Female Sexual Addiction Can Be More Difficult to Diagnose and Treat

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As stated in a previous post, female sex addicts —even when they’re having sex just as frequently, in the same ways, in similar venues, and with the same basic consequences as their male counterparts—tend to downplay their sexual involvement, instead discussing their issues in terms of relationships, dating, and intimacy. Because of this, they can be considerably more difficult to diagnose and treat.

Often, sex addiction in women is identified only after a woman has entered treatment for another issue—most often an eating disorder, a substance use disorder (alcoholism or drug addiction), depression, or some form of anxiety. Typically, these women seek help for their presenting issue, whatever that issue might be, and then they act out in highly sexual ways during treatment—everything from dressing inappropriately to disrupting group sessions with excessive flirting to engaging in sexual activity with other clients or even staff members. In fact, many of the women who eventually end up in treatment for sexual addiction get there only after they’ve been asked to leave another treatment setting because of their compulsive sexual behaviors.

Generally speaking, a man who masturbates regularly and hooks up with anonymous sex partners three or four (or ten to twenty) times per week will usually rather easily self-identify as a sex addict if and when his sexual behaviors start to cause problems. Meanwhile, a woman seeking clinical help, even though she may masturbate and have anonymous sex just as often, is unlikely to self-identify as a sex addict. She is also less likely to be diagnosed in treatment, even by a knowledgeable therapist, as sexually addicted.

The primary reasons for this are:

  • Women are less likely than men to openly present a full sexual history (unless questioned in detail).
  • Clinicians often struggle to overcome their culturally biased vision of women being less sexual than men.
  • Many therapists feel uncomfortable asking detailed, potentially graphic questions about sexual behavior, in part because they are typically not trained on how or when to do so.
  • Female sex addicts tend to distort and minimize their problematic sexual behavior patterns by entering therapy complaining about other issues—dating and relationships, drug and alcohol relapse, eating disorders, self-harm, childhood abuse, etc.

Making an already difficult clinical task even more challenging is the fact that females are much more likely than males to present in treatment with a history of childhood sexual abuse. In such cases, well-meaning therapists may focus on resolving a woman’s past sexual trauma, forgetting to address the other end of the spectrum—her adult-life sexual behaviors. A lot of women actually leave trauma-focused treatment because their lives are not improving, no matter how much they work on the past, because the adult-life manifestations of their trauma—their sexually compulsive behaviors—are not being addressed.