You may be reading this page as a result of a recent experience like any one of these worrisome sexual behaviors. You may be in a relationship, dating, engaged, or married to a partner who is engaging in sexual behavior that violates your safety, boundaries or expectations. Unfortunately, the most common reaction to most concerns of sexual behavior that appears to be out of control or problematic to yourself or someone with whom you have a sexual relationship is to call the behavior “sexual addiction”.
Sexual behavior problems cause much anxiety, shame, fear and intense reactivity among most adults. A common response to this reaction is to find a name for it. Much like anyone visiting the doctor with symptoms that are frightening, unwelcome and a threat to basic safety and wellbeing, we want an diagnosis and a treatment that will address the problem. And we want it fast.
We will use the term out of control sexual behavior (OCSB) as a general non-diagnostic term to describe the various theoretical models, diagnostic labels and proposed causes for symptoms of OCSB. At this time the diagnostic and statistical manual of the American Psychiatric Association is proposing a diagnosis of Hypersexuality to address the multiple symptoms and consequences of OCSB.
By far the most common term and language for discussing OCSB is the term sexual addiction. This term is both an adjective (it describes a situation or problem, like saying I have a runny nose) as well as a noun (It describes a clinical condition like saying I have an allergy to cats) Both look the same but we do not know what is really happening without further examination.
Other terms are Sexual Compulsivity and Compulsive Sexual Behavior (CSB).
I encourage men and women with concerns about regulating their sexual behavior to avoid a rush to labeling. Consulting with a trained professional with a range of experience with sexual disorders, sexual health, mental health as well as drug or alcohol addiction is an important first step.
Many areas of the United States lack well trained professionals with a strong background in all four of these areas. The specific expertise of the professional will often overly inform the assessment and diagnosis of the symptoms. So if you consult a mental health expert they may attend to the psychological aspects of the symptoms, like treating your depression, addressing a life history of trauma but may be under trained in aspects of sexual health, sexual disorders and unaddressed co-occuring chemical dependency. You may seek out a pastoral counselor specializing in sex addiction. She may address the spiritual and theological pain and suffering and rely upon sexual addiction perspective as an important explanation for the sin. She may not have training in sexuality, sexual health or advanced knowledge in mental health.
If you are concerned about OCSB symptoms, do some research. Treating symptoms of OCSB is an investment in time, money and improving your health. Talking about sex with a professional is never an easy choice. The privacy of some online information gathering may assist you in taking the step to make a call to a person you feel confident has a broad enough level of training to understand, assess and if necessary treat the symptoms with an open mind to your situation and circumstances.
We really cannot say with confidence how frequently symptoms of out of control sexual behavior occur in the United States. The most significant reason for this lack of knowledge is the difficulty we have in our country about gathering any accurate information about exactly what Americans are doing sexually. Keep in mind most sex research has only been done in the last 40 years. The incidence of OCSB demographic data and assumptions come from several resources. The sexual addiction field, sex researchers and sex crime statistics. Each views the symptoms from different lenses and tabulates data based on their theoretical understanding of the problem. Is it an addiction? Is it a sexual disorder? Is it a crime?
The most important incidence statistic is the prevalence of non-consensual sex compared to consensual sex. Sex that involves non-consent is often merged with the label sexual addiction. A person may expose himself to minors or adults without consent and be considered a sex offender, a sex addict, an exhibitionist, a “pervert”, a child molester or even a harmless fool. A man over the age of 18 engages in sexual chat, masturbates and does live web cam sex with a minor. A man drives by a school and masturbated in front of students walking by his car. A female baby sitter fondles a pre-teen.
What is most significant is that they are involved in non-consensual sexual behavior. More than 90% of the men (and the small number of women) sex offenders in treatment or incarcerated in the United States are identified as a result of a criminal charge. If you are engaging in non-consensual illegal sexual activity (put web resource here) you could be one of the lucky few who seek help before their life is destroyed by an arrest. Educating men involved in sex crimes to seek help prior to arrest is an important sexual health message. Most communities have specialists in their city, county or region who treat sex offenders in outpatient treatment offices.
