“Hypersexual Disorder” came very close to being added to the DSM-V, the controversial fifth edition of the standard psychiatric diagnostic manual, released earlier this year. That is the official term for what's sometimes referred to as "sex addiction."
Though it may not be officially recognized as a disorder, hypersexuality or sex addiction—call it what you will—is typically portrayed in the realm of men. The disparity is striking and important. Fictional sex addicts, like those seen on the show Desperate Housewives, and in the recent films Shame and Thanks for Sharing, are almost always men. So it is perhaps not surprising that research about sex addiction among women is scarce.
One of the only studies focusing specifically on female sex addicts was published just last year, and it has some surprising findings: For one, exposure to pornography as a child was a stronger predictor of hypersexual behavior than sexual abuse as a child. Prior to that, the one study that did include women (from 2003, which compared rates of sex addiction among males and females on a college campus) actually found that nearly twice as many women as men fell into the "needing further evaluation" and "at-risk" categories. But you won’t have any trouble finding research on female hypoactive sexual desire, also known as "low sex drive," which is neatly consistent with societal norms about sex: that men want it all the time and women never do.
It seems as if the sexual double standard and stigma around female sexuality are spilling over onto science. This has created an enormous blind spot in the research on sex addiction, so almost all of the research has been conducted with men, while female sex addicts have largely been ignored—except by the clinicians who’ve been treating them for decades. Linda Hudson is a licensed professional counselor and former president of the Society for the Advancement of Sexual Health who has been working with female sex addicts for more than 20 years. She and several other female therapists recently published the first book offering a targeted treatment for therapists working with female sex addicts called Making Advances: A Comprehensive Guide for Treating Female Sex and Love Addicts.
"I know it is hard to believe that there hasn’t been much research on this, but we only very recently developed the standard of care for female sex addicts, even though we have been treating them for more than 20 years," she says. Although mental health clinicians began using the Sexual Addiction Screening Tool (SAST) in 1988, researchers didn’t develop a version that satisfactorily assess sex addiction in females until 2010. The double standard also extends to treatment facilities, according to Elizabeth Edge, a certified sex addiction therapist in Atlanta who’s been working with sex addicts since 2003. She says she initially worked only with men who were struggling with sexual compulsivity “because the atmosphere where I worked mirrored society’s belief that women don’t have a problem with sex,” though she does see things starting to shift with the younger generations. For one thing, with the proliferation of porn, clinicians are realizing that more women are “visually wired” (highly responsive to erotic images), which was previously thought to be a characteristic exclusive to men.
Edge offers the following definitions of sex addiction: “Patrick Carnes, the founder and leader in the field, says that sex addiction is ‘a pathological relationship with a mood altering experience.’ Kelly McDaniel, a sex addiction therapist who wrote an important book for women called Ready to Heal, defines ‘sex and love addiction as a disease of loneliness, fueled by shame and despair. It is a compulsion to use romance, people, and sexuality to feel alive.’”
Sex addicts are hooked not just on the act itself, which often is actually a small part of the addiction, but all the aspects surrounding it—the planning, fantasizing, anticipation, excitement, relief, even the shame, guilt, and continual re-commitments to “do better.” That’s why it’s considered a process addiction; each phase of the cycle elicits neurochemical and emotional rewards that can be as compelling as other addictions. Hudson adds, “The components of any addiction include: compulsive pattern of use, loss of control, continued use in the face of negative consequences.” Many people hear sex addiction and, understandably, imagine it to mean addiction to intercourse itself, so they have a hard time believing sex addiction is even a real thing, let alone thinking of it as something women might struggle with.
“There is a huge cultural stigma with sex addiction in general and specifically as it relates to women,” Edge says. “Men are respected if they have a lot of sex or many sexual partners—this is not the same for women,” so there tends to be more shame around female sex addiction. When women do seek help, they’re often too ashamed to identify their problem as sex addiction, or may not even realize that’s what the problem is, usually calling it “love addiction” or “relationship addiction” instead. While these other types of process addictions often co-occur with sex addiction, those labels are sometimes inaccurate to describe a woman’s actual experience. Edge says that, at least initially, labels aren’t important as long as a woman has recognized that her life has become unmanageable and is ready to get help.
