Written by: Abbey Riendeau, LMHC
The term “sex addiction” has become more mainstream as of recent years. You may have heard the term used in television shows, movies, or maybe even among peers. The term is often used to refer to individuals who seem to be incapable of controlling their sex drive, whether through sexual intercourse, masturbation, and/or pornography use. Despite sex addiction becoming a well-known problem for many people, it is not a diagnosable mental health disorder like drug or alcohol addiction is. Why is this?
There are many challenges associated with clarifying sex addiction as a disorder. For one, experts cannot agree on criteria for the disorder, what to call it, or even agree if there is such a thing as sex addiction in the first place. Researchers are unsure if behaviors related to what is considered sex addiction best fit under addictive disorders, psychosexual development disorders, impulse control disorders, mood disorders, or obsessive compulsive disorders. This lack of consensus regarding terminology and definition negatively impacts the measurement and comparison of research results, and thus recommendations for addressing problematic behaviors.
There are additional challenges in separating what is considered normal and abnormal behavior in order to determine when loss of control occurs, resulting in a sexual addiction. For example, some individuals seek help because they perceive their sexuality as out of control. It is not clear if this perception is accurate, the result of another mental disorder, a new mental disorder, a conflict between the individual and society, or a conflict in the individual’s religious beliefs, self-imposed morality, personal expectations, or a misunderstanding of what constitutes normal sexuality. It is difficult to say who sets the standards for what is considered normal behavior when that varies from person to person and is impacted by many factors, including culture, beliefs, and experiences. It becomes important to assess for each individual person how behaviors related to sex, masturbation, and/or pornography use are negatively impacting them and causing distress in their life.
Despite controversy and disagreement among the existence of and criteria for sex addiction, professionals have recognized the phenomenon of individuals continuing to engage in sexual activity despite negative consequences. Regardless of diagnostic agreement, there are still people struggling with sexual behaviors that are causing problems and distress in their lives. There are still people looking for answers and help in overcoming problematic sexual behaviors.
Over the years, several professionals have attempted to identify criteria for sexual addiction or similar disorders. In 2010, diagnostic criteria for hypersexual disorder was proposed, but it did not pass consensus to be included. This proposed criteria included the following:
1. sexual preoccupation or excessive time invested in thought, planning, or engaging in the behavior.
2. Using sex to cope with negative mood states.
3. Repetitively using fantasies, urges and behavior in response to stressful life events.
4. Attempts to reduce or control the sexual behaviors without success.
5. Continuing to engage in repetitive sexual behaviors in spite of significant physical or emotional harm to oneself or others.
The diagnosis of hypersexual disorder would be warranted if at least four of the five criteria manifested concurrently for at least six consecutive months. This criteria resembles less of a sexual disorder or paraphilia and more of a substance-use disorder or addictive disorder. Ultimately reviewers concluded there was not enough empirical evidence to include hypersexual disorder. Researchers continue with field trials and advocacy for diagnostic clarity, but in the meantime, these criteria may serve as a recommendation for assessing for sex addiction or hypersexual disorder.
Another challenge related to clarifying sexual addiction is the complexity of factors tied into the development and maintenance of problematic behaviors. The field of addiction, and especially sex addiction, is rapidly changing and society and professionals continue to grapple with whether a medical, psychological, or social model is most appropriate. By using a biopsychosocial approach, therapists can be encouraged to adopt an eclectic, comprehensive model for both assessment and treatment that addresses the complexities of individual cases. Additionally, this model allows the problem to be understood and viewed in a holistic manner, with regard to how a person becomes involved in addictive behavior, stays involved in addictive behavior, and stops the addictive behavior.
BERSC Model
The BERSC (Biological, Emotional, Relational, Social, and Cultural) model is an expansion of the traditional biopsychosocial model and was developed specifically for use with sex addiction. In addition to exploring biological, psychological, and social influences, the model also explores relational components and the individual cultural context of each patient. This includes the influence of gender identity, sexual orientation, family of origin, faith, race, and work culture.
Below is a brief review of each section of the BERSC model and how it contributes to sex addiction:
Biology: Addiction affects both the reward system and the neocortex of the brain and dopamine is the common denominator in all addictions. There is growing evidence that early brain development may also influence the development of addiction. Trauma has also been found to impact brain development in the limbic system and brainstem.
Emotion: A key difference between compulsive and non-compulsive sexual behaviors is that they are used primarily for emotional regulation. Using sex for mood regulation is not necessarily problematic until it becomes the primary method of mood regulation, then dependency may follow. Shame is also a key component of sex addiction, as it can be understood to be not only a cause of the addiction but also a consequence. Sexual behaviors provide a powerful way of numbing difficult emotions, but at a cost.
Relationship: Early attachment wounds not only impact us biologically and emotionally, but also continues to impact us into our adult relationships. Different types of attachment styles impact how an individual relates in relationships and can increase the likelihood of developing a sex addiction for coping. Some hypothesize that once an attachment has been made to an addiction as a source of comfort, it is harder for an addict to create secure attachments within relationships and, hence, the addiction both causes and results in further insecure attachments.
Society: The advent of the internet and smartphones has resulted in not only greater access to pornography, but new types of sexual activities, such as cybersex, being available at our fingertips 24/7. At the same time, Western societies now enjoy greater sexual freedom and gender equality than perhaps at any other time in history, which means we have more sexual choices than ever before. For someone with a biological, emotional, and relational predisposition to sex addiction, our sexually liberated society provides an environment in which the addiction can flourish.
Culture: Cultural influences may include gender identity, sexual orientation, race, faith, peers, family, friends, and the workplace. Individual perspectives of ‘normal’ or ‘healthy’ sexuality are largely defined by our cultural context. Therefore, these influences not only the assessment of compulsive sexual behaviors but also the definition of sobriety, the treatment approach, and relapse prevention strategies.
Sex, masturbation, and/or pornography addiction is an under-discussed, under-researched, and complex problem that more and more people are struggling with. Despite the lack of agreed upon criteria and treatment, there is help available for those struggling with sexual addiction. If after reading the above information you are concerned about your own or a loved one’s relationship to sex, please reach out to a licensed therapist for help.
Our therapists at Forensic Insight Group are familiar with issues related to problematic sexual behaviors and are available to help you take control of your sex life. We offer individual therapy sessions as well as group therapy for sex addiction. For more information about services provided at FIG, please contact our office at 508-296-0229 or email us at info@forensicinsightgroup.com.
Citation:
Birchard, T., & Benfield, J. (2019). The Routledge International Handbook of Sexual Addiction. Routledge, Taylor & Francis Group.