisfaction from sex, stress now distorts your perceptions, invades other areas of your life, and leads you to make bad choices, which then elevates feelings of failure, and drives you back to compulsivity.
The Rabbit Hole of Lust
In How to Move Beyond Porn Dependency, I wrote: “A porn compulsion builds on itself until it looks like an addiction. Instead, it’s a self-sabotaging pattern you have trained your brain to follow.”
There is speculation that such people are chasing dopamine. They want to trigger the feel-good chemical dopamine in their brains. As with substance abuse, the more you use the drug, the higher the doses you crave. When the porn you used to watch doesn’t give you the same thrill, you chase dopamine down by watching more extreme porn, hoping to get the same exquisite rush you felt at the beginning.
In Do You Have a Balanced Sex Life?, I talk about the rabbit hole of extreme fantasies. My clients often start with the porn they find acceptable and end up accelerating to fantasies that disgust them and make them intensely confused about their sex or gender identity.
Emotional Instability Masked As An Addiction
You cannot overestimate the toll that untreated mental disorders take on a person’s choices. As a specialist in kink, I know there are two kinds of masochism: healthy masochism and unhealthy masochism. Healthy masochism is when a stable person enjoys intensity and experiences pleasure and satisfaction from a consensual sadomasochistic experience. Unhealthy masochism is when an unstable person uses masochism to punish themselves and prove to themselves that they’re terrible people.
This holds true for compulsions. You may be a person who needs to masturbate several times a day to feel content. Or you may be seeking to hurt yourself by engaging in an ego-destroying behavior. It takes a skilled therapist to make that distinction and to develop a treatment plan to address your underlying issues before tackling the compulsion.
I recently had great success with a client with a long history of being angry at himself and feeling like a loser. He was in a bad place mentally. He developed a self-harming sexual compulsion around that self-destructive urge. By working on his self-esteem and resolving some past traumas, he recovered remarkably quickly. The compulsion eased and ultimately vanished.
Recovery Is Possible
Compulsions can be successfully treated in a majority of cases. There are no magic bullets. It requires a team effort between therapist and client to unravel the roots of the behavior and, step by step, to make small but significant steps to regain self-control.
If it is a behavioral pattern you’ve trained yourself into, it’s one you can train yourself out of. If there is an underlying issue — such as trauma or mental instability — those problems need to be treated before you can heal your compulsivity.
Accepting that you have a compulsion and being ready to make the necessary changes will change your brain for the better and free you for life.
image credit Tom Pumford @ Unsplash.com
