Sex addiction: Controversy within Mainstream Addiction Medicine, Diagnosis Based on the DSM-III-R, and Physician Case Histories

Abstract

An ongoing controversy among addictionists is whether to accept “process” or behavioral addictions such as sexual addiction as within the scope of addiction medicine. This article delineates the controversy and reviews data that support the commonalities between behavioral and chemical dependencies. Similarities include obsession, denial, loss of control, compulsive behavior, continuation despite adverse consequences, and escalation of the behaviors. The DSM-III-R criteria for chemical dependency can be easily applied to sexual addiction. Another commonality is the refractoriness to treatment with traditional psychotherapeutic modalities versus the responsiveness to addiction treatment and 12-step mutual-help groups. Sexual addiction is of importance to addictionists because: 1) it is an addiction; 2) many chemically dependent patients are also addicted to sex and may relapse to chemical use because of untreated sex addiction; 3) sexual addiction contributes to the AIDS epidemic; and 4) compulsive sexual behavior explains many cases of sexual exploitation of patients by physicians.