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What Is Sex Addiction

Underlying many addictions are feelings related to depression, anxiety, trauma, narcissistic wounds from a deep sense of loss and low self worth.

Sex addiction is known as a "process addiction". What that means is that you are addicted to some type of process; in this case sex. Eating, gambling, spending and working are also examples of "process addictions".

This is an important distinction from "substance addiction". Sex addiction takes place in the brain beginning with fantasy or obsession, in this case about the sexual behavior. There is no way of detecting sex addiction outwardly. It cannot be easily observed by a partner or spouse. When someone suffers from substance abuse, you can smell alcohol on their breath, see that they have red eyes or hear slurring of their speech. The visible signs of someone who is addicted to sex would appear in a much more subtle way.

Why does someone become a sex addict? 

Sex addiction, like other forms of addiction, is a complex phenomenon with multiple contributing factors. Here are some of the potential reasons why someone may develop a sex addiction:

  1. Biological factors: There may be genetic or neurobiological predispositions that make some individuals more vulnerable to developing addictive behaviors, including sex addiction. Changes in brain chemistry, such as alterations in dopamine levels, can influence the reward system and contribute to the development of addictive patterns.
  2. Psychological factors: Underlying psychological issues, such as trauma, attachment disorders, low self-esteem, anxiety, depression, or unresolved conflicts, can drive individuals to seek solace or escape through compulsive sexual behavior. Sex addiction may serve as a coping mechanism for dealing with emotional pain or distress.
  3. Environmental factors: Early exposure to sexual content, experiences of abuse or neglect, dysfunctional family dynamics, cultural or societal influences, and peer pressure can all play a role in the development of sex addiction. These environmental factors may shape an individual's attitudes, beliefs, and behaviors related to sex and intimacy.
  4. Social and cultural factors: Living in a society that promotes hypersexuality, glamorizes sexualized imagery, or places unrealistic expectations on sexual performance and desirability can contribute to the normalization of compulsive sexual behavior. Social media, pornography, and other forms of media can also influence perceptions of sex and relationships.
  5. Past experiences: Traumatic experiences, such as sexual abuse, can profoundly impact an individual's relationship with sex and intimacy. Some individuals may use compulsive sexual behavior as a way to regain a sense of control or power in response to past trauma.
  6. Personality traits: Certain personality traits, such as impulsivity, sensation-seeking, perfectionism, or a predisposition towards risk-taking behavior, may increase the likelihood of developing addictive patterns, including sex addiction.
It's important to recognize that sex addiction, like other forms of addiction, is a complex and multifaceted issue that cannot be attributed to any single cause. Instead, it typically results from a combination of biological, psychological, environmental, and social factors interacting with individual vulnerabilities and life experiences. Treatment for sex addiction often involves addressing these underlying factors through therapy, support groups, and other interventions aimed at promoting healing, self-awareness, and healthier coping strategies.

Some signs of sex addiction are as follows:

• Sexual behavior that is out of control; also referred to as "acting out"
• Experiencing severe consequences due to sexual behavior, despite trying to stop
• A willingness to continue the self-destructive behavior
• An ongoing effort or desire to limit sexual behavior which often serves to fuel the addiction
• Sexual obsession and fantasy as a coping strategy
• Escalating sexual experiences when the current level of activity is no longer sufficient
• Severe mood changes relating to sexual activity
• Excessive time devoted to obtaining sex, being sexual and recovering from sexual experiences
• Neglect of significant activities in relationships, career and social life because of sexual behavior

Dr. Patrick Carnes | At What Point Does Behavior Constitute Addiction?

What is Porn-Induced Erectile Dysfunction?

Porn-induced erectile dysfunction (PIED) is a term used to describe a phenomenon where individuals experience difficulty achieving or maintaining an erection during sexual activity with a partner, but not necessarily during masturbation to pornography. It is believed to occur as a result of excessive consumption of pornography, particularly internet pornography, which can lead to changes in sexual arousal patterns and expectations.

  1. Excessive Pornography Consumption: Individuals who regularly consume pornography, especially high-speed internet pornography, may develop a tolerance to the content and seek out increasingly stimulating material to achieve the same level of arousal. This can lead to frequent and prolonged exposure to highly arousing, novelty-driven sexual stimuli.
  2. Desensitization: Over time, the repeated exposure to intense sexual stimuli can desensitize the brain's reward system, leading to a blunted response to normal sexual cues and a decrease in sensitivity to natural sexual stimuli. This desensitization can manifest as difficulty becoming aroused or achieving orgasm during real-life sexual encounters.
  3. Rewiring of Sexual Response: The brain's reward circuitry can become wired to respond primarily to the specific cues and stimuli present in pornography, rather than to the more nuanced and varied sensory experiences of real-life sexual encounters. As a result, individuals may find it challenging to become sexually aroused or maintain arousal in the absence of pornographic stimuli.
  4. Performance Anxiety: Individuals experiencing PIED may also develop performance anxiety or self-doubt during sexual encounters, fearing that they will be unable to achieve or maintain an erection, which can further exacerbate erectile dysfunction.
It's important to note that while excessive pornography consumption may contribute to erectile dysfunction in some individuals, it is not the sole cause of all cases of erectile dysfunction. Other factors, such as stress, relationship issues, medical conditions, medications, and psychological factors, can also play a role in erectile dysfunction.

