Guest blog: Harriet Jackson
For those unaware of this long-running debate, there is an ongoing and often heated dispute between some professionals about how we describe sexual behaviours that feel out of control. Should we call it “porn addiction” or “sex addiction”? Or should we instead use the clinically endorsed term “Compulsive Sexual Behaviour Disorder” (CSBD)?
This piece won’t dive into the science or research behind that question. Others far more qualified than myself have already done so at length. Instead, I want to approach the issue from a slightly different angle, shaped by the many hats I currently wear.
I work in marketing and communications for both the Laurel Centre and Pivotal Recovery who support people who describe themselves as struggling with porn or sex “addiction.” I’m also a trainee therapist. And before that, I completed a master’s degree in English, where I developed a lasting interest in language – how it carries meaning and how it shapes identity. None of this makes me an expert by any means, but it does mean this debate sticks with me.
Because it is a sticky one. It’s nuanced, emotionally charged, and full of good intentions colliding with real world consequences. And while I don’t believe there are any neat or universal answers, I do want to pose some questions and gently challenge the idea that we should simply stop using the word “addiction” when talking about sexual behaviour. I’m not convinced that doing so is as progressive or harmless as it may first appear.
A (very) brief summary of the debate
The terms “porn addiction” and “sex addiction” have always been controversial. They have never been formal clinical diagnoses, and in 2013 a proposed diagnosis was excluded from the DSM-5 due to insufficient evidence at the time. For some, this was taken as proof that the concept itself was invented. For others, it simply meant “not yet.”
In 2019, Compulsive Sexual Behaviour Disorder was included in the ICD-11 as an impulse control disorder. CSBD describes a persistent inability to control intense sexual impulses or urges, resulting in repetitive behaviours that cause significant distress or impairment – provided that this distress is not driven solely by moral or cultural disapproval.
Interestingly, both sides of the debate claimed victory. Critics of addiction language saw it as confirmation that this was not an addiction. Supporters saw long-awaited recognition of a genuine clinical condition, and perhaps a step along the same path that gambling disorder once took (transitioning from impulse control disorder to behavioural addiction).
Opposition to the word “addiction” is often grounded in legitimate concerns. It can pathologise more diverse sexual behaviours, reinforce shame, or be co-opted by moralistic or ideologically driven approaches. Some practitioners do, regrettably, treat sexual behaviour as if it were a substance problem – importing rigid abstinence models, moral frameworks, or belief systems that simply do not belong in sexual health. Many are not health professionals at all, let alone trained in sexology, and this is a genuine concern.
At the same time, it is misleading to collapse everyone who uses addiction language into that category. Many therapists who still use the word “addiction” are not practising unethically, nor are they denying diagnostic manuals and pretending it is indeed a “real thing”. Their therapeutic approaches often look remarkably similar to those of practitioners who oppose addiction framing entirely. More often than not, they are using the language their clients already bring into the room – and many remain unconvinced that the possibility of a recognised behavioural addiction has been conclusively ruled out.
And so, the questions persist… Should therapists restrict themselves to clinically endorsed terminology? What do we do when clients and the wider public continue to use “porn or sex addiction”? Can the terms CSBD and addiction coexist, or must one replace the other?
From what I can tell, they already coexist, and I suspect that is likely to continue – and for good reason.
A harsh truth: no one is googling CSBD
Putting my marketing hat on for a moment, I want to talk about data.
Search Engine Optimisation (SEO) is the practice of making websites easier to find through search engines, primarily Google. Keywords are a crucial part of this, because they reflect the language people actually use when they are searching for information online. And in the case of CSBD or porn/sex addiction – an issue often shrouded in shame and secrecy – we know the vast majority of people are using online searches to find help.
A few weeks ago, with the support of SEO specialists, I examined UK search data relating to help-seeking around sexual behaviour. On average, around 70,000 people per month search for resources using terms related to “porn addiction” or “sex addiction”. Using the same criteria, approximately 70 people per month search for “CSBD” or “Compulsive Sexual Behaviour Disorder”**.
