Sex Addiction: Controversies and Diagnosis of Sexual Disorders [Interview][Transcript]

Dr_Stephanie_Carnes_Sexual_AddictionGuest: Dr. Stephanie Carnes, Ph.D.

Presenter: Neal Howard

Guest Bio: Stefanie Carnes, Ph.D., CSAT-S is a noted authority on addictions and trauma and is the President of the International Institute for Trauma and Addiction Professionals, a training institute and professional organization for addiction professionals, and a senior fellow for Meadows Behavioral Healthcare where she works with sexually addicted clients and their families. She is a licensed marriage and family therapist and an AAMFT approved supervisor. Her area of expertise includes working with patients and families struggling with multiple addictions such as sexual addiction, eating disorders and chemical dependency.

Segment overview: Dr. Stephanie Carnes, Ph.D., CSAT-S and president of the International Institute for Trauma and Addiction Professionals (IITAP), a company that provides training and materials to addiction professionals, discusses what several studies reveal about sex addiction and the need for an official diagnosis for a sexual disorder.

Health Professional Radio

Neal Howard: Welcome to Health Professional Radio, I’m glad that you could join us today. Our guest in studio is Dr. Stephanie Carnes, she’s the President of the International Institute for Trauma and Addiction Professionals. It’s a company that provides training and materials to addiction professionals. She’s here to discuss several studies that reveal sex addiction and the need for an official diagnosis for sexual disorder. Basically she’s here to answer maybe the question, ‘Is sex addiction a real disorder’? Welcome to Health Professional Radio Dr. Carnes.

Dr. Stephanie Carnes: Thank you for having me Neal.

N: Thank you. You’re the author as well of the several books, ‘Mending a Shattered Heart: A Guide for Partners of Sex Addicts’, ‘Facing Addiction: Starting A Recovery from Alcohol and Drugs’ and ‘Facing Heartbreaks: Steps to Recovery for Partners of Sex Addicts’. Is sexual disorder, has that been your interest ever since you became a doctor or PhD?

C: It wasn’t initially, I started working in Chemical Dependency in the addiction field then over a time, I’ve got more involved in working with sex addiction. My father is actually a pioneer in the field, Dr. Patrick Carnes, a lot of people are familiar with his work. He and I started working together, in about the last 15 years I’ve been specializing in the area of sex addiction.

N: Sex addiction, you’re saying that there’s a need for it to be classified as a sexual disorder. Is that not the case now?

C: Yes, it’s not actually. The Diagnostic and Statistical Manual of mental disorders which is the diagnostic bible for psychiatrists, it used to contain a category called ‘Non-paraphilic Sexual Addiction’ and it was removed about 20 or 30 years ago. Since then there’s been a lot of controversy about, ‘What we’re going to call it?’ And a lot of questioning and confusion and certainly in the media about whether sex addiction is real. We’re actually at the point now where most of the professional health organizations agree that this is a very real thing and there’s a lot of research on it. However there’s still lot of controversy about what we’re going to call it, so some people will prefer to use the term sexual compulsivity, some people use the term addiction, some people look at it as impulse control disorder or hypersexual behavior. But in general, most practitioners and researchers do agree that this is an actual problem at this point in time but it is not yet in the DSM, which means that people can’t get insurance reimbursement, there’s less research funding for it. It really keeps the problem stigmatized and not a lot of resources for people struggling with the disorder.

N: Basically there’s has been a 25-30 year, I guess halt in research, and opinions, and papers being written and what not. And treatment therapies being developed simply because it was taken out of the diagnostic manual.

C: I wouldn’t say that Neal. I actually mentioned that because there has been a lot that’s been published and actually a lot of research but it’s been very controversial. There’s have been concerns from people that it would over classify as sex offenders, even though the data and a lot of the research shows that when you use the criteria, it doesn’t over classify offenders or that you de-pathologizing normal sexual behavior than healthy. But we’re really starting to narrow down a set of criteria. If you look across all the different research, the really of the constellation of behaviors that most theorists agree upon and so a lot of those concerns are being not really legitimate concerns. We are waiting for the DSM committees to actually review and look at this as a legitimate diagnosis and hopefully they’ll be doing that. They have just recently made the DSM a working document so people can submit proposals. The ICD (International Classification of Disease), the World Health Organization has a manual called the ICD, they’re coming out with their 11th version and they actually have included sexual compulsivity and sexual addiction in their classification system which most physicians use. The DSM is sort of the last to come to the party so to speak, but we’re really trying to advocate that a diagnosis be put in there so that people can get insurance reimbursement and research funding can be opened up and that kind of thing.

N: Are there criteria that exist that are included in the DSM for sexual deviations? Things that you might treat an offender for whose trying to be rehabilitated from an institution? Is that something that has caused some of the confusion? I heard you mentioned something happened to do with laws versus addiction as opposed to … (crosstalk)

C: Right, exactly and so yes there are diagnoses that are in a DSM, for example paraphilia which it can range from everything from sexual sadism, and masochism, to exhibitionism, and voyeurism, to pedophilia. And obviously, to be a diagnosis these things have to occur for a certain amount of time, and have to cause distress to the person or unwilling victim, that type of thing. But there are certainly diagnosis and often times, offenders might have a paraphilia diagnosis or an anti-social personality profile. There is certainly are many diagnostic categories that might be appropriate.

