Sexual addiction


 * Not to be confused with Erotomania or Nymphomania

Sexual addiction is a term used to describe the behavior of a person who has an unusually intense sex drive or obsession with sex. Sex addicts are people who, desperately afraid of any truly intimate relationship, repeatedly and compulsively try to connect with others through highly impersonal nonintimate behaviors: masturbation, empty affairs, frequent visits to prostitutes, voyeurism, and the like. Sex addicts—numbering in the millions, both men and women, young and old, of all races and religions—become mesmerized with the thrill and rush of adrenaline that they can achieve only through their obsessive, highly ritualized patterns of sexual behavior. Sexual addiction, also called sexual compulsion is a form of psychological addiction.

The behavior of sex addicts is comparable to behavior of alcoholics and [drug] addicts, where sex functions like a drug. A common definition of alcoholism is that a person has a pathological relationship with this mood altering drug. It provides a quick mood change, works every time and the user loses control over their compulsion. Like alcoholics, sex addicts' lives rotate around the constant desire for their "drug" of choice.


 * The Mayo Clinic uses compulsive sexual behavior for sexual addiction, and identifies characteristics of the sex addict as "an overwhelming need for sex and are so intensely preoccupied with this need that it interferes with your job and your relationships. [...] You may spend inordinate amounts of time in sexually related activities and neglect important aspects of your day-to-day life in social, occupational and recreational areas. You may find yourself failing repeatedly at attempts to reduce or control your sexual activities or desires."


 * According to |The Counseling Affiliates, an addiction is at work when sex becomes shameful, secret, or abusive.
 * The Society for the Advancement of Sexual Health further illustrates addiction by outlining several key components: "Compulsivity, that is, loss of the ability to choose freely whether to stop or to continue; Continuation of the behavior despite adverse consequences, such as loss of health, job, marriage, or freedom; Obsession with the activity."

Diagnosis
There is no consensus in the medical community that sexual addiction actually exists, and it is not presently included in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.). Those who support its diagnosis describe it as being in many ways similar to other addictions, where the activity comes to be used as a way to manage mood or stress and may become more severe with time. Diagnostic criteria have been suggested that are closely analogous to those the D.S.M. provides for other addictions.

Patrick Carnes, a pioneer researcher in the field of sexual addiction, asserts there are ten specific criteria of addiction:
 * 1) Recurrent failure (pattern) to resist impulses to engage in specific sexual behavior.
 * 2) Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended.
 * 3) Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
 * 4) Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience.
 * 5) Preoccupation with the behavior or preparatory activities.
 * 6) Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social obligations.
 * 7) Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
 * 8) Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk.
 * 9) Giving up or limiting social, occupational, or recreational activities because of the behavior.
 * 10) Distress, anxiety, restlessness, or irritability if unable to engage in the behavior.

Symptoms
Schneider, identified three indicators of sexual addiction. These indicators are Compulsivity, Continuation despite consequences and Obsession.


 * Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior.


 * Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires. Despite all of these consequences, they continue indulging in excessive sexual activity.


 * Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they should be thinking about are neglected.

Epidemiology
The prevalence of sexual addiction would be hard to determine, in part because addicts are secretive. Proponents of the concept suggest it is commonly seen in combination with other addictions as well as mood and stress disorders. Sometimes when multiple addictions are present (food, alcohol, drugs, gambling), sexual addiction can be said to be the "core" addiction; other times, one of the others is seen as the "core." Sexual addiction has in the past been conceptualized as a largely male problem, but more recent writers have suggested it may also be prevalent in women, usually manifesting in different ways.

Sexual addiction is hypothesized to be (but is not always) associated with Obsessive-compulsive disorder (OCD), Narcissistic personality disorder, and manic-depression. There are those who suffer from more than one condition simultaneously (known as a dual diagnosis or a co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.

Specialists in obsessive-compulsive disorder (OCD) and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with Denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.

Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full Personality Disorder even after successful addiction treatment.

Some bipolar people are misdiagnosed as sex addicts. Some sex addicts are misdiagnosed as bipolar. Some addicts do also suffer from bipolar disorder.