I expected a gap, of course. CSBD is relatively new and exists predominantly in clinical literature. But a difference of one thousand to one is not trivial and it has real consequences.
I’m aware that discussions of marketing can feel uncomfortably commercial in therapeutic contexts, where profit is (rightly) not the primary motivator. But SEO matters just as much for charities and not-for-profits as it does for private organisations. Visibility determines who finds effective, evidence-informed support, and who does not.
More importantly, this data represents people who are often desperate. People who may be ashamed or completely lost, and who are simply trying to put words to an experience that feels overwhelming. If we completely remove the word “addiction” from this space, we do not remove demand. We just make legitimate support harder to find. In doing so, we risk pushing people toward unqualified coaches or ideologically driven spaces that could cause harm.
This is not, at its core, a marketing issue. It is about inclusion and people getting the help they need. Should we privilege clinical language at the expense of accessibility?
**This data was collated using Semrush, a search engine marketing data aggregator. This data is publicly available, though more detailed reports may require a paid subscription.
Language, meaning, and how change actually happens
Whether we like it or not, language does not change because institutions instruct it to. It changes because people use words to make sense of their lives. Meaning emerges from use, not decree. Think of the many words we hear or use in day-to-day conversation that differ from their technical, dictionary definitions – “literally” (often now just a way to exaggerate a point), or “cool” (which, strictly speaking, is about temperature). Clinical terminology may claim authority, but popular language claims meaning and resonance – and both shape how individuals understand themselves.
The problem is institutions like the ones behind the DSM or ICD move slowly, and for good reason. Gathering evidence takes time, consensus takes even more time, and harm reduction obviously requires caution. But people do not wait for diagnostic manuals before seeking meaning and when clinical language fails to capture lived experience, people fill the gap themselves.
The word “addiction” is psychologically intuitive – meaning it naturally fits how people think, making it easy to understand. It already carries cultural meaning around compulsion, loss of control, and repeated behaviour despite negative consequences. It’s why we read so many stories about coffee addiction, phone addiction, or even chocolate addiction etc, etc. I suspect most people don’t genuinely think these are equal to something like heroin addiction, but it captures what they are trying to convey and we understand. CSBD, by contrast, is entirely unfamiliar. It has little cultural resonance and no presence in everyday discourse.
Can this be changed? The answer is yes – it’s possible. But after some online research, my understanding is this is a painfully slow process that must start from the top down. In other words, unless you get the “big dogs” like the World Health Organisation or the NHS in the UK to categorically state that this language should not be used anymore – it’s virtually impossible. And even then, you’re unlikely to eradicate it from wider public discourse because institutions like WHO or the NHS don’t control that**.
Once a term becomes embedded in something that means a great deal to people – like recovery culture or identity – it becomes remarkably resistant to change.
**Disclaimer: It was difficult to find any clear answers to this – perhaps because there aren’t any – but I welcome any feedback from readers who may have more professional insight on these processes.
Language, culture, and inclusion
There is another dimension to this discussion that is often overlooked: culture.
Much of this debate is taking place within a western, anglophone clinical context, and even within that context, CSBD has little public recognition. Outside of it, the chances of the term being understood are slimmer still.
If large parts of the western world have never heard of CSBD, what hope is there that it resonates globally? Language functions differently across cultures. Concepts of self, sexuality, responsibility, and distress vary widely. Words carry different moral and emotional weight depending on where and how they are used.
Insisting on a single term as the “correct” way to describe this experience risks excluding vast numbers of people. If we are serious about diversity and inclusion in mental health, accessibility must include linguistic accessibility. My understanding is that good therapy depends on shared meaning, and shared meaning depends on language people recognise.
The danger of ignoring these cultural nuances is twofold. First, clients from non-western or multilingual backgrounds may struggle to understand – or even relate to – terms that exist only in English-language clinical discourse. (Indeed, this could apply to both terms – “addiction” and “CSBD”). Second, adopting a single “correct” term without considering its cultural or social weight can inadvertently reinforce exclusionary hierarchies in therapy and mental health more broadly, privileging those already familiar with western diagnostic frameworks.
