Typically, regardless of age, race, gender, social history, or psychological underpinnings, the core signs and symptoms of sexual addiction are the same. In fact, nearly all sex addicts report, in some form, the following range of symptoms:

1. Obsessive sexual fantasy and preoccupation

Sex addicts can spend days at a time fantasizing about, planning for, pursuing, and engaging in sex. The majority of their decisions revolve around sex, including what they wear, which gym they go to, the car they drive, their relationships, and perhaps even the career path they choose.

2. Loss of control

Sex addicts lose the ability to choose to not engage in sexual fantasies and behaviors. They try to quit or cut back, making promises to themselves and/or others but repeatedly fail in these efforts.

3. Related adverse consequences

Sex addicts eventually experience the same basic negative life consequences that alcoholics, drug addicts, compulsive gamblers, compulsive spenders, and all other addicts deal with, such as job loss, trouble in school, financial woes, ruined relationships, declining physical and/or emotional health, loss of interest in previously enjoyable activities, loss of time, isolation, arrest, etc.

4. Tolerance and escalation

There comes a point when the addict must take more of a substance or a stronger substance to achieve and maintain the same high that he or she seeks. With sexual addiction, tolerance and escalation occur when the addict spends increasing amounts of time engaging in the addiction or when the intensity level of his/her sexual fantasies and activities increases.

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Over time, thanks to tolerance and escalation, many sex addicts find themselves engaging in sexual behaviors that hadn’t even occurred to them early in the addictive process. Some act out in ways that violate their personal moral code, their spiritual beliefs, and perhaps even the law. Some escalate to viewing illicit or bizarre images, and others simply lose increasing amounts of valuable time and energy to sex.

5. Withdrawal

With sexual addiction, withdrawal tends to manifest not so much physically, as often occurs with substance abuse (i.e., delirium tremens when detoxing from alcohol), but emotionally and psychologically. Sex addicts in withdrawal tend to become either depressive or restless, lonely, irritable, and discontented. As with tolerance, withdrawal is not a necessary element of the sex addiction diagnosis, but most sex addicts do experience the feeling of it.

6. Denial

Denial keeps sex addicts out of touch with the process, costs, and reality of their addiction. They routinely ignore the kinds of warning signs that would be obvious to a healthier person. Often, they externalize blame for the consequences of their sexual acting out onto other people or situations. In short, they are often unable or unwilling to see the destructive effects wrought by their sexual behavior until a related crisis shows up at the door.

Another way to look at the signs and symptoms of sexual addiction is with the “SAFE” formula developed by Dr. Patrick Carnes, a pioneer in the diagnosis and treatment of sexual addiction. Dr. Carnes uses SAFE as an acronym for Secret, Abusive, Feelings, and Empty. In his book, Out of the Shadows, he writes:

The question emerges for addicts as to how they determine when their sexual behavior is addictive. The following formula is suggested as a guideline. Signs of compulsive sexuality are when the behavior can be described as follows:

1. It is a secret. Anything that cannot pass public scrutiny will create the shame of a double life.

2. It is abusive to self or others. Anything that is exploitive or harmful to others or degrades oneself will activate the addictive system.

3. It is used to avoid or is a source of painful feelings. If sexuality is used to alter moods or results in painful mood shifts, it is clearly part of the addictive process.

4. It is empty of a caring, committed relationship. Fundamental to the whole concept of addiction and recovery is the healthy dimension of human relationships.

Throughout the 20th century, sex addiction specialists tended to place a considerable amount of emphasis on committed, monogamous relationships (see the “Empty” portion of the Carnes SAFE formula) as the endpoint of recovery from sexual addiction.

Over time, however, we have learned that marriage and long-term commitments are not an absolute requirement for everyone wishing to achieve sexual healing and/or sexual sobriety (unless one is already in a committed, long-term monogamous relationship).

In today’s world, healing from sexual addiction can encompass many types of meaningful, open, and honest sexual or romantic connections — as long as they are not secretive, abusive to self or others, repeatedly used to avoid feelings, or causing problems to the addict and/or the addict’s loved ones.

In short, sex addicts needn’t be married to be in sexual recovery. But they do need to be connected to their sexual partners and not treat or use them as objects. In fact, there are individuals in sexual recovery who have experienced such significant early life trauma that they might never be able to create and sustain meaningful monogamy.

But that does not mean they can’t heal, be in recovery, develop meaningful interpersonal connections (sexual and otherwise), and feel happy and at peace with themselves. In other words, today we see that sexual recovery is less about cultural norms and more about personal integrity relationship building that may or may not involve sex, and the elimination of impulsive and problematic sexual behavior.

This article adapted from Sex Addiction 101 by Robert Weiss, copyright HCI Books 2016.

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