Manifestation
According to proponents of the concept, sexual addicts may enjoy frequent sexual intercourse and other sexual activities including sexual fantasies, but the key to this addiction is more the enjoyment of the journey rather than the destination. That is, sexual addicts do not require an orgasmic event in order to feel accomplished in the pursuit of their addiction. This is why sex addicts are sometimes referred to as "chemical addicts", because of the high dose of brain chemicals that are released during sexual activity, arousal and sexual fantasizing. This heavy dose of brain chemicals is what the sex addict is really after (although many do not even realize it). Some reports indicate that these chemicals are hundreds of times more addictive than heroin or cocaine. While sexually, and even romantically, stimulating activities are what they seek, internally the shot of brain chemicals released when they engage in these activities is what they crave. One such brain chemical released by their activities is the "feel good" neurotransmitter dopamine. Dopamine levels rise dramatically when they are engaged in romantically and sexually enjoyable activities. It is this heightened level that provides them with a feeling of euphoria. An orgasm boosts this level even higher. Certain illegal drugs also facilitate the same release, for example methamphetamines or cocaine. These drugs are believed to raise the level of dopamine in the brain to as much as thirty times that which is present during an orgasm. This makes these drugs' effects on the brain extremely enjoyable and highly desirable to people seeking mood elevation.

Individuals who experience mood issues and discover the soothing effects brought on by these brain chemicals quickly learn which behaviors can effectively repeat the experience. Thereafter, a cascading effect begins. Already prone toward tendencies for compulsive or obsessive behavior, the sexual addict starts repeating 'rewarding' activities with a repetition that quickly creates a conditioned response. Over time, however, the constant release of these mood-elevating brain chemicals into the body causes them to lose their effectiveness and so addicts find themselves needing to increase, vary or intensify their activities more in order to achieve a similar effect (Interestingly, the brain chemical releases triggered by the sexual addict are similar to those experienced by gamblers and food addicts.)

According to proponents of the sexual addiction concept, the addicts' obsessive/compulsive tendencies are demonstrated by the frequency with which they use masturbation for stimulation. Quite often they will perform this activity to the point of injury or to where it interferes significantly with ordinary life. Masturbatory activities, because they are an effective and efficient path to success, combined with the sex addict's fear of truly intimate relationships, makes them a desirable alternative to sexual interactions with others. When a sexual addict does feel comfortable enough to involve other people, quite often they seek out strangers for anonymous sex or look for 'new love' through infidelity. Prostitutes are also employed because of their anonymity and non-judgmental willingness to engage in the sometimes unconventional sexual requests of sex addicts. The varying nature of a sexual addict's activities are in sharp contrast to individuals who commonly prefer more narrowly focused sexual activities such as those engaging in fetishism. But this is not to say that sex addicts cannot be found pursuing fetishes.

As mentioned before, a key feature of sexual addiction is its supposedly compulsive, unmanageable nature. Whereas a normal person might stare as they drive past an attractive person, a sexual addict will drive around the block to stare again. They may even plan future ways to spot attractive people so they can repeat the experience over and over. Addicts can spend an extraordinary amount of time and money on their habit, entirely lacking the ability to control it. They often experience an almost trance-like state in which acting out can go on for many hours. As with other addictions, some addicts experience episodic binges (between which they may believe there is no problem), while others experience more continuous problems. Some sexual addicts also swing into the opposite end of the spectrum, engaging in sexual anorexia, where they so tightly control themselves that they have absolutely no sexual experiences. This does not control or cure the basic compulsion but, like food addictions, is simply another manifestation of the addiction.

Some sexual addicts act in more intrusive ways, or progress to them, as they experience diminishing "highs" for their original activities. A Level 2 addict might include voyeurism, exhibitionism, and frotteurism. A Level 3 addict involves much more serious and intrusive sexual offenses, and has more harmful consequences.

Patrick Carnes states that specific activities are not what identify addiction. Even a rapist may not necessarily be a sexual addict. Rather, it is the compulsive nature of the behaviors that demonstrates addiction.

For sex addicts who try often to stop and fail, their behavior generally conforms to a cycle:


 * 1) Preoccupation — the addict becomes completely engrossed with sexual thoughts or fantasies.
 * 2) Ritualization — the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
 * 3) Compulsive sexual behavior — the addict's specific sexual acting out.
 * 4) Despair — the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.

To escape these negative feelings, the addict soon becomes preoccupied with sexual thoughts and fantasies again, restarting the addictive cycle. Risk factors for the addict include unstructured time, need for self-direction and demands for excellence, because they all push the addict toward restarting the cycle.

