Sexual Addiction vs. Paraphilia vs. Sexual Offending

There is a great deal of confusion, even within the therapeutic community, about what constitutes sexual addiction, what constitute paraphilic behavior, and what constitutes sexual offending. In an attempt to clarify, we provide below basic definitions of these three concepts.

Sexual Addiction

Sexual addiction involves repetitive patterns of compulsive or impulsive sexual fantasy, urges, and behavior engaged in with self and/or others. The activity is out of control (the addict can’t stop) and leading to negative life consequences. Sexual addiction is not defined by religious, moral, or ethical standards, nor is it defined by the presence of unwanted arousal patters (such as homosexuality, bisexuality, or a fetish). Instead, sexual addiction is defined by:

• Obsession and preoccupation with sexual fantasy, urges, and behavior
• Loss of control over sexual behaviors, meaning the inability to commit and maintain behavior change despite promises made to self and others
• Ongoing negative life consequences – relationship trouble, financial issues, job loss, failure in school, declining physical and/or emotional health, and more – arising directly from the sexual behaviors

Paraphilias

Paraphilias are recurring, intense, sexually arousing fantasies, urges, and behaviors involving nonhuman objects, the suffering of oneself or another person, and/or sex acts with a non-consenting person. Paraphilias are only considered pathologic (unhealthy) when:

1. They become obligatory for sexual functioning
2. They involve inappropriate partners (meaning minors or unwilling participants), or
3. They cause significant distress and/or impairment of social, occupational, or other important areas of functioning

Common paraphilic behaviors include:

• Fetishism (objects, body parts, items of clothing, etc.)
• Frotteurism (rubbing against a non-consenting person for sexual gratification)
• Pedophilia (attraction to preadolescents) and hebephilia (attraction to adolescents)
• Sexual sadism, masochism, BDSM, etc.
• Transvestic fetishism
• Exhibitionism, voyeurism, etc.

Sexual Offending

Sexual offending is a legal rather than a clinical term. In that respect, sexual offending is subjective rather than objective. For instance, behavior that is perfectly legal in one jurisdiction may be a felony in another. When sexual offending is looked at clinically, it is typically defined as any sexual act that is nonconsensual. If both partners do not fully agree to engage in the sexual act, or if both partners do not have the ability/capacity to fully consent to a sexual act (because one partner is too young, inebriated, mentally challenged, etc.) and the sexual act is carried out anyway, a sexual offense has taken place.

Is There Crossover?

Many sex addicts do not have paraphilias and do not cross either legal or clinical lines that define offending. In the same way, many paraphiliacs and many sex offenders do not meet the clinical criteria for sexual addiction. However, most clinicians dealing with sexual issues are seeing significant crossover in these three populations. Although a great deal of research is needed on this topic, early anecdotal evidence suggests most of these “crossover” individuals started out with one issue, with their behavior escalating and expanding over time into one or both of the other issues. Sexual addiction in particular has progressive features that can lead to this type of escalation. (This tolerance/escalation phenomenon is characteristic in all forms of addiction.) For instance, a man looking at legal porn may suddenly find himself looking at illegal imagery (which is both a paraphilia and a sexual offense) because it gives a bigger rush. Similarly, a woman who started out having serial affairs may escalate into erotic massages or prostitution (both of which are, from a legal perspective, sexual offenses in many jurisdictions).

Happily, most clinicians working in the sexual disorders field are now consciously aware of how common it is for patients – especially by the time their behavior is causing enough distress that they are willing to seek treatment – to have more than one sexual diagnosis (addict and/or paraphiliac and/or offender). They are also recognizing that no matter the diagnosis, nearly all of these men and women struggle with an underlying intimacy disorder. As such, they’ve grown accustomed to finding pleasure, escape, and/or power in non-relational, non-intimate, highly objectified sexuality. In other words, these individuals find it difficult to engage in, maintain, and enjoy truly intimate sexual experiences. Helping people to overcome this intimacy barrier is “stage two” of treatment, with stage one being to separate them from their problematic behaviors. The good news for nearly all of these individuals – addicts, paraphiliacs, and (most) offenders – is that there is, indeed, hope for a sexual life free of obsessive, compulsive, and harmful sexual activity.