Sexual addiction

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Sexual addiction (sometimes called sex addiction) is a conceptual model devised in order to provide a scientific explanation for sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control—in terms of being a literal addiction to sexual activity. This phenomenon is not newly described in the literature, but it has been described by many different terms: hypersexuality, erotomania, nymphomania, satyriasis, Don Juanism (or Don Juanitaism), and—most recently—sexual addiction, compulsive sexual behaviour, and paraphilia-related disorders.[1]:12[2][3]

Hypersexuality is a related continuous theoretical construct. Higher hypersexuality has been associated with addictive or obsessive personalities, escapism, psychological disorders, low self-esteem, self-destructive behavior, lowered sexual inhibitions, and behavioral conditioning. Alcohol, hormone imbalance, change of life hormone levels (e.g. during puberty, adulthood, middle age, menopause, or elderly life),[4][5][6] behavior modification, operant conditioning, and many drugs affect a person's social and sexual inhibitions, while reducing integral human bonding abilities for intimacy. Addiction is the state of behavior outside the boundaries of social norms which reduces an individual's ability to function efficiently in general routine aspects of life or develop healthy relationships.

Medical studies and related opinions vary among professional psychologists, sociologists, clinical sexologists, and other specialists regarding whether "sexual addiction" is a medical, physiological, and psychological addiction, and whether it is representative of a psychological/psychiatric condition at all.

Dispute about the concept[edit]

External media
Images
The History and Rise of Sex and Love Addiction (INFOGRAPHIC)
Audio
Robert Weiss & David Ley. Is sex addiction a myth? // KPCC (April 25, 2012, 9:29 am)
Video
Nicole Prause, Ph.D. (sexual physiologist). [1] CBS (July 18, 2013)

Medical studies and related opinions vary among professional psychologists, sociologists, clinical sexologists and other specialists on sexual addiction as a medical physiological and psychological addiction, or representative of a psychological/psychiatric condition at all. Proponents of the sexual addiction model draw analogies between hypersexuality and substance addiction or negative behavioral patterns similar to gambling addiction, recommending 12-step and other addiction-based methods of treatment. Other explanatory models of hypersexuality include sexual compulsivity and sexual impulsivity.

Science largely fails to support the addiction model. Recent data show most report distress associated with religious beliefs, which would represent cultural inconsistencies, not pathology.[7] A recent review of the addiction model (by a clinician, sexual physiologist, and addictions neuroscientist) with respect to viewing sexual images similarly found no evidence to support an addiction model [8] Earlier debates had not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.[9][10] Some experts regard sexual addiction as a medical form of clinical addiction, directly analogous to alcohol and drug addictions. Other experts believe that sexual addiction is actually a form of obsessive compulsive disorder and refer to it as sexual compulsivity.[11] Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.[12][13] Some who have expressed doubts about the existence of sex addiction argue that the condition is instead a way of projecting social stigma onto patients.[12]

An example of how far this critique sometimes goes is Marty Klein's claim that "The concept of sex addiction provides an excellent example of a model that is both sex-negative and politically disastrous."[14]:8 Klein singles out a number of features that he considers crucial limitations of the sex addiction model:[14]:8

  • pathology oriented
  • pathologize non-problematic behavior
  • clinically incomplete
  • without context (both individual and situational)
  • culturally bound
  • politically exploited

Klein states that the diagnostic criteria for sexual addiction are easy to find on the Internet (www.sexhelp.com/sast.cfm).[14]:9 Drawing on the Sexual Addiction Screening Test, he states that "The sexual addiction diagnostic criteria make problems of nonproblematic experiences, and as a result pathologize a majority of people."[14]:10

Origin[edit]

Sex addiction as a term first emerged in the mid-1970s when various members of Alcoholics Anonymous sought to apply the principles of 12-Steps toward sexual recovery from serial infidelity and other unmanageable compulsive sex behaviors that were similar to the powerlessness and un-manageability they experienced with alcoholism.[15] This resulted in the creation of new support groups that all seemed to independently surface spontaneously within this same era.[16] Sex and Love Addicts Anonymous (S.L.A.A.) was founded first in Boston in 1976, followed by Sex Addicts Anonymous (SAA) in 1977, Sexaholics Anonymous in 1979, and later, Sexual Compulsives Anonymous (SCA) and Sexual Recovery Anonymous (SRA). Together these are known as the “S” programs or S-fellowships because they all focus on sexual recovery.[17] They tend to differ on what constitutes sexual "sobriety". In SLAA, SAA, and SCA, members define their individual sobriety by abstaining from personally-identified sexually addictive behaviors. In SA, sobriety is solely defined as monogamous sex in a heterosexual marriage with no masturbation. SRA defines sobriety similarly to SA, but both committed heterosexual and homosexual relationships are recognized.