A variety of questionnaires and tests have been devised in attempts to evaluate sexual addiction, but few if any have been formally evaluated, normed, or proven accurate. Proponents of the sexual addiction concept believe the cycle and beliefs above strongly characterize the sexual addict, however. In addition, Carnes proposes a basic test for whether a particular sexual behavior has become addictive:


 * 1) It is a secret.
 * 2) It is abusive or degrading to self or others.
 * 3) It is used to avoid (or is a source of) painful feelings.
 * 4) It is empty of a caring, committed relationship.

Consequences of sexual addiction
Some consequences that often result from sexual addiction and indicate the existence of sexual addiction include:


 * Social: Addicts become lost in sexual preoccupation, which results in emotional distance from loved ones. Loss of friendship and family relationships may result.


 * Emotional: Anxiety or extreme stress are common in sex addicts who live with constant fear of discovery. Shame and guilt increase, as the addict's lifestyle is often inconsistent with the personal values, beliefs and spirituality. Boredom, pronounced fatigue and despair are inevitable as addiction progresses. Compulsive sexual thoughts and/or behavior leads to severe depression, often with suicidal ideation, low self-esteem, shame, self-hatred, hopelessness, despair, helplessness, intense anxiety, loneliness, resentment, self pity, self blame, moral conflict, contradictions between ethical values and behaviors, fear of abandonment, spiritual bankruptcy, distorted thinking, remorse, and self-deceit. The ultimate consequence may be suicide. Many sex addicts suffer from broken relationships. Some experience severe marital and other relationship problems. Sexual activities outside the primary relationship result in loss of self-esteem to both partners as well as severe stress to the relationship. The sex addict is frequently absent, resulting in a loss of time in parental role modeling. Pressure is placed on the partner to provide parental support and nurturing of the children. Partners of sex addicts may develop their own addictions (co-addictions) and compulsions, psychosomatic problems, or depression and other emotional difficulties.


 * Physical: Some of the diseases which may occur due to sexual addiction are genital injury, cervical cancer, HIV/AIDS, herpes, genital warts and other sexually transmitted diseases. Sex addicts may place themselves in situations of potential harm, resulting in serious physical harm or even death. Automobile accidents can result when sexual activity causes the driver's attention to stray (e.g. watching porn movies on a mobile DVD player).


 * Legal: Many types of sexual addiction result in violation of the law, such as sexual harassment, obscene phone calls, exhibitionism, voyeurism, prostitution, rape, incest, child molestation, and other illegal activities. Loss of professional status and professional licensure may result from sexual addiction. Some sex addicts go to jail, lose their job, get sued, or have other financial and legal consequences because of their compulsive sexual behavior. Legal consequences of sexual addiction result when illegal behaviors such as voyeurism, exhibitionism, or inappropriate touching, result in arrest and incarceration. Child molesting and rape in some cases are addictive behaviors. Sexual harassment in the workplace can be part of a sex addict's repertoire, and may result in legal difficulties on the job. Over half the cases of sexual exploitation by professionals are perpetrated by sex addicts. Churches and synagogues are being subjected to greater scrutiny as more clergy are charged with some form of sexually inappropriate behavior. Sexual misconduct by licensed professionals (including physicians, therapists, clergy, and lawyers) result in loss of license, academic standing, and reputations, and victimization of those people they are mandated to help.


 * Financial/Occupational: Indebtedness may arise directly from the cost of prostitutes, cyber sex, phone sex and multiple affairs. Indirectly, indebtedness can occur from legal fees, the cost of divorce or separation, and decreased productivity or job loss. Financial difficulties from the purchase of pornographic materials, use of prostitutes and telephone and computer lines, travel for the purpose of sexual contacts, and other sexual activities can tax the addict's financial resources, sometimes to the point of bankruptcy, as can the expenses of legal representation.

These consequences are progressive and predictable. The addict tends to minimize the consequences and tends to blame others for them. Family and friends minimize consequences by believing the addict's promise that the behavior will change.

Sexual addiction cycle
According to Patrick Carnes (Out of the Shadows) - the cycle begins with the "Core Beliefs" that sex addicts hold:
 * 1) "I am basically a bad, unworthy person."
 * 2) "No one would love me as I am."
 * 3) "My needs are never going to be met if I have to depend on others."
 * 4) "Sex is my most important need."

