Is there a thing called sexual addiction? There have been many argues, discussions and controversies about this subject during the last decades!
Sexual addiction is best described as a progressive intimacy disorder which is characterized by compulsive sexual thoughts and acts. The abuse can start at any time in life and then progresses until it becomes a compulsion which the sexually addicted person cannot cope with. Over time, the addict usually has to intensify the addictive behavior to achieve the same results.
There are many different variations of this addiction and, while for some sex addicts, behavior does not progress beyond compulsive masturbation or the extensive use of pornography, for others, addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, child molestation or rape. The fact is that The American Psychiatric Association does not currently recognize sex addiction as a mental illness.
Yes, interestingly sex addiction is not listed in the DSM-5. But why is that? [1]
- Some experts believe that sex addiction doesn’t exist and they argue that sex addiction is just a little more than a label for sexual behavior that significantly deviates from society’s norms.
- One of the main reasons that sex addiction is not yet included in the DSM-5 is that the empirical research in the area is relatively weak.
There are four things that are typical of almost all types of sex addictions!
The first is typical for all addictions — preoccupation — every addict becomes completely engrossed with his addiction, in this case-sexual thoughts or fantasies.
During the ritualization, the addict follows special routines in a search for sexual stimulation, which intensifies the experience and may be more important than reaching orgasm.
Compulsive sexual behaviors can present in a variety of forms and degrees of severity, much like that of substance use disorders, mood disorders, or impulse-control disorders.
Last but not least, despair is the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression.
Causes of sexual addiction
There are a number of theories that explain why sexual addiction occurs. For example:
- psychological and emotional difficulties,
- personality disorder,
- coping mechanism,
- a result of childhood trauma
- a result of some neurological disorders such as epilepsy, head injury, and dementia.
- some drugs have been found to cause hypersexuality and these are apomorphine and dopamine replacement therapy.
Symptoms of the addiction
Sexual addicts use widely varying activities and even masturbation can become obsessive, being done to the point of injury or to the point that it interferes significantly with ordinary life. Pornography can also be addictive, and addicts may spend huge amounts of money and their time on it.
How to recognize a sex addict? Well, there is a characteristic behavior of the sex addict which could be easily recognized. A person could be addicted to sex if he:
- Stay up late to watch television or surf the Web
- Look at pornographic material such as magazines, books, videos and clothing catalogs
- Are controlling during sexual activity
- have frequent mood swings before or after sex
- Are demanding about sex, especially regarding time and place
- Get angry if someone shows concern about a problem with pornography
- Lack intimacy before, during and after sex
- Do not want to socialize with others, especially peers who might intimidate them
- Feel depressed
- Increasing guilt, remorse and suicidal thoughts
- Irritability when unable to engage in the desired behavior
- Pronounced mood swings or violence
- Preoccupation with or persistent craving for sex
- Unsuccessful attempts to limit sexual activity
- Are increasingly dishonest
- Hide pornography at work or home
- Lack close friends of the same sex
- Frequently use sexual humor
- Always have a good reason for looking at pornography
Variations of the addiction
Compulsive sexual behavior can be divided into:
- paraphilic behaviors: Paraphilias are sexual interests in objects, situations, or individuals that are atypical — outside of the conventional range of sexual behaviors. These include the eight paraphilias recognized in the DSM-V: exhibitionism, voyeurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, fetishism, and frotterurism. [1] Some paraphilias have more than one term to describe them, and some terms overlap with others. DSM draws a distinction between paraphilias (which it describes as atypical sexual interests) and paraphilic disorders (which additionally require the experience of distress or impairment in functioning). Paraphilias begin in late adolescence and peak in the mid-20s.[3]
- and non-paraphilic behaviors: some studies report that up to six percent of the general population meets criteria [3] Non-paraphilic behaviors represent engagement in commonly available sexual practices, such as attending strip clubs, compulsive masturbation, paying for sex through prostitution, excessive use of pornography, and repeated engagement in extramarital affairs. The onset, clinical course, and predominance of the male population are fairly similar to paraphilic disorders.[3]
The most common paraphilias as classified by The American Psychiatrist Association are [4]:
- Pedophilia - an adult's sexual attraction toward children
- Exhibitionism - sexual excitement associated with exposing one's genitals in public
- Voyeurism - sexual excitement from watching an unsuspecting person
- Sexual masochism -sexual excitement from being the recipient of inflicted or threatened pain
- Sexual sadism - sexual excitement from threatening or administering pain
- Transvestic fetishism - sexual excitement from wearing the clothing of the opposite sex
- Frotteurism - sexual excitement from touching or fondling an unsuspecting person
- Nymphomania – it is a combination of an escape from the rejection of a real relationship and a compulsion to experience an immediate sexual thrill.
- Necrophilia
These disorders are sometimes accompanied by recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving non-human objects, suffering or humiliation, children or other non-consenting persons!
