Sexual addiction - AbsoluteAstronomy.com

Sexual addiction is a popular model to explain hypersexuality

Hypersexuality

Hypersexuality is extremely frequent or suddenly increased sexual urges or sexual activity. Hypersexuality is typically associated with lowered sexual inhibitions. Although hypersexuality can be caused by some medical conditions or medications, in most cases the cause is unknown...

—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control. Hypersexuality is typically associated with lowered sexual inhibition

Sexual inhibition

A sexual inhibition is a conscious or unconscious constraint or curtailment by a person of behaviour relating to specific sexual matters or practices or of a discussion of sexual matters....

s, and alcohol

Alcohol

In chemistry, an alcohol is an organic compound in which the hydroxy functional group is bound to a carbon atom. In particular, this carbon center should be saturated, having single bonds to three other atoms....

and some drugs can affect a person's social and sexual inhibitions.

There are differences of opinion among sexologists as to whether the phenomenon represents an actual addiction

Addiction

Historically, addiction has been defined as physical and psychological dependence on psychoactive substances which cross the blood-brain barrier once ingested, temporarily altering the chemical milieu of the brain.Addiction can also be viewed as a continued involvement with a substance or activity...

or even a psychological/psychiatric condition at all. Proponents of the sexual addiction model draw an analogy between hypersexuality and substance addiction, recommending 12-step and other addiction-based methods of treatment. Other explanatory models of hypersexuality include sexual compulsivity and sexual impulsivity.

Definition

Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon. Some experts believe that sexual addiction is literally an 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. Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.

ASAM

On August 15, 2011 the American Society of Addiction Medicine

American Society of Addiction Medicine

The American Society of Addiction Medicine is a physician society with a focus on addiction and its treatment.- History :ASAM has its roots in research and clinical traditions that pre-date its founding in the early 1950s, when Ruth Fox, M.D. began regular meetings with other physicians interested...

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."

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 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 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.

DSM

The American Psychiatric Association

American Psychiatric Association

The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

publishes and periodically updates the Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification 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

Paraphilia

Paraphilia is a biomedical term used to describe sexual arousal to objects, situations, or individuals that are not part of normative stimulation and that may cause distress or serious problems for the paraphiliac or persons associated with him or her...

sexual addiction, involving a succession of people who exist only as things to be used." The reference to sexual addiction was subsequently removed. The current version, published in 2000 (DSM-IV-TR), no longer mention sexual addiction as a mental disorder. The DSM-IV-TR still includes a miscellaneous diagnosis called Sexual Disorders Not Otherwise Specified, which now includes: "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.

Hypersexuality

Hypersexuality

, by itself, is a symptom of hypomania

Hypomania

Hypomania is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state...

and mania

Mania

Mania, the presence of which is a criterion for certain psychiatric diagnoses, is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels. In a sense, it is the opposite of depression...

in bipolar disorder

Bipolar disorder

Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...

and schizoaffective disorder

Schizoaffective disorder

Schizoaffective disorder is a psychiatric diagnosis that describes a mental disorder characterized by recurring episodes of elevated or depressed mood, or of simultaneously elevated and depressed mood, that alternate with, or occur together with, distortions in perception.Schizoaffective disorder...

, as defined in the DSM-IV-R.

Some authors continue to express that sexual addiction should be re-introduced into the DSM system; however, sexual addiction rejected for inclusion in the DSM-5, expected out in 2013. Darrel Regier, vice-chair of the DSM-5 task force, said that "[A]lthough 'hypersexuality

Hypersexuality

' is a proposed new addition...[the phenomenon] was not at the point where we were ready to call it an addiction."

ICD

The World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

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).

Symptoms and proposed diagnostic criteria

Irons and Schneider have noted that "Addictive sexual disorders that do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence." Similarly, Lowinson and colleagues use the addiction model and define sexual addiction as a condition in which some form of sexual behaviour is employed in a pattern that is characterized at least by two key features: recurrent failure to control the behaviour and continuation of the behaviour despite harmful consequences. Patrick Carnes, another proponent of the addiction model of sexual addiction, argued that most professionals in the field agree with the World Health Organization

World Health Organization

's definition of addiction.

Carnes

Patrick Carnes

Patrick Carnes, PhD, is an expert in the field of sexual addiction in the United States.Carnes is currently the Executive Director of the Gentle Path program at Pine Grove Behavioral Center in Hattiesburg, Mississippi....

, a proponent of the idea of sexual addiction, proposed using:

Recurrent failure (pattern) to resist impulses to engage in acts of sex.
Frequently 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.
Frequently engaging in sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations.
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.
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.
Resorting to distress, anxiety, restlessness, or violence if unable to engage in the behavior at times relating to SRD (Sexual Rage Disorder).

Goodman

Aviel Goodman, M.D., proposed 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:

tolerance, as defined by either of the following:
1. a need for markedly increased amount or intensity of the behavior to achieve the desired effect
2. markedly diminished effect with continued involvement in the behavior at the same level or intensity
withdrawal, as manifested by either of the following:
1. characteristic psycho-physiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior
2. the same (or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms
the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended
there is a persistent desire or unsuccessful efforts to cut down or control the behavior
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
important social, occupational, or recreational activities are given up or reduced because of the behavior
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

Schneider

Schneider identified three indicators of sexual addiction: 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 could be thinking about are neglected.

Epidemiology

Sexual addiction is hypothesized to be (but is not always) associated with obsessive-compulsive disorder

Obsessive-compulsive disorder

Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

(OCD), narcissistic personality disorder

Narcissistic personality disorder

Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...

, and manic-depression

Bipolar disorder

. 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.

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.

