Sexual addiction
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Sexual addiction, also sometimes called sexual compulsion, is a catch-all term for a postulated form of psychological addiction to sexual intercourse and other compulsive sexual behaviors including, but not limited to, viewing pornography, compulsive masturbation, serial cheating, cyber- and phone sex. It is also sometimes called love addiction, although that term has its own specialized distinctions. It has been defined by one addiction therapist as "any sexually related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones and one's work environment."[1]
Sexual addiction, like all addictions, has diverse explanations for how it might occur. Unusual childhood experiences, such as sexual abuse or trauma, presexualization, neglect, as well as other forms of childhood abuse, are particularly likely catalysts for sexual addiction.
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[edit] Diagnosis
There is no consensus in the medical community that sexual addiction actually exists, and it is not presently included in the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.). Those who support its diagnosis describe it as being in many ways similar to other addictions, where the activity comes to be used as a way to manage mood or stress and may become more severe with time. Diagnostic criteria have been suggested that are closely analogous to those the D.S.M. provides for other addictions.
Patrick Carnes, a pioneer researcher in the field of sexual addiction, asserts there are ten specific criteria of addiction:[1]
- Recurrent failure (pattern) to resist impulses to engage in specific sexual behavior.
- Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended.
- Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
- Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience.
- Preoccupation with the behavior or preparatory activities.
- Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social obligations.
- Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
- Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk.
- Giving up or limiting social, occupational, or recreational activities because of the behavior.
- Distress, anxiety, restlessness, or irritability if unable to engage in the behavior.
[edit] Epidemiology
The prevalence of sexual addiction would be hard to determine, in part because addicts are secretive. Proponents of the concept suggest it is commonly seen in combination with other addictions as well as mood and stress disorders. Sometimes, when multiple addictions are present (food, alcohol, drugs, gambling) sexual addiction is said to be the "core" addiction. Sexual addiction has in the past been conceptualized as a largely male problem, but more recent writers have suggested it may also be prevalent in women, although usually manifesting in different ways.
Sexual addiction is hypothesized to be (but is not always) associated with Obsessive-compulsive disorder (OCD), Narcissistic personality disorder, and manic-depression.
[edit] Manifestation
According to proponentes of the concept, sexual addicts may enjoy frequent sexual intercourse and other sexual activities, but the key to this addiction is more the enjoyment of the journey rather than the destination. That is, sexual addicts do not require an orgasmic event in order to feel accomplished in the pursuit of their addiction. This is why sex addicts are sometimes referred to as "drug addicts". While sexually, and even romantically, stimulating activities are what they seek, internally the shot of brain chemicals released when they engage in these activities is what they crave. One such brain chemical released by their activities is the "feel good" neurotransmitter dopamine. Typically, people raise their level of dopamine when they are engaged in romantically and sexually enjoyable activities. It is this heightened level that provides them with a feeling of euphoria. An orgasm boosts this level even more highly. Certain illegal drugs also facilitate the same release, for example methamphetamines or cocaine. These drugs are believed to raise the level of dopamine in the brain to as much as 30 times that which is present during an orgasm. This makes these drugs' effects on the brain extremely enjoyable and highly desirable to people seeking mood elevation[citation needed].
Individuals who experience mood issues and discover the soothing effects brought on by these brain chemicals, quickly learn which behaviors can effectively repeat the experience. A cascading effect begins. Already prone toward tendencies for compulsive or obsessive behavior, the sexual addict starts repeating 'rewarding' activities with a repetition that quickly creates a conditioned response[citation needed]. Over time, however, the constant release of these mood elevating brain chemicals into the body causes them to lose their effectiveness and so addicts find themselves needing to increase, vary or intensify their activities more in order to achieve a similar effect[citation needed]. (Interestingly, the brain chemical releases triggered by the sexual addict are similar to those experienced by gamblers and food addicts[citation needed].)
