Sex Addiction
Sexual addiction (sometimes called sex addiction) is a conceptual model devised in
order to provide a scientific explanation for sexual urges, behaviors, or
thoughts that appear extreme in frequency or feel out of one's control—in terms
of being a literal addiction to sexual activity. This phenomenon is not newly
described in the literature, but it has been described by many different terms:
hypersexuality, erotomania, nymphomania, satyriasis, Don Juanism, Don
Juanitaism, and, most recently, sexual addiction, compulsive sexual behaviour,
and paraphilia-related disorders. Someone who did much to popularise the concept
of compulsive sexual behaviour as an addiction was Patrick Carnes. It was his
book that was published in 1983 and activated interest in the construct of
sexual addiction
Hypersexuality
is often associated with addictive or obsessive personalities, escapism,
psychological disorders, low self-esteem, self-destructive behavior, lowered
sexual inhibitions and behavioral conditioning. Alcohol, hormonal imbalance and
change of life hormone levels (puberty, adulthood, middle age, menopause,
seniors), behavior modification, operant conditioning and many drugs affect a
person's social and sexual inhibitions, while reducing integral human bonding
abilities for intimacy. Addiction is the state of behavior outside the
boundaries of social norms which reduces an individual's ability to function
efficiently in general routine aspects of life or develop healthy relationships.
Medical studies and related opinions vary among professional psychologists,
sociologists, clinical sexologists and other specialists on sexual addiction as
a medical physiological and psychological addiction, or representative of a
psychological/psychiatric condition at all.
Robert Weiss & David Ley. Is sex addiction a myth? // KPCC (April 25, 2012,
9:29 am) retrieved 10.01.2013
Medical
studies and related opinions vary among professional psychologists,
sociologists, clinical sexologists and other specialists on sexual addiction as
a medical physiological and psychological addiction, or representative of a
psychological/psychiatric condition at all. Proponents of the sexual addiction
model draw analogies between hypersexuality and substance addiction or negative
behavioral patterns similar to gambling addiction, recommending 12-step and
other addiction-based methods of treatment. Other explanatory models of
hypersexuality include sexual compulsivity and sexual
impulsivity.
Sexologists
have not reached any consensus regarding whether sexual addiction exists or, if
it does, how to describe the phenomenon Some experts regard sexual addiction as
a medical form of clinical 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. Still
other experts believe that sex addiction is itself a myth, a by-product of
cultural and other influences. Some who have expressed doubts about the
existence of sex addiction argue that the condition is instead a way of
projecting social stigma onto patients.
An example
of how far this critique sometimes goes is Marty Klein's claim that "The concept
of sex addiction provides an excellent example of a model that is both
sex-negative and politically disastrous." Klein singles out a number of features
that he considers crucial limitations of the sex addiction model
pathology
oriented
pathologize non-problematic behavior
clinically
incomplete
without context (both individual and situational)
culturally
bound
politically exploited
Klein states
that the diagnostic criteria for sexual addiction are easy to find on the
Internet Drawing on the Sexual Addiction Screening Test, he states that "The
sexual addiction diagnostic criteria make problems of nonproblematic
experiences, and as a result pathologize a majority of
people."
Origin
Sex
addiction as a term first emerged in the mid-1970s when various members of
Alcoholics Anonymous sought to apply the principles of 12-Steps toward sexual
recovery from serial infidelity and other unmanageable compulsive sex behaviors
that were similar to the powerlessness and un-manageability they experienced
with alcoholism. This resulted in the creation of new support groups that all
seemed to independently surface spontaneously within this same era. Sex and Love
Addicts Anonymous (S.L.A.A.) was founded first in Boston in 1976, followed by
Sex Addicts Anonymous (SAA) in 1977, Sexaholics Anonymous in 1979, and later,
Sexual Compulsives Anonymous (SCA) and Sexual Recovery Anonymous (SRA). Together
these are known as the “S” programs or S-fellowships because they all focus on
sexual recovery. They tend to differ on what constitutes sexual
"sobriety".
There are
various online and phone support meetings for these groups as well as meetings
in many cities and towns all over the world.
There are
also programs for those who regard themselves as the traumatized or otherwise
affected partners of sex addicts such as COSA and
CO-SLAA.
