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An important note: the following information pertains to individuals who understand and prioritize consent in their sexual decision-making and behaviors.
As a substance use disorder treatment specialist with many years of training and clinical experience in this ever-evolving field, it has become clear to me that the terms “sex addiction” and “porn addiction” are harmful and misunderstood concepts that cause people to seek out sex therapy.
Historically, health professions have pathologized natural and healthy human interest and curiosity about the various ways we pursue and experience sexual pleasure. At our fingertips lives a world of technological advances that allows us to access any type of porn we can imagine, for better or worse. From biological and evolutionary perspectives, our brains are likely unable to fully comprehend, absorb, or understand the impacts this technology has on us. Nevertheless, the label of “addiction” gets thrown around cavalierly, and this causes real harm.
Over the years, I have received a large number of inquiries from people who tell me they have a sex or porn “addiction” and either want to stop using it altogether or to choose to have sex/use porn in a different way. The “addiction” label can cause real suffering in the form of deep shame and guilt for the person using porn. This emotionally-charged label and the resulting shame also prevent some individuals from reaching out to sex therapists to get the proper education, support, and understanding of what the true issues are.
After discussing this topic with author and my sex therapy mentor, Marty Klein, Ph.D., it became clear to me that if someone without clinical training, knowledge of the clinical language, and an understanding of symptoms and symptom clusters is able to “diagnose” someone as being an “addict,” that is probably a good indication that we have adopted too broad of a definition of what an “addiction” is. It also simultaneously perpetuates the myth that it is an actual disorder.
Let me be clear: there is no current diagnosis in the DSM-5 that uses terms like “sex addiction” or “porn addiction.” In fact, the word “addiction” is not even used when diagnosing problematic substance use. Someone who calls themself an “alcoholic” or an “addict” may have an Alcohol Use Disorder or an Opioid Use Disorder, but there is no DSM-5 diagnosis of “alcoholism” or “opiate addict.” Would it surprise you to know that there is also no current diagnosis of a “sex use disorder” or “pornography use disorder?”
In one of his videos, Dr. Klein eloquently described some of the reasons people choose to use sex or pornography in ways that either they and/or others describe as being addictive. Imagine, for instance, someone in a manic or hypomanic phase of bipolar disorder. One symptom this person might experience is impulsive decision-making. which carries risks and the potential for unpleasant consequences. Without medication and therapy, these individuals have a condition in their brain that they cannot control and that prevents them from being able to effectively regulate their emotions, thoughts, and actions, to a greater or lesser extent.
So, if unusual brain function within the context of a bipolar disorder is contributing to someone making impulsive sexual decisions, we treat the underlying psychiatric disorder. We do not treat one of the disorder’s symptoms, which we conveniently label as an “addiction.” The latter would be tantamount to playing a game of Whack-A-Mole and expecting those pesky moles to just stop popping up if we whack them enough times. Instead, we are better off working to understand the function and cause of a behavior or symptom and to then address the causal problem itself, not the symptom.
Another example Dr. Klein discussed in his video is the label of sex/porn “addiction” in individuals who have OCD. Some folks with OCD wash their hands compulsively, which can be distressing and disruptive to their lives. A person living with OCD may have as their compulsive behavior looking at pornography, masturbating, or having sex, which can be just as distressing and disruptive to their life.
Conflict in a relationship can be another cause of the behavior. One partner could be managing their emotions by choosing to escape through sex or the use of pornography and masturbation. For various reasons, this person could be indirectly communicating to their partner through their behaviors one or more of many emotions, including frustration, disappointment, fear, rage, jealousy, sadness, etc. Just a small sample of reasons for this communication choice might include feeling judged for their sexual interests, feeling unsupported in their career endeavors, fearing various forms of intimacy, worrying that their partner will leave them, not wanting to be in a monogamous relationship, or simply that this partner has different values and preferences from their partner regarding how acceptable it is to look at porn. Someone’s partner may see this as being a problem because they may not like that their significant other looks at porn, but that does not mean that the other person has a problem or an “addiction” to it. It simply means that we need to understand what is preventing the indirect communicator from more assertively expressing their thoughts and feelings, and then to help them learn the tools to practice doing so.
In most cases, each partner in a relationship has a different set of values, partterns, and preferences, influenced by one’s biology, politics, finances, religion, social environment, psychological health, and personality. That does not mean that one of them is right and the other is wrong, nor that one of them has an “addiction.” If there is any disorder or dysfunction, it is potentially in the match of the partners in the relationship, or in how they are choosing to discuss the issue, challenge their own belief systems, and/or engage in uncomfortable dialogue. And yet, there are many more possibilities for why a particular sexual behavior is not best accounted for by an “addiction.”
I do not think there is one “right way” to think about sex, masturbation, and pornography. I do believe we are all entitled to have our own belief system and values regarding each of them. While I also believe that we are not required to explain ourselves, or even necessarily to have a rationale for our beliefs, I do think it is important for people to work to understand why they feel the way they do, why they choose to do what they do, and how they go about making decisions as it relates to sex, porn, and masturbation. It is also crucial to question if the things we say are important to us are, in fact, important to us for the reasons we believe them to be, as well as if we want to continue making similar decisions based on that understanding.
It is clear that our society could benefit greatly from acknowledging that we have a fundamental misunderstanding of sex, sexuality, and sexual decision-making. In true form with our healthcare system’s inclination to pathologize the human experience, we could even label this as a “Disordered Understanding of Human Sexuality,” playfully shorthanded to “duhs.”
The treatment and prognosis? With proper education that is based on a comprehensive definition of what the underlying problem(s) is/are, combined with additional needed research and frank discussions about sex with our healthcare providers, friends, family, partners, and communities, it remains my belief we actually stand a chance to beat this.
