15 December 2010

Is sex addiction for real?

Does sex addiction exist? Or is it just a label which does more harm than good? CyberShrink comments.


Can sex really be an addiction, or is it just the last resort of someone who doesn't want to say 'no'? CyberShrink comments on whether sex addiction is for real.

A nymphomaniac, according to Dr Alfred Kinsey, renowned sex researcher, is simply "someone who has more sex than you."

But everyone enjoys sex, don't they? What is it that distinguishes the sex addicts from other people?

When is repeated sexual behaviour a problem?
Sexual behaviour becomes a problem when

  • it is harmful and hurtful to the individual or others
  • when it is repeated or engaged in inappropriately
  • when you feel out of control of what you are doing when it comes to choosing what, when, where and with whom
  • when you find yourself spending an inordinate amount of time thinking about what you have done and what you plan to do, to the extent that it interferes with your usual work and social life.

As with any other normal aspect of a fully rounded life, if your sexual activity has become so overwhelming that it is a preoccupation that takes precedence over your usual work and family or social duties, things are out of control.

Typical of many other self-defeating patterns of behaviour, the more you do it, the less you get whatever it was you were originally seeking by doing it. The Don Juan is like the unhappy millionaires I've known, who were sure that just another 10% more wealth would be completely satisfying, but could never meet that elusive and retreating target. At first it may seem to relieve stress, depression, anxiety or loneliness; soon it clearly only underlines and emphasises these uncomfortable states of mind.

Problems caused by sexual compulsivity
Sexually compulsive behaviour (depending on the type of indulgence chosen) could have a wide range of negative effects, which could include the following:

  • you could run into serious problems with the law
  • you could be at risk for STIs and HIV (both for yourself and your partners)
  • you could run up significant financial expenses.
  • you are likely to neglect - or lose - your marriage or primary relationship
  • failure to concentrate on your work may risk the loss of a job.
  • if you're a celebrity, like Tiger and - before him - Michael Douglas and others, you risk credibility, sponsorships, and career

Other terminology
Satyriasis is an old-fashioned term for the male variety of excessive sexual behaviour, named (perhaps unfairly to the animals) after the Satyr of Greek mythology, which was part man and part goat. Nymphomania was for long a preferred term for the female variety of this complaint.

For ages doctors and psychologists have recognised that some people engage in sex unusually often, often to the detriment of themselves or of others.

This behaviour has been given various names, and has attracted various responses, as will be discussed below.

In the 1970s it was renamed "sexual addiction" by researcher and psychologist Patrick Carnes and the phrase was greatly publicised. But this was no useful discovery, nor was it accompanied by any significant advances in treatment - merely renaming a problem rarely leads to a solution.

The theories on "sexual addiction"
Carnes claimed that people can become addicted to certain brain-chemical changes that occur during sex, much the same as a drug addict gets hooked on cocaine or heroin. Based on his experience, he estimated that around 8% of all American men, and 3% of American women, were sexual addicts.He offered no explanation of why some people would get hooked on the chemistry of sex, while the rest of us would just enjoy it without losing control.

Those writing on "sex addiction" mention that addictive sex may lead to remorse, excuses, shame, exploitation, secretiveness, or hypocrisy. They speak of compulsive masturbation, compulsive sex with prostitutes or with multiple partners, and indeed, any form of usual or deviant sexual behaviour which is unduly repeated. They claim that the condition is progressive and gets worse without treatment, even if it may go into remission for years at a time.

Men behaving badly?
Having examined some of the screening tests for alleged sex addiction, I find that they include far too much normal and usual behaviour. There is a difference between compulsive behaviour and addiction, and it's not useful to merge the two ideas. It allows the concept of "addiction" - something over which one has no control - to be enlisted by people who are simply behaving badly, as an excuse. It also has the huge disadvantage that it is a name that assumes a single type of problem with a single type of cause, rather than recognising how many different disorders and illnesses may contribute towards this situation.

Other causes of hypersexuality
Far from adding to our understanding, the "sex addict" over-simplification has helped people to forget that there can be many possible causes of troublesome increases in libido and sexual activity. One of the oldest and most eternally valid principles in medicine is that before you can plan an effective treatment, there has to be a comprehensive assessment and a sound diagnosis, not a rush to judgement.

It's worth understanding that someone may be labelled as a sex addict simply because they are more sexually active than the person applying the label, or because they enjoy themselves in ways the labeller doesn't appreciate.

For a number of reasons, libido may be increased, by something as commonplace as being under extra stress, as sex is excellent recreation and usually induces enjoyment followed by relaxation.

On the other hand, the primary problem may be a loss of impulse control, such as can follow some forms of brain injury or brain disease, in which the person is just much less able to control such desires as they may feel. It may be related to a form of epilepsy, or to something such as Alzheimer's Disease.

It can occur during manic phases of bipolar disorder, or even during a depressive episode (just as depression may include an increase or decrease in appetite for food, weight gain or loss). Someone may even be of low libido and uninterested in sex while their mood is normal, only to become, as they grow manic, increasingly interested in sex, hopefully with their settled partner, but potentially with just about anyone.

It can also be part of a formal obsessive-compulsive disorder.

What else can we call it?
Okay, so, having been scornful about the fashionable term, what else might we call this problem? Sexual compulsiveness, perhaps, or sexually compulsive or obsessive behaviour? Recognising the compulsive aspect of such behaviour can be useful, as it can respond to medicines and psychological treatments adapted from treatments for other obsessive and compulsive disorders. Typical of compulsivity, one loses a sense of proportion, and finds it difficult to choose whether to continue or stop, even if risks are obvious.

Similarly, it is worth recognising this, not as part of the field of addictions, but as one of the impulse control disorders. Others simply call it hypersexuality, which is acceptable and accurate. Older terms which have been used include erotomania, and nymphomania or satyriasis.

When should you seek professional help?
As soon as you recognise the problem for what it is - by definition, the matter is beyond mere self-help, although your own full collaboration will be essential for successful expert treatment.

What sort of treatment is likely to be used? Individual psychotherapy/serious counselling is surely needed, to help you understand and manage your sexual obsessions. Marriage/relationship counselling would be needed after you have begun to sort yourself out. Modern antidepressants of the SSRI family may help, both to attend to co-existing anxiety and depression, and they may reduce the power of the obsessiveness underlying the problem.

(Prof M.A. Simpson, aka Cybershrink, updated July 2010)

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