SA and OCD: Ask the Experts

Today we continue our Ask the Experts series with Dan Drake, CSAT and CCPS (APSATS) answering the question “How often do you find the SA also has OCD”?

Dan's Answer This is a good but difficult question: How often do sex addiction and Obsessive Compulsive Disorder go together? I’ve definitely seen these two conditions go together, so let’s take a few minutes to explore the connection between SA and OCD.

But, What is SA Exactly

The first thing we need to do is to look at how the mental health field understands SA. Unfortunately, as many of you may (painfully) know already, the mental health field doesn’t have a clear definition about how to define or understand SA in the first place… For example, people like Martin Kafka and Rory Reid see these sexual behaviors as symptoms of “Hypersexual Disorder.” Douglas Braun Harvey uses the phrase “Out of Control Sexual Behavior.” Bill Herring calls it “Chronically Problematic Sexual Behavior,” and the Society for Sexual Health uses the term, “Problematic Sexual Behavior.” Paula Hall has her ISAT, “Institute for Sex Addiction Training,” and Michael Barta has his TINSA, “Trauma Induced Sex Addiction,” model. Recently the World Health Organization finally began to recognize the term “Compulsive Sexual Behavior Disorder.” And IITAP, founded by Patrick Carnes, uses the term “Sex Addiction.” Still others, like AASECT, the American Association of Sexuality Educators, Counselors and Therapists came out saying that they do not endorse any sex addiction model. And still further, individuals like David Ley have made a living saying that sex addiction isn’t even real.

Lisa Taylor, who you all know(!) has done a lot of work to understand these different approaches to understanding SA, explaining the different approaches in an understandable way. So if you’re overwhelmed by all of this, I get it! But we ARE moving closer towards a better understanding of SA.

An OCD/SA Framework

So why spend a whole paragraph going through definitions of SA when that wasn’t the question?! When I saw the question about how SA and OCD go together, it made me think of Eli Coleman’s understanding of SA. Yes, there are still more approaches to understanding SA behaviors…. Eli Coleman looks at “Compulsive Sexual Behavior” as a variant of OCD. Meaning, he sees SA behaviors as one way that OCD can show up in people’s lives. This does make some sense, as a key component of addictive behaviors is obsession and preoccupation of behaviors.

Here’s where we have to get a bit clinical, though: For obsessions to meet criteria for OCD they need to be distressing. That is, the person with OCD has obsessive thoughts that are intrusive (they don’t like or want them), so they engage in compulsive behaviors to help minimize the distress of the obsessions. So, for example, if I have intrusive thoughts related to germs and intense fear of some kind of contamination (obsession), I may compulsively wipe down surfaces or wash my hands repeatedly (compulsion).

A number of years ago, Jennifer Schneider addressed this issue. In this article, she says, “When sexual or seductive (romantic) behavior is the focus of obsessive mental activity, is neither acted upon nor produces gratification, and is causing significant distress, then it may meet the criteria for OCD. In our experience, such rare cases are associated with nonsexual behavioral manifestations of OCD.” So going back to SA, typically the SA obsessions are NOT distressing. In fact, the preoccupation / obsession is a part of the high of the SA behaviors. There are of course times when this is not the case, and the obsessions may be distressing to the person. In these cases the obsessions may very well be a part of OCD.

Stay tuned next week though for more thoughts on the OCD/SA connection.


Dan Drake is a licensed professional counselor, certified sex addiction therapist, certified clinical partner specialist and board member of APSATS. He works out of Banyan Therapy in Los Angeles and is the co-author of Letters from a Sex Addict.