Signs and Symptoms of Sex Addiction

Sex addiction is the compulsive engagement in sex despite negative consequences. Moreover, it is a behavior that is emotionally distressing rather than fulfilling.

The concept of sex addiction can be difficult to grasp, given that an addiction typically refers to a brain disorder that results in compulsive and detrimental behaviors. A sexual addiction does share many of the hallmarks of a clinical addiction, without a clear understanding as to the cause.

One of these hallmarks of addiction is that the person will be unable to control their sexual urges. Even if the consequences are clear (or even likely), people with a sex addiction will be unable to stop the behavior unless there is some sort of intervening event.

As opposed to someone with a healthy sex drive, a person with a sex addiction will spend a disproportionate amount of time seeking or engaging in sex while keeping the activity secret from others. As a result, personal and professional relationships may suffer. There may even be an increased risk of sexually transmitted infection, including HIV, if a person is unable to rein in their sexual impulses.

People with a sex addiction often will use sex as a form of escape from other emotional and psychological problems, including stress, anxiety, depression, and social isolation.

Sexual addiction is part of an umbrella concept known as hypersexual disorder, which includes such behavioral disorders as:

• Hypersexuality (previously known an nymphomania or satyriasis)
• Erotomania (a delusional disorder in which person believes others are infatuated with him or her)
• Paraphilia-related disorder (a somewhat outdated diagnosis characterized by an intense sexual response to atypical objects, situations, or fantasies)
• Sexual disinhibition (the absence of sexual inhibition in a way deemed inappropriate)

These behaviors are closely aligned with a concept known as risk compensation in which people will adjust their sexual behavior based on their perception of risk. As a result, people will often put themselves in harm's way by "bargaining" that the risk (of infection, of getting caught, of missing work, etc.) is lower than it actually is.

Not everyone in the medical community is convinced that compulsive sexual behaviors can be classified as an addiction. Because of this, sex addiction is not listed as a clinical diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA).

As a result, the diagnostic criteria for a sex addiction is often vague and subjective. However, there are certain defining features common to people with sex addiction.

Among them:

• Sex dominates the person's life to the exclusion of other activities.
• The person masturbates habitually when alone.
• The person engages in other forms of sex when alone, including phone sex, pornography, or computer sex. 
• The person engages in sex with multiple partners and/or has extramarital affairs.
• Sexual activities will often be inappropriate and/or risky and may include exhibitionism, public sex, sex with prostitutes, or regular attendance at sex clubs.
• The constant urge for sex is typically interspersed with feelings of regret, anxiety, depression, or shame.

In fact, a sexual addiction is most often characterized by a vicious circle of hypersexuality and low self-esteem. Although sex can bring short-term relief, the harm to the person's psychological well-being will often increase and worsen over time.

A person does not have to engage in extreme or "strange" sex to have an addiction. They will simply be unable to stop themselves despite the harm that they know may result from their behavior.

There are a number of theories as to why a sexual addiction occurs. They include psychological and emotional problems that arise from past sexual trauma.

For example, women who are raped will sometimes engage in hypersexual behaviors as a form of self-punishment. In other cases, sex may be a coping mechanism to deal with deep-seated childhood abuse or trauma.

In some forms of mental illness (such as depression, obsessive-compulsive disorder, and bipolar disorder), hypersexuality may be a symptom, either as means of compensation (as with depression) or a feature of a manic episode (with bipolar disorder).

Rarely, neurological disorders (such as epilepsy, head injury, or dementia), have been known to cause hypersexual behaviors. Certain drugs, such as Apokyn (apomorphine) and dopamine replacement therapy (DRT), may also do the same. 

Sexual addiction requires treatment from a medical professional experienced in the field, such as a psychologist, psychiatrist, or sex therapist. Treatment can vary based on the underlying cause, but will typically be conducted on an outpatient basis with counseling and behavioral therapies.

If the sex addiction is associated with a mood, anxiety, or personality disorder, medications may be prescribed as part of the treatment plan. There are currently no recommendations on the appropriate use of drugs to treat a sex addiction outside of the realm of these clinically classified disorders.

The first point of contact can be a family doctor or local psychiatric association, both of which can make a referral to the appropriate specialist. Marital therapy may also be helpful.

There are also a growing number of sex addiction support groups, some of which deal with co-additions (such as sex and substance abuse) and others of which are built on a 12-step recovery model.