Annika Tamme, a clinical sexologist, says that watching crime films where people are killed and cut up for eight hours a day does not immediately give you the label of a homicidal addict, nor does it make you suspect that there is anything wrong with you. On the other hand, those who like to watch channels with sexual content are quickly labelled porn addicts and perverts.
Tamme (www.annikatamme.ee) explains in an interview with Tervisegeenius whether sex addiction exists at all, where the boundary between normal and excessive desire begins, where to seek help for sexuality-related concerns, and whether the adage “only the grave can heal the wounded” applies to cheaters.
Tamme is a graduate of the Contemporary Institute of Clinical Sexology in the UK, where she is trained in working with compulsive sexual behaviour. She was taught by Silva Neves, one of the world’s leading experts on compulsive sexual behaviour.
Is there such a thing as sex addiction and hypersexuality?
The behaviour you are trying to describe certainly exists. The vocabulary we use has simply changed over time as our understanding has evolved. The word ‘sex addiction’ was originally used to describe out-of-control sexual behaviour, because it can feel like an addiction to people, even if it is different in nature from material addictions. It is not a formal diagnosis.
Hypersexuality has been used as a concept by the American Psychiatric Association in its diagnostic manual, but as a separate diagnosis it was decided to exclude it from the latest version (DSM-V).
To the best of our knowledge, the World Health Organization has classified this behaviour as Compulsive Sexual Behaviour or Compulsive Sexual Behaviour Disorder in its latest International Classification of Diseases, version 11.
Why was this decision made?
The understanding of behaviour, its causes and how to help clients with it is constantly evolving, and so are the classifications of diagnoses and the vocabulary used. Each word has its own connotation or (figurative) meaning. For example, the word ‘addiction’ gives a person a definite and strong evaluation. Firstly, it implies that a person is an addict, which carries with it a certain stereotype and stigma, and secondly, it also gives a certain value to sex, as if it were something addictive.
In the case of hypersexuality, the word ‘hyper’ refers to the fact that there is too much of something, and so it’s as if we can say that if a person has a big craving, if someone thinks they are satisfying themselves too much, or having sex too often, then we can judge by outward behaviour – there is a problem.
There is now an understanding that as long as it does not interfere with the person themselves or their daily functioning, work and relationships, there is no external way of telling how much is ‘normal’ to have sex or to satisfy oneself, and where the line is drawn at ‘too much’. Of course, a high level of desire to have sex does not mean that you have the right to force or coerce someone else to have sex with you.
Thus, instead of assessing external behaviour, the view has now been taken that the problem arises more when the person feels unable to control their own behaviour, or that it is a compulsion that has started to interfere with life. Hence the term ‘compulsive sexual behaviour’.
What is an indication of compulsive sexual behaviour?
Compulsive sexual behaviour is indicated, for example, when a person feels that it is a compulsive behaviour that he or she cannot control or that he or she has no control over. It is important that we are not talking about the judgement of an outsider, or an external judgement, but about the person’s own feeling that they cannot control their behaviour. Also, this feeling, or the constant attempt to avoid it, can start to interfere with daily life, relationships or have other negative consequences.
What concerns about compulsive sexual behaviour can arise in a relationship?
In a relationship, it is important to distinguish between moral condemnation, a negative tone based on someone else’s opinion (e.g. a partner’s), and truly compulsive sexual behaviour, a feeling that “I can’t control myself, I feel coerced and out of control”.
There are two people in a relationship, and it is the rule rather than the exception that the desires and perception of how much sex you want, what sex should be like, how long it should last, are different for each partner. This is why, quite quickly, a situation can arise where one person starts to condemn the other and label the other, saying “you want so much, there’s something wrong with you, it’s not normal”. When a loved one labels us in this way, it sends out a message that the other person may start to believe and think that they are ‘diagnosed’ and do not meet the standards. And the other way round can happen too – the person with the lower desire will be blamed and condemned. Whichever way the accusations fly, the result tends to be negative.
When people come to my office with the opinion that sexual behaviour is compulsive, I first try to distinguish whether it is a moral condemnation. Just because one partner does not like the other’s seemingly frequent desire to have sex, or the way they like to do it, does not mean that the person is actually compulsive in their behaviour. What is important, however, is the person’s own sense of being out of control, and when the behaviour or the inability to control it starts to interfere with daily life.
Is cheating in a relationship also related to this?
This may or may not be the case. It is also likely that in some contexts and in some situations, sex addiction has been used as an excuse to take the bait. In the case of cheating, however, it should be stressed that the fact that the cheater feels that cheating is a compulsion or coercive behaviour, beyond his or her control, in no way excuses cheating or inappropriate behaviour towards a partner. However, we must all remain responsible for our own behaviour.