These beliefs drive the addiction on its progressive and destructive course: First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict) Sex addict is not able to take care of the pain agent in a healthy way. Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to disassociate (moves away from his feelings). A separation begins to take place between his mind and his emotional self. Sex addict is disconnected from his emotions and he becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.
 * Pain agent
 * Disassociation.
 * Altered state of consciousness / a trance state / bubble of euphoric fantasized experience


 * Preoccupation or "sexual pressure" involves obsessing about being sexual or romantic. Fantasy becomes an obsession that serves in some way to avoid life. The addict's thoughts become focused on reaching a mood-altering high without actually acting-out sexually. He thinks about sex to produce a trance-like state of arousal in order to fully eliminate feelings of the current pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle.

These obsessions are intensified through the use of ritualization or acting out. A sex addict first cruises and then goes to a strip show to heighten his arousal until he is beyond the point of saying no. Ritualization helps to put distance between reality and sexual obsession. Rituals are a way to induce trance and further separate oneself from reality. Once the addict has begun his ritual, the chances of stopping that cycle diminish greatly. He is giving into the pull of the compelling sex act.
 * Ritualization or "acting out".

The next phase of the cycle is sexual compulsivity or "sex act". The tensions that the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes that he has become nothing more than a slave to the addiction.
 * Sexual compulsivity

Almost immediately reality sets in and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. He may feel he has betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this will be the last battle.
 * Despair

For many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself (Carnes, "Facing the Shadow" 2006).

Etiology
Proponents of sexual addiction theorize the following factors to be involved in the etiology of the condition: The psychodynamic perspective is a very effective system to use when explaining sexual addiction. This perspective places very much importance on early childhood development. The way that a child is treated by his parents and his peers during his childhood and youth has a great impact on his later life. Negative events and maltreatment that occurs during this period can scar the rest of a child’s life. The impression that these elements have on someone’s life are very hard to later eliminate.
 * Trauma
 * Neurochemistry
 * Neural pathways, e.g. Mesolimbic pathway
 * Relationship of depression, anxiety, OCD, and Attention Disorders to Sexual Addiction
 * Social conditioning and imprinting
 * Developmental impairments
 * Interaction of loneliness, anger, boredom, and spiritual rebellion
 * Psychodynamic Perspective:

Patrick Carnes (2001, p.40) argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. If a child is brought up in a family where his parents take proper care of him, he has good chances of growing up, having faith in other people and having self worth. On the other hand, if a child grows up in a family where he is neglected by his parents he will develop unhealthy and negative core beliefs. He will grow up to believe that people in the world do not care about him. Later on in life, the person will have trouble keeping stable relationships and will experience feelings of isolation. Generally, addicts do not perceive themselves as worthwhile human beings (Carnes, Delmonico and Griffin, 2001, p. 40). They cope with these feelings of isolation and weakness by engaging in excessive sex (Poudat, 2005, p.121).

The development of a sexual addiction theoretically, for some, starts early in life through adolescent experimentation, the discovery of self-stimulation, or early exposure to pornography and other sexual stimulants. Sex becomes a powerful, exciting obsession very early on and the addiction accelerates. For others it may start later in life—during graduate school, divorce, or when stresses become so great that an escape is needed. It becomes a way to self-medicate and cope with the pressures of life and the guilt and shame that follow the addictive behavior.

Treatment
The initial therapeutic intervention for sexual addiction needs to include an assessment for other addictions. It is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist.

The behavior of sex addicts has profound effects on partners, children, parents and siblings. The addict is usually partially or totally unaware that their behavior has affected their loved ones. Families develop unhealthy coping skills as they strive to adapt to the addict's shifting moods and behavior. Curiously some addicts may act out in solo isolating behaviors leading to feelings of family abandonment. For these reasons, friends and families will often need to be involved in the recovery process.

Those who do not attend 12-step meetings have a much more difficult time recovering, if they do at all. In many ways recovery from significant sexual addiction can be more difficult than recovering from some of the other addictions. The heavy prevalence of sexual abuse in the backgrounds of sex addicts is one reason. In addition, sexual addiction fundamentally involves a problem with intimacy, something important for successful recovery.

Self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, and Sex and Love Addicts Anonymous are popular with proponents of the sexual addiction concept. These are large groups based on the 12-step system of Alcoholics Anonymous. There are various online support forums as well as real-life help through an out- or in-patient program or private counsellor. Some intensive programs work with both the addict and the addict's partner.

Professional help:
 * Individual therapy
 * Group therapy

Therapists also use cognitive-behavioral therapy, and medications may be of value particularly in overcoming conditions or disorders that lead to increased acting out.

It is important to distinguish between sexual addiction and sexual anorexia not related to sexual addiction, as both can present similar behaviors, but effective treatment may be quite different. Aside from depression, it also must be established whether or not the presenting behaviors are due to obsessive-compulsive disorders, bipolar disorders, etc.

