In fact, in the five years since Weiner’s initial scandal, the American Psychiatric Association had a big opportunity to recognize sex addiction and Internet addiction as distinct diseases. But the APA included neither in its 2013 update to the Diagnostic and Statistical Manual of Mental Disorders, citing a lack of reliable, controlled studies.
The problem is essentially this: Anecdotally speaking, many people use the Internet, or run their sex lives, in a way that look and sound pretty addictive. They appear to display, or they self-report, problematic behaviors like excessive use, tolerance, negative repercussions and withdrawal symptoms.
But just because it looks like a duck and quacks like a duck, that doesn’t mean it’s not actually … a moose. For one thing, no one has established that these behaviors are governed by the same sorts of neurological patterns that characterize, say, substance abuse. (In fact, a 2013 study suggested they are not.)
And no one knows for sure whether “Internet addiction” and “sex addiction” are actually their very own diseases, or another disease’s symptom. What little research exists in this vein suggests that these sorts of “addictive” behaviors frequently coexist with other problems, like depression, substance abuse, and anxiety disorders. Writing in The Atlantic in 2013, the psychotherapist Joseph Burgo linked problematic sexting to narcissism; a recent study in the journal Computers in Human Behavior also found that the people most inclined to problematic sexting are the ones inclined toward other sorts of “high-risk behaviors.”
In the absence of clarity, individual therapists have tried what they can: traditional one-on-one counseling, in-patient therapy, meetings of self-declared “sex addicts.” A 2008 paper published in the journal CNS Drugs recommended “marital and family therapy” and “online self-help books and tapes” (… no irony intended, as far as we can tell). Meanwhile, the Center for Internet Addiction, one of the first targeted treatment centers in the U.S., has developed an approach based in cognitive-behavioral therapy, or CBT. Prospective patients are encouraged to take a self-assessment test with questions like: “do you feel preoccupied with using the online world for sex?”
Alas, you don’t need an advanced degree to know none of that worked as intended.