A large number of sex addicts have attention deficit hyperactivity disorder (ADHD)

Dr. Rory Reid of UCLA did research in 2007 and 2011 in which groups of men in treatment for sex addiction were assessed for ADHD and in which 23%-26% were found to meet the criteria for adult ADHD.  Almost all of these (97%) were of the “predominantly inattentive type” rather than being predominantly hyperactive. (The prevalence of ADHD in the general population is 3-5% according to Reid.)

Can impulsivity or low self-concept explain the correlation?

Dr. Reid also gathered evidence about whether ADHD might be “driving” sex addiction due to the impulsivity of people with attention deficit as children.

He found that it is not impulsivity but the detrimental affects on self-esteem suffered by children with ADHD that causes them to seek to self-medicate with drugs or sex to cope with their poor self concept and low self confidence. (This argument rests on the fact that many adults with ADHD began as children with ADHD.)

The low self-esteem explanation makes sense in light of the fact cited by Dr. Reid that 11-35% of people with chemical dependency and pathological gambling also have adult ADHD.

Perhaps ADHD is so hard on children’s self esteem that they look for any drug they can find to cope with the pain.  As children, virtually the only drug available is sexual self-soothing.

Posttraumatic dissociation may look like ADHD

Dr. Patrick Carnes has talked about sex addiction as, among other things, an “Attention Deficit Disorder.”

Problems that resemble what we think of as Attention Deficit Disorder are evident in those cases where the person has a traumatic history leading to dissociative splitting, or dissociative avoidance.  In such cases the person cannot stay present and focused due to automatic reactions of fear learned earlier in life.  They “zone out” or freeze.

Most sex addicts have experienced trauma in the form of disturbances in their early attachment bonds to their parents or caretakers.  Maybe the addict’s inattentiveness and poor ability to focus in addicts is related to childhood experiences.

Diagnosing ADHD

I have worked with dozens of kids diagnosed with ADHD.   It seemed to me that most of them had problematic attachment histories and dysfunctional families.  I suspected that a large number of them were experiencing various trauma reactions, including dissociation rather than true ADHD.  (The best assessments for ADHD incorporate a battery of neuropsychological measures rather than relying on pencil and paper tests.   Such tests are more discriminating but they are not routinely used.)

So maybe these children were protecting themselves from stressful or traumatic life experiences like rejection, abandonment threats, or outright abuse by dissociating as a way to numb the pain.

As adults such people would “meet the criteria” for ADHD when in fact they simply had a life-long post traumatic response of detaching their attention and zoning out.  These people would also be at risk for sex addiction and other addictions.

But this implies that many more addicts should have ADHD-like symptoms such as inattentiveness and distractability.  In reality maybe they do.

Many sex addicts report ADHD symptoms when asked

More sex addicts feel that they have ADHD than are professionally assessed as meeting the criteria for ADHD.  Dr. Reid also reported a study in 2004 in which sex addicts filled out self-report questionnaires.  That study found that 67% of sex addicts subjectively reported symptoms of ADHD!  This finding supports the idea that there is something else going on, something like post-traumatic splitting or dissociation.

The difficult question is which came first, a “true” attention deficit disorder followed by low self esteem and later by addiction, or the early stressful attachment history followed by all of the above?

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  1. This article causes me to wonder if a sex addict with ADD like symptoms were to undergo deep trauma work if their symptoms and zoning out and deep insecurities would diminish to the point of no longer an issue in their lives.

    • I think you are right. But generally they need to be abstinent from acting out behavior for a while first because it’s hard to do deeper work with someone who is using a “drug”.

  2. Have you ever experienced the change in a client from someone who had ADD symptoms, but then, after deeper work,”lose” those symptoms?

    Is there any research showing help/improvement in sex addicts ability to cope and embrace their therapy better with ADD medication?

    • I don’t know of such research. I see addicts having fewer attention problems after sex addiction recovery.

  3. If 67% of any group self identifies with a diagnosis, does the diagnosis itself need to be refined by adding more excluding criteria?
    I believe it is the author Pete Walker who made a comment to the effect that if the underlying role of child maltreatment was accurately acknowledged when making psychological diagnoses, the DSM would only be three pages long.

    • Very funny/sad and true. The DSM is loaded with disease entities that are really symptoms.

  4. I have been in SA for about 19 months now, and I believe I have achieved a level of recovery beyond just sobriety. I feared working with others believing that I’d never be able to really listen to another addict. But one of the first things I noticed in my new state of living in the “Fourth Dimension” was a new-found ability to focus on others. in fact, many of my fellows in meetings and on phone calls tell me that they find me easy to talk to, that I really “listen”. Wonder if that’s a common byproduct of moving into Recovery?

    • Yes, you bet. Recovery is all about connecting with things and people outside yourself. Capacity for empathy comes with good recovery over time.

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