Both the professional literature and the popular media have directed considerable attention to a condition commonly referred to as sexual addiction. The idea that people can become dominated by insatiable sexual needs has been around for a long time, as exemplified by the terms nymphomania, applied to women, and satyriasis or Don Juanism, applied to men. Many professionals have traditionally reacted negatively to these labels, suggesting that they are disparaging terms likely to induce unnecessary

guilt in individuals who enjoy an active sex life. Furthermore, it has been argued that one cannot assign a label implying excessive sexual activity when no clear criteria estab­lish what constitutes "normal" levels of sexual involvement. The criteria often used to establish alleged subconditions of hypersexuality—nymphomania and satyriasis—are subjective and value laden. Therefore these terms are typically defined moralistically rather than scientifically, a fact that has generated harsh criticism from a number of professionals (Klein, 1991, 2003; Levine & Troiden, 1988). Psychotherapist Marty Klein (2003, 2012b) is especially critical of the sex addiction movement, which in his view both exploits people’s fear of their own sexuality and pathologizes sexual behav­ior and impulses that are not unhealthy. Nevertheless, the concept of sexual addiction achieved a heightened legitimacy with the publication of Patrick Carnes’s book The Sexual Addiction (1983), later retitled Out of the Shadows: Understanding Sexual Addic­tion (2001, 3rd ed.).

According to Carnes, many people who engage in some of the atypical or para – philic behaviors described in this chapter (as well as extreme coercive behaviors, such as child molestation) are manifesting the outward symptoms of a psychological addiction in which feelings of depression, anxiety, loneliness, and worthlessness are temporarily relieved through a sexual high not unlike the high achieved by mood-altering chemicals such as alcohol and cocaine.

The concept of sexual addiction has generated considerable attention in the pro­fessional community. While Carnes and his supporters argue for acceptance of sexual addiction as a legitimate diagnostic category, detractors point to a continuing "tradition in the sex addiction literature of forgoing empirical research and presenting conjectures as fact" (Chivers, 2005, p. 476). Many sexologists do not believe that sexual addiction should be a distinct diagnostic category, because it is rare and lacking in distinction from other compulsive disorders, such as gambling and eating disorders, and because this label negates individual responsibility for "uncontrollable" sexual compulsions that victimize others (Levine & Troiden, 1988; Satel, 1993).

Despite the skepticism of many sexologists about including sexual addiction as a diagnostic category, "Americans are being diagnosed as sex addicts in record numbers" (C. Lee, 2011, p. 50). Recent media attention to two cases of alleged sexual addiction, one involving Tiger Woods and the other Dominique Strauss-Kahn, has focused the nation’s attention on this type of behavior.

A number of professionals recognize that some people become involved in patterns of excessive sexual activity. Noteworthy in this group is sexologist Eli Coleman (1990, 1991, 2003), who prefers to describe these behaviors as symptomatic of sexual com­pulsion rather than addiction. According to Coleman, a person manifesting excessive sexual behaviors often suffers from feelings of shame, unworthiness, inadequacy, and loneliness. These negative feelings cause great psychological pain, and this pain then causes the person to search for a "fix," or an agent that has pain-numbing qualities, such as alcohol, certain foods, gambling, or, in this instance, sex. Indulging oneself in this fix produces only a brief respite from the psychological pain, which returns in full force, thus triggering a greater need to engage in such behaviors to obtain further temporary relief. Unfortunately, these repetitive compulsive acts soon tend to be self-defeating; that is, they compound feelings of shame and lead to intimacy dysfunction by interrupt­ing the development of normal, healthy interpersonal functioning.

Other sexologists, notably John Bancroft and Zoran Vukadinovic (2004), believe that because of a lack of empirical research, the currently fashionable concepts of sexual addiction and compulsive sexual behavior are of uncertain scientific value. These authors suggest that until we have more data to evaluate the scientific validity of these concepts, it is preferable to use the more general descriptive term out of control to describe such problematic sexual behavior.

We can expect that professionals in the field of sexuality will continue to debate for some time how to diagnose, describe, and explain problems of excessive or uncontrolled sexuality. Even as this discussion continues, professional treatment programs for com­pulsive or addictive sexual behaviors have emerged throughout the United States (more than 2,000 programs at last count), most modeled after the 12-step program of Alco­holics Anonymous (Kafka, 2009; National Council on Sexual Addiction and Compul- sivity, 2002). Data pertaining to treatment outcomes for these programs are still too limited to allow evaluation of therapeutic effectiveness. Besides formal treatment pro­grams, a number of community-based self-help organizations have surfaced throughout the United States. These groups include Sex Addicts Anonymous, Sexaholics Anony­mous, Sexual Compulsives Anonymous, and Sex and Love Addicts Anonymous.

