August 15, 2019 6 min read


Sex addiction is a process addiction (similar to food addiction or an eating disorder). Process addictions differ to substance addictions in that they begin early on in life once a blueprint has been laid out by the child or teenager. Sex addicts have all the same characteristics of substance addicts, but their “drug of choice” involves some kind/s of sexual acting out.

Sex addiction has its causes rooted in the individual's genetics, personality, having minimal coping mechanisms while living in a harsher environment and modelling the behaviour of other addicts.


All addictions have to be understood with the knowledge of the following:

  • Use – normal use of the behaviour/substance.
  • Abuse – excessive use of the behaviour/substance.
  • Dependency – a physiological process, whereby the individual develops a tolerance to the behaviour/substance and a withdrawal if removed.
  • Addiction – a physiological and psychological dependency to the behaviour/substance. A whole lifestyle of defence mechanisms, attitudes and behaviours are unconsciously and consciously set up by the individual to protect their acting out/addiction.

Sex addiction is about achieving immediate gratification. The addict has poor impulse control and a lack of awareness. The addict “zones out” through the acting out behaviour resulting in the escape from consciousness and feelings. Sex addicts are unable to understand and experience intimacy. They continuously search for that elusive feeling and the fantasy of what sexual intimacy really is. Shame, guilt, remorse and desperation almost always follow the acting out.

Sex addicts often have co-addictions, such as cocaine, alcohol or food, as well as co-morbidities such as depression and anxiety. Other excessive characteristics and behaviours are also often present.

As with all addictions, it is not the frequency, quantity or the actual drug of choice that is the problem, but rather it is the dysfunctional relationship the addict has with his/her drug of choice that is the problem.


Sex addicts form blueprints early on in life when the child associates an experience with certain behaviours and emotions. These experiences may range from severe traumas, such as molestation to innocent associations set up by the child. An example of the latter could be an anxious child discovering the warm sensation in his groin brought upon by using the fireman’s pole at nursery school. This warm sexual sensation alleviates his anxiety. He thus sets up the on-going process that serves to generalise the behaviour and the emotions. For example, moving from the pole, to other behaviours like masturbation or exhibitionism, and moving from anxiety to trying to escape from all types of emotions.

Sex addicts accordingly begin to “act out” instead of “feeling in”. Furthermore they do not manage to hold the dual feelings of good (physical arousal) and bad (guilt and shame). This later becomes a conflict for them in their developing emotional maturity.


The sex addict will experience an internal trigger, such as a particular emotion, or an external trigger, such as a billboard advertising sexual content. Ritualisation is of utmost importance to the addict as this is when the fantasy is realised. Dissociation is the longed for escape and numbing that the addict is pursuing. With this in mind, it is easy to understand how the long and drawn out rituals - such as, surfing for pornography for hours or driving around for hours - are usually more important than the actual end product of ejaculation. Once the addict has started the dissociative process, it is very difficult to stop the behaviour, as at this stage there is a total lack of control, no matter what the end consequences are.

Sex addicts act out on three different levels, (According to Patrick Carnes -the guru on sex addiction), these being:

  • Level 1 where behaviour is predominantly acceptable, for instance, masturbation, porn and prostitution;
  • Level 2 where behaviours may victimize others and have legal consequences, such as exhibitionism and voyeurism; and
  • Level 3 whereby the perpetrator strongly violates boundaries and transgresses laws, such as child molestation, incest or rape.

Although sex addiction is always a progressive disease, this progression may be seen within only one of the levels (eg starting with masturbation 5 times a week and leading to 5 times a day). It can also transgress from level one to two. Most sex addicts never go to level 3.


Sex addiction treatment involves working with the shadow and the dysfunctional defence mechanisms that have developed over time. The shadow is that part in all of us that we wish to keep hidden. With sex addicts, this unconscious shadow has the capacity to be especially dark and deceptive. Shadow work is about making friends with and becoming familiar with the shadow. At the same time, new coping mechanisms and associations are developed which in turn serve to ultimately shrink the shadow.

The sex addict needs to practice mindfulness as a reaction to his constant search for zoning out. He is taught to be present and aware of his various emotions throughout the day. Inner child work is important, especially the undoing of dysfunctional patterns and core beliefs set up in childhood. The addict needs to learn to stop objectifying women or men and to start seeing them as emotional human beings. Objectification is usually a result of long term pornography usage.

The sex addict needs to understand intimacy, as this is actually the elusive feeling that he is chasing so desperately and unsuccessfully. A relationship based on trust and respect between the sex addict and the therapist is so important for him in order to move from disgust and shame to compassion.

Sex addiction treatment is a long process, usually taking up to 3 years. Sex addicts need time to have their brains rewired. For instance, it can take approximately 7 months to get rid of PIED (porn-induced erectile dysfunction). As is common knowledge with all addictions, sex addiction cannot be cured. Rather it is a lifetime management of behaviour and emotions for the individual. He will constantly need to work on this for himself and his relationship(s).


It is vital to work from a systemic framework when dealing with any addiction, but with sex addiction in particular, one should really try to involve the partner as much as possible. This is absolutely necessary because of co-dependency and disclosures.

Co-dependency is when an individual only develops as a half core. This happens as a result of the child externalising his locus of control, instead of internalising it. For instance, his self-esteem is based on the foundation of what he does as opposed to who he is. Furthermore, boundary violations and confusions also serve to increase his development into only a half core. As such, the partner that he finds is someone who also has developed into only a half core. Together they make up a whole core which fuels neediness and fear as opposed to love and intimacy. Co-dependency also results in the partner enabling as opposed to supporting the sex addict. This is done usually because the partner has his/her own issues that she is trying to deny. It is therefore vital for the partner to also seek therapy in order to develop a full core.

Disclosures are unfortunately often made before entering into therapy resulting in much damage to the partner. Ideally disclosures should not concentrate on specific content as this only serves to act as secondary trauma to the partner. They should also be done once off, and not in a staggered and on-going manner, which only serves to create even more doubt and mistrust. The partner should be supported and behaviours regarding her self- care should be discussed, such as, STI screenings and negotiations around any future sexual relations between the two. Contracts defining various behaviours and their resulting consequences should be drawn up. Practical measures, such as filters to put on electronic devices, need to be considered.


Sex addicts are unlike substance addicts, in that they need to manage sexual activities healthily rather than being able to abstain. Furthermore, relapses are not black and white as with substance addicts. A sex addict requires his own unique recovery plan, that considers harm and risk factors. For instance, a sex addict whose “drug of choice” is prostitution, pornography and masturbation, may decide that prostitution has zero tolerance with regard to relapse, but the odd pornography and masturbation may be acceptable until functional coping mechanisms can be used successfully.


Sex addiction therapists need to understand the difference between someone who is only abusing sexual behaviour as opposed to someone who is a sex addict. The therapist also needs to be able to diagnose co-morbidity, if necessary. This may need to be treated with medication, for instance depression and anxiety. Clients further need to be wary of the therapist who departs from a religious perspective and understands addiction as a sin. For these reasons, the client should feel justified in checking the therapist’s credentials thus ensuring he will not be judged or mistreated. The sex addict should be in individual therapy and group therapy if possible. Groups are sometimes run by individual therapists and other groups can be accessed through the 12-step program (SAA, SLA, SA). Clients can also check out various addiction rehabilitation centres. Centres and therapists can be found by word of mouth, by referrals or on-line.

Written by Sharon Rosen – Sex Addiction Expert
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