Sexual addicts engage in a wide variety of sexually stimulating activities, many of which are considered unacceptable, immature or inappropriate by those around them. Thus, to pursue these activities, an addict resorts to secretive methods for his or her arousal. One example of this is the personal viewing of pornography. Repeated viewing of a small selection of pornographic materials can cause the addict to lose interest and to seek out new and different sources[citation needed]. Once the new materials lose their novelty, more are desired[citation needed]. This process explains in part the huge, financial success of the global pornographic industry that is constantly producing new materials for the adult viewer.
According to proponents of the sexual addiction concept, the addict's obsessive / compulsive tendencies can also be seen by the frequency with which they use masturbation for stimulation. Quite often they will perform this activity to the point of injury or to where it interferes significantly with ordinary life. For some addicts, it can even reach a point where the masturbatory activities replace their desire for sexual interactions with others. When a sexual addict does feel comfortable enough to involve other people, quite often they seek out strangers for anonymous sex or look for 'new love' through infidelity. Prostitutes are also employed because of their anonymity and non-judgmental willingness to engage in the sometimes unconventional sexual requests of sex addicts. The varying nature of a sexual addict's activities are in sharp contrast to individuals who commonly prefer more narrowly focused sexual activities such as those engaging in fetishism. But this is not to say that sex addicts cannot be found pursuing fetishes.
As mentioned before, a key feature of sexual addiction is its supposedly compulsive, unmanageable nature. Where as a normal person might stare as they drive past an attractive person, a sexual addict will drive around the block to stare again. They may even plan future ways to spot attractive people so they can repeat the experience over and over. Addicts can spend an extraordinary amount of time and money on their habit, entirely lacking the ability to control it. They often experience an almost trance-like state in which acting out can go on for many hours. As with other addictions, some addicts experience episodic binges (between which they may believe there is no problem), while others experience more continuous problems. Some sexual addicts also swing into the opposite end of the spectrum, engaging in sexual anorexia, where they so tightly control themselves that they have absolutely no sexual experiences. This does not control or cure the basic compulsion, but like food addictions is simply another manifestation of the addiction.
Some sexual addicts act in more intrusive ways, or progress to them as they experience diminishing "highs" for their original activities. A Level 2 addict might include voyeurism and exhibitionism, and rubbing against people in public places. A Level 3 addict involves much more serious and intrusive sexual offenses, and has more harmful consequences.
Patrick Carnes, the most prolific author and a pioneer researcher on this subject, states specific activities are not what identify addiction. Even a rapist may not necessarily be a sexual addict. Rather, it is the compulsive nature of the behaviors that demonstrates addiction.
Addicts have tried often to stop, and failed. Their behavior generally conforms to a cycle:
- Preoccupation -- the addict becomes completely engrossed with sexual thoughts or fantasies.
- Ritualization —- the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
- Compulsive sexual behavior -— the addict's specific sexual acting out.
- Despair —- the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.
To escape these negative feelings, the addict soon becomes preoccupied with sexual thoughts and fantasies again, restarting the addictive cycle. Risk factors for the addict include unstructured time, need for self-direction and demands for excellence, because they all push the addict toward restarting the cycle.
A variety of questionnaires and tests have been devised in attempt to evaluate sexual addiction, but few if any have been formally evaluated, normed, or proven accurate. Proponents of the sexual addiction concept believe the cycle and beliefs above strongly characterize the sexual addict, however. In addition, Carnes proposes a basic test for whether a particular sexual behavior has become addictive:
- It is a secret.
- It is abusive or degrading to self or others.
- It is used to avoid (or is a source of) painful feelings.
- It is empty of a caring, committed relationship.
[edit] Sexual Addiction Cycle
According Patrick Carnes ("Out of the Shadows") - the cycle begins with the "Core Beliefs" that sex addicts hold:
- "I am basically a bad, unworthy person."
- "No one would love me as I am."
- "My needs are never going to be met if I have to depend on others."
- "Sex is my most important need."
These beliefs drive the addiction on its progressive and destructive course:
- Pain agent
First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict) Sex addict is not able to take care of the pain agent in a healthy way.