Therapists as stewards of meaning
This brings me back to therapy.
Is it the therapist’s role to correct a client’s language? Of course, language should be explored – especially if it is causing harm. For example, if an addiction framework is reinforcing shame, encouraging rigid abstinence goals, or blocking intimacy, that deserves thoughtful attention. But if the word “addiction” helps someone articulate distress, legitimise their struggle, and remain engaged in therapy – it’s hard to justify calling for its extinction under the guise of progression.
A lot of the focus of my therapy training so far has been on the importance of the therapeutic relationship – not as a place of information sharing, but as a collaborative, co-construction of meaning. When a client uses the word “addiction”, it means something. They are communicating something about how their experience feels and to reflexively replace that language surely risks invalidating them and causing rupture.
From an ethical standpoint, I keep returning to a simple idea – therapists can’t be the owners of meaning. They are its stewards. Diagnosis and clinical language have their place, for sure, (and that’s mostly down to psychiatrists and researchers). But therapy itself is not primarily about classification; it is about relationship, understanding, and change. The role of the therapist is not to enforce linguistic compliance, but to help clients explore what their language reveals – and whether it is helping or hindering them. But that requires flexibility and humility. And it requires a willingness to sit, perhaps uncomfortably, with ambiguity rather than rushing to resolve it through terminology.
Ultimately, until the science fully settles, therapists are going to have to navigate some difficult tensions: accuracy vs. empathy, precision vs. usefulness, stigma reduction vs. agency.
Pluralism, ethics, and what actually causes harm
The BACP Ethical Framework emphasises autonomy, beneficence, and respect for the client’s lived experience. A rigid insistence on “correct” language, particularly when it risks alienation or exclusion, seems to sit uneasily with those principles. In this sense, using the language that best supports understanding, reduces harm, and facilitates change – (even when it is imperfect or contested) – seems more like an example of ethical responsiveness than negligence.
Of course, this does not mean abandoning or ignoring evidence. We can and should continue to refine and improve clinical terminology. But a pluralistic approach recognises that different frameworks are useful for different people at different times. It means recognising that no single term will ever capture the full range of human experience. In this sense, it seems wise to hold frameworks lightly and apply them thoughtfully, as the ethical failure is not in using the “wrong” word – it is in imposing a framework that does not serve the client’s best interests.
With a pluralistic approach, CSBD and addiction do not need to compete, and frankly, they shouldn’t because I doubt either would win. For now, they need to coexist. One can function as precise, clinical language for journals and diagnostic frameworks; the other can remain a client-facing shorthand that people recognise, relate to, and seek help under. Insisting on a single, “correct” term may satisfy academic neatness, but it does little for someone who just wants support and doesn’t care what chapter of a manual they fall into.
Most importantly, the fixation on terminology risks missing the point entirely. What actually causes damage isn’t the word itself – it’s how the distress is understood and treated. Clients don’t tend to struggle because someone said “addiction” instead of “CSBD” (or vice versa) – they struggle when they’re shamed, moralised, or denied help that resonates with their lived experience.
So yes – names matter – but not nearly as much as outcomes. Accessibility, cultural awareness, empathy, and pragmatic responsiveness are surely more important than terminological purity.
Final thoughts
If keeping the word “addiction” in circulation helps someone recognise their struggle, seek help, and stay engaged long enough to heal, then its continued use is not a failure. It is a reflection of the complex, messy, human realities that therapy exists to sit alongside.
In everyday life, words are tools to make sense of experience, not rigid rules to enforce, and their value lies in the meaning they carry for the person speaking or listening to them. Therapy is ultimately about connection, understanding, and support – about helping someone navigate their lived reality and meeting them where they are.
Perhaps the true measure of progress is not the precision of our language, but by whether our language opens doors or closes them.