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

Addiction theories

According to Patrick Carnes

Patrick Carnes

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). 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 addict begins 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
Ritualization
Ritualization is a behavior that occurs typically in a member of a given species in a highly stereotyped fashion and independent of any direct physiological significance....

or "acting out
Acting out
Acting out is a psychological term from the parlance of defense mechanisms and self-control, meaning to perform an action in contrast to bearing and managing the impulse to perform it. The acting done is usually anti-social and may take the form of acting on the impulses of an addiction 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
Spirituality
Spirituality can refer to an ultimate or an alleged immaterial reality; an inner path enabling a person to discover the essence of his/her being; or the “deepest values and meanings by which people live.” Spiritual practices, including meditation, prayer and contemplation, are intended to develop...

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.

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

Masturbation

Masturbation refers to sexual stimulation of a person's own genitals, usually to the point of orgasm. The stimulation can be performed manually, by use of objects or tools, or by some combination of these methods. Masturbation is a common form of autoeroticism...

, pornography

Pornography

Pornography or porn is the explicit portrayal of sexual subject matter for the purposes of sexual arousal and erotic satisfaction.Pornography may use any of a variety of media, ranging from books, magazines, postcards, photos, sculpture, drawing, painting, animation, sound recording, film, video,...

, including obsessive thoughts. Some individuals try to connect with others through highly impersonal intimate behaviors: empty affair

Affair

Affair may refer to professional, personal, or public business matters or to a particular business or private activity of a temporary duration, as in family affair, a private affair, or a romantic affair.-Political affair:...

s, frequent visits to prostitutes, voyeurism

Voyeurism

In clinical psychology, voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviors, such as undressing, sexual activity, or other activity usually considered to be of a private nature....

, exhibitionism

Exhibitionism

Exhibitionism refers to a desire or compulsion to expose parts of one's body – specifically the genitals or buttocks of a man or woman, or the breasts of a woman – in a public or semi-public circumstance, in crowds or groups of friends or acquaintances, or to strangers...

, frotteurism

Frotteurism

Frotteurism refers to a paraphilic interest in rubbing, usually one's pelvis or erect penis, against a non-consenting person for sexual gratification. It may involve touching any part of the body including the genital area. A person who practices frotteurism is known as a frotteur...

, cybersex

Cybersex

Cybersex, also called computer sex, Internet sex, netsex, mudsex, TinySex and, colloquially, cybering, is a virtual sex encounter in which two or more persons connected remotely via computer network send each other sexually explicit messages describing a sexual experience...

, zoophilia

Zoophilia

Zoophilia, from the Greek ζῷον and φιλία is the practice of sex between humans and non-human animals , or a preference or fixation on such practice...

, and the like.

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.

Neurochemical theories

Earle has argued that neurochemical changes, similar to an adrenaline rush

Adrenaline Rush

An adrenaline rush is the fight or flight response of the adrenal gland, in which it releases adrenaline . When releasing adrenaline, one's body releases dopamine which can act as a natural pain killer. An adrenaline rush causes the muscles to perform respiration at an increased rate improving...

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.

Psychological distress theories

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).

Treatment

The self-help groups under the names of Sex Addicts Anonymous

Sex Addicts Anonymous

Sex Addicts Anonymous is an organization that describes itself as providing a twelve-step program for recovery from what it calls sex addiction. SAA was founded in 1977 by several men who wanted a greater sense of anonymity than what they perceived in other twelve step programs for sex addicts...

, Sexaholics Anonymous

Sexaholics Anonymous

Sexaholics Anonymous is one of several twelve-step programs for hypersexuality based on the original Twelve Steps of Alcoholics Anonymous. SA takes its place among various 12-step groups that seek recovery from sexual addiction: Sex Addicts Anonymous, Sex and Love Addicts Anonymous, Sexual...

, Sexual Compulsives Anonymous

Sexual Compulsives Anonymous

Sexual Compulsives Anonymous is an organization that describes itself as providing a twelve-step program for recovery from what it terms sexual compulsion. SCA's founding is attributed variously to 1982 in New York City and to 1973 in Los Angeles...

, Sexual Recovery Anonymous and Sex and Love Addicts Anonymous

Sex and Love Addicts Anonymous

Sex and Love Addicts Anonymous is a twelve-step program for people recovering from what they call sex addiction and love addiction. SLAA was founded in Boston, Massachusetts in 1976, by a member of Alcoholics Anonymous . Though he had been a member of AA for many years, he repeatedly acted out and...

, all lead to similar "twelve step" treatment programs which require, among many other things, a turn to and/or faith in a higher power. They tend to differ on what constitutes sexual "sobriety". There are various online support forums for these groups as well as meetings in many cities and towns all over the world.

Due to their effect of reducing libido, SSRI

Selective serotonin reuptake inhibitor

Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...

s have been used in research studies and off-label to treat symptoms of overly frequent sexual urges, but their effects are not always robust.

Debate over status

Some authors have expressed doubts about the existence of sex addiction, arguing that the condition is instead a way of projecting social stigma

Social stigma

Social stigma is the severe disapproval of or discontent with a person on the grounds of characteristics that distinguish them from other members of a society.Almost all stigma is based on a person differing from social or cultural norms...

onto patients. and state that a person must be using a psychoactive substance and experience feelings of tolerance and withdrawal

Withdrawal

Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...

in order to be considered a victim of addiction.

Researchers have also said sex addiction is subjective

Subjectivity

Subjectivity refers to the subject and his or her perspective, feelings, beliefs, and desires. In philosophy, the term is usually contrasted with objectivity.-Qualia:...

, and therefore, difficult to measure and test.

Definition

ASAM

DSM

ICD

Symptoms and proposed diagnostic criteria

Carnes

Goodman

Schneider

Epidemiology

Addiction theories

Neurochemical theories

Psychological distress theories

Treatment

Debate over status

See also