But since therapists are susceptible to the same biases as the rest of society, the potential for female hypersexuality is often outside of their awareness or comfort zone, so they may not recognize sex addiction in female clients or know how to help them. That was Alison’s experience. Unlike many of the other women she met in Sex and Love Addicts Anonymous (SLAA), Alison never had a problem identifying herself as a sex addict. She can’t remember a time when she didn’t feel like something was wrong with her. Her body began developing when she hit puberty at early age, and she was overwhelmed by the attention she was getting from older men. At the same time, her mother was experiencing a “sexual awakening" of her own, Alison says, and she recalls adopting some of her mother's behaviors, like dressing and acting provocatively. Then, she says, “As early as junior high, I started having one boyfriend after another, lining one up before I dumped the last. In high school I started cheating on my boyfriends, which was a pattern that I repeated until I got into recovery."
After a four-year period of abstinence from these behaviors, she began a new job, where she embarked on an inappropriate relationship with a co-worker. “Thinking I was in love with this person I started pulling away from my husband, but my therapist told me the things I was describing to her about my relationships were out of her realm of expertise,” she recalls. After buying Charlotte S. Kasl’s book Women, Sex, and Addiction: A Search for Love and Power, and identifying with many of the stories in it, Alison began attending a 12-step group for sex addicts. A fellow group member referred her to Linda Hudson, and she began treatment. At its most intense, a week in Alison’s recovery included one or two individual therapy sessions, a group therapy session, three to five 12-step meetings, several daily calls with her sponsor and peers, as well as journaling, reading, step-work, prayer, and meditation. She estimates that she spent $16,000 on recovery in one year, but says “it was totally worth it - and tax-deductible.” But she got worse before she got better.
“My acting out really escalated towards the end, even after I got into recovery,” she says, but she’s grateful for the way her life is now. Three years after entering recovery, she’s currently a stay-at-home mother to her first child, and she feels fortunate that she’s been able to salvage her marriage. She maintains her sexual sobriety “by not crossing my bottom line, which is no sexual contact outside my marriage.” Each addict’s definition of sexual sobriety is different depending on the nature of their disorder, but it’s generally understood as abstinence from the addict’s problematic or “bottom-line” sexual behaviors, not necessarily total abstinence from sex.
While Alison doesn’t believe she was sexually abused growing up, that’s not true for many of the other female sex addicts she’s met, like Jenna*, an avid runner, yogini, and former model in her early 40’s. Jenna’s stepfather began molesting her when she was nine, marking the start of many years of secrecy and shame around her sexual behaviors. Though she didn’t recognize it until later, she eventually realized that she had been depressed and anxious since early childhood, and “had been using everything at my disposal to try to keep myself from feeling bad,” she remembers. “Like a shark who must constantly swim to stay alive, I would move from relationship to relationship, party to party, job to job, city to city, pregnancy to pregnancy, house to house, wanting to find that place that would make me feel like a safe little girl again.”
Though she initially resisted the “sex addict” label – she couldn’t even bring herself to say the words at first—Jenna now identifies as a sex, love, and relationship addict, and finds relief in that admission. She explains that she was addicted to “intrigue,” always depending on men who admired and paid attention to her. She’s not sure whether the sexual double standard affected her much, since she “identified as sexually powerful, and acted in much the same way that male sex addicts act.” Either way, her life was eventually filled with lies. “I know I looked like a sweet neighborhood mom,” she says, “but I was really a [professional dominatrix]." Jenna did sensual massage, as well as “sessions with men who liked to be dominated.”
“I know I acted married to my husband, but I was really cheating.” Her self-esteem, health, parenting, marriage, and friendships suffered extensively. Finally, she recalls, “I hit a bottom… when I realized I could no longer stomach doing sensual massage, and quit my six-figure business cold turkey—no more sex work.” She started getting counseling and found SLAA, and has been sober for five years. For Jenna, sobriety means not cheating on her husband, or even having “emotional affairs.” She and her husband have been together for eight years (married for almost three), and Jenna and her children are thriving. She’s now a certified life coach who helps other women struggling with relationship problems and difficult career choices, as well as “dancers, escorts, etc., who want to leave the business.” “When I look back on how far I’ve come, it's miraculous,” she says.