Sex addiction: Is it real? What experts think #Breaking112
But despite social acceptance of the term — and the pattern of killers claiming it as a motive for their crimes — sex addiction isn’t an accepted psychiatric diagnosis.
That’s because the “gold standard in terms of how we think of addiction” is determined by how substances, behaviors or activities trigger certain brain receptors and responses, said Dr. Ziv Cohen, a forensic and clinical psychiatrist and an adjunct assistant clinical professor of psychiatry at Columbia University. That is neurobiological evidence of addiction, which researchers have observed in people who gamble or consume drugs or alcohol, but largely not in people who have identified as sex or porn addicts.
Other reasons why ‘sex addiction’ isn’t an addiction
Symptoms of addictions include “impaired control over behavior, social impairment, … risky use that is continuing despite clear physical and other risks to the individual, and the development of, in the case of substances, tolerance and withdrawal,” said Dr. Paul Appelbaum, the chair of the DSM Steering Committee at the APA and a professor of psychiatry at Columbia University in New York City.
Psychiatrists are also hesitant to characterize levels or brands of sexuality as pathological.
“American psychiatry, for many years, considered homosexuality a psychiatric illness,” Cohen said. “There’s a legacy from that, a very painful legacy.”
Secondly, there are many people “who struggle with healthy sexuality who feel guilty or ashamed of normal sexuality,” Cohen added. “There’s a concern that if you say that there’s something called ‘sex addiction,’ that a lot of people who really don’t have it will start to think that their sexuality, their sexual urges, are not healthy.”
Also, knowing “where to draw the line between healthy and unhealthy sexual urges” is difficult, Cohen said. Sexual urges that violate the rights of other people are easy to classify as pathological. “But if you’re simply saying you have a high sex drive, which leads you to watch a lot of pornography or to pay for sex, it’s harder to just intrinsically label that as pathological because it’s not involved in violating the rights of others.”
Diagnosing and treating issues with sex
The clinical illegitimacy of sex addiction doesn’t mean, however, that people’s personal issues with sex aren’t real. Brain activity isn’t the only way that mental health professionals identify and diagnose disorders. Whether a person’s symptoms interfere with the ability to function in various aspects of life is also a consideration.
Advocates of treating sex addiction as a legitimate disorder “would say, ‘we have subjective distress and functional impairment in individuals with sex addiction, and therefore it should be a diagnosis,'” Cohen said. “You do have clinicians who are out there treating sex addiction, even though it’s not an official diagnosis. So that can seem a little confusing.”
What seems like sex addiction could be hypersexuality, which is sometimes a symptom of bipolar disorder or impulse control disorders, Cohen said.
“In bipolar disorder, when you’re having a manic episode, you tend to be very hyper, you have a lot of energy, you become very hedonistic, seeking pleasure,” he explained. “Manic people often end up becoming very sexually impulsive.”
“Through the sexual world that we live in, these people … are not prepared to manage these sexual desires that come up for them and the opportunity to pursue them. And so they hate themselves for having these sexual desires.”
Suppressing those desires may make the feelings more powerful and harder to avoid, Ley added, even if they don’t rise to the level of a mental disorder.
“People do struggle with these issues,” Ley said. “But it’s really important for us to understand why they struggle with them, and why certain people struggle with them and others don’t, so that we can help these people.”
CNN’s Saeed Ahmed, Eliott C. McLaughlin, Casey Tolan and Amanda Watts contributed to this story.