Consensual sexual behavior is any sexual behavior between two consenting adults (or more) who have agreed to have sexual relations with each other. Often consensual sex gets confused with secretive or betrayal sex. An affair is consensual sex if the two adults having the affair have consented to have sex with each other. It is also a betrayal, a secret and cause great harm in marriages, families and communities. The harm is not to be confused with the reality that it is consensual.
Most men and women seeking help for OCSB symptoms will merge consensual and non-consensual sexual behavior under the term sex addict. Sex addiction treatment providers are not necessarily highly trained to address non-consensual sex. A sexual health recommendation is to first consult with a specialist in sex-offending or non-consensual sexual behavior. If you are concerned about whether your sexual behavior is consensual or not, consult with a trained professional in non-consensual sex first. This professional will be in a much better position to assist you in answering this question than a therapist who primarily works with consensual sex and has limited to no training in non-consensual sexual activity.
Out of control sexual behavior symptoms, diagnosis and treatment is influenced by the culture, values, beliefs, religion, spirituality and sexual values of the community and country. When is a sexual behavior part of the overall spectrum of the wide range of sexual behavior among adults? For example, some adults believe that to masturbate is not acceptable and may consider difficulty abstaining from masturbation to be a sign of lack of control of sexual behavior. Another adult may consider multiple masturbation within the same day an acceptable means of self soothing and pleasure. Simply quantifying specific sexual behaviors, frequency or sexual interests in and of themselves as a problem risks diagnosis and treatment based upon disapproval more than a clinical symptom. Professionals that rely upon a narrow range of research, theory, assessment, and treatment approaches may be more at risk to prematurely or inaccurately diagnose and assess sex addiction, compulsive sexual behavior or any of the multiple forms of paraphilia. A common example of this is when sexual behavior or practices are in direct conflict with a person’s faith or religion. When sexual behavior risks maintaining an attachment with God, faith community, morals and beliefs a diagnosis of a psychiatric disorder is a great relief from the tumult and disorganizing fear that can be induced in anticipation of losing this vital life source. It takes a well-trained clinician to differentiate a values conflict from a sexual disorder.
The vast majority of adults (and emerging population of adolescents) experiencing symptoms of OCSB are male. There are a variety of hypothesis about this enormous gender disparity in symptom prevalence.
The signs and symptoms of OCSB have overlap and agreement among the various clinical theories. The prevailing terms for OCSB are
1) Sexual Addiction2) Compulsive Sexual Behavior (CSB)3) Sexual Impulsivity4) Sexual Paraphilia or desire disorder
Risk factors tend to be understood through the retrospective lens of the men and women who have been diagnosed and treated for OCSB symptoms. In other words, we listen to the childhood stories of clients in treatment and extrapolate consistent themes from their stories to understand adverse experiences (poverty, homelessness, victim of crime, family violence, divorce, parental death) traumatic experiences (domestic violence, sexual abuse, physical abuse, neglect, emotional abuse, threat of murder, homicide, crime in the home, drug addicted or alcoholic parents) disruptions in sexual development childhood diseases and treatment involving genitals, early puberty, late puberty, body hatred or image problems, lack of sex education or information, discovery of an unconventional sexual turn-on that is a source of shame, stigma, risk of safety or may be illegal or non-consensual) untreated mental illness (bi-polar disease, depression, anxiety disorders, drug addiction, alcoholism). We learn trends and draw conclusions. Our knowledge of which risk factors contribute to the development of OCSB symptoms is still in its’ infancy. When women and men address these life history events and the health and behavior consequences of their trauma or sexual development their OCSB symptoms are reduced or subside completely. (In many of the clients, but most certainly not all, this is not a precise science.)
San Diego Sexual Medicine is conveniently located on the spacious campus of Alvarado Hospital, a private, physician-owned hospital just ten miles from downtown San Diego, and is easily access by car or public transportation.