The term “sex addiction” is usually thought of as a disorder of intimacy commonly characterized by repetitive and compulsive thoughts about sex and sexual acts. Like other types of addictions, the behavior must have a negative impact on the person so that it leads to issues with the person’s social, occupational or legal functioning. As the disorder progresses, the person has to increase the intensity of the behavior in order to get the same results. This is termed “tolerance” in addictive behaviors and is considered an important symptom of an addiction, but people can also develop tolerance for a number of other stimulations that are not addictions.
Sex addiction behaviors can range from having “excessive” sexual relations with others, masturbation, use of pornography or other sexual devices to illegal activities such as exhibitionism and child molestation. So-called sex addiction can also involve compulsive searching for multiple sex partners, compulsive sexuality in a relationship or compulsive fixation on an unattainable partner. It is important to note that sex addicts do not necessarily become sex offenders (a little over half of convicted sex offenders are actually considered to be sex addicts).
The cause of sex addiction is not well understood. Like other addictions, there are purposed biochemical abnormalities or other brain-based changes believed to increase the risk for developing this disorder. Research has indicated that food, drug abuse, sexual interests and other activities of addiction share a common brain pathway within the survival and reward systems of the brain. These pathways are connected to the anterior areas of the brain that are responsible for judgment and rational thought. It appears that the brains of sex addicts are stimulated in a similar way that a starving or hungry person is informed that food is good. Certain medications such as antidepressants and dopamine blockers have been used with some success in several cases of sex addiction, giving further support to the idea that sex addiction is a problem with brain functioning. However, this type of evidence is shaky when trying to determine the cause of a behavior.
There is also some research that indicates that sex addicts have a higher prevalence of dysfunctional families or histories of abuse as children than normal controls. Sex addicts and family members of sex addicts are more likely to have a history of drug and/or alcohol abuse than normal controls also suggesting a possible genetic component. But again, these studies cannot definitively infer a cause and effect relationship and at best only identify associations between things.
Does It Really Exist?
Despite all of this research the diagnosis of a sex addiction has been somewhat controversial. The Diagnostic and Statistical Manual of Psychiatric Disorders, Volume Four (DSM-IV-TR) listed sex addictions under the “Sexual Disorders Not Otherwise Specified” category and not under the Substance Abuse and Addictive Behaviors category because of a lack of research showing that the behavior was consistent with an addiction. When the changes to the diagnostic criteria for mental disorders for the new version of the DSM were proposed, some researchers opted to change the name from “sex addiction” to “hypersexual disorder” (“hyper” used here to mean excessive). However, the latest edition of the DSM, the DSM-5, does not list sex addiction in any diagnostic category due to a lack of evidence. In fact, most research has failed to identify the presence of an actual “sex addiction” when compared to other forms of addiction. Thus the validity of the diagnostic entity is questionable (at least according to the APA).
Nonetheless, when an individual’s behavior becomes problematic for themselves, therapists, physicians and counselors should be prepared to help them adjust their actions to a more functional and comfortable level. Just because this class of behavior does not meet the current diagnostic standards for an actual addiction does not mean that people who experience difficulties in their lives due to their high desire for sex should not be helped as well.
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