Diagnosis and Treatment of Sexual Addiction: A Survey among German Sex Therapists

Controversies exist about the diagnostic concept of “sexual addiction.” The aim of this study was to investigate if German specialized sex therapists are confronted with patients who possess sexual addiction symptoms and to obtain information about diagnoses, comorbidity and treatment. A 12-item questionnaire was sent to all members of the German Society of Sex Research asking them about diagnoses, comorbidity and treatment of patients who experienced sexual addiction problems. Forty-three out of 149 members (28.9%) responded to the survey and reported about 97 patients with sexual addiction symptoms. Most common were pornography dependence, compulsive masturbation, and protracted promiscuity. Using ICD10 definition “excessive sexual drive” was diagnosed more often in women while “disorder of sexual preference” was mainly diagnosed in men. In women neurotic (e.g., anxiety disorders) and eating disorders were most commonly diagnosed as comorbid disorders, while in men substance disorders were most commonly diagnosed. Most patients were treated by individual psychotherapy. We discuss the difficulties of the “sexual addiction” concept critically and propose an algorithm to facilitate the diagnostic process. This algorithm differentiates between the paraphilic and non-paraphilic (we use the term paraphilia-related disorder) types of excessive sexual behavior first. As a second step it includes a dynamic perspective differentiating between a progressive and a non-progressive course.