What is sexual addiction?

By Luke, founder of Bramble · his story · how this was written · October 4, 2026

Sexual addiction is a name for a pattern, not a diagnosis. A man keeps doing something sexual, most often looking at porn or masturbating, after he has decided he will not, and he keeps doing it after he can see what it costs him. Clinicians argue about whether “addiction” is the right word for that. They do not argue about whether the pattern is real.

That second sentence is the one that gets lost, and it gets lost in both directions. A man who reads that the term is disputed can feel let off: it isn’t even a real thing. A man who reads a list of signs on a treatment-center website can feel sentenced: so that’s what I am. Neither is a fair reading, and I would rather you had the actual definitions in front of you than either.

This page does three things. It sets out what the major definitions say, and who wrote them. It shows where the argument actually is. And it names what a clinician looks for, which is a shorter list than any of the definitions and the one nobody disputes. At the end there is a test, if you want one.

Neither manual uses the word

The two books clinicians diagnose from are the World Health Organization’s International Classification of Diseases and the American Psychiatric Association’s Diagnostic and Statistical Manual. Neither lists sexual addiction.

The WHO’s eleventh edition, in effect since January 2022, lists compulsive sexual behaviour disorder, code 6C72. It sits among the impulse-control disorders. The WHO keeps a separate block for “disorders due to addictive behaviours,” which holds gambling and gaming, and that block names compulsive sexual behaviour as an exclusion (the WHO entry). The American manual lists nothing. A working group proposed “hypersexual disorder” for its fifth edition in 2010 and tested it on 207 patients in a field trial. The APA’s trustees left it out, and it did not return in the 2022 revision (Briken and colleagues, 2024).

So the first thing to know is a little strange. “Sex addiction” is everywhere: on treatment-center websites, in twelve-step rooms, in books. It is nowhere in the manuals. The term comes from clinical practice and the recovery community, which is a fine place for a word to come from, and also a reason to ask what it means.

The definitions, side by side

Here are the five that matter, in the order they appeared. Read down the third column and something becomes visible: the words change from one to the next, and the structure hardly does.

The ten signs in the Carnes row are as summarized in a 2018 review that cites his 2000 paper. His own books were not available to check, so treat the wording as a summary.

Where Carnes fits

Patrick Carnes published Out of the Shadows in 1983, and the term travelled with the book. The international guideline panel that reviewed the field in 2022 describes that early work as resting on clinical case reports and theory, not on empirical research (Turner and colleagues). That is how most clinical descriptions begin. Someone treats a great many people, sees a pattern, and gives it a name. It is also the reason the research that followed matters, and the reason this page is careful about which claims it repeats.

Where the argument actually is

The case for calling it an addiction

Men with the pattern describe craving, loss of control and carrying on despite harm, which is how substance addiction is described. Two small brain-imaging studies found heightened responses to sexual cues in men with compulsive sexual behavior: 19 men compared with 19 controls in 2014, and 28 men seeking treatment compared with 24 controls in 2017. The first found the response was one of wanting, not of liking more. The American manual moved gambling into its addictions chapter in 2013 on similar grounds, and some researchers argue sexual behavior should follow. Those studies are small, all male, and a single snapshot, so they cannot say which came first.

The case against

The WHO’s own authors took what they called a “relatively conservative position”: it is not yet known whether sexual behavior works through the same processes as drugs or gambling, so they placed it with the impulse-control disorders and said the understanding would evolve (Kraus and colleagues, 2018). AASECT said in 2016 that it found insufficient evidence to classify sex or porn addiction as a mental health disorder. A review of 371 papers published between 1995 and 2020 found mostly simple study designs, weak theory, poor measurement and almost no high-quality research on treatment. And two signs that make something look like a drug addiction, needing more and feeling withdrawal, are still debated for sexual behavior. Neither the proposed hypersexual-disorder criteria nor the WHO text includes them.

What is not in dispute

That some people lose control of their sexual behavior and pay for it. The WHO says so. So does AASECT, the sharpest critic of the addiction label: it acknowledges that people can suffer serious physical, psychological, spiritual and sexual consequences. That shame and guilt are real, and are not the diagnosis. That the first treatment is talking with someone trained, and that no medication has a formal indication for it (Turner and colleagues, 2022). So the word is argued over. The suffering is not.

How common is it?

Nobody can give you a trustworthy headcount of sex addicts, because the number depends on the question. Here are four findings, each from a serious study, and each answering a different one.

In order: Briken et al., 2022; Dickenson et al., 2018; Skegg et al., 2010; Bőthe et al., 2023. The German figures are the lifetime ones for men; the 12-month figure is 3.2%. The New Zealand figure for men was just under 13%.

You may also have seen “3 to 6 percent.” It is the most repeated figure in this field, and it has no study behind it. It began as an estimate, and a 2013 review found no original research data supporting it.

