Sex addiction: bona fide condition or excuse for bad behavior?

It’s often helpful to have a celebrity spokesperson for a disorder: Doug Flutie for autism; Patty Duke for bipolar disorder. Yet when it comes to sex addiction, the star connection may hurt. Who wouldn’t be a sex addict, some may argue, given money, power and unlimited access to beautiful women? Some psychologists argue the condition is indeed real and that the recent spate of celebrity “sex addicts” are clouding what’s in fact a very painful reality for some.

“You see these very rich, very handsome superstars and your perceptions of them are that they’re on top of the world,” says Aline Zoldbrod, Ph.D., a psychologist and sex therapist in Lexington, Mass. “You come out feeling like they’re spoiled brats, even though we don’t know what their background is. If you read the comments people post on news stories, you’ll see people say this diagnosis is cooked up to excuse bad behavior.”

Sex addiction is not listed in the DSM (although “hypersexual disorder” is being considered for DSM-V). Some psychologists debate it’s a bona fide condition.

Yet consider someone who spends much of his work day looking at porn, to the point his job is in jeopardy or is getting himself into debt from seeing escorts a few times a week. And in spite of a desperate craving for sex, he feels awful about it afterward.

“The common belief that these guys are having a great time with wild sex is quickly dispelled if you talk to these men heart to heart,” says Lynn Margolies, Ph.D., a psychologist in private practice in Newton Centre, Mass. “They are out of control and feel out of control. Afterwards, they universally feel shame and depression and it leads to a vicious cycle of having to banish that feeling by more acting out.”

Two big determining factors for sex addiction are if someone uses sex, like a drug, to alter one’s mood and if one’s sexual behavior is having a major detrimental effect on any major area of his life, says David Greenfield, Ph.D., a West Hartford, Conn. psychologist who’s been treating sex addiction for the past 20 years.

To Greenfield, Tiger Woods fit this definition.

“His actions showed his judgment was impaired,” Greenfield says. “If you were to ask him in a clear-headed state if what he did was dangerous, he’d say yes. But when you’re in an addictive pattern, you’re just concerned with getting away with it. [Woods’s behavior] looked like a sex addiction, because he didn’t want to go a day without it or to a different port without it.”

We’ll probably never know whether it was an uncontrollable compulsion, a sense of invincibility coming from celebrity or some degree of both that were at work for the golfer. In most cases of sex addiction or sexual compulsivity (which term should be used is a matter of debate for psychologists), trauma – whether or not it was sexual in nature – plays a significant role, Zoldbrod says.

“My experience and the research shows that 80 percent of people who have trouble with sexual compulsivity come from a family where there’s been neglect, abuse or violence,” she says. “Some have experienced extreme deprivation and if it were a child, people would feel sorry for them.”

Masturbation and sex become ways for some to soothe themselves, to manage negative feelings that they think they can’t share with others, just as drinking might, Zoldbrod adds. Neglect or abuse, whether physical or psychological, has been linked to starting to have sex at an earlier age, a study published online in Pediatrics last year found.

“I think we’re at with [sexual compulsivity] where we were at with alcoholism 30 years ago,” Zoldbrod says. Someone who’s sexually compulsive “is no different from someone who’s had trouble with alcohol; it’s just that sex is more shameful.”

Indeed, a collective sexual hang-up is likely part of the problem, says Greenfield.

“We don’t have a healthy attitude toward sex,” he says. “It’s overtly celebrated, but covertly shameful… If the [Tiger Woods scandal] happened in Europe, it would get a headline for a day or two, but that’s it.

And, as with other addictions, not getting too hung up on the label may help one progress toward resolving the problem, says Carl Hindy, Ph.D., a psychologist in Nashua, N.H., who focuses on marriage and relationship counseling. “I’d like to think it’s about the choices people make,” he says. “If we develop ways of self-comforting that have bad consequences – and those ways get narrower and narrower – we call that an addiction. Sometimes the word can be useful to help someone understand what they’re doing, but it’s not helpful if it ‘explains it away’ and makes people feel like they don’t have choices.”

Hindy acknowledges that biological factors play a part in our decision-making, but is wary of clinging to biological explanations. “There’s an understandable tendency in human nature to think that we’ll ultimately find biological bases of every human problem,” he added via email. “No doubt we will. But will it be useful to operate at that level in helping people?”