Working as a therapist at Del Amo Hospital in Torrance back in the early 1980s, Patrick Carnes had a lot of patients whose sexual behavior reminded him of alcoholism and drug dependency: Though it disrupted or ruined their lives, they just could not control it.
So he came up with a new concept, one that would jolt the staid practice of sex therapy, rock mainstream psychiatry, make Carnes a leader of the burgeoning recovery movement, and splashily enter American slang.
He called it "sex addiction."
Fifteen years after he popularized the term in a self-help book, groups such as Sexaholics Anonymous and Sex Addicts Anonymous steer thousands through 12-step therapy programs. Advice books on sex addiction sell briskly. The National Council on Sexual Addiction/Compulsivity, an 11-year-old information clearinghouse that publishes a professional journal, promotes "acceptance and diagnosis of sexual addiction."
Few ideas have leapt from therapeutic circles into popular thinking so quickly. What therapists and patients appreciated was that it removed the shame and stigma from some behaviors long regarded as willful perversions. Classifying them instead as clinical conditions encouraged more people to admit the problem and seek treatment, therapists say.
It was perhaps inevitable that the phrase caught on, given that a lot of people are fairly hooked on the activity to begin with. But its very catchiness has created something of a public-relations crisis, inspiring more snickers than sympathy.
Ironically, a term invented to convey an agonizing, life-destroying compulsion connotes the opposite to non-experts, who cannot really be blamed for thinking that a sex addict--like a "chocolate addict" or a "Jerry Lewis addict" or "golf addict"--suffers from nothing but a naughty and vaguely comical resistance to common sense.
In addition, some psychiatrists and social scientists say that a self-destructive behavior cannot be "addictive" the way a drug can be, no matter how often the behavior happens and how much havoc it causes. Accordingly, to apply the label of addiction to sex--an instinctual drive, after all--is to invite unending debate over where to draw the line between the pathological and the merely excessive.
Nor have researchers established the basis for sex addiction in body and brain chemistry, as they have done for drug addictions. For that reason, the American Society of Addiction Medicine, a group of health professionals that lobbies Congress on drug-dependence and alcoholism issues, staunchly refuses to recognize any compulsive behavior as an addiction.
The American Medical Assn. and the American Psychiatric Assn. also do not accept the concept of sex addiction as a distinct entity.
Reflecting the controversy, the current, 886-page diagnostic manual of psychiatry does not include an entry on "sex addiction," despite efforts by Carnes and others over the years to get the concept included.
The debate also feeds into a larger cultural soul-searching over personal responsibility. Granted, sometimes the term "sex addict" is just shorthand for people who engage in more sex than is probably good for them. But even then it can seem to exalt or excuse behavior that is "fairly common and probably not pathological," said Stuart Kirk, a UCLA social welfare expert and coauthor of a 1996 book critical of rampant psychiatric diagnoses, "Making Us Crazy."
Whatever it is called, the problem known as sex addiction encompasses more than a dalliance outside marriage.
According to the National Council on Sexual Addiction and Compulsion, some behaviors that "may represent an addictive disorder" are multiple extramarital affairs; using a position of power to gain access to multiple partners; excessive use of prostitutes; indecent telephone calls; excessive time and money spent on pornography, Internet sex, and phone sex; multiple anonymous sexual encounters; touching others without their permission.
Carnes, who is now clinical director at the Meadows, a private recovery center in Wickenberg, Ariz., laces his books with case histories. He tells of a married woman whose many anonymous affairs led her to a stranger who brutally beat her in a motel room; a male therapist who structured his day around masturbating every few hours; and a physician who had unprotected sex with 200 partners in four months despite his knowledge that he carried the AIDS virus.
The key elements of a sex addiction, according to experts, are a lasting preoccupation with engaging in the behavior; loss of control over it; continuation despite adverse consequences; and denial of the problem.
Carnes has defined "sexual addiction" as a "compulsive" behavior that "dominates the addict's life," becoming "more important than family, friends and work."