Sex Addiction

By Alexandra Katehakis

Sex Addiction—Is it Real?

Are the politics of terminology preventing us from addressing a real problem?

By Alexandra Katehakis MFT

Sex Addiction sounds like a lame excuse used by men to justify their infidelities.” This is a sentiment we hear a lot from people who wonder if men get away with more than their fair share of bad behavior. And clinicians skeptical of sexual addiction regularly make the argument that sex addiction is not in the DSM-IV Diagnostic and Statistical Manual of Mental Disorders (the reference book published by the American Psychiatric Association).

So, is sex addiction real or not?

When we consider how frequently psychological terminology becomes part of everyday language, it’s understandable why people might question the validity of “sex addiction.” We are all familiar with diagnostic terms being overused in casual ways—especially as a way of pointing out someone else’s uniquely intense behaviors. “He’s obsessive compulsive.” “She’s a narcissist.” “He’s a psychopath.” “She’s a social-phobe.” “He’s a work-aholic.” “She’s addicted to chocolate.” Yet, despite some examples of diagnostic labels being used in somewhat glib ways, there are endless real life examples of people whose lives are ruined because of their out-of-control behaviors. And sometimes these out-of-control behaviors involve sex.

So, isn’t the potential ruin of someone’s life (whether they’ve brought it upon themselves or not) enough reason to carefully examine certain behaviors that may have calamitous consequences—even behaviors that are sexual in nature?

As a clinician, I’ve spent time with a lot of clients who have described themselves as “concerned,” “worried,” “scared,” “embarrassed,” and “ashamed” of their habitual sexual behaviors. In most cases when someone expresses worry and shame about certain behaviors, there is a very good chance that person wants to stop the behaviors that have them concerned. But what does it mean when they can’t stop or don’t know how to stop?

Let’s for a moment consider people who cannot stop drinking alcohol even when their pattern of drinking causes real problems in their lives. It was not that long ago when we viewed these people as having some sort of character flaw—as being “weak-willed,” “pitiful,” “losers.” Today, however, we might describe someone who has a problem with alcohol as a person who suffers from alcoholism, a person who has an addiction, a person who struggles with alcohol dependency. Today, when we see someone who doesn’t stop drinking, even though it’s wreaking havoc on his life, we understand that person needs help.

Yet today when we come across a person who seems to have out-of-control patterns with sex (numerous affairs, excessive viewing of pornography, frequent hiring of prostitutes), it’s easy to stigmatize that person with various character flaws. “That person’s a jerk… a loser.” Yes, sometimes a person might be those things. But I’ve also worked with plenty of clients who, outside of their problematic sexual behaviors, are very accomplished people. I think it’s fair to say that a lot of people who are cheating on their significant-others are lying and are being selfish. But I’ve also seen clients, once they managed to get their sexual behaviors under control, end up embodying the really good qualities they always wanted to represent.

So regardless of whether we call it “sex addiction” or not, there are people who are struggling with out-of-control sexual behaviors. They are struggling because their endless affairs are destroying their families emotionally. They are struggling because their sexual exploits are completely unraveling their professional and public reputation. They are struggling because their constant patterns of paying for sex are causing financial ruin. They are struggling because their escalating sexual behaviors are putting them at risk with the law and possibly exposing them to sexually transmitted infections. They are struggling because they see how all aspects of their lives are falling apart and they still can’t stop. And some continue to struggle because the people who are in a position to possibly help them are too busy trying to figure out if sex addiction is a real condition or not.

So how can we tell if someone is really struggling with out-of-control sexual behaviors/sex addiction?

A good place to start is to look for signs and symptoms that are similar to those we look for in alcohol or chemical addiction. Using criteria for chemical dependency from the Diagnostic and Statistical Manual of Mental Disorders as a reference, the following criteria have been modified to consider sexual behaviors.

1. Tolerance—when a sexual behavior has a reduced ability to cause the desired effect, requiring a need to increase the frequency or intensity of the activity

2. Withdrawal symptoms such as anxiety or depression when the sexual behavior is stopped

3. Participation in the sexual behavior is in larger amounts or over a longer period than was intended

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

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

6. Important social, occupational, or recreational activities are given up or reduced because of engagement in the sexual behavior

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

So should we be calling these types of out-of-control sexual behaviors “sex addiction”? I’m less concerned with what we call it, and am more concerned with getting help for the people who are suffering as a result of their destructive habitual sexual behaviors.

Alexandra Katehakis, MFT is Founder and Clinical Director of the Center for Healthy Sex in Los Angeles, Senior Fellow at The Meadows, Facility for the International Institute of Trauma and Addiction Professionals, and the 2012 Carnes Award recipient. She is a Certified Sex Addiction Therapist/Supervisor and Certified Sex Therapist/Supervisor specializing in the treatment of sexual disorders. Ms. Katehakis is author of Sex Addiction As Affect Dysregulation: A Neurobiologically Informed Holistic Treatment, 2016 published by W. W. Norton & Co. She is co-author of the 2015 AASECT award winning Mirror of Intimacy: Daily Reflections on Emotional and Erotic Intelligence (2104), contributing author to the Clark Vincent award winning Making Advances: A Comprehensive Guide for Treating Female Sex and Love Addicts, in M. Feree (Ed.), (2012), and author of Erotic Intelligence: Igniting Hot Healthy Sex After Recovery From Sex Addiction (2010).
Professional affiliations include Certified Sex Addiction Therapist/Supervisor, International Institute of Trauma and Addiction Professionals (IITAP), Certified Sex Therapist/membership American Association of Sex Educators, Counselors and Therapists (AASECT), the Society for the Advancement of Sexual Health (SASH), Society for the Scientific Study of Sexuality (SSSS), and the Global Association for Interpersonal Neurobiology (GAINS).

Ms. Katehakis received her early training in transpersonal psychology from John Cogswell, Ph.d. where she co-founded a mind/body psychotherapeutic modality known as "Walking-in-Your-Shoes." She specializes in and has extensive experience in working with a full spectrum of sexuality from sexual addiction to problems of sexual desire and dysfunction for individuals and couples. She speaks to professional audiences on the subject of sex addiction and sexuality and teaches workshops on healthy sexuality in retreat settings.

Alexandra is a weekly guest expert on Dr. Drew Midday Live appearing every Friday at 12:45pm on KABC Talk Radio 790 AM. More information is available through her website at

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