By Amanda MacMillan
November 10, 2017
TIME Health
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Is sex addiction real? It depends who you ask: Hollywood stars and industry heads who’ve cited it in defense of reported sexual indiscretions—ranging from infidelity to harassment to rape—may argue that it is. Over the last decade, celebrities including David Duchovny and Tiger Woods have famously sought treatment for sex addictions; more recently, Harvey Weinstein and Kevin Spacey have made similar announcements after accusations of misconduct.

Among scholars and medical experts, the consensus is less clear. And just this week, three non-profit organizations came out against the notion that sex or pornography can be “addicting,” saying the term can be misleading or even harmful to people seeking help for intimate issues.

The new position statement, drafted by the Center for Positive Sexuality (CPS), the Alternative Sexualities Health Research Alliance (TASHRA), and the National Coalition for Sexual Freedom (NCSF), is published this week in the online Journal of Positive Sexuality. It follows a similar statement last year from the American Association of Sexuality Educators, Counselors, and Therapists, which also spoke out against the idea of sex or porn addiction.

In their statement, the advocacy groups write that perceptions of sexual “addictions” may have more to do with people’s religious or cultural beliefs than of actual scientific data. The concept of sex addiction “emerged in the 1980s as a socially conservative response to cultural anxieties,” the authors wrote, “and has gained acceptance through its reliance on medicalization and popular culture visibility.”

The idea that people can be addicted to sex (or to porn) implies that people’s sex drives and erotic interests can be grouped into “normal” and “not normal,” the groups say, which could leave those with alternative sexual identities vulnerable to discrimination. It can also suggest that using sex or pornography as a coping mechanism is always a bad thing—when in fact, the statement argues, it may be perfectly healthy way to deal with stress and other problems.

These groups have the medical community at least partially on their side. Sex addiction is not recognized in the Diagnostic and Statistical Manual (DSM-5), the reference guide for mental illnesses published by the American Psychiatric Association (APA). One reason for that is a lack of evidence that sexual behavior changes the brain the same way other addictive substances—like drugs and alcohol—do.

“Drugs activate [an addict’s] brain’s reward system directly, like getting food or water,” Dr. Charles O’Brien, chair of the substance-related disorders work group for the APA, recently told Health.com. “It could be that there are some similarities in those people who are called ‘sex addicts,’ but it hasn’t been studied or demonstrated.”

In fact, several studies have found that people who are what clinicians call “hypersexual” do not display the symptoms of addiction.

On the other hand, more recent studies have suggested that the science is still emerging. And at least one small study has suggested that watching porn may be associated with brain changes similar to those seen in people who are addicted to drugs. (More research is needed, the authors say, and it’s unclear whether this is really a cause-and-effect relationship.)

There are also plenty of mental-health professionals who say that sex addiction is real.

Sandra Davis, a psychologist in private practice in Pittsburgh, says she’s treated clients for various sexual issues, including addictions to pornography and compulsions to cheat. She even believes that repeat sexual offenders can change their ways, with intensive and long-term treatment.

“We’re talking about the inability to stop a behavior that brings someone pleasure, despite the significant consequences that can and do occur,” says Davis. “And we certainly see that happen with sex.” Oftentimes, Davis says, these compulsions are linked to previous psychological trauma—often from childhood—or to obsessions with power, dominance, and unmet emotional needs.

People who feel they’re addicted to sex may be unable to resist being unfaithful to their spouse or engaging in risky or inappropriate situations, she says. When it comes to pornography, there are people (mostly men) who feel they’ve become dependent on watching it, and are unable to perform sexually without watching it.

In their position statement, CPS, TASHRA, and NCSF acknowledge that many people struggle with sexual issues and have valid reasons for seeking professional help. But rather than diagnosing those people with an addiction, the statement suggests, professionals should support behavioral change “in healthful ways that are consistent with clients’ moral beliefs and worldviews.”

Dough Braun-Harvey, author of Treating Out of Control Sexual Behavior, agrees that the term “sex addiction” may be muddying the waters around a very real problem. “People can have sexual behaviors that feel very much uncontrollable, and those feelings should be taken seriously by health professionals,” says Braun-Harvey, a certified sex therapist. “But it’s way too premature to call that an addiction or a psychiatric disorder.”

Experts who reject the concept of sex addiction also worry that it unnecessarily demonizes what can be (and often is) a normal and enjoyable part of life. For that reason, Davis says it’s important to draw the line between what—and how much—is healthy, and what’s not.

“You have to think about how much your behavior is affecting your life and your relationships,” she says. “Are you watching porn six hours a day and curtailing your other activities? Is it creating problems in your life, or your relationships? These are the things we look at when assessing whether someone has a problem.”

Braun-Harvey also says that sexual behavior involving (or directed at) non-consensual individuals should be considered another issue entirely. “If someone is engaging in sexual conduct that is not consensual, they are violating a fundamental human endeavor,” he says. “To call that sex addiction is absolutely not supported by the research.”

People who have committed sexual assault should indeed seek treatment, he says, but a sex-addiction counselor may not be able to help. “Sex addiction therapy is not a specialization in non-consensual behavior,” he says. “These people need to work with someone highly trained in this area, like a sex-offender treatment professional.”

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