It is highly imperative the addict finds an experienced, trained counsellor to help with their addiction. Addicts suffering from other disorders in addition to sexual addiction (Narcissistic Personality Disorder, Borderline Personality Disorder, etc.) rarely reach and maintain a sober recovery without highly trained assistance.

Supposedly, the longer a sex addict has been acting out and the higher the level an addict they are, the lower the chances of a successful, sober recovery being maintained. Unless a sexual addict hits bottom (much like a drug addict) they will rarely seek recovery on their own. Other related, untreated psychological conditions or disorders can also reduce the chances of the addict maintaining a sober recovery.

It is also important that the partner of a sexual addict seek their own, individual counselling to help them learn how to deal with their partner's addiction. There are also online support groups in addition to real-life help.

Controversy
Scientists specializing in sexual behavior generally agree on what constitutes out-of-control sexual behavior, but they disagree over whether it is appropriately diagnosed as an addiction or as a symptom of an underlying obsessive-compulsive disorder, which can cause sexual obsessions and in some cases acting out of the obsessions. For opposing positions in this debate, see the two special issues on Medical Aspects of Sexual Addiction/Compulsivity of the American Journal of Preventive Psychiatry and Neurology, dated May 1990 and Spring 1991.

There are many people and organizations who do not acknowledge sexual addiction as a valid form of addiction. There is an argument as to whether the term has any true meaning for describing human sexual behavior. Many view sexual addiction as an excuse for acting out in this fashion. Other distinctions are difficult to make in a clinical sense, as in between promiscuity and sexual addiction as the main difference lies within the motivation of the act.

Other interpretations of sexual addiction (other than addiction): a compulsion, an impulse control disorder, a sexual desire disorder, a lack of morals and willpower, a form of obsessive compulsive disorder, a disease.

Those who do recognize sexual addiction often equate it to food, gambling addiction, and shopping addictions, where an outside substance isn't used to create the "high."

Diagnostic criteria
Since there is no diagnostic criteria established in the DSM IV, there is some controversy regarding the existence of sexual addiction and regarding standard treatment. A good abstract on the problem of the DSM IV's failure to include sexual compulsive behavior is outlined in: "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV", Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, 1996. by Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D.


 * ABSTRACT The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes certain sexual disorders which are characterized by, or include among their features, excessive and/or unusual sexual urges or behaviors. Common disorders in the differential diagnosis include paraphilias, impulse disorder not otherwise specified (NOS), sexual disorder NOS, bipolar affective disorder, cyclothymic disorder, post-traumatic stress disorder, and adjustment disorder. Infrequent disorders in the differential diagnosis consist of substance-induced anxiety disorder, substance-induced mood disorder, dissociative disorder, delusional disorder (erotomania), obsessive-compulsive disorder, gender identity disorder, and delirium, dementia, or other cognitive disorder. Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence.

The American Psychiatric Association (APA) does not yet recognize sex addiction as a mental illness; however, the APA has classifications that are helpful for understanding sexual behavior disorders. These disorders are called paraphilias. The most common include: pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, transvestic fetishism, frotteurism, etc. All of these disorders are characterized by recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving:
 * non-human objects;
 * the suffering or humiliation of oneself or one's partner, children or other nonconsenting persons; and
 * clinically significant distress in social, occupational or other important areas of functioning caused by the behavior, sexual urges or fantasies.

Proponents of the sexual addiction concept state that sex addiction may include some obsessions and behavior caused by these disorders. Sexual addiction itself, however, is generally conceptualized as most typically involving conventional, or non-paraphiliac, sexual behaviors that, when taken to an extreme, can interfere with daily functioning and produce guilt, shame and recurrent harm to oneself or others.

The DSM-IV describes one example under the heading of "Sexual Disorders Not Otherwise Specified" as "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used." Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.

Not all sexual behaviors that cause problems necessarily reach a diagnostic threshold. Criteria proposed by Eli Coleman to define nonparaphilic compulsive sexual behavior (Compulsive sexual behavior: What to call it, how to treat it? SIECUS Report. New York: Jun/Jul 2003.Vol.31, Iss. 5; pg. 12):

a. involves recurrent and intense normophilic (nonparaphilic) sexually arousing fantasies, sexual urges, and behaviors that cause clinically significant distress in social, occupational, or other important areas of functioning; and

b. is not due simply to another medical condition, substance use disorder, or a developmental disorder

It is important not to label "problems" prematurely and ignore intra-/inter-sociocultural considerations that might better explain the behavior.

