Sex addiction seems to be popping up all over. Actor David Duchovny checked into a rehab facility for sexual addiction in August — just before the new season of his randy TV series, Californication. In her new book, Desire: When Sex Meets Addiction, Susan Cheever recounts having sex with men she barely knew at times of stress: “Moving men, doctors, lawyers, book salesmen — any man associated with a threatening change in my life became erotically charged, with predictable results."

Illustration: Jayachandran / Mint

But is sex addiction a real disease, or just an excuse for behaving badly? How much is too much? When does preoccupation cross the line into pathology?

The psychotherapy community has been wrestling with such questions for years.

One camp thinks the very notion of “sex addiction" implies a narrow, moralistic view of what’s acceptable. “There are millions of people stuck in unhappy relationships who go to massage parlours or the Internet and to demonize their sexuality is terribly unfair," says Marty Klein, a licensed marriage and family therapist and certified sex therapist in Palo Alto, California. He says people who are unhappy with their sexual choices may be depressed or bipolar or need to face the fact that their relationships have failed, but the problem isn’t necessarily sex.

Sex addiction was listed in the official Diagnostic and Statistical Manual of Mental Disorders III (also known as DSM III) in 1980, then dropped from the fourth edition in 1994, amid a wave of sentiment that only substances, not behaviour, could be addictive. A task force is considering restoring it in the DSM V, but it could be a long debate.

The notion of sex addiction dates back to the 1970s, when psychologist Patrick Carnes saw parallels with compulsive gambling: Addicts can’t control their behaviour, continue despite negative consequences and spend excessive amounts of time pursuing the behaviour.

“It’s not about hormones or being horny. It’s about using the excitement of sexual interaction to induce the neurochemical high that all addicts seek," says Robert Weiss, head of sexual addiction programming at the Life Healing Center in Santa Fe, New Mexico.

“You need to ask yourself: Is this a secret? Are you spending money on it you don’t have? How does it affect your job or your marriage? What would happen if you were caught?" says Robin Cato, executive director of the Society for the Advancement of Sexual Health, an Atlanta group for professional therapists.

There are no definitive numbers, but SASH estimates that 3-5% of Americans engage in what could be considered sexually compulsive behaviour — and that it has ballooned in recent years because the Internet has made sex of all kinds accessible, affordable and anonymous. “In 1985, if I wanted to watch porn, I had to get in my car and go to a video store," says Weiss. “Now I can download it to my iPod."

Therapists say addicts are frequently narcissists — that is, they constantly seek external validation because they are unable to generate their own feelings of self-worth. They may seem egotistical, but they are emotionally empty and crave quick ego boosts — “like eating potato chips when you’re hungry," says Weiss. Real emotional intimacy may be frightening. “It’s scarier to be emotionally vulnerable with your spouse than it is to go downtown at 3am and pick up a hooker. She can’t hurt you if you don’t care about her," he says.

Plenty of people have unmet emotional needs — why do only some turn to sexual compulsions? Addiction therapists say many of those who do were neglected or abused, or exposed to illicit images as children. And needy people engage in all kinds of other compulsive behaviour — including workaholism and eating disorders, says Eric Griffin-Shelley, a psychologist in Lafayette Hill, Pennsylvania.

Men with sexual compulsive behaviour outnumber women about 5:1, and the numbers are reversed with eating disorders, according to Weiss. And, women are more likely to be addicted to love than sex. “I know of women who’ll meet a guy and immediately wonder what colour hair their kids will have," says Dr Griffin-Shelley.

Treatment for sex addiction has grown rapidly in recent years. Many therapists prescribe antidepressants, which can ease feelings of worthlessness and can damp sex drives. Inpatient programmes (about a dozen in the US specialize in sex addiction) and outpatient therapists often work with 12-step programmes specifically for sex addicts (therapists say it’s rare for attendees to use such meetings for quick hook-ups — scenes from Nip/Tuck, Blades of Glory and Choke notwithstanding).

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