Because sex has become a highly sought-out topic among users of the Internet, some professionals have suggested that a new variety of sexual addiction or sexual compulsiv – ity has emerged. The issue being debated is whether cybersex addiction and compulsiv – ity is a harmless sexual outlet or problematic sexual behavior. We examine this issue in the final paragraphs of this chapter.

A prominent physician in our home state recently lost his position and staff privi­leges at a local hospital when it was discovered that he was using a hospital computer to visit sexually explicit Internet sites that specialize in child pornography. An investigation revealed that this individual spent an inordinate amount of time, both on the job and at home, compulsively surfing sexually oriented websites, especially those with explicit sexual content dealing with children. This case illustrates a variety of behavior, spawned by the Internet, that has raised the concern of a number of mental health specialists.

Sexually oriented Internet sites are among the most widely visited topical areas of the World Wide Web. Does the widespread incidence of "surfing for sex" indicate prob­lematic behavior and warrant societal concern? Some suggest the opposite—that pur­suing cybersex is a harmless recreational pursuit offering anonymous access to sexually oriented material that provides sexual outlets (such as chat room sex or masturbating to sexual images) that are safe from the dangers of STIs and other relationship risks (Waskul, 2004). In addition, the Internet can be useful to people who wish to explore sexual fantasies online in the safety and privacy of their homes (Quittner, 2003).

A less benign view of Internet sex emerges from a growing awareness that for a small but ever-increasing number of individuals who surf the Internet primarily for erotic stimulation and sexual outlets, the affordability, accessibility, and anonymity of the Internet are creating a new breed of sexual compulsives addicted to cybersex (M. Ross et al., 2011). Many of these individuals are using cybersex to the exclusion of personal relationships (Ayres & Haddock, 2009; Cooper, 2002, 2003; Dew & Chaney, 2004; Philaretou, 2005).

It is difficult to accurately estimate how many Internet users in the United States experience problems associated with visiting Web sex sites. A large majority of people who access the Internet for sexual purposes do not appear to experience adverse con­sequences (Waskul, 2004). However, some research indicates that 6-10% of Internet users do report being concerned about the possible negative consequences of their online sexual activities (Dew & Chaney, 2004). Furthermore, studies indicate that 1% of sex site surfers are so hooked on or addicted to cybersex that their capacity to func­tion effectively in their everyday lives is severely damaged (Carnes, 2001; Cooper et al., 2000). Such individuals are likely to spend endless hours each day surfing sex sites, masturbating to sexually explicit images, or engaging in mutual online sex with someone contacted through a chat room.

The sexual excitement, stimulation, and orgasmic outlets provided by a virtually infinite variety of Internet sexual opportunities may lead to a compulsive pursuit of

cyberspace sex that can have a devastating effect on a cybersex addict’s life and family (Cooper, 2002; Woodward, 2003). Partners of these individuals report feeling ignored, abandoned, devalued, or betrayed as a result of their mate’s compulsive pursuit of cybersex (Brody, 2000; Cooper, 2002). Some people devote so much time to forays into cybersex that they end up neglecting family members or job responsibilities, or both (Philaretou, 2005).

An additional hazard faced by some cybersex addicts and compulsives who pursue online sexual relationships is that they may progress to arranging off-line meetings that can have seriously adverse consequences, including exposure to STIs and sexual assault (Cooper, 2002; Genuis & Genuis, 2005).

Mental health professionals have expressed concern about teenage addiction to cybersex (Abelman, 2007; Fleming & Rickwood, 2004; Jancin, 2005). Some clinicians believe that teenagers, especially males, are becoming addicted to sex on the Internet. According to psychotherapist Ann Freeman, it is common to encounter youths who are addicted to masturbating to Web sex sites three or four times daily (in Jancin, 2005). Such excessive Internet-based sexual behavior may lead to social isolation, unhealthy sexual attitudes, loneliness, depression, and possible "stranger-danger" in the form of being tracked and lured by cybersex pedophile predators (Fleming & Rickwood, 2004; Jancin, 2005; Subrahmanyam & Greenfield, 2008). (See Chapter 17 for a discussion of pedophiles in cyberspace.)

We hope that future studies of cybersex will provide a clearer answer to the ques­tion, "Is compulsive exploration of online sex a relatively harmless sexual outlet or a potentially harmful variety of problematic sexual behavior?" For the present, a number of professionals have raised our awareness of the potentially adverse consequences of getting hooked on cybersex.

Summary

What Constitutes Atypical Sexual Behavior?

■ Atypical, paraphilic sexual behavior involves a variety of sexual activities that, in their fully developed form, are sta­tistically uncommon in the general population.

■ Such behaviors exist in many gradations, ranging from mild, infrequently expressed tendencies to full-blown, regularly manifested behaviors.

■ Paraphilias are usually expressed by males, are sometimes harmful to others, may be preludes to more serious sexual offenses, and tend to occur in clusters.