Sexual addiction is a popular model to explain hypersexuality—sexual urges, behaviors, or thoughts that appear extreme in frequency or feel out of one's control. Hypersexuality is typically associated with lowered sexual inhibitions, and alcohol 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 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.
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Sexologists have not reached any consensus regarding whether sexual addiction exists or, if it does, how to describe the phenomenon.[1][2] 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.[3] Still other experts believe that sex addiction is itself a myth, a by-product of cultural and other influences.[4][5]
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."[6]
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. [7]
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."[8] The reference to sexual addiction was subsequently removed.[9] The current version, published in 2000 (DSM-IV-TR), no longer mention sexual addiction as a mental disorder.[10] 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.[10]
Hypersexuality, by itself, is a symptom of hypomania and mania in bipolar disorder and 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;[11] however, sexual addiction rejected for inclusion in the DSM-5, expected out in 2013.[12] 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 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).[13]
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."[11] 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.[14] Patrick Carnes, another proponent of the addiction model of sexual addiction, argued that most professionals in the field agree with the World Health Organization's definition of addiction.[15] Carnes has suggested four types of addiction in his writings: Chemical, Process, Feelings, and Compulsive Attachments. Carnes has categorized sex addiction as a process addiction.
Patrick Carnes, a proponent of the idea of sexual addiction, proposed using:[16]
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:
Schneider identified three indicators of sexual addiction: compulsivity, continuation despite consequences, and obsession.[17]
Sexual addiction is hypothesized to be (but is not always) associated with obsessive-compulsive disorder (OCD), narcissistic personality disorder,[20][21] and manic-depression.[22] 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.[1][23][24]
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.[23]
Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full personality disorder even after successful addiction treatment.[20]
According to Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts hold:[25]
These beliefs drive the addiction on its progressive and destructive course:[25]
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.[26]
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, zoophilia, and the like.
Dr. Carnes mentions that:
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.[28]
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).
The self-help groups under the names of Sex Addicts Anonymous, Sexaholics Anonymous, Sexual Compulsives Anonymous, Sexual Recovery Anonymous and Sex and Love Addicts Anonymous, 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, 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.[29][30]
Some authors have expressed doubts about the existence of sex addiction, arguing that the condition is instead a way of projecting social stigma onto patients.[31] and state that a person must be using a psychoactive substance and experience feelings of tolerance and withdrawal in order to be considered a victim of addiction.
Researchers have also said sex addiction is subjective, and therefore, difficult to measure and test.
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