This is the first of a two-part series that discusses the differences between sex addiction and Obsessive-Compulsive Disorder (OCD).
Lately, sex addiction has become a hot topic in the news. Certainly, the biggest factor in this explosion of interest has been the revelation that Tiger Woods has had a seemingly infinite number of extra-marital affairs, and subsequent reports that he is undergoing treatment for sex addiction.
Is Sex Addiction OCD?
Every so often, the OCD Center of Los Angeles receives a call from a prospective client looking for treatment for sex addiction. These individuals (or their spouses) call us because they believe, or more frequently, have been told by previous therapists, that their sexual behavior is evidence of Obsessive-Compulsive Disorder (OCD). And invariably, they are surprised and confused when I inform them that sex addiction has absolutely nothing whatsoever to do with OCD.
In fact, the two conditions are radically different. Yes, both conditions include obsessional thoughts and compulsive behaviors. But people exhibit obsessive thoughts and compulsive behaviors in a whole host of conditions that are not OCD, including Anorexia Nervosa, Bulimia, Alcoholism, Drug Addiction, Pathological Gambling, Compulsive Shoplifting, Trichotillomania, and Body Dysmorphic Disorder.
So the question arises: what distinguishes sex addiction from OCD? In a word…pleasure.
Very simply put, individuals who are addicted to sex get pleasure from their behavior. Conversely, those with OCD get not a scintilla of pleasure from doing their compulsions. In fact, in fifteen years of treating clients with OCD, I have never once had a client report getting anything resembling pleasure in the course of doing a compulsion.
To better understand how OCD operates, it is helpful to understand the concept of the Obsessive-Compulsive Cycle. For the person with OCD, obsessions are specific, repetitive thoughts that are experienced as unwanted and extremely anxiety-provoking. And like all humans, people with OCD don’t like the feeling of anxiety. As such, those with OCD develop strategies do eliminate or reduce that anxiety. The compulsive and avoidant behaviors seen in OCD are done with the sole purpose of reducing or eliminating the immediate anxiety caused by these very specific thoughts. And the compulsions are often done repeatedly and in a ritualized fashion, sometimes for hours, until the individual feels some relief from the anxiety caused by these specific thoughts. This Obsessive-Compulsive Cycle is consistent and stable in all cases of OCD that I have ever seen.
Now let’s compare that to sex addiction. Are the obsessive sexual thoughts experienced by a sex addict prior to sexual activity unwanted and anxiety-provoking? I would argue just the opposite. It seems to me that the thoughts experienced by sex addicts are arousing and pleasurable. Some might argue that sex addicts experience various conflicting emotions prior to acting compulsively, including anxiety. But it seems self-evident that the primary feeling is one of sexual arousal. The thoughts the sex addict experiences after the fact may be distressing, but prior to that sexual activity, the thought of having sex is primarily experienced as pleasurable and desirable.
Conversely, those with OCD never feel any pleasure related to an obsession. Not for one second. Their obsessions are experienced as the worst kind of mental torture. In fact, on more than one occasion, I have had clients with OCD tell me that would gladly give up a limb if doing so would allow them to be free of their obsessions.
Likewise, the compulsive behavior done by a sex addict, whether it is sex with another person or masturbation, undeniably provides the individual with pleasure. The individual with OCD gets no pleasure whatsoever from doing compulsions. The person with OCD gets only a temporary reduction in anxiety related to the very specific fear about which they were obsessing.
Treatment for OCD vs. Treatment for Sex Addiction
Finally, it is also worth noting that if sex addiction is OCD, then by extension, it should respond to the same treatment as OCD. Multiple controlled research studies have consistently found that the most effective treatment for OCD is a very specific type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). This therapy requires that the client purposely expose themselves to the very object or situation that generates their anxiety. For example, if one obsesses about contamination, this might mean purposely having repeated contact with specific items that one perceives as “contaminated”.
Applying this principle to sex addiction would suggest that the best treatment would be for the sex addict to purposely and repeatedly watch porn, spend private, non-sexual time with prostitutes, etc. This is not just unlikely to be a successful intervention – it is very likely to have the exact opposite of the intended effect. Simply put, asking a sex addict to purposely be around sexual triggers is like asking a heroin addict to purposely be around heroin.
So, if sex addiction is experientially different than all other types of OCD, and it doesn’t respond to the same treatment that is known to consistently be the most effective treatment for OCD, it stands to reason that it isn’t OCD.
Next week, we will continue our discussion by answering the question: “If sex addiction isn’t OCD, then what is it.”
•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. In addition to individual therapy, the center offers six weekly therapy groups, as well as online therapy, telephone therapy, and intensive outpatient treatment. To contact the OCD Center of Los Angeles, click here.
I do like the very simple explanation of the difference between the two: pleasure. I think that would be very helpful and easy for clients to understand.