- Disassociation.
Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to disassociate (moves away from his feelings. A separation begins to take place between his mind and his emotional self.
- Altered state of consciousness / a trance state / bubble of euphoric fantasized experience
Sex addict is disconnected from his emotions and he becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.
- Preoccupation or “sexual pressure” involves obsessing about being sexual or romantic
Fantasy becomes an obsession that serves in some way to avoid life. The addict’s thoughts become focused on reaching a mood-altering high without actually acting-out sexually. He thinks about sex to produce a trance-like state of arousal in order to fully eliminate feelings of the current pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle.
- Ritualization or “acting out”.
These obsessions are intensified through the use of ritualization or acting out. A sex addict first cruises and then goes to a strip show to heighten his arousal until he is beyond the point of saying no. Ritualization helps to put distance between reality and sexual obsession. Rituals are a way to induce trance and further separate oneself from reality. Once the addict has begun his ritual, the chances of stopping that cycle diminish greatly. He is giving into the pull of the compelling sex act.
- Sexual compulsivity
The next phase of the cycle is sexual compulsivity or “sex act”. The tensions that 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 that he has become nothing more than a slave to the addiction.
- Despair
Almost immediately reality sets in and the Addict begins to feel ashamed. Like a dog, he has returned to his vomit. 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. He has betrayed God, possibly a wife, and his own sense of integrity. At a superficial level, the addict hopes that this will be the last battle.
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 (Carnes, "Facing the Shadow" 2006).
[edit] Etiology
Proponents of sexual addiction theorize the following factors to be involved in the etiology of the condition:
- Trauma
- Neurochemistry
- Neural pathways, e.g. Mesolimbic pathway
- Relationship of depression, anxiety, OCD, and Attention Disorders to Sexual Addiction
- Social conditioning and imprinting
- Developmental impairments
- Interaction of loneliness, anger, boredom, and spiritual rebellion
The development of a sexual addiction: Theoretically, for some, sex addiction starts early in life through adolescent experimentation, the discovery of self-stimulation, or early exposure to pornography and other sexual stimulants. Sex becomes a powerful, exciting obsession very early on and the addiction accelerates. For others it may start later in life—during graduate school, divorce, or when stresses become so great that an escape is needed. It becomes a way to self-medicate and cope with the pressures of life and the guilt and shame that follow the addictive behavior.
[edit] Treatment
Self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, and Sex and Love Addicts Anonymous are popular with proponents of the sexual addiction concept. These are large groups based on the 12-step system of Alcoholics Anonymous. There are various online support forums as well as real-life help through an out- or in-patient program or private counsellor. Some intensive programs work with both the addict and the addict's partner.
Professional help:
- Individual therapy
- Group therapy
Therapists also use cognitive-behavioral therapy, and medications may be of value particularly in overcoming conditions or disorders that lead to increased acting out.
It is important to distinguish between sexual addiction and sexual anorexia not related to sexual addiction, as both can present similar behaviors, but effective treatment may be quite different. Aside from depression, it also must be established whether or not the presenting behaviors are due to obsessive-compulsive disorders, bipolar disorders, etc.
It is highly imperative the addict finds an experienced, trained counsellor to help with their addiction. Addicts suffering from other disorders in addition to sexual addiction (Narcissistic Personality Disorder, Borderline Personality Disorder, etc.) rarely reach and maintain a sober recovery without highly trained assistance.
Supposedly, the longer a sex addict has been acting out and the higher the level an addict they are, the lower the chances of a successful, sober recovery being maintained. Unless a sexual addict hits bottom (much like a drug addict) they will rarely seek recovery on their own. Other related, untreated psychological conditions or disorders can also reduce the chances of the addict maintaining a sober recovery.
It is also important that the partner of a sexual addict seek their own, individual counselling to help them learn how to deal with their partner's addiction. There are also online support groups in addition to real-life help.