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."
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.
DSM
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." The reference to
sexual addiction was subsequently removed, The current version, published in
2000 (DSM-IV-TR), no longer mentions sexual addiction as a mental disorder. 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.) Even this
still-present diagnostic definition does not mention sexual addiction, but
focuses on the patient's distress as to their sexual behavior (contrary to the
pattern of denial in addiction as mentioned below), not on the sexual behavior
itself.
Hypersexuality, by itself, can also be 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; however, sexual addiction has been rejected for inclusion in the DSM-5,
expected out in 2013. Darrel Regier, vice-chair of the DSM-5 task force, said
that "lthough 'hypersexuality' is a proposed new addition... was not at the
point where we were ready to call it an addiction." The proposed diagnosis does
not make the cut as an official psychiatric diagnosis due to a lack of
substantial empirical evidence, according to the American Psychiatric
Association.
ICD
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).
Symptoms and
proposed diagnostic criteria
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." 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. 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.
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.
Carnes
Patrick
Carnes believes that people become addicted to sex in the same way they become
addicted to alcohol or drugs. He proposes using:
1.Recurrent failure
(pattern) to resist impulses to engage in acts of sex.
2.Frequently engaging
in those behaviors to a greater extent or over a longer period of time than
intended.
3.Persistent desire or unsuccessful efforts to stop, reduce, or
control those behaviors.
4.Inordinate amount of time spent in obtaining sex,
being sexual, or recovering from sexual experience.
5.Preoccupation with the
behavior or preparatory activities.
6.Frequently engaging in sexual behavior
when expected to fulfill occupational, academic, domestic, or social
obligations.
7.Continuation of the behavior despite knowledge of having a
persistent or recurrent social, academic, financial, psychological, or physical
problem that is caused or exacerbated by the behavior.
8.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.
9.Giving up or limiting social,
occupational, or recreational activities because of the
behavior.
10.Resorting to distress, anxiety, restlessness, or violence if
unable to engage in the behavior at times relating to SRD (Sexual Rage
Disorder).
Although
Patrick Carnes’s theory has become popular in recent years, it remains quite
controversial and many other theories exist
Goodman
Aviel
Goodman, M.D., proposed a maladaptive pattern of sexual 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:
1.tolerance, as defined by either of the following: 1.a need for
markedly increased amount or intensity of the behavior to achieve the desired
effect
2.markedly diminished effect with continued involvement in the
behavior at the same level or intensity
2.withdrawal, as manifested by either of the following:
1.characteristic psychophysiological withdrawal syndrome of physiologically
described changes and/or psychologically described changes upon discontinuation
of the behavior
2.the same (or a closely related) behavior is engaged in to
relieve or avoid withdrawal symptoms
3.the sexual
behavior is often engaged in over a longer period, in greater quantity, or at a
higher intensity than was intended
4.there is a persistent desire or
unsuccessful efforts to cut down or control the behavior
5.a great deal of
time spent in activities necessary to prepare for the behavior, to engage in the
behavior, or to recover from its effects
6.important social, occupational,
or recreational activities are given up or reduced because of the
behavior
7.the sexual behavior continues despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely to have
been caused or exacerbated by the behaviour
Schneider
Jennifer P.
Schneider, MD, PhD identified three indicators of sexual addiction:
compulsivity, continuation despite consequences, and
obsession.
1.Compulsivity: This is the loss of the ability to choose freely
whether to stop or continue a behavior.
2.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. Despite all of these consequences, they
continue indulging in excessive sexual activity.
3.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 experiences. Because
their minds are so preoccupied by these thoughts, other areas of their lives
that they could be thinking about are neglected.
Causes
Sexual
addiction is hypothesized to be (but is not always) associated with
obsessive-compulsive disorder (OCD), narcissistic personality disorder, and
bipolar disorder. 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.
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.
According to
proponents of sexual addiction as a disorder, addicts often display narcissistic
traits; these are said to often clear as sobriety is achieved, although others
exhibit the full personality disorder even after successful addiction
treatment.
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, and the like.
Neurochemical theories
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.
Psychological distress theories
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)
According to
Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts
hold
1."I am basically a bad, unworthy person."
2."No one would love me
as I am."
