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Sexual addiction is a term used to describe the behavior of a person who has an unusually intense sex drive or obsession and addiction with sex[1]. The nomenclature of "addiction" is not universally accepted by scientists,[2] and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. Those who use this term have described sex addicts as people who, possibly out of fear of any truly intimate relationship, repeatedly and compulsively try to connect with others through highly impersonal intimate behaviors: masturbation, empty affairs, frequent visits to prostitutes, voyeurism, and the like. Sex addicts—numbering in the millions, both men and women, young and old, of all races and religions—become mesmerized with the thrill and rush of adrenaline that they can achieve only through their obsessive, highly ritualized patterns of sexual behavior.[3] Sexual addiction, also called sexual compulsion is a form of psychological addiction.
The behavior of sex addicts is comparable to behavior of alcoholics and [drug] 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.[4] It provides a quick mood change, works every time and the user loses control over their compulsion.[5] Like alcoholics, sex addicts' lives rotate around the constant desire for their "drug" of choice.
The Mayo Clinic uses compulsive sexual behavior for sexual addiction, and identifies characteristics of the sex addict as "an overwhelming need for sex and are so intensely preoccupied with this need that it interferes with your job and your relationships. [...] You may spend inordinate amounts of time in sexually related activities and neglect important aspects of your day-to-day life in social, occupational and recreational areas. You may find yourself failing repeatedly at attempts to reduce or control your sexual activities or desires."[6] According to The Counseling Affiliates, an addiction is at work when sex becomes shameful, secret, or abusive. The Society for the Advancement of Sexual Health further illustrates addiction by outlining several key components: "Compulsivity, that is, loss of the ability to choose freely whether to stop or to continue; Continuation of the behavior despite adverse consequences, such as loss of health, job, marriage, or freedom; Obsession with the activity." 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:[4]
Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex. Frequent 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. Frequent engaging in violent 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, 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. Distress, anxiety, restlessness, or violence if unable to engage in the behavior. Schneider,[7] 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 [8]. 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.[9] 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 experiencesThe 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[citation needed], 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.
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.[citation needed]
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.[citation needed] 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.[10] (Interestingly, the brain chemical releases triggered by the sexual addict are similar to those experienced by gamblers and food addicts.)[citation needed]
According to proponents of the sexual addiction concept, the addicts' obsessive/compulsive tendencies are demonstrated 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. Masturbatory activities, because they are an effective and efficient path to success, combined with the sex addict's fear of truly intimate relationships, makes them a desirable alternative to 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.[citation needed]
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.
For sex addicts who try often to stop and fail, their behavior generally conforms to a cycle:
Preoccupation — the addict becomes completely engrossed with sexual thoughts or fantasies. Ritualization — the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm. Compulsive sexual behavior — the addict's specific sexual acting out. 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:
It is a secret. It is abusive or degrading to self or others. It is used to avoid (or is a source of) painful feelings. It is empty of a caring, committed relationship.