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"I'll be using the terms 'online sexual compulsivity' and 'sexual acting out,'" he tells the audience. "As this field develops, it's important to develop a consistent lexicon. ... There are debates about names and definitions in the field that are beyond the scope of what we're talking about today."
Then he plugs his book. "And if you buy it today, we'll throw in a blender," he jokes.
Throughout his speech, he avoids using the word "addiction," though he does reference the work and treatment philosophy of Dr. Patrick Carnes, the controversial figure who coined the term "sex addiction" in the 1980s. The seminar itself is titled "Cybersex Addictions: How to Identify and Treat the Affects of Aberrant Online Sexual Pursuits."
"I'm mixed about [the debate]," Cooper tells me later. "I think people kind of have an association with 'sex addiction,' but I don't think it's that accurate and I think it's a little simplistic. So, in professional meetings I usually say that. If I do an interview and they want to use the term 'sexual addiction,' I may make a comment about it, but I'm willing to do it because, I mean ... I know they're not going to take 300 words to explain the finer point."
Cooper, like many others in the field, prefers the term "sexual compulsivity." "A compulsion is more that you're driven by psychological needs, not a physiological dependence on it," Cooper says. "For me, I have a position, I believe in my position, it's the most informed position that I can have."
Certainly, the debate runs deep within the professional community, and Cooper is by no means considered an extremist on the subject. "[Professionals in the field] can't seem to arrive at a consensus as to what to call this clinical syndrome," says Dr. Eli Coleman, director of the human sexuality program at the University of Minnesota Medical School and a past president of the Society for the Scientific Study of Sexuality. "There is a problem with excessive and compulsive and impulsive sexual behavior. But 'sexual addiction' is a term that has caught on mostly in the media, and has not been greeted very well in the scientific community or the psychiatric community. The dangers are in oversimplifying a complex phenomenon. 'Sex addiction' is an unfortunate and imprecise term which can be very misleading to understanding the source of the problem, and can create a potential misdirection of treatment."
Still others warn that the concept of addictive sexual behavior -- regardless of whether it's called an "addiction" or a "compulsion" -- is a sex-negative perspective. The actual level of sexual danger has been inflated in the media, in response to the work of people like Carnes and Cooper.
"My issue with 'sex addiction' is that it pathologizes what, in many cases, are perfectly valid and helpful activities," says Dr. Marty Klein, an outspoken Palo Alto-based opponent of the sex addiction model who publishes frequently on sexuality. "And when it does address activities that are not healthy, it does it in a way that is based on certain assumptions about sexuality that I don't think are helpful.
"That people are more involved in the Internet and sexuality than they like to be is an important thing to talk about," he goes on. "But Dr. Cooper describes online sexual activity to include a lot of things that, if they were not done online, they would not be considered sexual. ... He has expanded the category so broadly that it inflates the number of people who are involved, sexually, on the Internet. It obscures the actual phenomenon of people who are involved in Internet sexuality in a problematic way."
Cooper, however, believes the issue is significant, and he says it merits the attention it's getting. "I think it's a big problem," he says. "We see it all over. It's a big problem for society and I don't think we're inflating it at all. ... We hear it from clinicians all over the country, we see it in the media, we see it in the Centre, we see it from our research."
There are many who agree with him. His data is now being referenced by about 20 psychologists and scientists who are conducting a large-scale study that may lead to the inclusion of "sexual compulsivity/addiction" in the next edition of the Diagnostic and Statistical Manual(DSM-V). (They are not an official working group for the publication.) The members of this group, which includes people with varying opinions on the terminology debate, have read Cooper's articles; their study will look at four different populations: a sample group representative of the American population as a whole; a group consisting of people receiving treatment for "out-of-control sexual behavior"; another group consisting of people receiving therapy for non-sex-related primary psychiatric problems; and a group made up of incarcerated sex offenders. These randomly selected individuals will respond to a test-piloted survey in order to help researchers better understand the issue and to clarify the phenomenon's defining clinical signs and symptoms.
"The main controversy around [trying to include 'sexual compulsivity/addiction' in the DSM] is that some people in the scientific community would probably argue that there isn't good empirical data to demonstrate that this is a disorder," says Iowa State's Epperson, who is heading the study. "The purpose of this large-scale study is to answer that question."