Are you a sex addict?
“You couldn’t put together two more potentially explosive words in our culture,” says gay psychiatrist John Sealy.
Yet psychiatrists are currently working at ways of linking these two ideas together and defining them as a medical condition.
Sealy, medical director of a sexual addiction recovery program in Torrance, California, hopes to get a definition of sexual addiction included in the upcoming revision of the bible of psychiatric medicine – the Diagnostic And Statistical Manual Of Mental Disorders (DSM).
The initiative demonstrates the interesting connections between gay liberation – sex is good and loving it shouldn’t be a problem – and how sexual behaviour is treated by doctors.
The DSM is the main tool for psychiatrists in defining what is a disorder and what is not. Inclusion of a condition in the DSM means doctors have to take it seriously and pharmaceutical companies often develop drugs to deal with it.
Homosexuality was removed as a disorder in the third edition of the manual, called DSM-III, in 1973. Gender identity disorder, which applies to transsexual and transgendered people, is still defined as a disorder in the manual that’s in current use, DSM-IV.
But now preparations for DSM-V are in the works, though it’s years from being finished. The term “addiction” itself is not likely to appear in the DSM – the word is fraught with negative connotations – researchers expect terms like “hypersexuality” or “sexual compulsivity” might work instead.
But what is sexual addiction and how does it fit into modern notions of sexual liberation? Many homosexuals have spent a lifetime trying to shrug off the guilt associated with their sexual orientation, to lead their sexual lives according to their own criteria, not the criteria of mainstream society. And with the removal of homosexuality as a disorder, it seemed the medical community agreed.
But gay liberation has also been built upon the notion that practices like casual sex with strangers, promiscuous sex and kinky sex may not be condoned by society, but that doesn’t mean they’re bad.
So should gay libbers be worried that people who spend a lot of their time seeking sex could be considered sick?
First, the researchers are careful to point out what addiction is not. Type, frequency and social acceptability of sexual habits have nothing to do with addiction or compulsion.
“We are not judging the behaviour. We’re looking at the consequences,” says Jes Montgomery, a gay psychiatrist with the Pride Institute in Dallas, Texas. The key determining factor is the impact of behaviours on a person’s life over an extended period of time.
To diagnose simply on the basis of frequency is insufficient, says Joe Amico, the openly gay president of the National Association Of Addiction Professionals. For example, Amico says college fraternity students would regularly be diagnosed as sexual addicts and alcoholics if frequency was the determining factor.
“Yet we all know that the vast majority of fraternity members go on to productive lives, free from any addiction,” he says.
John Sealy uses the example of a surgeon who was recently referred to him for treatment of sexual addiction (though the behaviour is not officially defined in the DSM, people still do seek and receive counselling for it).
The surgeon roamed the Internet for hours on end, seeking a variety of anonymous erotic experiences. His time on the ‘net increased dramatically until he was staying up all night searching for virtual sex. After one all-night session, the exhausted surgeon operated on a patient who died on the table.
“The tragedy goes beyond the death of the patient to include the complete ruin of a talented doctor,” says Sealy.
At the same time, Sealy is concerned that over-application of the term addiction has been used to demonize gay sexual practices. The American Foundation For Addiction Research cites a website called Cybersexualaddiction.com which offers a questionnaire to determine if you’re a sexual addict. Questions include things like, “Have you subscribed or regularly purchased/rented sexually explicit magazines or videos?” “Do you visit sexual bathhouses, sex clubs and/or adult video bookstores as a regular part of your sexual activity?” and “Have you ever cruised
public restrooms, rest areas, and/or parks looking for sexual encounters with strangers?”
Even one “yes” answer prompts the site to tell you to talk to your family about the possibility of a problem.
Sealy admits that straight criteria often shut gay and lesbian people out.
“Yet when gay people want to get married and have just one partner, you can’t because that’s sinful, that’s desecrating marriage,” he says. As a result of these mixed messages, Sealy suggests that gay and lesbian people have adapted a fuck-you attitude: “You can’t win, it’s a prejudice no matter which way you go, so we’ll do what we want.”
There is a sharp distinction drawn in medicine between addictions involving substance abuse – drugs and alcohol are the primary examples – and behavioural addictions, such as food, gambling, overwork and sexual compulsivity.