There are various online and phone support meetings for these groups as well as meetings in many cities and towns all over the world.

There are also programs for those who regard themselves as the traumatized or otherwise affected partners of sex addicts such as COSA and CO-SLAA.

Medical models[edit]

DSM[edit]

The American Psychiatric Association publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders (DSM), a widely recognized compendium of acknowledged mental disorders and their diagnostic criteria.

The version published in 1987 (DSM-III-R), referred to "distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used."[18] The reference to sexual addiction was subsequently removed.[19] The DSM-IV-TR, published in 2000 (DSM-IV-TR), did not include sexual addiction as a mental disorder.[20] The DSM-IV-TR included a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified,stating : "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used." (Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.)[20] This diagnostic definition did not mention sexual addiction, but focused on the patient's distress as to their sexual behavior (contrary to the pattern of denial in addiction as mentioned below), not on the sexual behavior itself.

Hypersexuality, by itself, can also be a symptom of hypomania and mania in bipolar disorder and schizoaffective disorder, as defined in the DSM-IV-R.

Some authors suggested that sexual addiction should be re-introduced into the DSM system;[21] however, sexual addiction was rejected for inclusion in the DSM-5, which was published in 2013.[22] Darrel Regier, vice-chair of the DSM-5 task force, said that "[A]lthough 'hypersexuality' is a proposed new addition...[the phenomenon] was not at the point where we were ready to call it an addiction." The proposed diagnosis does not make the cut as an official psychiatric diagnosis due to a lack of substantial empirical evidence, according to the American Psychiatric Association.[23][24]

ASAM[edit]

On August 15, 2011 the American Society of Addiction Medicine issued a public statement defining all addiction (including sex addiction) in terms of brain changes. "Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry."[25]

The following excerpts are taken from the FAQs:

"The new ASAM definition makes a departure from equating addiction with just substance dependence, by describing how addiction is also related to behaviors that are rewarding. This is the first time that ASAM has taken an official position that addiction is not solely "substance dependence." This definition says that addiction is about functioning and brain circuitry and how the structure and function of the brains of persons with addiction differ from the structure and function of the brains of persons who do not have addiction. It talks about reward circuitry in the brain and related circuitry, but the emphasis is not on the external rewards that act on the reward system. Food, sexual behaviors[clarification needed] and gambling behaviors can be associated with the pathological pursuit of rewards described in this new definition of addiction."

"We all have the brain reward circuitry that makes food and sex rewarding. In fact, this is a survival mechanism. In a healthy brain, these rewards have feedback mechanisms for satiety or 'enough.' In someone with addiction, the circuitry becomes dysfunctional such that the message to the individual becomes ‘more’, which leads to the pathological pursuit of rewards and/or relief through the use of substances and behaviors. So, anyone who has addiction is vulnerable to food and sex addiction.[26]

ICD[edit]

The World Health Organization produces the International Classification of Diseases (ICD), which is not limited to mental disorders. The most recent version of that document, ICD-10, includes "Excessive sexual drive" as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).[27]

Symptoms and diagnostic criteria[edit]

Several mental health providers have proposed various, but similar, criteria for diagnosing sexual addiction, including Patrick Carnes,[28] Aviel Goodman,[29] and Jennifer P. Schneider.[30] None of these proposals has been adopted into any official diagnostic manual, however.

During the update of the Diagnostic and Statistical Manual to version 5 (DSM-5), the American Psychiatric Association rejected two independent proposals for inclusion.

