Famous People and Sexual Addiction

We frequently receive media requests related to public figures who engage in problem sexual behavior (such as Tiger Woods, Elliot Spitzer, and Bill Clinton). While it may be tempting to diagnose a public figure’s problems based on media accounts, accurate assessment requires a face-to-face evaluation of the individual and knowledge of the circumstances surrounding the behaviors.

Many psychiatrists and some addiction specialists do not accept the idea that sexual behavior can be addictive. They use other diagnoses to describe out-of-control sexual behaviors, such as mania, impulse-control disorder, or personality disorder. We believe that in many cases of repetitive problem sexual behaviors, the addiction model readily explains apparently irrational behavior, which is easily understood by patients and family members, and leads to effective treatment.

Many pleasurable and life-affirming behaviors can be healthy for most people but addictive in others (such as food and gambling addictions). Addiction is a concept that was traditionally applied only to substances like drugs or alcohol with the potential for physically or psychological dependency. Today, the term “addiction” is routinely used to describe and diagnose behaviors such as gambling, overeating, and sex when they are repeated, seemingly out of the person’s control, and causing obvious losses and consequences to the user. To addiction specialists familiar with these behaviors, the parallels with substance addictions are obvious. In many cases, addiction treatment has been successful when “will power” or traditional therapy has failed.

The key elements of any addiction, whether chemical or behavioral, are:

• Loss of control over the behavior; continuing to engage in a particular behavior after repeated attempts and promises to self and/or others to stop)

• Continuation despite adverse consequences, such as loss of job, money, marriage, or health, or arrests or public humiliation

• Preoccupation or obsession with obtaining and using the substance or participating in the behavior to the detriment of other essential life activities or goals such as important relationships, family, career, etc.

Addictions are defined not by the amount of using or engaging in the behavior, but rather its effects on the person’s life. Addiction may be present when the behavior has made the person’s life unmanageable.

Some clues regarding sexual addiction are:

• The problem behavior is not an isolated occurrence; there is a pattern of this behavior over a significant time span.

• Despite a previous significant adverse consequence, the behavior is repeated. Sexual decisions do not appear to be made on a rational basis.

• Increasingly greater risks are taken over time. For example, sexual encounters may initially take place only out of town, but later closer to home.

• The person denies to him/herself and others that there is a problem when it is evident to others, using minimization, rationalization, and justification to continue to engage in the behavior while trying explain the problem away.

For the sex addict, sexual behaviors that are secretive, illicit, or dangerous carry an even greater internal experience of intensity or arousal (high), which encourages irrational choices. This is no different than the compulsive gambler who will gamble far beyond his or her limit to do so, as her or she is aroused and distracted by the intensity of the process.

Some sexual behaviors that may represent an addictive disorder are:

• Multiple extramarital affairs, betrayal, and infidelities

• Compulsive masturbation

• Excessive viewing of porn

• Using a position of power to gain sexual access to multiple partners

• Use of prostitutes, escorts, and sexual massage

• Excessive expenditure of time and money on pornography, phone sex, or cybersex

• Multiple anonymous sexual encounters

• Touching others without permission

The majority of sex addicts, like most other addicts, have parents or other close family members with histories of alcoholism, drug dependency, mental illness, abuse, or other significant family dysfunction. Often these families are sexualized or have exposed the child to an overwhelming sexual experience at an early age. This type of history distorts their adult relationships and can encourage the isolation and superficiality, which is a hallmark of addictive disorders.

Effective treatment for sexual addiction involves the same approach as for any other chemical or behavioral addictions. The process brings the addicted person out of their distortions and denial, forcing them to realistically confront themselves and the damage their behaviors have caused. Family members must be involved in the process, learning the full reality of the sex addict’s disorder.

There are numerous 12-step recovery programs, similar to Alcoholics Anonymous, which help the sexual addict to learn to live and cope in a more honest and healthy manner. Treatment is best provided by a specialist in behavioral addictions, as traditional psychotherapies are not the treatment of choice. For those seeking help, most major metropolitan areas provide outpatient specialists in sexual addiction as well as residential specialty programs.