A Word of Caution regarding "Compulsive Sexual Behavior" and "Relationship Dependency" (by Dr. Steve Eichel)

There is considerable controversy surrounding the term "sexual addiction." It is important to state that the diagnostic labels "sexual addiction" "sexual dependency" and "sex addict" are not formally accepted by the organized mental health community. The diagnosis does not exist in the DSM-IV-TR and, as of this writing, is not slated to appear in the next revision of the Diagnostic & Statistical Manual (DSM) of Mental Disorders, the DSM-V.

In some ways, this controversy is similar to the one that surrounded the "repressed [dissociated] memory," Multiple Personality Disorder (MPD, now called "Dissociative Identity Disorder" or DID) and "false memory syndrome" debate of the late 1980s and 1990s. On one extreme were those who claimed there was no such thing as "repressed memories" or MPD/DID, on the other extreme were those who believed there was a near-epidemic of MPD/DID, often associated with satanic ritual abuse.

I believed both sides had valid points, that MPD/DID exists but was also being overdiagnosed [for more information click here]. Similarly, I believe sexual compulsivity ("addiction") exists, but I am also aware that this label has occasionally been misapplied, with very harmful results. In addition, sometimes it has been a convenient way to "explain" behavior that one might find immoral, objectionable and/or distasteful (but nevertheless is not psychopathological). As a scientist, I remind myself and others that there are many behaviors that we now consider quite normal and even beneficial but were once considered signs of "mental illness." Two good examples are masturbation (which can be compuslive but in the vast majority of people is not) and extramarital affairs (which, while they may be highly objectionable, are statistically quite common). Prior to 1972, homosexuality was formally listed as a mental disorder. There are many people who still consider homosexual behavior, premarital sex or anything "kinky" to be degenerate, immoral and/or mentally disturbed behaviors. Sometimes excessive masturbation or extramarital affairs are symptomatic of sexual compulsivity; often they are not (but may indicate other serious problems).

Defining Compulsive Sexual Behavior and Relationship Dependency

After taking the above caveats into account, it nevertheless seems clear that problems related to uncontrolled and/or inappropriate sexual behavior and dysfunctional/dependent relationships have existed for ages. These behaviors have recently been seen by some as compulsions or "addictions." Self-help groups such as Sex and Love Addicts Anonymous (SLAA) began in the mid-1970s based on the 12-Step recovery model pioneered by Alcoholics Anonymous. Drs. Eichel and Dubrow-Marshall are very familiar with this treatment modality. They have been treating individuals with sexual compulsivity since 1990.

What is an addiction? How can sex be "addictive"?

Any compulsive, self-destructive behavior that involves an alteration of mood or awareness, is used to avoid a more productive method of coping with feelings and/or conflicts, that induces feelings of shame and guilt, and that persists in spite of negative consequences, might be considered an addiction. Addictions have in common the pursuit of a "high" (which can be dissociative), mental obsessions, compulsive behavior, being "out of control," tolerance, withdrawal, and progression. Most or all of these can apply to dysfunctional relationships and problems with sexual behaviors. While many sexual compulsives "act out" behaviorally, others may "act in" (become completely controlled and/or asexual). Still others primarily experience recurring thoughts, images, or fantasies related to sexual behaviors or relationships that do not lessen with time. Sexual behavior is used as the primary or even exclusive method for coping with unpleasant or disturbing feelings, ideas, conflicts and stresses, or as almost the only way the individual can relate to or connect with others.

What about sexual minorities and "alternative lifestyles" (by Dr. Steve Eichel)

I do not view alternative lifestyles (e.g., cross-dressing,, BDSM, "kink" or polyamory) as inherently harmful. I consider myself a "kink-aware" professional and as an active and trained member of AASECT (American Association of Sexuality Educators, Counselors and Therapists) I am strongly "sex-positive." In my practice, I have worked with numerous individuals, couples and alternative relationships in which sexual practices, while outside the mainstream, were nevertheless healthy, fully consensual and life-affirming. Sexual compulsivity can involve mainstream or "mundane" sexual behaviors (e.g., "straight" sex in and/or outside relationships, obsessive/compulsive viewing of pornography, etc.) or "kinky" ones; one does not automatically rule out or in the diagnosis of sexual compulsivity. In assessing for sexual compulsivity, I consider the whole person; I not only look at the behavior(s) in question, but at the behavior(s) in the context of the person's whole Being and life. There are times when a sexual behavior, while incongruent or perhaps unwanted by the individual engaging in it (or to his/her partner), nevertheless does not constitute a compulsion, addiction, or otherwise unhealthy activity.

