Everything that revolves around sex and sex itself can no doubt be stressful and confusing, at least some of the time. But for a decent number of Americans, a new survey suggests, their sexual hangups might be causing them a significant amount of mental anguish.
According to the survey, published Friday in JAMA Network Open, 8.6 % of people report experiencing distress or feeling unable to function normally due to what they perceive as problems controlling their sexual urges, feelings, and behaviors. But the experts elsewhere bring up problems with interpreting the survey results that are representative of issues that plague the entire field of this research; for example, that what can be perceived as distress caused by sexual urges might actually be distress due to persecutory societal norms and beliefs.
The concept of sex addiction is roundly criticized, even by researchers and clinicians who study and treat sex-related problems. In 2016, for instance, the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) issued a position statement asserting that sex and porn addiction shouldn’t be classified as mental health problems, and that sex addiction training and treatment was inadequately “informed by accurate human sexuality knowledge.”
But at the same time, mental health professionals don’t deny that people can feel pain over trying to control their sexual urges and feelings, or that people’s sexual compulsions can be harmful to themselves and others.
“WHO agreed to list Compulsive Sexual Behavior, because they wanted to reduce barriers to treatment for the fraction of screenees who really need professional help,” he said. But the DSM committee chose to do otherwise because it feared that labeling compulsive sexual behavior a mental disorder would only contribute to more stigma around sex and create false positives (people who might have some sex-related problems but not to an extent that requires treatment).
The question of how many people with unhealthy sexual compulsions need help is still up in the air, as is who exactly is at a greater risk of CSBD and why. So the researchers behind this study, led by Janna Dickerson, a postdoctoral fellow at the University of Minnesota’s Program in Human Sexuality, decided to take a stab at the Matter.
In the fall of 2016, they recruited more than 2,300 adults at the ages of 18-50 to take an online survey. Hoping to get a nationally representative sample, they asked people who had once taken part in a similar survey, the National Survey of Sexual Health and Behavior, to participate, as well as a random slice of Americans
With answers on a one to five scale ranging from never to very frequently, there would be questions asked like “How often did you have sex or masturbated more than you wanted to?” Those who had a score of 35 or more on the scale, called the Compulsive Sexual Behavior Inventory (CSBI), were considered to have distress or impairment associated with difficulty controlling their sexual impulses, feelings and behaviors.
Overall, 8.6 % of the group met that criteria, breaking down to 10.3 % of men and 7 % of women.
“The critical point is that there is extensive research showing that feeling as though it is hard to control your sexual desires doesn’t actually predict sexual behaviors or behavior problems,” he said.
Douglas Braun-Harvey, a San Diego-based sex educator and AASECT member, also points out that the scale used in the study doesn’t take into account other important aspects of diagnosing CSBD. For one, people generally aren’t diagnosed with the disorder if they have moral conflicts that might be causing them to feel distraught about their sexual thoughts, but the scale doesn’t take this into consideration.
“Nor can a survey study differentiate between medical conditions related to distress about sexual control,” he added.
Dickerson and her colleagues admit to these caveats in the paper, and that these numbers are only meant to be an early, imperfect estimate of how common CSBD might be.
“But we don’t yet have a clear estimate of this disorder, so this screening tool is the best we have to date,” she said.
There’s a wide variety of problems that could be considered as CSBD. For some, they might personally feel as though they’re masturbating way too much; for others, it could be that they feel their sexual impulses are somehow ruining their close relationships. But CSBD isn’t meant to legitimatize the idea of someone “objectively” being too sexual, Dickerson said.
“One of the debates has typically been, ‘Well, what is excessive sexual behavior?’ But there really isn’t a quantifiable amount of ‘healthy sexuality,’” she said. “This isn’t about having too much of any one behavior, it’s about whether you’re having difficulty controlling your behaviors, and whether that difficulty enters your social and personal life.”
Dickerson and the team were surprised by some of their findings, particularly that women were almost as likely as men to report these problems.
“Sexual compulsivity has thought to be a syndrome of men. But what our study found is that this isn’t the case after all,” Dickerson said. “What we now know though that women are experiencing difficulty, we don’t really know this means.”
Past efforts to study CSBD among women may have fallen short because of the researchers’ own biases, for instance, leading to an underestimate of the problem. The disorder may also be expressed differently among women, or happen for different reasons than it does in men, perhaps due to societal pressures.
“Women sort of face different consequences for not conforming to sexual standards and currently, we don’t have a good gender-informed model of CSBD in women. And so, that’s an important direction to move into,” Dickerson said.
But at the same time, Dickerson doesn’t want the public to come away with the wrong impressions and assume that CSBD is becoming more common in women. “Given that CSBD is new, we really don’t have an understanding of what this could be like in women. There are many factors at play,” she said.
The same caution applies to figure out why racial and sexual minorities are a greater risk of CSBD, such as “gay lesbian, bi and other” people, or black and Hispanic people. We don’t really know if these patterns are genuine or a fluke of the data collection, or why they might be true.
Some researchers, have previously speculated that homosexual men are more likely to develop a sexual compulsion, in part, because they have more sexual partners and have more or are more accepting of casual sex. But more recent research has found that the stress and marginalization of being a minority itself can raise the risk of compulsive behaviors and other mental health problems.
There’s just not enough we know about CSBD right now, including the best way to help people through it. But researchers like Dickerson are trying to figure it out.
“The way we approach it at our clinic is to get people to come up with their boundaries about sexual behavior, hold on to them, and begin to work on the underlying factors which led them to engage in the behaviors in the first place,” she said.
And despite their criticisms, Ley and the other experts we reached out to think this research is valuable, so long as we’re careful about interpreting it.
“The hopeful news is that research like this helps us to help the people who are struggling, not by suppressing their sexual behaviors, but by exploring these moral conflicts,” Ley said.