“Just as a heroin addict chases a substance-induced high, sex addicts are bingeing on chemicals — in this case, their own hormones.”
Alexandra Katehakis
Although D.V. are false initials, they correspond to a real case, and his story begins where almost all those told by men and women who, like him, are hooked on sex begin: in adolescence.
From then until today, at the age of 35, he has lived hiding his inability to repress his sexual desires from himself and others.
"It all came about because of a breakup and I began to have relationships with many women as a way to escape the pain. There were days when I could have several encounters or have 12 different relationships during a week. The need to seduce and conquer became an obsession. I couldn't quench my cravings with frequent masturbation or with pornographic magazines or videos, which I watched on the sly like many other sex addicts. I would jump from bed to bed in order to get a few seconds of physical pleasure and mental relief, but it always turned into hours and days of pain, shame and regret as a result of this compulsive sexual behavior. Many of my stable relationships broke up because they found out about my double life and I suffered for my partner and myself. My obsession affected my work life as well as my personal life. In addition, I was violating my values by lying and cheating. Because of all this I decided to ask for help from a specialist."
In the age of smartphones and frictionless dating apps, sex addiction is like being hooked on a drug that is always available in unlimited supply. It’s like living with a meth dealer by your side, or a brick of cocaine in your pocket. What’s worse, you can get a potential high from every person you meet.
But unlike other addictions, this one is not officially recognised. There is no health coverage for it, no medication, and for those caught in its strange and unrelenting spell, there is no easy way out.
Arousal
Sex addiction is big business. The number of certified sex addiction therapists has doubled since 2008, according to the International Institute of Trauma and Addiction Professionals. Dating apps like Tinder (26 million matches a day) and Grindr (1.6 million daily active users) are growing and multiplying. The film industry has also dealt with this issue in some films, such as the two parts of Lars von Trier’s Nymphomaniac.
Forty years ago, the term sex addiction didn’t exist. Today it is fully assimilated into the culture. But even now, sex addiction seems to exist in parallel realities: one in which millions of people struggle with it, and another in which it is barely studied or even clinically recognized.
Research has not yet confirmed that extreme sexual behavior is truly addictive in the same neuroscientific sense that, for example, habitual heroin use appears to be. For this reason, many clinicians prefer the term hypersexuality, although they admit that the distinction is mostly semantic.
But the practical effects of this uncertainty are enormous. There are no drugs to treat sex addiction; no health plan specifically covers it; and there is virtually no funding for research, despite the fact that more and more people are seeking treatment.
If sex is normally a way of coping with another person, sex addiction is a way of coping with yourself. You behave – you can’t not behave – to escape unbearable feelings: depression, severe attention deficit, bipolar disorders, the scars of family trauma, deep despair.
Poet and teacher Michael Ryan captures this experience in his haunting and mesmerizing autobiography, “Secret Life,” where he confesses, “The substance I consumed was human beings.”
Madness
A sex addict’s body can become his whole world. The urgent messages he gets from his brain – I’m depressed, I’m lonely, I’m afraid, I’m angry – drown out everything else around him. He can’t feel happiness except as a physical sensation.
Arousal and orgasm, as you know them, are not a lived experience, but an escape from it. They are a simulation of all that may be absent from your life: the joy, the intimacy, the feeling of fulfillment. They are a kind of biochemical, brute-force attempt to erase an overwhelmingly bad feeling with an overwhelmingly good one.
In the space between arousal and orgasm, he finds a fleeting calm. He strives to prolong it, to escape time, to escape his own mind. He teeters between unhappiness and euphoria, endlessly circling over himself. He wants to be outside himself, but he becomes his own prison.
The search for that elusive high can lead sex addicts to increasingly risky behaviour: from exhibitionism and regular anonymous sex to, in some cases, a fascination – even in people who have always preferred adults – with child pornography.
Some of these men are resolving conflicts about their sexuality, but others are not. Instead, they may have other intricate motives: expressing self-hatred through behavior they may consider demeaning, subjugating a partner they consider more physically powerful than a woman, feeling desired by a father who was emotionally distant, and being intimate with him.
Treatment
In 2010, a group led by Harvard psychiatrist Martin Kafka pushed hard for hypersexual disorder to be included in the DSM, the bible of psychiatric diagnoses, which was about to be updated for the first time in two decades.
Kafka’s argument cited epidemiological data and case studies from nearly 250 books and journal articles, including 20 he co-authored. But, he admitted, knowledge about the disease still had “major gaps and shortcomings”.
The DSM working group rejected Kafka’s proposal out of hand, while they did consider it appropriate to approve fifteen new diagnoses, including skin pitting disorder.
“There may have been political reasons for it,” Kafka said. In particular, there was reluctance to equate any kind of consensual sexual behavior with mental illness. (The psychiatric establishment had been through this before: Its prolonged classification of homosexuality as a mental disorder-removed only in 1973-caused untold harm to gays and severely damaged the field’s reputation.) There was also concern that an official diagnosis could provide a kind of loophole for people accused of sexual offences. Says Kafka: “The difference between what is normal and what is abnormal: where does one draw that line? How does one draw such a line?”
The consequences of exclusion from the DSM were enormous: inclusion would have meant that health insurance companies could cover the costs of treatment; that the government, which has provided virtually no money for sex addiction research, could take an interest in it; that pharmaceutical companies could try to develop drugs for it. The study of sex addiction is caught in its own vicious cycle: no funding, no research; no DSM diagnosis, no funding.
To fill the treatment gap, experienced therapists recommend a combination of individual therapy, medication (usually antidepressants), and a 12-step program, the last of which appears to provide practical coping strategies and relief from shame. There is no data on the effectiveness of residential rehabilitation centers, which can cost tens of thousands of dollars to treat.
When a sex addict is married, recovery is complicated by orders of magnitude. Some therapists guide couples through a process known as disclosure: a controlled recounting by the sex addict, to his or her partner, of all the secret behaviors he or she has engaged in.
It’s not uncommon for sex addicts to take a polygraph test at their partner’s insistence, says Jenner Bishop, a sex addiction therapist in Oakland. The goal is to restore trust and teach the addict how to have sex that isn’t compulsive and selfish. “You have to calm the partner’s hypervigilance and trauma,” Bishop says. “The irony is that it’s done by someone who is usually too narcissistic to have the empathy to do it.”
How often does a marriage survive sex addiction? Not very often, you might think. Says Kafka, “Many of these relationships end up taking a long time to recover – like years – or never do.”
