“Sex Addiction” & “Porn Addiction”

Originally posted: 04/24/2022. 

Edited most recently: 01/22/2024.

An important note: the following information pertains to individuals who understand and prioritize consent in their sexual decision-making and behaviors.

My professional lenses are that of a Clinical Psychologist and a Certified Sex Therapist working to balance my training and experience in sex therapy with my training and experience as a substance use disorder treatment specialist. Through those professional lenses, it has become clear to me that terms like “sex addiction” and “porn addiction” are often more harmful than they are effective at increasing our understanding of a problem and motivating lasting change. They are also quite frequently overused. Yes, these labels can prompt some people to seek professional help for a concerning behavior, and we want that end goal. Unfortunately, before many people get that help, the addiction model of understanding often leaves many to believe that there’s something wrong with them, that they are out of control, that sexual behaviors are either bad or good, and that they need to be fixed.

Historically, health professions have pathologized natural and healthy human interest and curiosity about the various ways we pursue and experience sexual pleasure. At our fingertips exists a world of technological advances where we can access any type of porn we can imagine, for better or worse. While we know some of the ways some of our brains respond to certain stimuli and behaviors, we don't yet have a complete understanding of the myriad of ways that this technology affects our human brains, or how. Nevertheless, many so-called experts prematurely use the addiction model to understand and explain their patients' complex reactions and sexual decision-making. This model is a vague enough catch-all that effectively discourages people from really understanding why they choose to use porn or sex. This causes real harm.

Over the years, I have regularly received calls or emails from people telling me they have a sex or porn “addiction” and that they want either to stop using it altogether or to reduce their porn use so that it stops causing the issues with which they are concerned. The label of an “addiction” with porn use or sex can cause real suffering. This emotionally-charged label and the resulting guilt and shame also prevent some individuals from reaching out to sex therapists altogether. These individuals then never get the proper education, support, and understanding of what the true underlying issues actually are.

I decided to discuss this topic with Marty Klein, Ph.D., LMFT, CST-S. Dr Klein is a published author on sex therapist and a sex therapist with over four decades of experience. I'm also fortunate to have him as a mentor. After our discussions, it became clear to me that if someone with no clinical training, no knowledge of the clinical language, and an understanding of symptomatology is able to “diagnose” someone as being an “addict,” that is probably a good indication that we as a society have adopted too broad of a definition of what “addiction” is. It also simultaneously perpetuates the myth that it is an actual disorder.

Let me be clear: there is no current diagnosis in the DSM-5 that uses the terms “sex addiction” or “porn addiction.” In fact, the word “addiction” is not even used when diagnosing problematic substance use. Someone who calls themself an “alcoholic” or an “addict” may have an Alcohol Use Disorder or an Opioid Use Disorder, but there is no DSM-5 diagnosis of “alcoholism” or “opiate addict.” Would it surprise you to know that there is also no current DSM-5 diagnosis of a “sex use disorder” or “pornography use disorder?”

In one of his videos, Dr. Klein eloquently described some of the reasons people choose to use sex or pornography in ways that either they and/or others describe as being addictive. Imagine, for instance, someone in a manic or hypomanic phase of bipolar disorder. One symptom this person might experience is impulsive decision-making. which carries risks and the potential for unpleasant consequences. Examples of this symptom might include having unprotected sex with strangers or having sex that betrays the trust of their partner. Without medication and therapy, these individuals have a condition in their brain that they cannot control and that prevents them from being able to effectively regulate their emotions, thoughts, and actions, to a greater or lesser extent. 

In that example, we have a non-sex-related mental health condition causing use of porn or sex in ways that have some risk for harm. Now, that can be problematic, but it is not a sex-specific problem. Rather, it is a bipolar disorder problem (and maybe a communication problem).

So, if unusual brain function within the context of a bipolar disorder is contributing to someone making impulsive sexual decisions, we treat the underlying psychiatric disorder. We do not single out one of the disorder’s symptoms (e.g., unprotected sex with strangers), which we conveniently label as an “addiction.” The latter would be tantamount to playing the game of Whack-A-Mole and expecting those pesky moles to just stop popping up if we whack them enough times. Instead, we are better off working to understand the underlying functions and causes of a behavior or symptom and to then address the causal problem itself, not the behavior-as-symptom.

Another example Dr. Klein discussed in his video is the label of sex/porn “addiction” in individuals who have OCD. Some folks with OCD might compulsively wash their hands or create time-consuming rituals to prevent a feared outcome from happening, which can be distressing and disruptive to their lives. Some living with OCD may have a compulsive behavior or ritual of viewing pornography and masturbating, which can be similarly distressing and disruptive to their lives. 

However, mental health conditions are not the only cause for porn use or sex that gets unfairly labeled as an addiction. Conflict in a relationship can be another contributing factor of the behavior. One partner could be avoiding unpleasant thoughts or emotions through sex or the use of pornography and masturbation. Sex or masturbation could be coping skills for this person. Have we considered if the behavior is actually helpful for them, even if only at times? When their partner wants to connect with them outside of sex, though, it’s likely to cause conflict. 

For various reasons, someone could also be signaling to their partner through their behaviors that they are feeling unpleasant emotions, such as frustration, disappointment, fear, rage, jealousy, sadness, etc. Just a small sample of reasons for this communication choice might include feeling judged for their sexual interests, feeling unsupported in their career endeavors, discomfort with intimacy, believing that their partner will leave them, not expressing that they don't want to be in a monogamous relationship, or (more often than we might realize) perhaps one person has different values and preferences from their partner regarding how acceptable it is to look at porn (as well as what kind of porn, and how often, etc.). Someone’s partner may see porn use as a problem because they may not like that their significant other views porn. However, that does not mean that the porn user has a problem or an “addiction” to it. It simply means that we need to understand what is preventing the indirect communicator from more assertively expressing their thoughts and feelings, and then to help them learn the tools to practice doing so. We would also need to understand what about porn use feels so bothersome or threatening to the partner. Increasing effective communication of both partners in the relationship is the ultimate goal.

In most cases, each partner in a relationship has a different set of values, patterns, and preferences, all influenced by one’s biology, politics, finances, religion, social environment, psychological health, and personality. That does not mean that one of them is necessarily right and the other is wrong, nor that one of them has an “addiction.” If there is any disorder or dysfunction, it is potentially in the match of the partners in the relationship, or in how they are choosing to discuss the issue, to challenge their own belief systems, and/or to engage in uncomfortable dialogue. And yet, there are many more possibilities for why a particular sexual behavior is not best accounted for by the addiction model.

I do not think there is one “right way” to think about sex, masturbation, and pornography. I do believe we are all entitled to have our own belief systems and values regarding each of them. It is important for people to work toward understanding why they feel the way they do, why they choose to do what they do, and how they go about making decisions as it relates to sex, porn, and masturbation. It is also crucial to question if the things that we say are important to us are, in fact, important to us for the reasons we believe them to be, as well as if we want to continue making similar decisions based on that understanding.

Our society could benefit greatly from acknowledging that we have a fundamental misunderstanding of sex, sexuality, and sexual decision-making. In true form with our healthcare system’s inclination to pathologize the human experience, we could even label this as a “disordered understanding of human sexuality,” playfully shorthanded to “DUHS.”

The treatment and prognosis? With proper education based on a comprehensive understanding of what each individual's unique underlying problems are, combined with additional needed research and frank discussions about sex with our healthcare providers, friends, family, partners, and communities, it remains my belief we actually stand a chance to beat this.