Sex Addiction Treatment: Psychoanalytic Perspectives
March 3, 2016

The Problem of defining sex addiction: What it IS and IS NOT

What Sex Addiction Is…and Isn’t

sex addiction treatment needs to understand it


First – let us consider what sex addition is NOT:  Sex addition is not defined by sexual desireSex addiction is not defined by the type of sexual act performed.  It isn’t defined by the frequency of sexual activity.

Rather, sex addiction is defined by the addict’s continual sexual urges, cravings, fantasies and behaviors to address non-sexual emotional needs.

Sex addiction is an obsessive relationship to sexual thoughts, fantasies or activities that an individual continues to engage in despite adverse consequences. These thoughts, fantasies or activities occupy a disproportionate amount of “psychic space” (the inner world of the addict that isn’t conscious, but is emotionally powerful enough to overrule thinking).  These thoughts result in an imbalance in the person’s overall functioning in important areas of life, such as work and marriage. Distress, shame and guilt about the behaviors erode the addict’s already weak self-esteem.

Sexual addiction can be thought of as an intimacy disorder.  This means that  manifested as a compulsive cycle of preoccupation, ritualization of sexual behavior, and despair. Central to the disorder is the inability of the individual to adequately bond and attach in intimate relationships. The syndrome is rooted in early attachment failure with primary caregivers and is a maladaptive way to compensate for this early child/parent misattunement. Addiction is a symbolic enactment of deeply entrenched unconscious dysfunctional relationships with self and others.

While the definition of sex addiction has similar features as that of other addictions, sexualcompulsion is set apart from other addictions in that sex involves our innermost unconscious wishes, needs, fantasies, fears and conflicts.

Like other addictions, it is relapse-prone.

What are the signs/symptoms of addiction?  

While there currently is no diagnosis of sex addiction in the DSM-IV, clinicians in the sex addiction field have developed general criteria for diagnosing sex addiction. If an individual meets three or more of these criteria, he/she could be considered a sex addict: The sex addict uses sex as a quick fix, or as a form of medication for anxiety, pain, loneliness, stress, or sleep.  Sex addicts often refer to sex as their “pain reliever” or “tension reliever.”   This is what the Association for Sexual Health has to say about a definition for sex addiction.

  • The addict displays increasingly secretive behavior, deception, and withdrawal from those closest to him resulting in severe stress to the relationship and loss of self-esteem for both partners. Sexual addiction is often accompanied by other addictions, such as an addiction to work or chemicals
  • The addict displays increasingly secretive behavior, deception, and withdrawal from those closest to him
  • Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex; frequently engaging in those behaviors to a greater extent or over a longer period of time than intended
  • Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience
  • Preoccupation with the behavior or preparatory activities
  • Frequently engaging in sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations
  • Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior
  • Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk
  • Giving up or limiting social, occupational, or recreational activities because of the behavior
  •       Experience of distress, anxiety, restlessness, or violence if unable to engage in the behavior at times relating to SRD (Sexual Rage Disorder)
  •  Tolerance, as defined by either of the following:
  •    a need for markedly increased amount or intensity of the behavior to achieve the        desired effect
  •    markedly diminished effect with continued involvement in the behavior at the same level or intensity
  • Withdrawal, as manifested by either of the following:
  • o characteristic psycho-physiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior
  • o the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
  • There is a persistent desire or unsuccessful efforts to cut down or control the behavior.
  • The behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior
  • Repeatedly and compulsively attempting to escape emotional or physical discomfort by using ritualized, sexualized behaviors such as masturbation, pornography, including obsessive thoughts.

Some individuals try to connect with others through highly impersonal intimate behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism, frotteurism, cybersex, sexual arousal to objects, situations, or individuals that are not part of normative stimulation.







Dorothy Hayden, LCSW has 20 years of experience treating sex and porn addicts, love addiction, codependency, fetishes, sadomasochism, "kink friendly", crossdressers and their wives, partners of sex addicts. She has been interviewed on "HBO", "20/20" and Anderson Cooper 360. Ms. Hayden has authored the book "Total Sex Addiction Recovery - A Guide to Therapy"

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