The International Classification of Diseases (ICD-10) of the World Health Organization, however, does include an entry for "Excessive Masturbation"[31] and another for "Excessive Sexual Drive."[32]

Causes[edit]

Sexual addiction has been variously hypothesized often to be associated with obsessive-compulsive disorder (OCD), Borderline Personality Disorder (BPD), narcissistic personality disorder,[33][34] and bipolar disorder.[35] There are those who suffer from more than one condition simultaneously (co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.[9][36][37]

Specialists in obsessive-compulsive disorder and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.[36]

According to proponents of sexual addiction as a disorder, addicts often display narcissistic traits; these are said to often clear as sobriety is achieved, although others exhibit the full personality disorder even after successful addiction treatment.[33]

Proponents of the concept have described sufferers as repeatedly and compulsively attempting to escape emotional or physical discomfort by using ritualized, sexualized behaviors such as masturbation, pornography, including obsessive thoughts. Some individuals try to connect with others through highly impersonal intimate behaviors: empty affairs, frequent visits to prostitutes, voyeurism, exhibitionism, frotteurism, cybersex, and the like.[citation needed]

Neurochemical theories[edit]

Earle has argued that neurochemical changes, similar to an adrenaline rush in the brain, temporarily reduce the discomfort an individual experiences with urges and cravings for sexualized behaviors that can be achieved through obsessive, highly ritualized patterns of sexual behavior.[38]

Psychological distress theories[edit]

Patrick Carnes (2001, p. 40) argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. A child brought up in a family that takes proper care of them has good chances of growing up well, having faith in other people, and having self-worth. On the other hand, a child who grows up in a family that neglects them will develop unhealthy and negative core beliefs. They grow up to believe that people in the world do not care about them. Later in life, the person has trouble keeping stable relationships and feels isolated. Generally, addicts do not perceive themselves as worthwhile human beings. (Carnes, Delmonico and Griffin, 2001, p. 40) They cope with these feelings of isolation and weakness by engaging in excessive sex. (Poudat, 2005, p. 121)

According to Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts hold:[39]

  1. "I am basically a bad, unworthy person."
  2. "No one would love me as I am."
  3. "My needs are never going to be met if I have to depend on others."
  4. "Sex is my most important need."

These beliefs drive the addiction on its progressive and destructive course:[39]

  • Pain agent — First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict). A sex addict is not able to take care of the pain agent in a healthy way.
  • Dissociation — Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addicts begin to dissociate (moves away from his or her feelings). A separation begins to take place between his or her mind and his or her emotional self.
  • Altered state of consciousness / a trance state / bubble of euphoric fantasized experience — Sex addict is emotionally disconnected and is pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.
  • Preoccupation or "sexual pressure" — This involves obsessing about being sexual or romantic. Fantasy is an obsession that serves in some way to avoid life. The addict's thoughts focus on reaching a mood-altering high without actually acting-out sexually. They think about sex to produce a trance-like state of arousal to eliminate the pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before they move to the next stage of the cycle.
  • Ritualization or "acting out" — These obsessions are intensified by ritualization or acting out. Ritualization helps distance reality from sexual obsession. Rituals induce trance and further separate the addict from reality. Once the addict begins the ritual, the chances of stopping that cycle diminish greatly. They give into the pull of the compelling sex act.
  • Sexual compulsivity — The next phase of the cycle is sexual compulsivity or "sex act". The tensions the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes they are a slave to the addiction.
  • Despair — Almost immediately reality sets in, and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. They may feel they have betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this is the last battle.

According to Carnes, for many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself.[40]

Dr. Carnes mentions that:

Al Cooper (one of the original researchers in internet sex) described internet sex as the ‘crack cocaine’ of sexual addiction because it is an accelerant for adults of all stages of the lifespan. He felt that people would never have the problem if it had not been for the internet.[41]

Treatment approaches[edit]

Therapies[edit]

Certified Sex Addiction Therapists are specially trained to treat sex addiction.[42]

Other treatment[edit]

Decades of pharmaceutical research and billions of dollars in marketing have emphasized the broad range of physiological chemical inhibitors that range from positive to negative emotional psychological chemical hormones. Targeted to treat addictions by interrupting neurotransmitters, these synthetic chemical hormones attempt to adjust behavior through the effect of reducing libido, SSRIs have been used in research studies and off-label to treat symptoms of overly frequent sexual urges, but their effects are not always robust.[43][44]

In popular culture[edit]

Sexual addiction has been portrayed in the 2005 film I Am a Sex Addict, the 2008 film Choke, the 2010 film Group Sex, and the 2011 film Shame. It also is a core theme of the 2012 film Thanks for Sharing, the 2013 film Don Jon, and the 2014 film Nymphomaniac.

