The sex addiction movement addresses fundamental human issues: lust, desire, guilt, fantasy, decision-making, and the relationship of love and sex. The answers generated by this model, however, have important limitations—and for many people, they are disastrous. We will examine how patients’ impulsive or seemingly out-of-control sexual behavior may really involve:
- medicating their depression, anxiety or anhedonia
- acting out hostility they can’t let into their consciousness
- an arousal disorder
- denial of a disturbing sexual preference or orientation
- denial of existential despair
- fear of getting too close to a primary partner
- a recurring sexual dysfunction with a partner
- inadequate attraction to or unspoken resentment toward a primary partner
How can we best diagnose patients with problematic sexual decision-making? How can we treat them most effectively? Why does it matter what we call (supposedly) out-of-control sexual behavior?
We’ll also look at the new narrative of porn addiction, and how it is being used to support the idea that porn is now a public health problem (rather than an old-fashioned immorality problem).
- Does science (especially neuroscience) really support this diagnosis?
- What are our options when a patient is convinced he’s a porn addict—or when he begs to be diagnosed (and treated) as one to appease his partner?
- How do we work with couples in conflict about one partner’s porn use?
- How do we evaluate patients who seem to be using porn self-destructively?
- How can we treat these patients most effectively?