Many experts believe that the best treatment is to take the addiction to the extreme, and to engage in sexual activities in a public area where it is possible to be seen by others[citation needed]. This could act as a test in order to find out if the "addict" is really an addict.
[edit] Controversy
There are many people and organizations who do not acknowledge sexual addiction as a valid form of addiction. There is an argument as to whether the term has any true meaning for describing human sexual behavior. Many view sexual addiction as an excuse for acting out in this fashion. Other distinctions are difficult to make in a clinical sense, as in between promiscuity and sexual addiction as the main difference lies within the motivation of the act.
Other interpretations of sexual addiction (other than addiction): a compulsion, an impulse control disorder, a sexual desire disorder, a lack of morals and willpower, a form of obsessive compulsive disorder, a disease.
Those who do recognize sexual addiction often equate it to food, gambling, and shopping addictions, where an outside substance isn't used to create the "high."
[edit] Diagnostic criteria
Since there is no diagnostic criteria established in the DSM IV, there is some controversy regarding the existence of sexual addiction and regarding standard treatment. A good abstract on the problem of the DSM IV's failure to include sexual compulsive behavior is outlined in: "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV", Sexual Addiction & Compulsivity 1996, Volume 3, pp 7-21, 1996. by Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D.
- ABSTRACT The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes certain sexual disorders which are characterized by, or include among their features, excessive and/or unusual sexual urges or behaviors. Common disorders in the differential diagnosis include paraphilias, impulse disorder not otherwise specified (NOS), sexual disorder NOS, bipolar affective disorder, cyclothymic disorder, post-traumatic stress disorder, and adjustment disorder. Infrequent disorders in the differential diagnosis consist of substance-induced anxiety disorder, substance-induced mood disorder, dissociative disorder, delusional disorder (erotomania), obsessive-compulsive disorder, gender identity disorder, and delirium, dementia, or other cognitive disorder. Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence.
The American Psychiatric Association (APA) does not yet recognize sex addiction as a mental illness, however, APA have classifications that are helpful for understanding sexual behavior disorders. These disorders are called paraphilias. The most common include: Pedophilia, Exhibitionism, Voyeurism, Sexual masochism, Sexual sadism, Transvestic fetishism, Frotteurism, etc. All of these disorders are characterized by recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving:
- Non-human objects
- The suffering or humiliation of oneself or one's partner, children or other nonconsenting persons
- Clinically significant distress in social, occupational or other important areas of functioning caused by the behavior, sexual urges or fantasies.
Proponents of the sexual addiction concept state that sex addiction may include some obsessions and behavior caused by these disorders. Sexual addiction itself, however, is generally conceptualized as most typically involving conventional, or non-paraphiliac, sexual behaviors that, when taken to an extreme, can interfere with daily functioning and produce guilt, shame and recurrent harm to oneself or others.
The DSM-IV describes one example under the heading of "Sexual Disorders Not Otherwise Specified" as "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.
Not all sexual behaviors that cause problems necessarily reach a diagnostic threshold. Criteria proposed by Eli Coleman to define nonparaphilic compulsive sexual behavior (Compulsive sexual behavior: What to call it, how to treat it? SIECUS Report. New York: Jun/Jul 2003.Vol.31, Iss. 5; pg. 12):
a. involves recurrent and intense normophilic (nonparaphilic) sexually arousing fantasies, sexual urges, and behaviors that cause clinically significant distress in social, occupational, or other important areas of functioning; and
b. is not due simply to another medical condition, substance use disorder, or a developmental disorder
It is important not to label "problems" prematurely and ignore intra-/inter-sociocultural considerations that might better explain the behavior.
[edit] Healthy sexuality
It is important to remember that just because a person engages in certain sexual behaviors, it doesn't mean they are a sexual addict. The key factor in determining if a person is an addict is if their behavior is compulsive. For example, a person occasionally looking at pornography is not necessarily a sexual addict. But a person who spends ten hours a day, spends the mortgage payment, and gets fired because of excessive pornography use is most likely a sex addict. Another example: someone who cheats on their spouse isn't necessarily a sex addict. But someone who is a serial cheater, lies to their spouse about it, and is "driven" to cheat despite what they may want to do is possibly a sex addict.
