When does having sex or fixating on romantic relationships become an addiction? Photo / Getty Images
Elizabeth Gilbert, the author of Eat, Pray, Love, delves into her struggle with an obsessive relationship in a new memoir.
In Elizabeth Gilbert’s third memoir, All the Way to the River, she introduces herself as a sex and love addict, divulging in granular detail her relationship with her best friend, Rayya Elias, a hairdresser and former drug addict, and their eventual descent into codependency and obsessive romantic love.
Their romance begins shortly after Elias is diagnosed with cancer. Gilbert quickly assumes the role of caregiver, and later, the role of enabler, buying cocaine for Elias and tying off her arms or legs so that Elias can shoot up.
It’s a dark departure from Gilbert’s wildly successful 2006 book Eat, Pray, Love, which chronicled her travels abroad as she sought lighthearted adventure, romance and healing after a painful divorce.
What she details in her newest book is that this ravenous quest for intimacy has been a long-standing pattern. In an interview last year, Gilbert admitted to having had more than 40 “deeply intimate relationships” before embracing sobriety and choosing abstinence from both sex and romantic pursuits.
“You’re sort of pimping yourself out” to “try to get that love connection,” she said at the time. “It’s not pretty, but it’s what I’ve done.”
But when does having sex or fixating on romantic relationships become an addiction?
Although there is an entire treatment industry devoted to “sex and love addiction,” as well as numerous 12-step groups, there is no such diagnosis in psychiatry or psychology.
The current version of the DSM, the diagnostic manual used by mental health professionals, leaves out sexual compulsions in the chapter on addiction, citing limited scientific evidence. Sexual compulsion would fall under what the manual calls “unspecified sexual dysfunction”.
“There is an enormous controversy about the term,” said Anna Randall, a sex therapist and clinical social worker who leads The Alternative Sexualities Health Research Alliance.
Instead, experts sometimes use the term “out of control sexual behaviour” or the diagnosis “compulsive sexual behaviour disorder,” which is cited by the World Health Organisation.
But there has been “a lot of discussion” about including sex addiction in the next version of the DSM, said Dr Petros Levounis, an addiction expert and former president of the American Psychiatric Association.
Whether you call it “sex addiction” or not, the symptoms are real and often debilitating. According to the WHO, compulsive sexual behaviour disorder is characterised by the “failure to control intense, repetitive sexual impulses or urges” that can include intercourse, masturbation or viewing pornography.
Love addiction, like sex addiction, is not a clinical diagnosis. But the term is sometimes informally used to describe a pattern of intense preoccupation with, or dependency on, romantic relationships.
Love addiction tends to express itself in two predominant ways. In the “attraction phase,” people are excessively preoccupied with appearing attractive and having people love them, Levounis said.
And in the “attachment phase,” people feel as if they must always be in a romantic relationship, he added. They may end up with partners who are not good for them, but they are so “addicted” to a romantic relationship that they “have to have somebody, no matter what,” Levounis said. It’s possible to experience both phases at the same time, he added.
In the book, Gilbert recounts how she blew up marriages – hers and those of other people – in pursuit of her compulsions.
“No matter how costly the consequences, I kept acting out,” she wrote. And when it came to Elias, she added, “I came to believe, quite literally, that I could not live without Rayya – that a world without Rayya’s attention and infinitely calming ministrations was a world not worth enduring”.
There is very little research on love addiction and to what extent it might occur alongside sexual compulsions. Typically, people who identify as love addicts, like Gilbert, are fixated on a specific person and fantasise that their love interest will be their “everything” and meet every unmet need, Randall said.
Oftentimes, yes.
While sexual compulsions can feel uncontrollable, a fixation on sex, porn or love may not be the only issue to address, Randall said. Rather, these urges might be a person’s way of handling interpersonal conflict, past trauma, boredom or emotional pain that seems overwhelming.
They can also signal the presence of psychiatric issues such as obsessive-compulsive or attention deficit hyperactivity disorders, which may lead to difficulties with intrusive thoughts or impulse control.
Silva Neves, a psychotherapist in London who specialises in the treatment of compulsive sexual behaviours, believes that self-identified love addicts may have experienced what psychologists call attachment injury during childhood.
In other words, when a child’s relationship with a caregiver is compromised because of trauma like abuse, neglect or separation, that child may develop problematic relationships later in life.
A person diagnosed with compulsive sexual behaviour disorder is in “significant distress” and has trouble functioning, said Beata Bothe, a sexual compulsions expert and an assistant professor in the department of psychology at the University of Montreal. They might be in conflict with friends or family members, or have difficulties at school or work.
Frequency of sexual behaviour alone does not suggest that a person has a sexual compulsion, Bothe clarified. And people may also find that their sexual activities become less and less satisfying over time.
Those who identify as love addicts may report similar problems, as well as a constant need for reassurance and a history of difficult relationships.
Typically, patients address sexual or love compulsions with group or individual therapy as well as 12-step programmes.
In All the Way to the River, Gilbert attributes her sobriety to the 12-step process, explaining what it felt like to turn herself over to a higher power, make amends and accept that she was powerless over her addictions.
At first, she said, she hated going to the meetings, finding them both “confronting and confusing”. But she now credits the programme with teaching her “that pouring myself into someone is not necessarily ‘romantic’ – and just might be toxic for all parties concerned”.
Because 12-step programmes are morality-based, they aren’t for everyone, Neves said. He has counselled clients who felt “harmed” by 12-step programmes, he added, because they pushed for abstinence or monogamy.
“That doesn’t really give people real agency over their sex life and their relationship,” Neves said.
The type of treatment required depends on the person’s symptoms and access to resources. It’s also important to diagnose and treat any conditions, like ADHD, that may occur alongside the compulsions, experts said.
With support, most people with sexual compulsions can improve. There may not be a “universal cure,” Bothe said, but “recovery and improved wellbeing are possible.”
This article originally appeared in The New York Times.
Written by: Christina Caron
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