Dr. Eichel is a strong supporter of equal rights (including the right to full sexual freedom) for the GBLTQ community.

Treating Compulsive Sexual Behavior

We view sexual compulsivity as inherently a shame-based psychological problem. It is not due to "perversion," immorality, sinfulness, or lack of will-power; it is a treatable problem similar in many ways to alcoholism. In addition, sexually compulsive individuals may have histories of trauma and abuse, and comorbid dissociative, depressive, or affective disorders. Humiliating, shaming or "guilt-tripping" the sexual compulsive individual typically makes the problem worse! Sexual compulsivity is treated using some combination of six treatment modalities:

• Psychoeducation: sexual compulsivity is not well-understood, even by some addictions specialists and sexologists. Through reading and attending workshops and lectures, individuals recovering from sex and relationship compulsivity begin to understand the dynamics of their compulsion and the recovery processes.
• Individual psychotherapy: for shame reduction, insight into the causes of the compulsion, resolution of trauma, and establishment and expansion of alternative coping strategies.
• Sexuality therapy: to explore, discover and utilize life- and self-affirming sexual behaviors that bring joy and satisfaction, and are consistent with the client's values and lifestyle.
• Group psychotherapy: for shame reduction, group support, and to practice healthy interpersonal skills.
• Family/couples psychotherapy: to help the family understand the nature of compulsive sexual behavior, to reduce shame, to improve communication, to set and respect individual boundaries, to explore, discover and utilize growth-enhancing sexual behavior, and to assist the spouse, significant other, and/or family member(s) evaluate and cope with any related issues.
• Medication: some people find antidepressant or antianxiety medications helpful in reducing the urge to act out. Others may have underlying affective disorders (e.g., bipolar disorder) that respond to medication and assist in the recovery process.
• 12-Step self-help groups: regular participation in one or more "S"-group (SLAA, SAA, SA, SCA) is, for many, a vital means for redefining intimate friendships, finding and utilizing peer support, reducing shame, and enhancing general recovery and spirituality.

The individual with sexual compulsivity who suffers repeated relapses, or who continues to place him/herself at risk for a particularly serious consequence (e.g., HIV or other sexually transmitted diseases, violence, arrest, loss of child custody) may be better helped through inpatient treatment. To find an inpatient treatment program, one source of referral information can be found at http://sash.net/directory/treatment-facilities.html 

Drs. Eichel and Dubrow-Marshall have authored chapters in Dr. Eric Griffin-Shelley's second book on sex and love addiction, Intensive Outpatient Treatment of Sex and Love Addiction (Praeger, 1993). They have conducted numerous workshops on the treatment of sexual compulsivity for a large variety of regional and national professional psychology and counseling associations.

N.B. During the height of that debate, there was significant polarization between those who denied the very existence of "repressed" memories and MPD,/DID and those who believed that Satanic ritual abuse was responsible for an epidemic of MPD/DID. I believed then and continue to believe that DID exists, that dissociated memories exist, but that the former has been and remains quite rare. As to the latter, it is often difficult to tease out what may have "really" happened and has been accurately remembered from the morass of other factors that typically constitute our memories and can even lead to confabulated or otherwise inaccurate memories. In other words: Are there "repressed memories"? Yes. Are there also "false memories"? Yes. Can a recalled, formerly dissociated memory contain both accurate and inaccurate information? Yes.

In over 30 years of practice, I can say with reasonable certainty that I have seen one case of "true" DID and one case that may have been DID. In 1991, I can remember a number of colleagues telling me that at any given time the majority of their practices--well over 20 clients per therapist--consisted of MPD/DID clients. I found that hard to believe then, I am just as skeptical now. [Go back.]

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