Treatment for porn-induced erectile dysfunction typically involves reducing or eliminating pornography consumption, addressing underlying psychological factors such as anxiety or low self-esteem, and exploring healthy sexual behaviors and communication strategies within intimate relationships. Therapy, support groups, and lifestyle changes may also be recommended to support recovery and promote healthier sexual functioning.

How is porn erectile dysfunction and sex addiction connected?

Porn-induced erectile dysfunction (PIED) and sex addiction are connected through their shared impact on sexual arousal, behavior, and dysfunction.

  1. Common Underlying Factors: Both PIED and sex addiction can be influenced by similar underlying factors, such as excessive consumption of pornography, distorted perceptions of sex and relationships, and compulsive sexual behaviors driven by the need for arousal or gratification.
  2. Pornography as a Trigger: In cases of sex addiction, pornography often serves as a primary trigger for compulsive sexual behavior. Individuals with sex addiction may use pornography as a means of seeking sexual stimulation and gratification, leading to excessive consumption and potential desensitization to sexual stimuli over time.
  3. Escalation of Behavior: In both PIED and sex addiction, there can be a pattern of escalation where individuals seek out increasingly extreme or novel forms of sexual stimulation to achieve the same level of arousal or gratification. This escalation can contribute to the development of tolerance, desensitization, and difficulties with sexual functioning.
  4. Impact on Sexual Functioning: Excessive pornography consumption and compulsive sexual behavior can both have negative effects on sexual functioning, including erectile dysfunction, decreased libido, and difficulties with arousal and orgasm. In the case of PIED, these effects may be specifically linked to the desensitization and rewiring of the brain's reward system in response to pornographic stimuli.
  5. Psychological and Emotional Factors: Both PIED and sex addiction can be influenced by underlying psychological and emotional factors, such as anxiety, depression, low self-esteem, and unresolved trauma. These factors may contribute to the development and maintenance of addictive patterns of behavior and dysfunction.
  6. Treatment Approaches: Treatment for both PIED and sex addiction often involves addressing underlying psychological factors, reducing or eliminating problematic sexual behaviors, and promoting healthier attitudes and behaviors related to sex and intimacy. Therapeutic approaches may include cognitive-behavioral therapy, mindfulness-based techniques, relapse prevention strategies, and couples therapy.
It's important to recognize that while there is overlap between PIED and sex addiction, not everyone who experiences PIED will have a diagnosable sex addiction, and vice versa. Each individual's experience is unique, and treatment approaches should be tailored to address their specific needs, concerns, and goals for recovery.

Understanding Porn-Induced Erectile Dysfunction
Adapted from Sexual Dysfunction by Scott Brassart.

For males, porn-induced erectile dysfunction, sometimes referred to as PIED, is among the most common consequences of porn addiction. Research suggests that erectile dysfunction (ED) and other forms of male sexual dysfunction like delayed ejaculation (DE), and anorgasmia (the inability to reach orgasm) occur in anywhere from 17% to 58% of all male sex/porn addicts. The more porn one uses, the more likely it is to experience sexual dysfunction.

Simply stated, growing numbers of physically healthy men, including men in their sexual prime, are suffering from sexual dysfunction – typically with real-world partners rather than with porn – and their dysfunction is directly related to their abuse of online pornography. This issue is not entirely due to the frequency of masturbation and orgasms outside of a primary relationship (i.e., the need for a sexual refractory period in which males “reload,” so to speak). In reality, the problem is increasingly related to the fact that when a man spends most of his sexual life masturbating to online porn – endless images of sexy, exciting, constantly changing partners and experiences – he is, over time, likely to find a real-world partner less sexually stimulating than the endless variety of visuals he finds online. Basically, digital pornography creates an emotional and psychological disconnection that manifests physically as sexual dysfunction with real-world partners.

In their paper, Evaluation and Treatment of Sex Addiction, Kenneth Rosenberg, Patrick Carnes, and Suzanne O’Connor state the matter rather clearly, writing, “Sex addiction patients are generally not good at sex. They function poorly in the bedroom. Sex addicts feverishly pursue their dysfunctional sexual behaviors yet generally have sexual difficulties with intimate partners…. Premature ejaculation, erectile dysfunction [and] anorgasmia … are common.” This is most apparent when sex addicts are hooked primarily on pornography.

