A “sex addiction epidemic” is unfolding like a plague in the US, according a recent Newsweek cover story—but don’t reach for the chastity belt just yet. The over-stimulated article is weakly reported, superficial, and perpetuates confusion about sexual disorders that researchers in the field have been trying to alleviate.
“Sex addiction” has been a popular story since the publication of Out of the Shadows: Understanding Sexual Addiction, a 1983 conceptual treatise by therapist Patrick Carnes. Newsweek cites an estimate by The Society for the Advancement of Sexual Health, an education and treatment organization co-founded by Carnes, that “between 3 and 5 percent of the U.S. population—or more than 9 million people—could meet the criteria for addiction.”
Carnes (or the society) gave the same estimate to the Minneapolis Star Tribune in 1988, to The Washington Post in 1998, and to The Wall Street Journal in 2008—and stories quoting the media darling have put the estimate of sex addicts in America as high as 16 million.
The real story is about the “criteria for addiction” that Newsweek mentioned, but never explained. The only news is the shameless plug for Shame, a recently released movie about a sex addict, which gets not only a full-page sidebar, but a full paragraph in the story itself. The piece also touts a reality show about sex addicts, Bad Sex, quoting its therapist host. The pandering treatment of Hollywood should be no surprise given that Newsweek’s entertainment reporter, Chris Lee, wrote the article.
The result is the latest installment in a long line of voyeuristic articles (even the accompanying photos smack of soft porn) that crop up every time some Lothario pulls a David Duchovny or a Tiger Woods. It begins with the predictable peeping-Tom lede, which sets its gaze on Valerie, a pseudonymous woman “logging” a laundry list of promiscuous activities.
After mentioning that “‘sex addiction’ remains a controversial designation often dismissed as a myth,” the article drops the quote from Steven Luff asserting that it’s actually “a national epidemic.” Luff, like most of the other sources in the article is the author of a book about dealing with sex addiction and the leader of sex-addiction recovery program. The problem with relying on therapists, as most of the articles over the years have done, rather than qualified experts in academia, is that they have a vested interest in promoting the idea that there’s a widespread problem. The more people believe it, the more money they make.
In fact, the evidence that Lee uses to substantiate the alleged “growth” in sex addiction is the swelling number of sex therapists and treatment centers. Whether that reflects a proliferation of sex addiction or just a proliferation of clever marketing isn’t clear. It becomes readily apparent that Lee isn’t really interested in the answer when he goes on to claim, “This year the epidemic has spread to movies and TV.” That’s the cue for the free advertising mentioned above, after which Lee finally makes an attempt to show that he dug into the scholarly literature. It falls flat.
The bottom half of the article contains four variations of the phrase “research shows ”, none of which specify what research Lee is referring to. In one instance, he mentions “research showing that chronic masturbators who engage with online porn for up to 20 hours a day can suffer a ‘hangover’ as a result of the dopamine drop-off,” and then asserts, “But there are other collateral costs.” Lee doesn’t define those costs, however. Instead, he quotes the head of a Christian website that combats porn addiction, who suggests that looking at online porn will lead you “to do so many things you never thought you’d do.”
Spending twenty hours a day looking at porn is undoubtedly problematic behavior and extremely unhealthy, but allowing that kind of vague, moralistic commentary in a paragraph that purports to be about scientific research is outrageous.
His other statements about what “research shows” aren’t much better. According to one, “Although sex addicts sometimes describe behavior akin to obsessive-compulsive disorder, research hasn’t directly correlated the two.” (Yes, it has; more on that in a minute.) The next sentence reads, “But a growing body of research shows how hypersexual disorder can fit into other forms of addiction.” (That’s true, but ‘correlate with’ would be a better choice of words than ‘fit into.’) And, finally, a paragraph later, Lee writes, “Research shows that substance abusers and sex addicts alike form a dependency on the brain’s pleasure-center neurotransmitter, dopamine.” (That’s accurate, but more complex than it seems.)
What Lee is scratching at, but fails to reveal, is a serious debate about how we define, diagnose, and treat problematic hypersexuality.
There’s little consensus. The current, fourth edition of the Diagnostic and Statistical Manual of Mental Disorders includes a number of sexual dysfunctions—including hyposexuality (or being “under-sexed”)—and gender identity disorders. There’s no mention of hypersexuality, but rather a group “paraphilias,” defined as recurrent and intense sexually arousing fantasies, urges, and behaviors involving either nonhuman objects, the suffering or humiliation of oneself or one’s partner, or children or other non-consenting persons.
