Sexual addiction

Sexual addiction
By Carlos T Mock, MD
February 16, 2009


Sexual addiction refers to a controversial phenomenon in which individuals report being unable to control their sexual behavior. It has also been called "hypersexuality," "sexual dependency," and "sexual compulsivity." It affects all human beings and is not dependent on your sexual orientation or gender identity. Studies currently show that 40 percent of people considered sexual compulsives are women.

The existence of the condition is not universally accepted by sexologists, and there is a lot of debate about its causes, nature, and existence. Proponents of the concept have offered many descriptions, each according to their beliefs related to the cause.

Terminology

"Nymphomania" and "satyriasis" are not listed as disorders in the DSM-IV, though they remain a part of ICD-10, each listed as a subtype of "Hypersexuality." The threshold for what constitutes hypersexuality is subject to debate, and critics question whether a standardized diagnostic threshold even exists. The consensus among those who consider this a disorder is that the threshold is met when the behavior causes distress or impaired social functioning. 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 most recent version of that manual, DSM-IV-TR, was published in 2000 and does not recognize sexual addiction as a diagnosis.

Addiction Model

Patrick Carnes, noted psychologist and author of Out of the Shadows, is a proponent of the addiction model of sexual addiction. He proposed using the following symptoms as a definition of “Sexual Addiction:”
1. Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex.
2. Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended.
3. Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
4. Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience.
5. Preoccupation with the behavior or preparatory activities.
6. Frequent engaging in violent sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations.
7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
8. 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.
9. Giving up or limiting social, occupational, or recreational activities because of the behavior.
10. Distress, anxiety, restlessness, or violence if unable to engage in the behavior.

Obsessive/compulsive model

Jennifer Schneider, a physician certified in Internal Medicine, identified three indicators of the obsessive/compulsive model:
1. Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior.
2. Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires. Despite all of these consequences, they continue indulging in excessive sexual activity.
3. Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected.

Skeptics

Sex drive varies widely in humans; what one person would regard as a normal sex drive might be deemed to be excessive by some and low by others. Skeptics believe that a “normal” amount of sexual activity can’t be quantified; therefore they refuse to define what would be considered hypersexual. For instance a person who is unemployed because of a mild disability has a lot of free time. He has a lot more time and access to sexual behavior than a workaholic. The argument follows the logic that what some people consider a normal amount of time spent working at your job, varies from one individual to another. Skeptics argue that society does not condemn workaholics, and for that reason should not condemn hypersexual individuals.

Those who work in the sexual addiction field say that for some, its root is in childhood trauma. For others, there are underlying factors such as anxiety, depression, a need for attention and validation and extreme loneliness. Other issues that impact the problem are high rates of substance abuse and alcoholism, which add another layer. But according to skeptics and many others in the field, it isn’t about the actual sex. That’s why you see a compulsive gambler continue sitting at the table even after he or she won all the money they could possibly need. It’s the prospect of winning, of getting laid, of finding a steamier image than the last.

Manifestation

According to the book Synopsis of Psychiatry, sex addicts are unable to control their sexual impulses, which can involve the entire spectrum of sexual fantasy or behavior. Eventually, the need for sexual activity increases, and the person's behavior is motivated solely by the persistent desire to experience the sex act and the history usually reveals a long-standing pattern of such behavior, which the person repeatedly has tried to stop, but without success. Although a patient may have feelings of guilt and remorse after the act, these feelings are not sufficient to prevent its recurrence and the patient may report that the need to act out is most severe during stressful periods or when angry, depressed, anxious, or otherwise dysphoric. Eventually, the sexual activity interferes with the person's social, vocational, or marital life, which begins to deteriorate.

Etiology

Addiction theories: Neurophysiologist 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.

Obsessive/compulsive theory: Psychologist Patrick Carnes argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. If a child is brought up in a family where his or her parents take proper care of him or her, he or she has good chances of growing up, having faith in other people and having self worth. On the other hand, if a child grows up in a family where he or she is neglected by his or her parents he or she will develop unhealthy and negative core beliefs. He or she will grow up to believe that people in the world do not care about him or her. Later on in life, the person will have trouble keeping stable relationships and will experience feelings of isolation. Generally, addicts do not perceive themselves as worthwhile human beings. They cope with these feelings of isolation and weakness by engaging in excessive sex.

Treatment

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.
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 counselor.

Conclusions

The Society for the Advancement of Sexual Health estimates that 3-5 percent of Americans suffer from sexual addiction. They call their estimate “conservative” because the numbers are only based on those who seek treatment. Many don’t because of the stigma attached to it. Proponents of addiction as the cause of the phenomenon refer to it as "sexual addiction" and often compare it to substance addictions. Proponents of lack-of-control as the cause of the phenomenon refer to it as "sexual compulsivity" and consider it part of the obsessive-compulsive disorders (OCD). Skeptics believe that it is a myth that the phenomenon exists as a disease or disorder at all and is instead a by-product of cultural and other influences.

Sex drive varies widely in humans; what one person would regard as a normal sex drive might be deemed to be excessive by some and low by others. Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon. Despite the skepticism that surrounds it, “sexual addiction” is a topic that can’t be ignored. While most people will not even talk about the subject, the fact is that many of these people know someone who fits the bill, whether it’s a friend who spends every night of the week hooking up with strangers at the expense of sleep and relationships, or a coworker who gets fired for constantly surfing for porn during office hours.



Dr. Mock has published four books with Floricanto Press, Berklety, CA. His articles have appeared on publications like The Chicago Tribune and several gay and lesbian newspapers. He was inducted in The Chicago GLBT Hall of Fame in 2007. He can be reached at: www.carlostmock.com