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But they haven’t had sex since June 2012, haven’t even seen each other naked (except by accident) since he told her he was a sex addict.

Almost every night, they separately attend meetings or therapy.

For this reason, many clinicians prefer the term even though they concede that the distinction is mostly semantic.

But the practical effects of such uncertainty are enormous.

In the age of smartphones and frictionless-dating apps, sex addiction is like being hooked on a drug that's always available in unlimited supply.

It's like living with a meth dealer at your side, or a brick of cocaine in your pocket.

But what the picture really seems to capture, and perhaps this is why he won’t look directly into the lens, is Jacob at war with himself, trying to erase one terrible thought from his brain: that if his wife knew who he really was—if she knew about the pornography, the explicit online chats, the anonymous sex with other women, with random men—she would get as far away from him as she could.

There's no health coverage for it, no medication, and for those trapped in its strange and unrelenting spell, no easy way out.

SEX ADDICTION— diagnosing it, treating it, portraying it on-screen—is big business.

The movie industry, for its part, has released at least five films on sex addiction in the past five years, six if you count both parts of Lars von Trier’s But even now, sex addiction seems to exist in parallel realities: one in which millions of people are struggling with it, and another in which it is barely studied and not even clinically recognized.

Research has yet to confirm that extreme sexual behavior really is addictive in the same neuroscientific sense that, for instance, habitual heroin use appears to be.

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