Thank you for your comment on our article.
I think people sometimes fail to see this fundamental difference – when doing compulsions, people with OCD are motivated by the desire to eliminate anxiety experienced in relation to very specific, very distressing thoughts. I believe that this is not the case for behavioral addictions, which all have a component of gratification / pleasure. Addiction is obviously complex, but the existence of gratification undeniably applies to addictions to gambling, sex, food, etc. Likewise, our clients with Trichotillomania and Dermatillomania almost always acknowledge getting gratification / pleasure from the process.
I would would like to hear more concerning sex addiction that I would reason ti what you are saying sounds more valid then a sex addiction being OCD that does not bring pleasure.
Thank you for your comment. We will be posting the second part of this series on sex addiction within the next week. It will provide a in-depth discussion of diagnostic issues related to sex addiction
Very articulate, succinct, and well-though-out article. My practice focuses on clients with sex addiction at The Center for Counseling & Recovery, and you’re right in that the big difference is ‘pleasure.’ Without contradicting that idea, I also notice that many addicts (sex addicts or otherwise) display many obsessive-compulsive traits which do not constitute full-blown OCD or OCPD. For the sex addict who compulsively masturbates until raw or injured, there’s clearly no pleasure in it–that includes an OC component.
There’s clearly cross-over between OCD and sex addiction, but they’re not the same thing. I look forward to next week’s article!
Thank you for your comments.
I agree that there is a lot of overlap between OCD and compulsive sexuality. And we have treated clients who clearly have both conditions.
I would actually disagree with the idea that compulsively masturbating until raw is necessarily devoid of pleasure. I would think that there is still pleasure in the act (and in the orgasm), though it is obviously mixed with other emotions / sensations.
I think the issue really gets down to a question of motivation – is a person doing a behavior to eliminate anxiety related to a specific thought (which is OCD), or are they doing a behavior to get some sense of gratification (perhaps this is a better word than “pleasure” in this case, and is clearly not OCD).
I think another major difference is that those with OCD do not generally do compulsions in an attempt to deaden broad feelings of low-self worth, ennui, etc., although there are certainly situations in which those with OCD use compulsions to cope with emotionally overwhelming situations.
Our follow-up article will be published this week.
I don’t know if my problem is hocd or sex/fantasy addiction, or just addicted to the thought of being with a woman as it would be easier thn being with my husband (real life). But I love him deply and don’t want to be gay. I would rather be dead, but I can’t seem to relinquish the thought. I think I am going crazy. I feel very trapped. I was always attracted to men. Always. I am terrified and very very sad.
Thank you for commenting.
While I cannot provide a diagnosis via a blog comment, the symptoms you describe sound very much like HOCD. You note that you are terrified of these thoughts, that you “feel trapped” by them, that you don’t want to be gay, that you have always been attracted to men, and that you “would rather be dead” than be a lesbian. This all sounds like HOCD to me.
I’m not sure why it would be “easier” to be with a woman than to be with your husband who you profess to love deeply. I am guessing there may be more to this story than merely fantasizing about being with women (which by the way, would not necessarily mean that you are a lesbian).
The main issue here is likely that you are trying to “relinquish the thought”, which is a mental compulsion that will only serve to make your obsession worse. I encourage you to read our four-part series on HOCD. I also encourage you to consider an alternative approach to your unwanted gay thoughts, namely to accept their existence, just as you would accept any other thought in your mind that is less than ideal, but hardly catastrophic. That doesn’t mean accepting that you are lesbian – it means accepting that you have this unexpected and unwanted thought that is popping into your head. The presence of the thought doesn’t mean you a lesbian or an addict, it means you have HOCD.
Well, I have OCD and Sex Addiction too. I was diagnosed with OCD when I was 19 and in college. And when I was doing a doctoral program in human sexuality I realized I was a sex addict. Many people in the sex therapy world, especially the “sex positive” types don’t believe in sex addiction and say that it is actually a form of OCD. However, my OCD therapist agrees with you in regard to this component of pleasure and how OCD is simply not pleasurable. My standard OCD symptoms are fear of causing harm, checking, symmetry, and obsessional thoughts. Well, my OCD therapist and I have had some talks about “need to know” and “just so” obsessions and compulsions related to my sex addiction, and I believe that my sex addiction did relate to both the “need to know” and “just so” (among other things). “Just so” would come out in the need to feel like I got the “right kind” of orgasm, and I couldn’t stop until it felt “just right”. And yes, sometimes I would have sex until injury because I wanted to feel “just so.” Meanwhile “need to know” came out in my promiscuity and in my sexual orientation as well. I would think, “well maybe I should try having sex with this race or this gender, or this transgender so that I can find out who I really am sexually.”
I would like to know your thoughts on these things! Let me know.
