Tiger Woods may garner some positive coverage this week when he returns to golf for the first time in more than four months to play in the Masters, but his life off the green has been a series of bad headlines in recent months. Day after day, woman after woman came forward to say that they, too, had an affair with the married golf phenom. His wife took the kids and left, sponsors canceled his endorsement deals and the media hounded him daily. Finally, in January 2010 the philandering sports star checked into a rehab for sex addiction.
Now another famous star has found himself in similar straits. Sandra Bullock’s husband, Jesse James, checked into a treatment center last week—though unconfirmed, it’s presumably a sex rehab—as his tally of alleged extramarital affairs climbs to four. Are these guys legitimately addicted to sex or is signing into a rehab just an attempt to do damage control on all fronts?
First of all, experts stress that not all cheaters are sex addicts. “Sex addiction is a highly repetitive, compulsive behavior. It’s feeling compelled to keep doing the same thing over and over again despite the negative impact,” says Gail Saltz, M.D., iVillage’s sex and relationship expert. The addict may feel guilt, ruin relationships or end up in financial straights but still engage in the behavior despite the consequences. “Most people who cheat are not in that boat.”
The key piece here is compulsion. Sex addicts tend to cheat with multiple partners or be involved in multiple behaviors (watching pornography, masturbating, calling sex lines) constantly. “You can look at porn and not be a sex addict,” says Dr. Saltz. “You can need to have it 20 times a day with your wife and that’s a problem. It’s really about the repetitiveness, the risk taking and consumption—how often you are thinking about it, planning it, texting about it.”
Right now sex addiction is not a specific condition listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the bible of mental health disorders. But Martin Kafka, M.D., who specializes in conditions that are sexual in nature, says it’s possible that a diagnosis could be added in the near future.
“The popularity of the concept of ‘sexual addiction’ is ahead of the evidence needed to declare that disordered sexual behavior is, in fact, a behavioral addiction,” says Dr. Kafka, a member of the American Psychiatric Association’s Sexual and Gender Identity Disorders Work Group, which is currently drafting the fifth edition of the DSM due in May 2013. Right now, hypersexual disorder is the diagnosis being proposed for consideration in the DSM-5, but it is not finalized. He says the characteristics of a hypersexual disorder include repetitive sexual behavior, risk taking, problems with control, responding sexually to stressful life events or emotions, excessive time spent pursuing sex, and often adverse consequences for the addict. Still, Dr. Kafka says that more empirical data is needed to back up a diagnosis before hypersexual disorder can be recognized in the DSM-V.
The signs of sex addiction
Many experts say the condition is real even if it’s not yet recognized officially. Still, unlike physical conditions, mental health disorders like this can be hard to diagnose. “There’s no blood test for these things. Psychiatric diagnoses in general are a language we have so we can speak to each other to understand symptoms and move toward treatment,” says Dr. Saltz. “If someone keeps repeating a sexual behavior and feels like they just can’t stop, then probably we would say they have an addiction.”
Again, there are comparisons to substance abuse. “People often don’t see the signs of alcohol and drug addiction, though they might in retrospect. The same is true with sex addiction,” says Dr. Saltz. The addict may be spending more money, being secretive, having blocks of unaccounted time or spending a lot of time masturbating, looking at porn and going to a lot strip clubs. “Usually someone does know there is a problem, but they don’t understand the nature of the problem.”
It’s also hard to label someone based on what’s been swirling around the tabloids. Dr. Kafka won’t say whether he thinks Woods or James are legitimate sex addicts. “A lot of these Hollywood types—I don’t know if they have a hypersexual disorder or not. I’d have to hear their stories.”
But he does point out that “highly productive” (or famous) people can, in fact, be addicts. “On the surface what looks like narcissistic and entitled behavior could be a much more complex issue,” he says.
“Everybody wants to have sex and needs to have sex and it’s a healthy part of life. So it’s hard to understand how we can call sex addiction a disease,” says Dr. Saltz. But there are groups and psychiatric professionals that can help a true sex addict.
“Like most addictions, it can be a lifelong struggle,” says Dr. Saltz. “But, you can get better and not do those behaviors anymore,” which is the goal when treating sex addiction. “In mental health, cure isn’t the word so much as ‘that’s resolved’ or ‘I’m symptom free.’”
There also isn’t any scientific data on what treatments work best for sex addicts. Dr. Saltz and Dr. Kafka agree that right now 12-step programs are the predominant treatment model, which treat the addict in a group setting, giving him or her coping skills to deal with personal triggers and patterns. Depending on the nature of one’s addiction, it can also be treated with psychotherapy and/or medications if the person has another psychiatric disorder that frees or uninhibits sexual behavior.
Dr. Kafka is encouraged that sex addiction is being taken more seriously as a condition. He likens current attitudes about sex addiction—is it real or just an excuse? —to how people viewed alcohol abuse 50 years ago. “Alcoholism was in the same place; it was just considered bad behavior.” But progress is being made in dealing with it. “I view it in positive terms that there are treatments centers for this. [This] is more complex than just being a bad choice.”
Still, Dr. Saltz understands why we may be dubious of a man saying he cheated because he’s an addict. “People are angry at the idea of sex addiction because it lets the person off the hook. Having a diagnosis doesn’t mean you are not responsible. You need treatment and you are responsible for that,” she says. “[Giving it a name] is not condoning the behavior or deferring the responsibility.”