Compulsive sexual behaviour can be a real problem in some people, causing them to engage in risky and self-destructive acts revolving around their libido, experts say.
The career of professional golfer Tiger Woods took a beating from revelations of cheating with as many as a dozen women. Former New York Mets general manager Steve Phillips was fired from his job as a baseball analyst on the ESPN network after a workplace sex scandal.
But are they, and others like them, suffering from an actual addiction?
Both Woods and Phillips have claimed they are, and both men sought treatment at sexual addiction programmes.
Mental health professionals agree that some people indulge in uncontrollable and harmful sexual behaviour and that they truly cannot help themselves.
They disagree, however, about whether this behaviour constitutes a true addiction or is better characterised as some other sort of mental disorder.
New diagnostic category
The new edition of the Diagnostic and Statistical Manual of Mental Disorders, the book considered the bible of psychiatry, will contain a new category of behavioural addictions - but sexual addiction will not be included in that category.
"There's not enough empirical evidence to call sex an addiction at this point," said Dr Martin P. Kafka, an associate clinical professor of psychiatry at Harvard Medical School and a member of the task force that's revising the manual.
Therapists active in sexual addiction disagree.
"We've been treating sexual addiction for more than 20 years now," said Douglas Weiss, a psychologist and executive director of the Heart to Heart Counseling Center in Colorado Springs, Colo.
Weiss noted that the psychiatric field sometimes has had to play catch-up with the facts. Homosexuality, for instance, was included as a mental disorder in early editions of the manual, and it took psychiatrists some time to agree that alcoholism was a disease.
Just a strong sex drive?
Also, there are clear differences between people with strong sex drives and people who are sex addicts, Weiss said.
"The high libido person wants an emotional connection," he said. "The sex addict just wants a fix. It's not about intimacy. It's about getting the fix. Sex addicts are disconnected during the act itself."
Even psychiatrists who disagree with the existence of sexual addiction agree that there are people with sex problems who seem to fit the mould.
"The notion of sexual addiction is extremely clinically useful," Kafka said. "People come in and say, 'I'm addicted to sex. This is wreaking havoc on my life.' For people with this condition, calling it a sexual addiction really does capture their experience."
However, there are problems with trying to fit sexual compulsion into the psychiatric model established for addictions, Kafka said:
It's not been shown that you need increasing amounts of sex to get the same effect, which is the case with drug addiction.
Though it involves risk-taking behaviour, there's not strong evidence that the risk-taking escalates as it does in other forms of addiction.
Though it can be difficult or impossible for people to stop compulsive sexual behaviour, researchers aren't sure they suffer from actual withdrawal.
Not all that similar
The problem stems from trying to apply the addiction model to innate biological activities, Kafka said.
Drug use and gambling "are not biological drive states like eating or sleeping or sex," he said. "We all have a wish to eat and a wish to sleep and a wish to have sex." In other words, it's hard to ascribe to addiction something that people need to do as a part of being human.
Psychiatry has been able to diagnose and address aberrations in those biological drives without calling them addictions. People who compulsively eat, for example, are diagnosed as suffering from bulimia or a binge-eating disorder -- but they aren't called food addicts.
Weiss has proposed creating a new illness category, hypersexual disorder, in the diagnostic manual that would cover the behaviours now referred to as sexual addiction.
The new diagnosis would include such activities as excessive promiscuity, overdependence on pornography and compulsive masturbation. "These behaviours have specific characteristics and cause adverse consequences when they are frequent and intense," Weiss said. (HealthDay, May 2010)