Diagnosing Sexual Addiction, Part Two: Questions to Pose

As mentioned in part one of this blog, sexual addiction can be difficult to identify. Because of its highly secretive nature (the addict’s denial/unwillingness to disclose), even therapists sometimes struggle to uncover and diagnose active sexual addiction. The good news here is that there are some basic tools that can be used to identify (or rule out) sexual addiction. For starters, there are fifteen basic questions that therapists can ask if they are told about or suspect that sexual addiction may be an issue. Before proceeding, it is important to for me to state that the questions below (pulled in part from my recently published book, Always Turned On: Sex Addiction in the Digital Age) are not a validated psychotherapeutic instrument. They are merely intended as a starting point for therapeutic discussion, and as a way to safely and comfortably broach with clients the topic of sexual behavior and possible sexual addiction.

1. Do you find yourself spending increasing amounts of time looking at porn and/or engaging in sexual or romantic fantasy, even when you have other things to accomplish that you are putting aside to be sexual?
2. Have you promised yourself that you will stop viewing or using certain sexual sites or apps, only to find yourself back there again anyway?
3. Do you find yourself involved in hidden romantic or sexual affairs, either online or in person?
4. Do you extensively collect pornography or sexual contacts, storing images and videos, romantic emails, texts, etc. related to past and present acting out partners and activities?
5. Do you find yourself habitually going online to see who might be available for sex and/or romance even when you don’t have time or it was not your clear intention to do so?
6. Have you had negative consequences at work, in school, in relationships or in other important areas of your life related to your sexual fantasies and behaviors?
7. Has your focus on sex led to a decreased focus on friends, family, faith-based and/or recreational activities?
8. Has your sexual behavior caused you to lose anything or anyone important to you (career, school, relationships, finances, self-esteem, health, etc.)?
9. Do you lie or keep secrets from those close to you about your involvement with pornography, including the types and amounts of porn you view, or other sexual activities?
10. Have you found yourself covering up or hiding your porn use or some other sexual activity so that a spouse, coworker, family member, etc. won’t discover it?
11. If in a committed relationship, would your partner/spouse say that your sexual activity violates the underlying agreements surrounding your relationship (if he or she knew everything)?
12. Do you feel that your involvement with sexual fantasies and behaviors is interfering with your personal goals, such as developing relationships, healthy intimacy and/or a family/community life?
13. Have you found yourself viewing sexual material or engaging in sexual activity that is illegal?
14. Have you heard complaints or concern from family or friends about the nature and/or the extent of your sexual activity?
15. Do you become defensive, angry or extremely ashamed when asked to look at, give up or reduce your sexual involvement?

If you client does not answer yes to any of these questions, then he or she is probably not a sex addict. If your client answered yes to one or two questions, he or she may be at risk for sexual addiction. (See my previous posting for a fuller explanation of “at risk.”) If your client answered yes to three or more of the questions, he or she is probably sexually addicted, and you should proceed accordingly.

Perhaps more important than the number of yes answers is how willing your client is to be honest about his or her sexual fantasies and behaviors with himself/herself and at least one other person who is important in his or her life. For instance, your client may spend ten hours per week looking at online pornography, but if his or her spouse knows about this and is perfectly OK with it – if it doesn’t violate or interfere with the client’s personal and relationship commitments – then his or her porn use may not be a problem. In other words, if your client is living his or her sex life honestly and openly, this “sexual integrity” might be a mitigating factor in terms of a sex addiction diagnosis. If, however, your client is spending ten hours per week using online porn, keeping this a secret from his or her spouse and other important people, and he or she is no longer having sex with his or her spouse (who is concerned about this), then it’s quite likely that your client is a sex addict.

So, as you can see, there are multiple factors that may (or may not) culminate in a sexual addiction diagnosis. As such, the questions above are more a guide than a definitive test. However, an affirmative answer to question 13, regarding illegal sexual activity, is always a problem. If your client answered yes to that question, you should immediately inform him or her of your reporting requirements – in particular, what he or she can and cannot safely disclose to you. And, as always, if you feel uncomfortable or unqualified to handle any of your client’s issues, you should refer that individual to a specialist who is better suited to hand those problems. There is no shame in this; it is simply good psychotherapeutic practice.

If you are interested in learning more about diagnosing and treating sexual addiction, the International Institute for Trauma & Addiction Professionals offers Certified Sex Addiction Therapist (CSAT) training.

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships and Always Turned On: Sex Addiction in the Digital Age. He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe and Asia. For more information you can visit his website, www.robertweissmsw.com.