However, it cannot be said unequivocally that those who engage in compulsive sexual behaviour are necessarily cheating. Since there are hundreds of different reasons for having sex, it would be naïve to think that the reasons for cheating are the same. It is unlikely that the majority of cases of cheating have anything to do with compulsive behaviour. Nor can it be said with any certainty that someone who has cheated once will certainly cheat again. It is all very individual and depends on the life lived, the experiences and the person themselves, as well as why things came to the point of cheating in the first place.
It seems to me that if we put all the fraudsters in one pot, we would not get a homogeneous group. Causes, situations and circumstances are very varied and therefore no single conclusion can be drawn.
When it comes to compulsive sexual behaviour, sexuality in general and sex-related concerns, do we dare to seek and ask for help?
I can’t say that the troubled don’t reach out to me, but it seems that unfortunately there are still quite a few who have a concern but are just getting started to reach out, or who don’t know that help is available and available in Estonia. What holds us back is largely a lack of awareness or courage.
We have not yet come to the understanding that psychologically it can also contribute in some way to the functioning of the body and sexuality, to the arousal process. I see in my practice that there is a lot of discomfort, insecurity, fears. There is a lack of vocabulary related to sexuality. So there are those whose sexual side of life is not satisfying, but unfortunately they do not come to the realisation that this is not some physical, irremediable peculiarity, but that the cause may lie deep down, in the psychology. Little do we know that help is out there and closer than we think.
We certainly still have attitudes that prevent us from seeking help. For example, there is still a perception that sex can be painful for a woman, when in fact there is no direct reason why it should be. Unless, of course, the pain is related to a specific disease or condition. Sex does not have to be painful. If people think and believe that this is normal, that it cannot be helped, then they will not seek help.
A similar situation can arise in the case of compulsive sexual behaviour. If a person labels themselves as a sex addict, or is labelled as such by others, help is cut off. In the case of older people, however, studies show that help is cut off by the widespread belief that sexuality disappears in old age. In fact, it doesn’t have to.
If it looks like compulsive sexual behaviour, where to turn for help?
Help should be sought from a sex therapist, sexual counsellor or a psychologist or psychotherapist qualified to work with compulsive sexual behaviour.
However, whoever you turn to, it is important that you don’t simply work from your own moral judgements, as this can exacerbate a sense of shame that often reinforces the behaviour. It is perfectly acceptable, for example, to ask, before booking an appointment, whether the chosen professional has a history of dealing with such concerns, and whether they have the knowledge and skills to work on the issue.
It is very important to get to a specialist who would not lightly and without further thought label a person as a sex addict or recommend, for example, that they avoid all sex-related stimuli. This is not realistic. The nature of compulsive sexual behaviour is not the same as that of substance dependence. Alcoholics Anonymous-type interventions cannot help here. You cannot set a goal of ‘never having sex again’ and then expect that the desire will not arise and the body will not respond to sexual stimuli. It is perfectly normal that when a person sees a sexual stimulus, the body responds. And denouncing these normal reactions does not help anyone.
In the case of compulsive sexual behaviour, the most important thing is to identify and actually work on the root problem. How to help a particular person depends specifically on the person and the situation. Compulsive sexual behaviour usually has a specific function as to why a person feels the way they do. Therefore, there is no one-size-fits-all approach, as people’s stories and experiences are very different. Simply prohibiting or making people feel ashamed will not improve the situation.
When to seek help?
Just as at one time we didn’t talk very much about mental health issues, we don’t dare talk very much about sexual health issues now.
We can talk about criteria for diagnosis when we discuss the need to seek help, for example, but it makes no difference to the person whether they meet some criteria or whether their problem is diagnosable. So the most correct thing to say is that if a person has a problem and feels that they need help, that is a good enough reason to seek help.
I often see that those who come in believing that they are sex addicts or porn addicts are in fact perfectly normal people. It’s just that they’ve read something somewhere, heard something somewhere, got an external assessment and don’t seem to meet the ‘normal’ standard and have come to think of themselves as addicts.
For example, if someone watches crime films where people are killed and cut up for eight hours a day, they don’t immediately get the label of a homicidal maniac or start to suspect something is wrong with them. On the other hand, those who like to watch channels with sexual content are quickly labelled as porn addicts and perverts. This external judgement leads people to suppress their own perfectly normal behaviour, even though it did not actually harm anyone.
In short, if worry is getting in the way of your life, it’s important to seek help. To get some reassurance and clarity, you can start by asking a specialist a simple question – is what is happening to me or how I am behaving normal?
If you’re struggling with (sexual) health concerns, you can find help in getting your thoughts and action plan in place through active exercise or taking part in wellness services. You can find wellness service providers on Stebby.eu. You’ll also find psychologists on Stebby HERE.
