Sex Addiction or Simple Cheating? How to Tell the Difference

Unfaithful celebrities check into sex rehab all the time. Is too much sex really a treatable addiction?

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It seems like every time celebrities get caught with their hands in the cookie jar (usually repeatedly), they check into a clinic to cure their "sexual addiction" (actor David Duchovny, model Amber Smith, the entire cast of Dr. Drew Pinsky's celebrity-themed Sex Rehab show, and now purportedly Tiger Woods, for example). But is there such a thing as an addiction to sex—given that for the survival of our species, we all need to be a little hooked? If so, how do we distinguish an addict from a plain old crummy cheater?

"The term sex addict is very popular in the media, but it isn't well accepted within psychiatry," says Eli Coleman, a psychologist who is director of the human sexuality program at the University of Minnesota Medical School in Minneapolis. "There's a lot of debate about what really constitutes hypersexuality, and we have no clearly defined and agreed upon criteria for this." Habits like compulsive gambling and binge eating are established mental disorders, but sexual addiction isn't listed in the current version of the Diagnostic and Statistical Manual of Mental Disorders, the bible used by psychologists to diagnose mental illnesses. And while treatment for alcohol or drug addiction usually involves completely abstaining, not so for sex.

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"Hypersexual disorder" may appear in the revised edition of the DSM, due out in 2012, but some experts worry that this will lead to a slew of overdiagnoses. "We need to really distinguish if someone has made a mistake, which a lot of people do, and is suffering the consequences," Coleman explains, or if that person has, say, a lack of ability to control impulses because of low activity in parts of the brain responsible for decision making. Coleman estimates that only about 5 percent of folks have what might be considered a true hypersexual disorder. The rest of us, well, just make mistakes.

How do experts tell the difference? One major clue is if you spend most of the day consumed by sexual urges, fantasies, and activities. Another is if you spend an excessive amount of time engaged in sex, to the extent that it leads to adverse consequences like getting fired or losing custody of your kids. "We also need to do a careful assessment to determine what seems to be causing the problem," says Coleman who treats about 100 new patients a year for hypersexuality.

For instance, a sexless marriage that drives a spouse to prostitutes or serial affairs may not indicate a psychological disorder. Nor does a porn or masturbation habit. "I've seen young single men who want me to treat their compulsive behavior of masturbating several times a week, which goes against their religious values," says Coleman. "But they really have a conflict with their internal value system, not a mental problem."

A true hypersexual disorder is usually a prolonged, repetitive problem, not a one-time offense fueled by too much alcohol. And it's usually driven by impulsive behavior (you can't keep yourself from falling into bed with the plumber) or by compulsive behavior (you spend the day obsessing about sex and trying to resist the temptations). "People with impulse control problems," says Coleman, "have an inability to make good decisions," like opting not to have intercourse in an airplane bathroom when there's a fairly high certainty of being caught and arrested. Those with sexual compulsions, on the other hand, "constantly think about and plan for how they're going to engage in some sexual activity," he says. They often suffer from anxiety or depression that may be relieved by sex—until those guilty, remorseful feelings rush in. "It becomes a repetitive cycle."

A full evaluation should include screening for a range of problems that frequently accompany hypersexuality. These include mood disorders, substance abuse, eating disorders, and past physical or emotional traumas. "You'll want to find an expert trained in treating a variety of mental disorders as well as sexual disorders," says Coleman. The Society for Sex Therapy and Research has a list of clinicians for referral. (Insurance companies, he adds, often reimburse for treatment if a physician puts down a diagnosis of "sexual disorder not otherwise specified.")