Another factor in determining sexual addiction as opposed to normal sexual function is if the behaviors are used to self-medicate and escape reality, much like a food addict uses food to self-medicate.
The informal diagnostic criteria is also imprecise as it could be interpreted to indicate sexual addiction in a normal relationship issues.
[edit] Portrayal in popular culture
Some sexual addiction proponents have commented that the concept faces many obstacles to being viewed seriously by the general public. One of these obstacles is the manner in which it is portrayed in popular media. Daily media sources sensationalize and denigrate people who are reported to be sex addicts. This portrayal typically extends into fictional television shows and movies.
- I Am A Sex Addict
- Caveh Zahedi's documentary film I Am A Sex Addict addresses, as the title implies, his personal obsession with prostitutes and the subsequent destruction of short-term relationships that initiate in bar/club scenes. In the film Zahedi re-enacts and reminesces on his struggles with sex addiction and his recovery from it.
- Six Feet Under
- Brenda, a character from HBO's Six Feet Under, was a sex addict, and while the portrayal may seem to be accurate to a point, the problem also seemed to disappear almost as fast as it appeared. Sex addicts may relate to periods where Brenda was having lots of dangerous and anonymous sex, but may disagree with her recovery resulting from very little counselling or intervention. This contributes to the idea that sex addiction is not a true addiction as it can be cured quickly with marriage or discipline.
- Nip/Tuck
- The character Christian Troy in Nip/Tuck has been diagnosed as having a sexual addiction by psychologist Grace Santiago. The character Gina Russo was also attending group therapy for sexual addiction, eventually contracting HIV.
- A Dirty Shame
- This 2004 movie entitled A Dirty Shame starring Tracy Ullman as Sylvia Stickles is about a conservative housewife who suffers a concussion and is passed "the gift of sex addiction" by Ray Ray Perkins (Johnny Knoxville). While the movie refers directly to Sylvia as being a sex addict, the movie does not accurately represent sexual addiction and rather mocks the stereotype of the condition.
- Choke
- Choke, a novel by Chuck Palahniuk, shows how the main character, Victor Mancini, snoops around groups similar to Sexaholics Anonymous, not only recovering from his own sex addiction, but also to find possible sex partners.
- Slaughter Disc
- Slaughter Disc, written and directed by David Quitmeyer, is a modern horror film where the main character is a college-aged porn addict. The ghost of a murdered porn star seeks revenge by using a porn addict's gravitation towards explicit sexual content to kill them off and enslave their souls. This film has caused controversy amongst horror film fans as it depicts gore, graphic violence and actual explicit hardcore sex acts.
[edit] References
- ^ a b Carnes, Patrick (2001). Out of the Shadows: Understanding Sexual Addiction. Center City, MN: Hazelden.
- Feeney, Judith and Patricia Noller. Adult Attachment. Thousand Oaks, CA: Sage Publications, 1996.
- Kasl, Charlotte Davis. Women, Sex, and Power: A Search for Love and Power. New York, NY: Harper and Row, 1990.
- Schaumburg, Harry W. False Intimacy: Understanding the Struggle of Sexual Addiction. Colorado Springs, CO: NavPress 1997.
[edit] See also
- Addiction
- Pornography addiction
- Cybersex
- Disease model of addiction
- Obsessive-compulsive disorder
- Self-help groups / programs: 12 steps:
[edit] External links
- General Information about Sexual Addiction
- Sexual Addiction Blog and Sex Addiction Recovery Video Training
- Overcome Sexual Addiction
- Sex Addiction on the Internet, Mark Griffiths
- Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV
- Diagnosis and Treatment
- Does Sex Addiction Exist? by Lynne Schultz
- The myth of sex addiction and Why There's No Such Thing as Sexual Addiction -- And Why It Really Matters by sex therapist Marty Klein, Ph.D.