When Newsweek and other media outlets write about sex addiction, however, they’re almost always referring to problematic behaviors that fall with the bounds of conventional sexual activities. They include things like chronic masturbation and promiscuity and the excessive use of pornography and phone sex. The emphasis is on the word “problematic,” meaning the behavior is accompanied by a loss of control, emotional distress, or other negative consequences. Researchers have taken a lot of interest in these behaviors, but they’re absent in the DSM (the other main diagnostic manual, the International Classification of Diseases, lists “excessive sexual drive” and “excessive masturbation”), so patients who exhibit the behavior are often diagnosed with a mood disorder, compulsive disorder, or sexual disorder “not otherwise specified.”
At any rate, addiction is just one model for conceptualizing problematic hypersexuality, and it’s probably the best, but certainly not flawless. The current edition of the DSM treats addiction within the context of “substance-related disorders,” differentiating between substance abuse and substance dependence. There are seven criteria—from uncontrolled use to social and professional impairment—characterize dependence, three of which must be met within a twelve-month period for positive diagnosis. But researchers and therapists have extrapolated these criteria beyond substance abuse in order to attribute certain behavioral disorders, including hypersexuality, to addictive processes.
The justification for this, as Lee hinted, is hypersexuality’s association with neurological addiction mechanisms like the reward pathway modulated by dopamine and its concurrence with other addictive behaviors. In addition, treatment programs adapted from the traditional twelve-step programs used for substance abuse and dependence have been fairly successful. There is a fundamental difference when it comes to treating sex addiction, however, insofar as abstinence is not the goal. Thankfully, Lee picked up on this in Newsweek, emphasizing that most programs “advocate something called ‘sexual sobriety’” instead.
Overreliance on the addiction model can mask other important considerations related to the causes and effects of problematic hypersexuality, however. The two other primary models for conceptualizing the disorder are compulsivity and impulsivity. The former is associated with calculated behavior designed to avoid harm or reduce anxiety, whereas the latter is associated with spontaneous behavior designed to maximize pleasure or gratification. Both involve reduced inhibition and repetitive actions, but under DSM guidelines, compulsive behavior is often diagnosed as an anxiety disorder, like obsessive-compulsive disorder (OCD), impulsive behavior is often diagnosed as an impulse-control disorder, like pyromania. It’s no surprise that the different motivational states underlying each type of behavior necessitate different treatment, and patients have responded differently to medications and neuroimaging depending on which type they exhibit.
Problematic hypersexuality, which represents a whole spectrum of behavior, has both compulsive and impulsive attributes. To a certain extent, the addiction model accounts for that duality, but none of the models are perfect. As such, one leading researcher, Martin P. Kafka, a clinical psychologist at McLean Hospital, a affiliate of Harvard Medical School, has proposed the term “Hypersexual Disorder” for inclusion in the long-awaited and much-anticipated fifth edition of the DSM, due out in 2013.
Other researchers, such as Charles P. Samenow, an assistant professor of psychiatry and behavioral science at The George Washington University Medical Center, have challenged Kafka’s proposal, arguing that although “sex addiction” is “vague, overused, misused, clinically inaccurate, and stigmatizing,” it should not be discarded.
“It may seem petty to argue over the name of a disorder, as long as the clinical criteria are valid and reliable indicators of the disease process,” he wrote in a 2010 essay. “ The purpose of this editorial is not to throw punches at the current proposed DSM-V disorder. Rather, it is to critically examine the continued use of the term Sexual Addiction in our work and our title. Simply because the lay public misuses or does not understand a clinical term, does not mean that the term is not valid. Rather, it is our job as researchers and clinicians to continue educating the public in the appropriate use of the term and to apply scientific rigor to its definition and use.”
Unfortunately, Newsweek’s article did the exact opposite. Its superficial reporting and tawdry claim about an “epidemic” of sex addiction will undoubtedly lead to more public misunderstanding and misuse of the term. It totally missed the complex and fascinating debate about how we define, diagnose, and treat problematic hypersexuality, which two psychologists at the University of Ottawa ably summarized in a comprehensive review of the scholarly literature.
The risk is not just another cheap, voyeuristic article—but that by sensationalizing sex addiction, a lot of people will seek out and spend their hard earned money on treatments that are ineffective or unnecessary. If they really want to help people, journalists need to stop fetishizing this subject and start taking it seriously.