See also[edit]

References[edit]

  1. ^ Coleman, Eli (June–July 2003). "Compulsive Sexual Behavior: What to Call It, How to Treat It?". SIECUS Report. The Debate: Sexual Addiction and Compulsion (ProQuest Academic Research Library) 31 (5): 12–16. Retrieved 2012-10-15. 
  2. ^ Coleman, E. (2011). "Chapter 28. Impulsive/compulsive sexual behavior: Assessment and treatment". In Grant, Jon E.; Potenza, Marc N. The Oxford Handbook of Impulse Control Disorders. New York: Oxford University Press. p. 375. ISBN 9780195389715. 
  3. ^ Carnes, Patrick (1994). Contrary to Love: Helping the Sexual Addict. Hazelden Publishing. p. 28. ISBN 1568380593. 
  4. ^ Bancroft, J. (September 2005). "The endocrinology of sexual arousal". Journal of Endocrinology 186 (1): 411–427. doi:10.1677/joe.1.06233. PMID 16135662. Retrieved 2012-06-04. 
  5. ^ Heidi Murkoff Increased Sex Drive During Pregnancy
  6. ^ Salynn Boyles. "Testosterone Increases Libido in Women". WebMD. Retrieved 2012-06-04. 
  7. ^ Grubbs, J., Exline, J., Pargament, K., Hook, J., & Carlisle, R. (2014). "Transgression as Addiction: Religiosity and Moral Disapproval as Predictors of Perceived Addiction to Pornography". Archives of Sexual Behavior. online first. doi:10.1007/s10508-013-0257-z. 
  8. ^ Ley, D ., Prause, N., and Finn, P. (2014). "The Emperor Has No Clothes: A Review of the ‘Pornography Addiction’ Model". Current Sexual Health Reports 1 (1). doi:10.1007/s11930-014-0016-8. 
  9. ^ a b Francoeur, R. T. (1994). Taking sides: Clashing views on controversial issues in human sexuality, p. 25. Dushkin Pub. Group.
  10. ^ Kingston, D. A.; Firestone, P. (2008). "Problematic hypersexuality: A review of conceptualization and diagnosis". Sexual Addiction and Compulsivity 15 (4): 284–310. doi:10.1080/10720160802289249. 
  11. ^ Mayo Clinic Website
  12. ^ a b Levine, M. P.; Troiden, R. R. (1988). "The myth of sexual compulsivity". Journal of Sex Research 25 (3): 347–363. doi:10.1080/00224498809551467. 
  13. ^ Giles, J. (2006). "No such thing as excessive levels of sexual behavior". Archives of Sexual Behavior 35 (6): 641–642. doi:10.1007/s10508-006-9098-3. PMID 17109229. 
  14. ^ a b c d Klein, Marty (June–July 2003). "Sex Addiction: A Dangerous Clinical Concept". SIECUS Report (ProQuest Academic Research Library) 31 (5): 8–11. Retrieved 2012-10-15. 
  15. ^ Augustine Fellowship (June 1986). Sex and Love Addicts Anonymous. Augustine Fellowship. ISBN 0-9615701-1-3. OCLC 13004050. 
  16. ^ | AddictionBlog.org article by Alexandra Katehakis
  17. ^ Sex Addicts Anonymous S-Fellowship page
  18. ^ American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author.
  19. ^ Kafka, M. P. (2010). "Hypersexual Disorder: A proposed diagnosis for DSM-V" (PDF). Archives of Sexual Behavior 39 (2): 377–400. doi:10.1007/s10508-009-9574-7. PMID 19937105. 
  20. ^ a b American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author.
  21. ^ Irons, R.; Irons, J. P. (1996). "Differential diagnosis of addictive sexual disorders using the DSM-IV". Sexual Addiction & Compulsivity 3: 7–21. doi:10.1080/10720169608400096. 
  22. ^ Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' USA Today.
  23. ^ Rachael Rettner (Dec 6, 2012). "'Sex Addiction' Still Not Official Disorder". LiveScience. Retrieved 2013-01-02. 
  24. ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 481, 797–798. ISBN 978-0-89042-555-8. "Thus, groups of repetitive behaviors, which some term behavioral addictions, with such subcategories as "sex addiction," "exercise addiction," or "shopping addiction," are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders." 
  25. ^ American Society of Addiction Medicine. (2011). Public Policy Statement: Definition of Addiction. http://www.asam.org/research-treatment/definition-of-addiction
  26. ^ American Society of Addiction Medicine." (2011). DEFINITION OF ADDICTION: FREQUENTLY ASKED QUESTIONS. http://www.asam.org/pdf/Advocacy/20110816_DefofAddiction-FAQs.pdf[dead link]
  27. ^ International Classification of Diseases, version 2007.
  28. ^ Patrick Carnes; David Delmonico, Elizabeth Griffin (2001). In the Shadows of the Net. p. 31. ISBN 1-59285-149-5. 
  29. ^ Goodman, Aviel (1998). Sexual Addiction: An Integrated Approach. Madison, Connecticut: International Universities Press. pp. 233–234. ISBN 978-0-8236-6063-6 
  30. ^ Schneider,[citation needed] 1994, pp.19–44
  31. ^ "2012 ICD-10-CM Diagnosis Code F98.8 : Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence". Icd10data.com. Retrieved 2012-06-22. 
  32. ^ "2012 ICD-10 Diagnosis Code F52.7 : Excessive sexual drive". Retrieved 2013-02-22. 
  33. ^ a b Ulman, Richard B.; Harry Paul (2006). The Self Psychology of Addiction and Its Treatment. Psychology Press. ISBN 1-58391-307-6. 
  34. ^ Ralph Earle; Gregory M. Crow, Kevin Osborn (1989). Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents. p. 57. 
  35. ^ Williams, Terrie M. (2008). Black Pain: It Just Looks Like We're Not Hurting. Simon & Schuster. p. 114. ISBN 0-7432-9882-9. "[..]diagnosed as bipolar or manic-depressive, but his depression first started manifesting itself as sexual addiction," 
  36. ^ a b Hollander, Eric; Dan J. Stein (1997). Obsessive-compulsive Disorders. Informa Health Care. p. 212. ISBN 0-203-21521-4. 
  37. ^ Linda Berg-Cross; Marcia Hill (2001). Couples Therapy. Haworth Clinical Practice Press. p. 375. "They found that sexual narcissism is more common among men ... These characteristics are also central to the person with a sexual addiction" 
  38. ^ Earle, R., Crow, G. M., & Osborn, K. (1989). Lonely all the time: Recognizing, understanding, and overcoming sex addiction, for addicts and co-dependents. Simon & Schuster.
  39. ^ a b Patrick Carnes, Out of the Shadows: Understanding Sexual Addiction" (1983), ISBN 978-1-56838-621-8
  40. ^ Patrick Carnes (2006) Facing the Shadow
  41. ^ University of Florida Department of Psychiatry
  42. ^ r.evolution psychotherapy article "Sex Addiction Therapy: What to Look for, What to Avoid"
  43. ^ books.google.com
  44. ^ ajp.psychiatryonline.org