While OCD and sex addiction are not the same thing, it is quite feasible for an individual to have more than one condition. For example, we have treated numerous people with OCD who also have had eating disorders, substance abuse disorders, and/or depression.
While I cannot provide a diagnosis via this blog, the symptoms you report suggest that you have both OCD and a sexual addiction. As I noted in the article, there are certain similarities between these conditions, and it seems reasonable that your symptoms would at times overlap. It also seems likely that if you successfully treated either of these conditions, you would still have to contend with the other.
I encourage you to work on both conditions with a therapist who has a solid track record in treating both. If such an individual is not available, you would do best to consider finding two specialists – one for each condition. While this may sound like too much therapy, it would be the appropriate course of action. If you had both a broken leg and diabetes, I would likewise encourage you to seek out a specialist for each condition.
i think I am involved in some kind of sex addiction, because i am an heterosexual man but sometimes i fantasize about wearing like a woman and having sex with a men and this type of things. When i have this thought, it may happen that i masturbate to the thoughts, so it’s not just a thought. What recalls an OCD is the fact that the thought of the transvestic behavior can be called an intrusive thought, since when it comes it creates a certain anxiety or distress, and I begin to question my sexuality. When the thought goes away then I think to myself again as a man, an heterosexual man, and if I masturbate with the thoughts i am ashamed about this.
There is no way that I can discern via a blog comment if you are struggling with sex addiction, or OCD, or whatever. What I can say is that it is not at all unusual for people to masturbate to sexual fantasies, some (many?) of which they would not actually choose to act out in real life. Unless your masturbation to these thoughts is negatively impacting your life, I would not be too concerned.
Also, you note that you believe your fantasies are not just thoughts because you masturbate to them. Sorry, but I disagree. They are still just thoughts. Your thoughts don’t become special or different just because you masturbate to them. They are still just thoughts.
All that being said, if you feel your masturbation is an addiction, then I encourage you to seek out an evaluation by a therapist who specializes in treating sexual compulsivity.
I have OCD and have been also struggling with intimacy with my husband. I feel if it is not satisfieing than I don’t want to do it at all. I feel he doesn’t touch me the right way. Like he doesn’t try. When I give up and have sex with him he finishes successfully. And I don’t get mine. This happens over and over. I actually don’t think I ever actually organismed. I’m always daydreaming and fantasizing on enjoying others in sexual ways. Only to come home and not get anything. So I’m dieing here. I’ve had several offers to suposably fulfill my needs outside of marriage. But I just can’t.. or haven’t yet. I don’t want to harm my marriage but I deeply need to fill that part of me sexualy. I’ve asked my husband to please show me more slow and passionate kisses and touching. So I feel special And wanted. He turns it around and blames me. I don’t know if I hate him for that. Or just plain hate him for lasting 14 years of married and I still feal screwed on sex. Am I addicted to sex or do I just have a screwed up situation. ?
There is absolutely nothing in your comment to suggest that you are a sex addict. On the other hand, everything in your comment suggests that, as you put it, you are in “a screwed up situation”. I strongly encourage you to get in to couples counseling with your husband.
I struggle with understanding my condition. I consider myself in recovery from sex addiction related to pornography, masturbation, an fantasy thoughts. However, I also believe I have pure O ocd. I experience intrusive sexual thoughts and images about women, children, and animals. I also ruminate on all the bad things I have done or thought and worry I am an evil person. I also spend time seeking reassurance online, or feeling the need to confess. I struggle with doubt about if I have sex addiction, ocd, or both. I worry that a therapist will not understand and treat things in an unhelpful way.
Just as one can have two (or more) medical conditions simultaneously, one can also have multiple psychological conditions at the same time. It is not particularly unusual for people with OCD to also struggle with other conditions, including sex addiction. Any good therapist who specializes in either of these conditions will be understanding and should be able to help you.
i think my worst problems started because on my childhood i have been sex assaulted with more than one person,as a child i didnt know what to do,eventually it became pleasure.i think that what made my ocd..these things made anxiety on me and i have do things again again.fearing god i know doing things repeatedly cant change my sin,but i cant able to stop,when i am getting older those creepy minds completely taken me,on my age of 15-16 i had sex with childrens like i wanted to touch there private parts and show mine.i didnt think that it made their life bad too,and on my age of 16 i had sex with a lady. that change my life that i realized how bad i became.from that moment i tried had to control myself.but it was too late.its been 6 or more years i havent feel happy,i loved to be a normal boy but i cant and thought of those childrens made me worried,and i didnt know what would i do,if they say those thinks.i have tried to suicide but my family problems made me back.these thoughts even made my ocd symptoms more worst.icant do a single thing without a touch of ocd.dont know a doctor can help me?i often watch porn and masturbate thinking that can help me.can a doctor able to help me ?
Watching porn and masturbating is no cure for feeling guilty about past behaviors. I encourage you to discuss your concerns with a local therapist.