Sexual addiction

Not to be confused with Erotomania or Nymphomania

The term Sexual addiction is used to describe the behavior of a person who has an unusually intense sex drive or obsession with sex. Sexual Addiction Causes, Symptoms, Diagnosis and Treatment on MedicineNet.com Sexual addiction, also called sexual compulsion is a form of psychological addiction.

The behavior of sex addicts is comparable to behavior of alcoholics and addicts, where sex functions like a drug. A common definition of alcoholism is that a person has a pathological relationship with this mood altering drug. It provides a quick mood change, works every time and the user loses control over their compulsion. Like alcoholics, sex addicts' lives rotate around the constant desire for their "drug" of choice.

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.
  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 the 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, 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 irritability if unable to engage in the behavior.

Symptoms

Schneider, identified three indicators of sexual addiction. These indicators are compulsivity, continuation despite consequences and obsession.

Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior .

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.

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 should be thinking about are neglected.

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 can be said to be the "core" addiction; other times, one of the others is seen as the "core." 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, 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. There are those who suffer from more than one condition simultaneously (known as a dual diagnosis or a 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.

Specialists in obsessive-compulsive disorder (OCD) 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.

Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full Personality Disorder even after successful addiction treatment.

Some bipolar people are misdiagnosed as sex addicts. Some sex addicts are misdiagnosed as bipolar. Some addicts do also suffer from bipolar disorder.

Manifestation

According to proponents of the concept, sexual addicts may enjoy frequent sexual intercourse and other sexual activities including sexual fantasies, 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 "chemical addicts", because of the high dose of brain chemicals that are released during sexual activity, arousal and sexual fantasizing. This heavy dose of brain chemicals is what the sex addict is really after (although many do not even realize it). Some reports indicate that these chemicals are hundreds of times more addictive than heroin or cocaine. 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. Dopamine levels rise dramatically 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 higher. 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 thirty 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 .

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. Thereafter, 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 . 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 . (Interestingly, the brain chemical releases triggered by the sexual addict are similar to those experienced by gamblers and food addicts.)

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. Whereas 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, exhibitionism, and frotteurism. A Level 3 addict involves much more serious and intrusive sexual offenses, and has more harmful consequences.

Patrick Carnes states that 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:

  1. Preoccupation - the addict becomes completely engrossed with sexual thoughts or fantasies.
  2. Ritualization - the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
  3. Compulsive sexual behavior - the addict's specific sexual acting out.
  4. 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 attempts 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:

  1. It is a secret.
  2. It is abusive or degrading to self or others.
  3. It is used to avoid (or is a source of) painful feelings.
  4. It is empty of a caring, committed relationship.

Consequences of Sexual Addiction

Some consequences that often result from sexual addiction and indicate the existence of sexual addiction include:

These consequences are progressive and predictable. The addict tends to minimize the consequences and tends to blame others for them. Family and friends minimize consequences by believing the addict's promise that the behavior will change.

Sexual Addiction Cycle

According to Patrick Carnes (Out of the Shadows) - the cycle begins with the "Core Beliefs" that sex addicts hold:

  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:

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. 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. Sex addict is disconnected from his emotions and he becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.

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.

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.

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. He may feel he has betrayed spiritual beliefs, possibly a partner, and his or her 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).

Etiology

Proponents of sexual addiction theorize the following factors to be involved in the etiology of the condition:

The psychodynamic perspective is a very effective system to use when explaining sexual addiction. This perspective places very much importance on early childhood development. The way that a child is treated by his parents and his peers during his childhood and youth has a great impact on his later life. Negative events and maltreatment that occurs during this period can scar the rest of a child's life. The impression that these elements have on someone's life are very hard to later eliminate.

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. If a child is brought up in a family where his parents take proper care of him, he 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 is neglected by his parents he will develop unhealthy and negative core beliefs. He will grow up to believe that people in the world do not care about him. 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 (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).

The development of a sexual addiction theoretically, for some, 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.

Treatment

The initial therapeutic intervention for sexual addiction needs to include an assessment for other addictions. It is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist.

The behavior of sex addicts has profound effects on partners, children, parents and siblings. The addict is usually partially or totally unaware that their behavior has affected their loved ones. Families develop unhealthy coping skills as they strive to adapt to the addict's shifting moods and behavior. Curiously some addicts may act out in solo isolating behaviors leading to feelings of family abandonment. For these reasons, friends and families will often need to be involved in the recovery process.

Those who do not attend 12-step meetings have a much more difficult time recovering, if they do at all. In many ways recovery from significant sexual addiction can be more difficult than recovering from some of the other addictions. The heavy prevalence of sexual abuse in the backgrounds of sex addicts is one reason. In addition, sexual addiction fundamentally involves a problem with intimacy, something important for successful recovery.

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:

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.

Controversy

Scientists specializing in sexual behavior generally agree on what constitutes out-of-control sexual behavior, but they disagree over whether it is appropriately diagnosed as an addiction or as a symptom of an underlying obsessive-compulsive disorder, which can cause sexual obsessions and in some cases acting out of the obsessions. For opposing positions in this debate, see the two special issues on Medical Aspects of Sexual Addiction/Compulsivity of the American Journal of Preventive Psychiatry and Neurology, dated May 1990 and Spring 1991.

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 addiction, and shopping addictions, where an outside substance isn't used to create the "high."

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.

The American Psychiatric Association (APA) does not yet recognize sex addiction as a mental illness; however, the APA has 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:

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.

Clinically relevant criteria for diagnosing sexual addiction proposed by Goodman (Goodman, 2001, pp. 195-196)

A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:

1. tolerance, as defined by either of the following: a. a need for markedly increased amount or intensity of the behavior to achieve the desired effect

b. markedly diminished effect with continued involvement in the behavior at the same level or intensity 2. withdrawal, as manifested by either of the following:

a. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior

b. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms

3. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended

4. there is a persistent desire or unsuccessful efforts to cut down or control the behavior

5. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects

6. important social, occupational, or recreational activities are given up or reduced because of the behavior

7. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior

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.

References

Alyson, 2003

Science based (research based) books on sexual addiction:

More books can be found at: *www.sexaddictrecovery.com/saresources.html

Articles in scientific journals:

See also

External links

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This article is based on "Sexual addiction" from the free encyclopedia Wikipedia (http://en.wikipedia.org). It is licensed under the terms of the GNU Free Documentation Licencse. In the Wikipedia you can find a list of the authors by visiting the following address: http://en.wikipedia.org/w/index.php?title=Sexual+addiction&action=history