Further reading[edit]

There are several books which offer overview history and treatment techniques for sexual addiction, including the following
There are also books focusing on partners of sex addicts
  • My Secret Life with a Sex Addict - from discovery to recovery by Emma Dawson. (Thornton Publishing, 2004) ISBN 978-1-932344-70-7
  • Hope After Betrayal: Healing When Sexual Addiction Invades Your Marriage by Meg Wilson. (Kregel Publications, 2007) ISBN 978-0-8254-3935-3
  • Deceived: Facing Sexual Betrayal Lies and Secrets by Claudia Black. (Hazelden, 2009) ISBN 978-1-59285-698-5
  • Your Sexually Addicted Spouse: How Partners Can Cope and Heal by Barbara Steffens and Marsha Means. (New Horizon Press, 2009) ISBN 978-0-88282-309-6
  • Mending a Shattered Heart: A Guide for Partners of Sex Addicts by Stefanie Carnes. (Gentle Path Press, 2011) ISBN 978-0-9774400-6-1
  • A Couple's Guide to Sexual Addiction: A Step-by-Step Plan to Rebuild Trust and Restore Intimacy by Paldrom Collins and George Collins. (Adams Media, 2011) ISBN 978-1-4405-1221-6
The interested reader can find discussions of the concept of sexual addiction in

External links[edit]