Sex Addiction: Signs, Symptoms, and Treatment

Sam squirmed uncomfortably in his chair, finding it difficult to look in my eyes as he talked about his porn habit, which in the past few months had overtaken his life. “I’ve been watching porn since I’m 11," he admitted. "But it used to be somewhat under control. Now I’m sneaking into the men’s room at work with my phone for hours at a time. When my wife is sleeping I’m online. I just can’t stop.”

Sam is beginning to realize he is a sex addict. That term began receiving renewed scrutiny in 2017 when former film producer Harvey Weinstein declared that was what ailed him and entered rehab. (After more than 80 women came forward alleging sexual assault and sexual abuse by Weinstein, he was found guilty of rape in the third degree and a criminal sexual act in 2020, and sentenced to 23 years in prison.)

Practitioners in the country’s mental health community still can’t come to an agreement about how to regard a multitude of dysfunctions ranging from compulsive masturbation to uncontrollable infidelity to illegal behaviors including exhibitionism and child pornography. These get lumped together under the label “sex addiction” and affect between 3% and 6% of the US population. There is even disagreement over whether sex addiction or, as it’s frequently called, compulsive sexual behavior disorder, is a treatable mental disorder.

Regardless of the name used, this disorder is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) used by practitioners to diagnose psychiatric illnesses. The rationale for the exclusion is that sex addiction does not cause physical symptoms of withdrawal such as illness or anxiety.

Another concern is not to stigmatize people who enjoy kink, non-monogamous behavior, and other out-of-the-accepted "normal" standards of sexuality. However, this exclusion makes it extremely difficult to receive reimbursement for treatment.

Clinical psychologist and author of The Myth of Sexual Addiction David Ley, PhD, does not mince words. He told me, “Sex addiction is an excuse and distraction used by powerful men when they get caught engaging in impulsive promiscuous behavior.”

However, while the majority of those afflicted may be male, they don’t own a patent on sexual dysfunction. For instance, actress Jada Pinkett Smith has been very open about her past addictions to alcohol, working out, and sex. In July 2018 the actress revealed on her talk show "Red Table Talk": “When I was younger, I definitely think I had a sex addiction of some kind, yes—that everything could be fixed by sex?"

The Society for the Advancement of Sexual Health (SASH), a non-profit multidisciplinary organization dedicated to promoting sexual health, prefers yet another term—“hypersexual disorder.” SASH defines this as “a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior…despite adverse consequences or deriving little or no satisfaction from it.”

When the obsessive behavior continues for six months or more, resulting in “significant impairment” or distress to functioning in other areas of your life—for example, family, relationships, work, self-care, hobbies—attention must be paid.

A patient I’ll call Ed describes his torment: “As soon as you’re done having sex, you feel a sudden repulsion to the person lying next to you. There is trouble focusing on the task at hand. You get sexual images in your head every minute of the waking hours and there are nightmares about sexual taboos such as having sex with a close relative…”

A.D. Burks, author of Sex and Surrender: An Addict’s Journey, labels himself a “former sex addict.” His bottom line: “If a man or woman is continually using sex to escape pain, he or can be considered an addict.”

Indeed addictions, whether they manifest in compulsive gambling, shopping, substance misuse, or sexual acting out, are rooted in the desire to escape emotional pain. The distraction of the pleasurable event becomes harmful when the person’s impulse control abilities are not sufficient to lessen or curtail the activity.

There is a sort of "buyer beware" sticker attached to treatments as sex addiction therapy is unregulated by insurance companies and government agencies. Do your research and make sure wherever you go for help has a good reputation and no complaints.

For some people the 12-step program Sex Addicts Anonymous can be of help by providing community and support. Another good 12-step program is offered by Sex and Love Addicts Anonymous (SLAA). Others may need one-on-one therapy and possibly psych meds.

For instance, my patient Sam and I explored the underlying causes of his addiction. It turned out the now-33-year-old first began viewing porn at age 11 to escape the grief over his father’s recent death. When I asked what was going on in his life a few months previously when the once manageable habit became all-consuming, he reported his mother had just passed away. Not only was my patient grieving his mom, but also the fresh loss had triggered the pain he’d kept bottled up for 22 years. Making this realization allowed Sam to start getting in touch with his emotions; it was a good first step to recovery.

Rather than delving into feelings, cognitive behavioral therapy (CBT) is a short-term approach geared toward helping patients notice and correct the irrational thoughts and feelings that lead to compulsive behavior via learning techniques that serve to regulate the urges. This often involves journal keeping and workbook exercises and can be an effective treatment for sexual addictions.

Doug Weiss, PhD, is the author of, among other books, Sex Addiction: 6 Types and Treatments, and the founder of Heart to Heart Counseling Center, which offers sex addiction therapy that combines psychotherapy, CBT, and group work. Weiss says the crux of treatment is learning to “engage your whole being during sex with a partner you love versus just using someone as a sexual conduit.”

Additionally, it is crucial to follow up with treatment once home and to involve others affected by your addiction in your recovery. Keep in mind, when sexually compulsive behavior stops, physiological and psychological discomfort may be experienced. But withdrawal from sex or even porn isn’t well researched, so most information on the topic is anecdotal.

Weiss, who is also the president of The American Association for Sex Addiction Therapy, offers perhaps the best advice for those struggling with addiction: “You have to be motivated for treatment, not doing it to make someone else happy.”