So, recently I’ve stepped back from the debate around whether sex addiction ‘exists’ or ‘is real’. In the midst of the battle, a mix of opinions boom, and sharp barbs defend anything from adamant support of the term ‘sex addiction’ and its existence; to ‘it’s a myth’ or the new paradigm that it is an ‘out of control sexual behaviour’. Ever the diplomat, I’ve been biting my tongue and holding my breath for the purposes of professional pleasantry/respect to the point that I’m exhausted and frustrated. So I took a step back to breathe. On the first inhalation, my old friend, the scientific method, came with it.
Ironically, the scientific method thrives on debate and conflicting arguments. I know this as a former neuroscience graduate who fled the battle ground for a less confrontational life. Yet, if we were to step back from our biases and consider looking at this through the scientific method, I think we would find that we are exactly where we need to be. The debate is healthy. Actually, the debate is necessary in order to explore the phenomenon described by our clients and support them! The debate advances our understanding both in the natural and social sciences.
Much of the debate around 'sex addiction' arises because of the lack of information from the latter half of the scientific process. The only behavioural addictions recognised by the American Psychiatric Association in the DSM 5, are gambling and internet gaming. This is due to the amount of research that has taken place around gambling. The APA did not include addiction to sex in the DSM 5 due to lack of 'current evidence'. Some individuals and organisations have interpreted the DSM's stance to mean that the APA does not believe sex addiction exists. I think that's a very unfortunate and unhelpful mindset.
The World Health Organisation (WHO) is including compulsive sexual behaviours as an impulse control disorder in the ICD 11. I think the difference between the APA and WHO's approach is not one of believers vs. non believers, but instead represents where we currently are in the scientific process of exploring an observable phenomenon.
So where are we in the process of exploring the phenomenon described by our clients as ‘compulsive’, ‘addictive’, ‘out of control’ sexual behaviours? Let’s look at the scientific method and see:
1. Observation: We observe a phenomenon and we become curious.
We observe by hearing our clients. In the case of health professionals, we are observing an increase in the number of men and women, seeking assistance around sexual behaviours that feel compulsive, are difficult to stop, and continue despite causing negative effects (social, physiological, higher risk of harm, relationship, career, financial, legal, etc.) in their lives. Thus, health care providers are grappling with the phenomenon in 'real time'. We hear the impact on individual lives for the person who feels their behaviour is compulsive, but also for the partners who may be traumatised upon discovery of the behaviour(s). From a qualitative perspective, what we hear about the client's experience feels robust enough to push for more quantitative data. Curiosity doesn’t kill the cat, but instead drives it. It’s the backlash of pursuing that curiosity, i.e. challenging systems, that sometimes feels as though one has put themselves on the firing line. (Right Galileo?). Yet every ‘discovery’, and eventually ‘theory’, starts with an observation.
2. Exploring what we know: Once we become curious, we tend to look for more information.
We have found other phenomena (e.g. addictions, compulsive disorders) with which we can draw comparisons. Sometimes, where we look for more information is limited by the fact that it is also a poorly explored field, (e.g. certain behavioural addictions). This is the stage of exploration where we try to put together the pieces of a jigsaw puzzle of what we think could be happening. As professionals, as social and natural science minds, we, like our clients are in the process of making meaning.
3. Hypothesis: We use the observations and knowledge found to make an ‘educated guess’ as to what is really going on.
Here is where the battling voices and the passion to pursue our ‘meaning’ tend to get loud. We have hypotheses and proposed models around biological substrates (e.g. neuroscience), social factors (e.g. media, permissiveness, medicalisation of addiction), and psychology (e.g. attachment theory), yet our ‘educated’ guesses are not always so unbiased. This can lead us to fight to defend our hypothesis before we’ve even had a chance to do the research. We can also make the mistake of using our observations as evidence, rather than the evidence arising from additional research.
4. Research Question: We ask a question that can be tested.
This is the tricky one. To develop a research question is an art and a right of passage in order to call oneself a researcher. Asking ‘Does sex addiction exist?’ doesn’t work because of the difficulty of testing it. ‘What is the prevalence of people aged 18 - 25 who report they have difficulty turning away from internet porn even if they want to?” or “How reliable is Sexual Behaviour Inventory ‘X?’” can be tested.
5. Research Design: We create a method (experiments, inventories, questionnaires, etc.) to test our question.
This is where money weighs more heavily in the process. Academic researchers typically get funding to conduct the research from grants and/or organisations who support the hypothesis or have a biased interest in the findings. Lack of money is a major obstacle for our field. We can hypothesise and develop testable questions all we want, but if we don’t have the means ($) to get the answers, then we stay in the hypothesising and questioning stages. Worse, those who deny the client’s experience completely, regardless of what it is labelled, close the option to research. It surprises me that given the negative impact upon mental health; sometimes career, family, social standing, and financial loss; and possibly higher risk of STI’s (dependent upon the behaviour) that there isn’t more funding available for research.
6. Data Collection & Analysis: Gather the data, process it, and see if there are significant patterns.
When repeated by other researchers, we get ‘reliable’ data, ie. we are more likely to trust it.
7. Conclusion: We use the results to answer the research question...even if it doesn’t support our hypothesis.
8. Share the research:
Yes, that’s right, S-H-A-R-E. People say they interviewed X amount of people and these are their results, but fail to tell us how they designed the research, or how they analyzed the data. In part, this could be due to lack of support for publication (go back to the money argument above). What's surprising is how often we buy into conclusions without questioning the method. We may be tempted to follow a banner because it sounds ‘right’ or sounds closest to our experience or belief. Instead, we should be engaging with an open mind and questions. Researchers need to give us the opportunity to follow the process. If done well, results may stand when repeated. They will become reliable.
In summary, we have a phenomenon described by our clients, some knowledge, developing hypotheses (addiction vs. impulse control disorder, neuroscience extrapolation with other types of addiction, social construct), and development of scales and testing. A common statistic used is 3-6% of the population experience sex addiction. Statistics on the percent population varies. That lack of reliability alone demonstrates a need for greater research and evaluation of the experimental collection methods being used.
So, here’s my view: Let’s argue. Let’s agree to disagree. But, let’s ensure there is a place for our clients to voice the language they have available to describe their sexual experience. Let’s recognise that it is their language, not ours. Let’s be curious. Let’s keep going on this journey together and do it with an open mind. Let’s recognise our biases and sideline them long enough to hear a new hypothesis. Let’s empower the researchers to do their jobs and get their funding to give us a more robust picture. THEN, let’s deal with the semantics and find a term(s) that fits!