Possible signs of porn-induced male sexual dysfunction include:
  • A man is able to achieve erections and orgasms with pornography, but he struggles with one or both when he’s with a real-world partner.
  • A man is able to have sex and achieve orgasm with real-world partners, but reaching orgasm takes a long time and his partners complain that he seems disengaged.
  • A man is able to maintain an erection with real-world partners, but he can only achieve orgasm by replaying porn clips in his mind.
  • A man increasingly prefers pornography to real-world sex, finding it more intense and more engaging.
  • Thanks to heavy porn use, growing numbers of men are suffering from sexual dysfunction, be it ED, DE, or anorgasmia. Even worse, male sexual dysfunction affects not just men but their romantic partners. The partner of a person suffering from compulsive sexual behavior may experience diminished sexual pleasure due to the Sex Addict's acting out. 
If you or a loved one are dealing with porn addiction, with or without sexual dysfunction, I can help your coupleship.

Recovering from Sex Addiction Using Patrick Carnes 30 Tasks

Patrick Carnes is a well-known expert in the field of sex addiction and has developed various frameworks and strategies for recovery. One of his notable contributions is the "30 Tasks of Recovery," which outline a comprehensive approach to overcoming sex addiction. These tasks are designed to help individuals address underlying issues, develop healthier coping mechanisms, and rebuild their lives in a more fulfilling way.

Here is a summary of the tasks:

  1. Acknowledge powerlessness over addictive sexual behavior.
  2. Recognize the unmanageability of life as a result of sexual compulsivity.
  3. Turn your life over to a higher power or a supportive community.
  4. Conduct a thorough self-assessment of your sexual history and behavior.
  5. Develop honesty about your sexual thoughts, fantasies, and behaviors.
  6. Make a list of people harmed by your sexual behavior and make amends to them.
  7. Seek out a therapist or support group specializing in sex addiction recovery.
  8. Accept responsibility for your actions and their consequences.
  9. Develop empathy and understanding for those affected by your behavior.
  10. Practice rigorous honesty in all areas of your life.
  11. Develop a plan for managing triggers and cravings.
  12. Establish healthy boundaries in relationships.
  13. Learn to identify and express your emotions in a healthy way.
  14. Address any underlying trauma or emotional issues contributing to your addiction.
  15. Develop a relapse prevention plan.
  16. Cultivate self-compassion and forgiveness.
  17. Practice mindfulness and self-awareness.
  18. Engage in activities that promote physical and emotional well-being.
  19. Explore spirituality or develop a connection with a higher power.
  20. Cultivate healthy sexuality and intimacy.
  21. Build a supportive network of friends and family.
  22. Practice gratitude and focus on the positive aspects of life.
  23. Engage in ongoing self-improvement and personal growth.
  24. Take responsibility for your ongoing recovery process.
  25. Share your experiences and insights with others in recovery.
  26. Stay accountable to yourself and others.
  27. Develop healthy coping mechanisms for stress and difficult emotions.
  28. Work on rebuilding trust in relationships.
  29. Set goals for your future and work towards them.
  30. Embrace a lifelong commitment to recovery and personal development.
These tasks are not meant to be completed in a linear fashion but rather as ongoing processes that support long-term recovery from sex addiction. Individuals may work on multiple tasks simultaneously and revisit them as needed throughout their journey.

Patrick Carnes 30 Tasks of Sex Addiction Recovery

What does recovery from sex addiction generally consist of?  
1. Individual therapy 
2. Couple/Family therapy 
3. 12 Step support group work (i.e. SA.org – Sexaholics Anonymous, LDS Church 12-Step Addiction Recovery Program) 
4. Group therapy (i.e. LifeSTAR Sexual Addiction Recovery Program)

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Susan Zola, LCSW, CCPS, CSAT

T: 631-332-2213
E: suezola@me.com
Licensed in the State of New York, the State of Florida, the State of Connecticut, the State of Maine, the State of Texas, and the State of Massachusetts.
License Pending IN: New Jersey, New Hampshire, and Arizona.


Bachelor of Arts, Psychology – SUNY Binghamton, 1980
Master of Social Work – Adelphi University School of Social Work, 1982.
Private Practice – "Mind Over Matters," 2006.
LCSW License #078530-1
APSATS The Association of Partners of Sex Addicts Trauma Specialists
Certified Sex Addiction Therapist
The International Institute for Trauma and Addiction Professionals
Certified Clinical Partner Specialist

Susan Zola Clinical Partner Certification
Susan Zola What Is Sex Addiction

Susan Zola, LCSW, CCPS, CSAT
Licensed in New York, Florida, Connecticut, Maine, Texas, and Massachusetts

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