Addiction to sexual activities can be just as destructive as addiction to chemical substances. Addicts may jeopardize their marriage and family relationships, allow their job performance to deteriorate, and endanger themselves and their partner through multiple sexual exposures. Even though they realize the consequences, they cannot control their compulsions without appropriate treatment. The author explains how to spot addicts and coaddicts among your patients. For most people, sex enhances the quality of life. However, about 3% to 6% of Americans have sexual addiction(1).
Through their addiction, they may injure themselves physically, experience psychological distress, lose their livelihood, and ruin meaningful relationships. Sexual addiction often coexists with chemical dependency, and untreated sexual addiction contributes to relapse to chemical use. These patients not only endanger themselves but also put their loved ones at risk for AIDS and other sexually transmitted diseases. Physicians can help by learning about this phenomenon, which is gaining increasing attention in behavioral medicine, and then educating these patients and their families.
Criteria for sexual addiction The concept of sexual addiction was introduced less than 10 years ago(2). It not only provides an explanation for otherwise irrational behavior but also suggests effective treatment for patients who have not been helped by more traditional therapy. The Diagnostic and Statistical Manual of Mental Disorders, revised third edition (DSMIIIR)(3), lists nine criteria for chemical dependency (table 1). The presence of three establishes the diagnosis.
Most of the criteria concern behavior: Two indicate decreased control, one . shows preoccupation with obtaining and using the substance, and three reflect continued use despite negative consequences. These criteria can be used to diagnose other addictions as well. Goodman(4) proposed a set of diagnostic criteria for addictive disorder that may be modified and applied to sexual behavior (table2). Any behavior that is used to produce gratification and escape internal discomfort can be engaged in compulsively and can constitute an addictive disorder.
Compulsive gambling(5), spending, and overeating meet these criteria as well. Characteristic findings of any addictive disorder are the following: 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. All of the patients in the following illustrative case reports exhibited these findings.