Russell J Stambaugh, PhD, DST, CSSP is a clinical psychologist in private practice. He is a member of the American Association of Sexuality Educators, Counselors and Therapists, and has maintained a Diplomate in Sex Therapy since 2005. He has served in AASECT leadership since 2000,including service as a Director 2004-2009. In June, 2015, he was awarded the Distinguished Service to AASECT Award for the second time. He chaired AASECT AltSex Special Interest Group from 2011-15. He has been studying sexual deviance, sexual variation, and the psychology of sexuality for 33 years.
Th[e] blog, [The Elephant in the Hot Tub: Kink in Context] has repeatedly commented on the problems of diagnosing ‘sex addiction’ and hypersexuality. See “Arrival of the Death Star,” “Out of the Shadows,” “Umbra,” and “Ken Zucker, PhD and Michael First, MD’s DSM – 5 Plenary at AASECT” on this blog for additional discussion of this issue. To summarize those problems briefly:
1) Disagreement exists on how ‘too much sex’ might be recognized behaviorally, a requirement needed for reliability,
2) The model postulating that ‘sex addiction’ might be similar to chemical addictions might not be valid,
3) If the criteria for too much sex cannot be objectively operationalized, psychiatry might be discredit for making illnesses of ordinary behaviors, thereby loosing legitimacy and
4) If the diagnosis is intrinsically stigmatizing, the costs of labeling need to be proven to be offset by medical benefits of treatment that require that disadvantage, otherwise alternate means need to be used where the cost benefit is superior.
5) Additional obstacles to ‘sex addiction’ treatments include the legitimating of past addicts as paraprofessional therapists. This biases such treatment by making acceptance of the label ‘addict’ a quantification to do treatment, and makes that acceptance an integral part of treatment for clients.
6) While there can be little objection to self-labeling in chemical addictions where the behavior of taking drugs for recreational purposes is illegal, it is objectionable to advocate complete abstinence for otherwise healthy sexual behaviors,
7) This labeling problem becomes particularly problematic when social prejudices and religious attitudes contest with the scientific criteria for defining sexual behaviors that are in social dispute such as homosexuality, variant gender expression, BDSM and polyamory.
All of which might seem to be a damning case, but sex addiction practitioners have five crucial advantages which perpetuate use of their terms and ideology:
1) The public has already come to accept the term ‘sex addiction’. Its wide use and recognition make it an effective marketing tool.
2) Because psychiatry has weak construct validity, sex addiction therapies that make clients feel better cannot easily be removed from the professional cant,
3) The biological mechanisms that underlie all perceptions of pleasure have neurological similarities, and it is quite difficult to conduct research that identifies whether these mechanisms are causes or effects. The scientific jury is still largely out as to whether effective neurological agents might not be developed to treat excessive or unwanted sexual behavior, and their is big money at stake, and
4) The therapeutic techniques of ‘sex addiction’ therapies and less stigmatizing treatments overlap considerably.
5) Psychiatry, psychotherapy, and religious ideologists all have some vested interest in showing that they have explanatory power in understanding problems of sexual behavior above and beyond the client’ self-definition. After all, if we do not know something special, why should anyone expect us to offer special relief for their discomforts.