N: Having a sexual addiction, has nothing to do with type of sex, it has to do with whether or not causes problems for you and those around you. Is it similar to drug and alcohol addiction?

C: Yes it is actually. When you look at it, the type of thing we look for is like people continuing despite consequences, we look for a pattern of compulsive behavior over time, excessive amounts of time, doing the behavior or recovering from the behavior, efforts to stop the behavior, consequences because of the behavior, so it really not so much about what the behavior is that they’re doing. Just like whether an alcoholic drinks gin or beer it does not really matter, but it’s the constellation of the consequences and criteria that we’re looking at. Most sex addicts are, most common things are pornography obviously, prostitution, anonymous sexual encounters, and hook ups, those will definitely be the most common types of presenting issues.

N: Do you consider an addiction to pornography to be a full blown sex addiction or can a sex addiction include pornography or are they separate?

C: Yes, sometimes they are not separate. Sometimes you have pornography addicts that is also engaging in other types of behavior, so they’re not mutually exclusive. But there are people that are researching now how porn addiction might be different from sex addiction and how treatment approaches should be different. There’s been a lot of neuroscience research that has really shown how pornography is similar in the brain in terms of the neuroscience and how it’s similar to drug and alcohol addiction, with FMRI research and things like that. There is a lot of research that’s going into pornography addiction itself. There is an overlap obviously in treatment techniques between in the two groups. But there are certainly things that are unique, depending on and how the sex addiction is presenting for that individual.

N: We’ve touched on a few things that could contribute to the lack of it being included in the DSM, but as an author of several books and informational website and what not – what do you think is the reason that is was taken out of the DSM which caused the controversy? Had that gap not existed, do you think that much larger leaps and bounds, and strides would’ve been made into the research and well it’s not yet a disorder but probably would have been if not for this information gap?

C: Yes, I think that it has held back the research in this area. The different reasons that I’ve heard that it was taken out is that there was concern a diagnosis would be used to get sex offenders off the hook in court cases although a pedophilia diagnosis doesn’t usually get people off the hook, or drug addiction diagnosis doesn’t get people off the hook but there is concern around that. There was also someone argued that it was theoretical that it was an addiction. Which there’s still a lot of argument about the theory underlying this disorder like is it a compulsion? Is it an addiction? Is it an impulse control disorder? And so there’s a lot of back and forth on the differences from the theoretical perspective there.

N: Do you find that there is more resistance experienced from the medical community, the medical financial community as an insurance company, as an HMO or things to that nature or do you find that many patients or potential patients are reluctant to buy into it being an addiction or disorder? Maybe they were in their search for what was wrong or what the problem was, they were hoping for something else.

C: Yes, I have actually in terms of physicians, I found physicians to be pretty open to the idea of sex addiction and sexual compulsivity overall. As a matter of fact, the American Society of Addiction Medicine, in their most recent addition of their definition which took them 4 years to develop and had 80 neuroscientists involved in defining addiction. They actually included what we call behavioral addictions, which is like food, sex, gambling that type of thing, those things because they know that the neuroscience is very similar to what we see in chemical dependency. There’s a very similar process going on with the reward system in the brain. Physicians have been pretty open about it, there are people in the sex therapy community, it’s not all of course there’s are some that are very open to the concept of sex addiction. But there are people that in that community is one that has always been very concerned about looking at sexual in a positive way, promoting the ideas of sexual health and LGBT cue advocacy and we want people to be able to explore their sexuality all in a positive way. As the result of that, there are some those individual that are reticent to look at sex as a disorder or to pathologize anything sexually. Some people has, there still some people out there you’ll see that will say sex addiction is not real, it’s a myth, it doesn’t exist, that is really very difficult for our clients – stigmatizing it makes harder for them to reach out for help it sort of denies their reality. That’s why it’s so important for us to get a diagnosis back in the DSM so people see this as a legitimate concern.

N: In wrapping up Dr. Carnes, where can our listeners go and learn more about the International Institute for Trauma and Addiction Professionals?

C: Sure. You can go to or you can also go for more information on sex addiction you can go to

N: And as far your books, Mending a Shattered Heart, Facing Addiction, and Facing Heartbreak. Where can new get copies of those books?

C: They’re available on Amazon.

N: Great. Well, it’s been a pleasure doctor.

C: Thank you very much Neal.

N: You’ve been listening to Health Professional Radio with Dr. Stephanie Carnes, President of the International Institute for Trauma and Addiction Professionals a company that provides training and materials to addiction professionals. And we’ve been discussing whether or not sex addiction is a real disorder and whether it should be included in the DSM. Transcripts and audio of the program are available at and at and you can subscribe to this podcast on iTunes and listen in on SoundCloud.

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