Diagnostic criteria for sex addiction
While there is no official diagnosis of sex addiction, clinicians and researchers have attempted to define the disorder using the next criteria [5]:
- Frequently engaging in more sex and with more partners than intended.
- Being preoccupied with or persistently craving sex; wanting to cut down and unsuccessfully attempting to limit sexual activity.
- Thinking of sex to the detriment of other activities or continually engaging in excessive sexual practices despite a desire to stop.
- Spending considerable time in activities related to sex, such as cruising for partners or spending hours online visiting pornographic Web sites.
- Neglecting obligations such as work, school or family in pursuit of sex.
- Continually engaging in the sexual behavior despite negative consequences, such as broken relationships or potential health risks.
- Escalating scope or frequency of sexual activity to achieve the desired effect, such as more frequent visits to prostitutes or more sex partners.
- Feeling irritable when unable to engage in the desired behavior.
In general, the hypersexual disorder causes personal distress caused by the sexual behaviors that interfere with relationships, work or other important aspects of life.
A research evaluated more than 200 patients who had problems with out-of-control sexual behavior, a substance-abuse or depression or anxiety. The researchers found that the proposed criteria for hypersexual disorder accurately classified:
88% of hypersexual patients as having the disorder; but the criteria were also accurate in identifying negative results 93% of the time. In other words, the criteria appear to do a good job of discriminating between patients who experience hypersexual behavior and those who are seeking help for other mental health conditions.
A significant finding of the study was that patients who met the criteria for hypersexual disorder experienced significantly greater consequences for their sexual activities, compared with individuals with a substance-abuse diagnosis or a general medical condition [5]:
- 17% had lost a job at least once,
- 39% had a relationship end,
- 28% contracted a sexually transmitted infection and
- 78% had interference with healthy sex.
- 54% felt their sexual behavior began to be problematic before the age of 18.
- 30% reported that their sexual behavior began to be problematic during their college-aged years, from 18 to 25.
In short, the study showed increased hypersexual behavior was related to greater emotional disturbance, impulsivity and an inability to manage stress.
The study analyzed the types of sexual behavior that hypersexual patients reported, and the most common included:
- masturbation and excessive use of pornography,
- sex with another consenting adult,
- and cybersex.
Effects of sexual addiction on relationships
There were several studies on this subject and some of them revealed that most people who indulge sexual addiction cannot maintain a close, loving relationship. Not too many people know that person caught in the world of sexual addiction feel a deep, heavy loneliness. The loneliness is caused by the sexual addiction. But in too many cases the sexually addicted person believes that the sexual addiction is the answer to their loneliness! In more advanced cases sexual addiction can lead to withdrawal from the world at large.
Treatment of sexual addiction
Although, treatment of sex addiction is very much similar to the treatment of all other addictions, there are some things which are unique! Unlike drug or alcohol treatment, the goal of sexual addiction treatment is not lifelong abstinence, but rather a control of compulsive, unhealthy sexual behavior. This could be a big problem because it is very difficult for a sex addict to distinguish between healthy and unhealthy sex. Many programs suggest a 60- to a 90-day period of self-imposed abstinence. The biggest problem is definitely an addict’s motivation to change! Sex addicts generally don't seek help on their own. People shouldn’t this get wrong — it isn't that sex addicts don't know they have a problem, they do, but they have lost the interest to change something! Social support is also very important because support family and friends are critical to treatment.
Treatment goals
The fact is that treatment will focus on two main issues:
- The first is the logistical approaches of separating a person from harmful sexual behavior. In order to accomplish this, it might require residential treatment for several weeks.
- The second and most difficult issue and it involves facing the guilt, shame, and depression associated with this illness.
Cognitive-Behavior Therapy
This is also one very effective form of therapy and it is pointed at triggers that could be the cause of addiction. It also reinforces actions related to sexual addiction and looks for methods of short-circuiting the process. Treatment approaches include teaching addicts to:
- stop sexual thoughts by thinking about something else;
- substituting sexual behavior with some other behavior, such as exercising or working out;
- preventing the relapse of addictive behavior
Interpersonal Therapy
Although many doubt that this could be an effective treatment- researchers are indicating that traditional talk therapy can be helpful in increasing self-control and in treating related mood disorders and effects of past trauma.
Group Therapy
It is a very effective form of therapy and it has been widely used for years now. It typically consists of a healthcare professional working with a group of between 6 and 10 patients. Working with other addicts allows you to see that your problem is not unique and that you are not alone. It also enables you to learn about what works and what doesn't from other people experiences.
Medication
Recent research suggests that certain psychiatric medications, mostly antidepressants, may be useful in treating sexual addiction.
What to expect
A doctor who evaluates a sex addict will consider three general things before determining the most appropriate type of treatment:
- the severity of the addiction,
- that person’s motivation to change
- available support from family or friends