Clinically relevant criteria for diagnosing sexual addiction proposed by Goodman (Goodman, 2001, pp. 195-196)

A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1. tolerance, as defined by either of the following:

a. a need for markedly increased amount or intensity of the behavior to achieve the desired effect

b. markedly diminished effect with continued involvement in the behavior at the same level or intensity

2. withdrawal, as manifested by either of the following:

a. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior

b. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms

3. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended

4. there is a persistent desire or unsuccessful efforts to cut down or control the behavior

5. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects

6. important social, occupational, or recreational activities are given up or reduced because of the behavior

7. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior

Portrayal in popular culture
Some sexual addiction proponents have commented that the concept faces many obstacles to being viewed seriously by the general public. One of these obstacles is the manner in which it is portrayed in popular media. Daily media sources sensationalize and denigrate people who are reported to be sex addicts. This portrayal typically extends into fictional television shows and movies.
 * In the television show, Nip/Tuck, one of the main characters in some seasons, Gina Russo is portrayed as being a sex addict. She meets Christian Troy, who also has been diagnosed as having a sexual addiction by psychologist Grace Santiago, at a sexaholics anonomyous meeting, after which he sleeps with her after she was 8 months celibate.  She later contracts HIV.
 * Caveh Zahedi's documentary film I Am A Sex Addict addresses, as the title implies, his personal obsession with prostitutes and the subsequent destruction of short-term relationships that initiate in bar/club scenes. In the film Zahedi re-enacts and reminisces on his struggles with sex addiction and his recovery from it.
 * Brenda, a character from HBO's Six Feet Under, was a sex addict, and while the portrayal may seem to be accurate to a point, the problem also seemed to disappear almost as fast as it appeared.
 * A Dirty Shame starring Tracy Ullman as Sylvia Stickles is about a conservative housewife who suffers a concussion and is passed "the gift of sex addiction" by Ray Ray Perkins (Johnny Knoxville). While the movie refers directly to Sylvia as being a sex addict, the movie does not accurately represent sexual addiction and rather mocks the stereotype of the condition.
 * Choke, a novel by Chuck Palahniuk, shows how the main character, Victor Mancini, snoops around groups similar to Sexaholics Anonymous, not only recovering from his own sex addiction, but also to find possible sex partners.
 * Love Creeps, a novel by Amanda Filipacchi, describes the romantic relationship between a stalker and a sex addict.
 * Slaughter Disc, written and directed by David Quitmeyer, is a modern horror film where the main character is a college-aged porn addict. The ghost of a murdered porn star seeks revenge by using a porn addict's gravitation towards explicit sexual content to kill them off and enslave their souls. This film has caused controversy amongst horror film fans as it depicts gore, graphic violence and actual explicit hardcore sex acts.
 * Blades of Glory, a 2007 film, features Will Ferrell as Chazz Michael Michaels, who repeatedly claims to suffer the burden of sex addiction and attends a meeting of Sex Addicts Anonymous.
 * The Riches, a 2007 TV series, focuses on a family of con artists. In one episode, the mother, Dahlia Malloy/Cherien Rich (Minnie Driver), is forced to pretend to be a sexual addict while conning a former baseball player (who attends Sexaholics Anonymous) into "investing" the scheme her husband Wayne Malloy/Doug Rich (Eddie Izzard) is using to avoid getting fired.
 * Black Snake Moan, a 2007 film directed by Craig Brewer, tells the story of how a Southern farmer named Lazarus, played by Samuel L. Jackson, takes in and looks after a young woman name Rae, played by Christina Ricci, in order to cure her of her sexual addiction.
 * Josh's agent in the episode 'Hard Ball' of the television show 30 Rock confides to Jack that he "needs the money, he has a really bad sex addiction". Jack is sympathetic.
 * DS Phil Hunter of the UK television show The Bill confesses he is a sex addict and secretly picks up a pamphlet during one of his work visits to a doctor.
 * In the television show Cheers, the main character and owner of the Cheers bar Sam Malone (played by Ted Danson) is a notorious womanizer. However in an episode of the show Frasier in which Sam makes a cameo, it is revealed he actually suffers from sexual addiction and has been attending meetings to help him. This plan backfires however, as Sam merely meets a new girlfriend at the meetings who is also a sex addict.