Few would disagree that sex addiction is an actual condition, one that describes a pattern of compulsive sexual behavior that disrupts relationships, work, and emotional well-being. However, despite 12 Step programs and numerous treatment centers that seek to help those afflicted by it, the term sex addiction is not defined as a mental illness by the DSM-5 – nor is its more technical name, hypersexuality. The reason for this is due to, quite surprisingly, a lack of evidence.
What we really mean is, there is a lack of empirics to support sex addiction as an official diagnosis. Indeed there is very little in the way of anatomical, brain imaging, molecular genetics, pathophysiology, epidemiology, and neuropsychological testing to support its inclusion as a disorder. This, despite our knowing (or hearing about) people who seem to seek out sexual gratification to their detriment. In my practice, I frequently encounter patients who view way too much pornography or who spend most of their money on sex workers. I've also treated many people, particularly men, who also involve methamphetamine and other drugs to power unprotected sexual encounters with strangers that can last for days.
How is it then that such behavior does not qualify as a compulsion or addiction? After all, other compulsive behaviors, such as compulsive gambling, are recognized disorders in the DSM-5. Surely, the evidence is all around. However, when we go and put this hypothesis to the test, we find little empirical data to support what we seem to observe. Indeed there is a relative paucity of research on anatomical and functional imaging, molecular genetics, pathophysiology, epidemiology, and neuropsychological testing to support its inclusion as a disorder. But this may be more due to the fact that we are uncomfortable with conducting such research, and the conclusions it might lead to.
This evidence gap may reflect deeper institutional biases rather than the actual validity of the condition. Research funding bodies, from government agencies to private foundations, have historically shown reluctance to support studies involving human sexuality – particularly those examining compulsive or problematic behaviors. This hesitancy often stems from concerns about public reaction, political pushback, and the complex ethical considerations inherent in studying sexual behavior.
Moreover, the methodological challenges in designing such studies present another significant barrier. Unlike research into substance addiction, which can utilize objective measures like blood tests or brain scans, studying sexual behavior patterns requires more nuanced approaches. Many institutional review boards approach such protocols with extreme caution, often requiring multiple rounds of revision or rejecting them outright. The result is a self-perpetuating cycle: without adequate research, sex addiction cannot achieve DSM recognition, and without DSM recognition, it becomes even more difficult to secure the funding necessary for comprehensive research.
These institutional barriers have inadvertently created a knowledge vacuum that affects both clinicians and patients. Treatment providers, while witnessing the destructive patterns firsthand in their practices, lack the empirical foundation needed to standardize their approaches. Patients, meanwhile, often face skepticism from insurance companies and medical professionals, leading many to avoid seeking help altogether or to pursue unproven treatment methods out of desperation.
The parallels to historical attitudes toward other behavioral addictions are striking. Gambling disorder, for instance, faced similar skepticism and research obstacles before finally gaining recognition in the DSM-5. Yet while gambling research eventually overcame these hurdles – partly due to pressure from the gaming industry's own need to address problem gambling – sex addiction research remains caught in a web of societal taboos and institutional resistance.
The path forward likely requires a shift in how we approach this research at multiple levels. First, funding bodies need to recognize that understanding compulsive sexual behavior is crucial for public health, regardless of political sensitivities. Second, research institutions must develop more sophisticated protocols that can adequately study sexual behavior while maintaining ethical standards. Finally, the scientific community needs to acknowledge that our reluctance to study controversial topics often perpetuates the very problems we aim to address.
What we really mean is, there is a lack of empirics to support sex addiction as an official diagnosis. Indeed there is very little in the way of anatomical, brain imaging, molecular genetics, pathophysiology, epidemiology, and neuropsychological testing to support its inclusion as a disorder. This, despite our knowing (or hearing about) people who seem to seek out sexual gratification to their detriment. In my practice, I frequently encounter patients who view way too much pornography or who spend most of their money on sex workers. I've also treated many people, particularly men, who also involve methamphetamine and other drugs to power unprotected sexual encounters with strangers that can last for days.
How is it then that such behavior does not qualify as a compulsion or addiction? After all, other compulsive behaviors, such as compulsive gambling, are recognized disorders in the DSM-5. Surely, the evidence is all around. However, when we go and put this hypothesis to the test, we find little empirical data to support what we seem to observe. Indeed there is a relative paucity of research on anatomical and functional imaging, molecular genetics, pathophysiology, epidemiology, and neuropsychological testing to support its inclusion as a disorder. But this may be more due to the fact that we are uncomfortable with conducting such research, and the conclusions it might lead to.
This evidence gap may reflect deeper institutional biases rather than the actual validity of the condition. Research funding bodies, from government agencies to private foundations, have historically shown reluctance to support studies involving human sexuality – particularly those examining compulsive or problematic behaviors. This hesitancy often stems from concerns about public reaction, political pushback, and the complex ethical considerations inherent in studying sexual behavior.
Moreover, the methodological challenges in designing such studies present another significant barrier. Unlike research into substance addiction, which can utilize objective measures like blood tests or brain scans, studying sexual behavior patterns requires more nuanced approaches. Many institutional review boards approach such protocols with extreme caution, often requiring multiple rounds of revision or rejecting them outright. The result is a self-perpetuating cycle: without adequate research, sex addiction cannot achieve DSM recognition, and without DSM recognition, it becomes even more difficult to secure the funding necessary for comprehensive research.
These institutional barriers have inadvertently created a knowledge vacuum that affects both clinicians and patients. Treatment providers, while witnessing the destructive patterns firsthand in their practices, lack the empirical foundation needed to standardize their approaches. Patients, meanwhile, often face skepticism from insurance companies and medical professionals, leading many to avoid seeking help altogether or to pursue unproven treatment methods out of desperation.
The parallels to historical attitudes toward other behavioral addictions are striking. Gambling disorder, for instance, faced similar skepticism and research obstacles before finally gaining recognition in the DSM-5. Yet while gambling research eventually overcame these hurdles – partly due to pressure from the gaming industry's own need to address problem gambling – sex addiction research remains caught in a web of societal taboos and institutional resistance.
The path forward likely requires a shift in how we approach this research at multiple levels. First, funding bodies need to recognize that understanding compulsive sexual behavior is crucial for public health, regardless of political sensitivities. Second, research institutions must develop more sophisticated protocols that can adequately study sexual behavior while maintaining ethical standards. Finally, the scientific community needs to acknowledge that our reluctance to study controversial topics often perpetuates the very problems we aim to address.
Medical Disclaimer: This article is for informational purposes only and should not replace professional medical advice. Always consult with your healthcare providers about specific medical decisions.