Read the four together and the honest answer is a range. A few percent of adults meet a strict screen. Roughly a tenth of men report real distress about their control. How many of them would be diagnosed after a proper interview, nobody knows. The New Zealand figure is the one to remember: far more people feel out of control than are living with the consequences of it.

What a clinician actually looks for

Put the definitions down and look at what they share. It is five things.

• Loss of control. He tries to cut back or stop, and it does not hold. Every definition has this one.
• Carrying on despite harm. He can see what it costs, and he keeps going.
• Time and attention. It takes real time, or it becomes the center of his days, to the point of crowding out other things.
• Distress or damage. Marked distress, or real harm to his work, his relationships or other parts of his life.
• Duration. Not one bad week. The WHO’s example is six months or more.

The older sets, including the one attributed to Carnes, add tolerance, needing more to feel the same, and restlessness without it. The WHO’s text and Kafka’s criteria do not, and researchers still disagree about whether they apply here.

Just as useful is what clinicians say is not enough on its own. The WHO’s guidance for the people applying its diagnosis is specific about it.

• A high sex drive, or a lot of sex. High interest without impaired control is not the disorder.
• Shame or guilt. They are real, and they are not reliable markers. People who call themselves sex addicts do not always show the disorder on examination.
• Disapproval alone. If the distress is entirely about moral judgment, the diagnosis does not apply. The WHO’s own example is a religious young man who believes he should never masturbate.
• A short spike. A few months after a move or a breakup is not a pattern.
• Calling yourself one. Clinicians are told to check whether control is actually impaired, whatever name the man uses for himself.

Conscience and control are different troubles

The third item on that list deserves its own section, because it is where a lot of Christian men get lost.

A man who believes something is wrong and grieves it can feel exactly like a man who cannot stop. From the inside they are hard to tell apart, and researchers have been studying the mix-up for a decade. In several samples, being more religious predicted feeling addicted to porn, and the link ran through moral disapproval and not through how much porn a person actually used (Grubbs and colleagues, 2015). A 2019 review pulling the studies together concluded that many reports of addiction are better explained by the gap between what a person believes and what he does.

It cuts the other way as well, and those studies deserve the same weight. In a Polish sample of about a thousand adults, how often a person used porn was the strongest predictor of feeling addicted, stronger than moral disapproval (Lewczuk and colleagues, 2021). In the German survey above, a strict religious upbringing was more common among the people who met the screen, 32.0% against 22.6%, and the authors warned that a screen can undercount religious men who have real symptoms (Briken and colleagues, 2022).

Put plainly: some men carry a problem of conscience, some a problem of control, and many carry both. They need different help. Conscience needs a pastor or a counselor who takes your convictions seriously. Control needs someone trained in exactly this, and usually another person in the room, because it was rarely a willpower problem. Telling which is which is a conversation, not a questionnaire. And the grief, whichever it is, is not evidence against you. What it proves is what you love.

What this is not saying about you

If you came here wondering whether you are one, this page cannot say, and no page can. I would also gently suggest that the word is not the question. I am not a clinician. I am a man who struggled from the age of ten to thirty-eight, and for years I would have said no to most of what a page like this one asks. What finally freed me was not a better word for it. It was no longer doing it alone.

At Bramble we picture it as a bramble in the ground: something that took root and grew thick, and not a verdict on the man. The plain words are porn, masturbation, and a loss of control over either. The picture is only there so that you do not have to become the word.

What about the SAST?

The test most people mean when they search for this is the Sexual Addiction Screening Test, Carnes’ own. The original has 25 yes-or-no questions. A revised version, the SAST-R, came out in 2010 with 45, of which 20 form the core. Two things are worth knowing about it.

It is copyrighted. IITAP, the institute Carnes founded, offers the official version free and anonymous, so this site links to it and does not reproduce it. And the lines for reading it have never been settled. A 2018 validation study of the original, run on 2,528 people in Spain, notes that it is “not possible to determine with true certainty” its diagnostic validity, and published cut-offs differ between versions and between sources.

That is no reason to avoid it. It is a reason to read a score as a prompt for a conversation, and not as an answer. The official test is here.

A test, if you want one

We built a different one, on the WHO’s definition instead of Carnes’. Nineteen statements about the last six months, a score, and a plain reading of what the score can and cannot tell you. It comes from a screen that its researchers published for anyone to reproduce, so unlike the SAST, we can show it to you whole. Nothing you answer leaves the page.

If you would rather start smaller, ten honest questions takes about three minutes, and six more takes two. Neither gives a score.

The short version

• Sexual addiction is a name for a pattern, not a diagnosis. The only formal one is the WHO’s compulsive sexual behaviour disorder, filed under impulse control and not under addiction. The American manual has none.
• Clinicians dispute the word. They do not dispute that people lose control of their sexual behavior and pay for it.
• What they look for is loss of control, carrying on despite harm, time and attention, distress or damage, and enough duration to be a pattern.
• A high sex drive, shame or moral disapproval is not enough on its own, and conscience and control are different troubles.
• A test is a reason to talk to someone. It is not a verdict.