Sealy points out that people are most often able to recognize a parallel with overeating. Food is necessary for survival and is a source of pleasure. It’s only when food becomes a controlling influence in a person’s life that it becomes harmful. The same is true with sex, he says.
“What we look for is the out- of-control behaviour, with an inability to stop despite severe personal consequences,” says Montgomery, “The persistent pursuit of self-destructive or high-risk behaviour, or using sex and fantasy as a primary coping strategy are indicators of the disorder.”
Montgomery says compulsions are a coping mechanism to deal with pain or adverse experience.
“It’s a protective thing,” says Montgomery. “It’s nothing about joy or choice.”
The researchers point out that any disenfranchised population is at far greater risk for both substance abuse and behaviour compulsions. According to Amico, studies show that 26 to 33 percent of the gay population have substance abuse problems – a rate more than three times higher than the general population.
Researchers suggest that lesbians and gay men dealing with the pain of being shamed by their culture more frequently turn to addictions to dissociate – that is, to block themselves off from a painful reality.
At the Gay And Lesbian Medical Association conference in Toronto earlier this winter, Amico presented a draft diagnostic tool created by the American Foundation For Addictions Research (AFAR) which plots frequency, duration and consequences of a wide variety of sexual behaviours. They sought the participation of gay physicians in testing the tool with their patients.
The foundation has sexual addiction as one of its top priorities, as it explores the neurochemistry of sexual addiction, the effects of cybersex on behaviour and how to assess sexual addiction.
Amico says the actual number of patients who would merit the diagnosis of sex addict is very small. But defining sexual compulsivity would have a beneficial consequence for the gay community.
“If we do this right,” says Montgomery, “we will broaden the definition of normal sexual behaviour.” In essence, Montgomery says, any behaviour between consenting adults is okay – which flies in the face of historical straight prejudices. Only behaviours that negatively affect lives will be problematic.
Sealy says that he got involved in AFAR’s efforts to formalize a definition because people were unable to get treatment for addictions that were ruining their lives. In the US, physicians may only bill for illnesses covered by the DSM, so sexual addiction was not covered. People were being misdiagnosed.
“People are being diagnosed as bipolar [manic depressive] with this problem, and put on lithium, which does nothing to control the destructive behaviours,” says Sealy. Treatment specifically for sexual compulsivity is available in the US, but at prohibitive cost because most Health Management Organizations (HMOs) and insurers won’t cover any procedure not set out in the DSM.
The situation is somewhat different in Ontario. Anne Ptaziuk, spokesperson for the Centre For Addiction And Mental Health (CAMH), says that while the centre doesn’t have any programs for sexual addiction itself, the therapies available at CAMH cover sexual compulsivity indirectly.
Toronto’s Bellwood Health Services and Homewood Health Centre both deal specifically with sexual addiction, but most of their programs are not covered by OHIP. Many employment insurance programs would cover such programs, but those without such extra insurance are only able to access care at great cost.
There are also a variety of self-help groups in Toronto, including Sex And Love Addicts Anonymous and Sexual Compulsives Anonymous. (None of these programs or groups are specifically for gay and lesbian patients; some have religious affiliations.)
Sealy says profound shame keeps most people from seeking help with a sexual addiction problem, though it’s also hard to keep the problem secret.
Amico says a true sexual addict has already had their world ruined because there is no joy in sexual experiences any longer.
“It’s going to get a lot worse [without treatment],” he says “it’s already ruining your life. It’s just that nobody knows about it yet.”
Treatment for sexual compulsions does not mean an end to sex, but rather a return to healthy sexuality. The researchers compare it to a food addiction – you don’t stop eating, instead you regain control of your eating habits.
“Shame is a huge word for me. I think nothing drives the addictive or compulsive behaviour more,” says Amico. “When people have to hide who they are, they have to find some way to cope. Sexual addiction and compulsivity is a way to cope.”
* The Centre For Addiction And Mental Health is at www.camh.net. Sex And Love Addicts Anonymous is a non-religious group meeting at The 519 Community Centre (519 Church St) on Sundays at 2:30pm and Tuesdays at 6pm. Contact (416) 486-8201 or www.icomm.ca/slaa for more information.
Are you a sex addict?