3."My needs are never going to be met if I have to depend on
others."
4."Sex is my most important need."
These
beliefs drive the addiction on its progressive and destructive course:
Pain
agent — First a pain agent is triggered / emotional discomfort (e.g. shame,
anger, unresolved conflict). A sex addict is not able to take care of the pain
agent in a healthy way.
Dissociation — Prior to acting out sexually, the sex
addict goes through a period of mental preoccupation or obsession. Sex addicts
begin to dissociate (moves away from his or her feelings). A separation begins
to take place between his or her mind and his or her emotional self.
Altered
state of consciousness / a trance state / bubble of euphoric fantasized
experience — Sex addict is emotionally disconnected and is pre-occupied with
acting out behaviours. The reality becomes blocked
out/distorted.
Preoccupation or "sexual pressure" — This involves obsessing
about being sexual or romantic. Fantasy is an obsession that serves in some way
to avoid life. The addict's thoughts focus on reaching a mood-altering high
without actually acting-out sexually. They think about sex to produce a
trance-like state of arousal to eliminate the pain of reality. Thinking about
sex and planning out how to reach orgasm can continue for minutes or hours
before they move to the next stage of the cycle.
Ritualization or "acting
out" — These obsessions are intensified by ritualization or acting out.
Ritualization helps distance reality from sexual obsession. Rituals induce
trance and further separate the addict from reality. Once the addict begins the
ritual, the chances of stopping that cycle diminish greatly. They give into the
pull of the compelling sex act.
Sexual compulsivity — The next phase of the
cycle is sexual compulsivity or "sex act". The tensions the addict feels are
reduced by acting on their sexual feelings. They feel better for the moment,
thanks to the release that occurs. Compulsivity simply means that addicts
regularly get to the point where sex becomes inevitable, no matter what the
circumstances or the consequences. The compulsive act, which normally ends in
orgasm, is perhaps the starkest reminder of the degradation involved in the
addiction as the person realizes they are a slave to the addiction.
Despair
— Almost immediately reality sets in, and the addict begins to feel ashamed.
This point of the cycle is a painful place where the Addict has been many, many
times. The last time the Addict was at this low point, they probably promised to
never do it again. Yet once again, they act out and that leads to despair. They
may feel they have betrayed spiritual beliefs, possibly a partner, and his or
her own sense of integrity. At a superficial level, the addict hopes that this
is the last battle.
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.
Dr. Carnes
mentions that:
Al Cooper (one of the original researchers in internet sex)
described internet sex as the ‘crack cocaine’ of sexual addiction because it is
an accelerant for adults of all stages of the lifespan. He felt that people
would never have the problem if it had not been for the
internet.
order to provide a scientific explanation for sexual urges, behaviors, or
thoughts that appear extreme in frequency or feel out of one's control—in terms
of being a literal addiction to sexual activity. This phenomenon is not newly
described in the literature, but it has been described by many different terms:
hypersexuality, erotomania, nymphomania, satyriasis, Don Juanism, Don
Juanitaism, and, most recently, sexual addiction, compulsive sexual behaviour,
and paraphilia-related disorders. Someone who did much to popularise the concept
of compulsive sexual behaviour as an addiction was Patrick Carnes. It was his
book that was published in 1983 and activated interest in the construct of
sexual addiction
Hypersexuality
is often associated with addictive or obsessive personalities, escapism,
psychological disorders, low self-esteem, self-destructive behavior, lowered
sexual inhibitions and behavioral conditioning. Alcohol, hormonal imbalance and
change of life hormone levels (puberty, adulthood, middle age, menopause,
seniors), behavior modification, operant conditioning and many drugs affect a
person's social and sexual inhibitions, while reducing integral human bonding
abilities for intimacy. Addiction is the state of behavior outside the
boundaries of social norms which reduces an individual's ability to function
efficiently in general routine aspects of life or develop healthy relationships.
Medical studies and related opinions vary among professional psychologists,
sociologists, clinical sexologists and other specialists on sexual addiction as
a medical physiological and psychological addiction, or representative of a
psychological/psychiatric condition at all.
Robert Weiss & David Ley. Is sex addiction a myth? // KPCC (April 25, 2012,
9:29 am) retrieved 10.01.2013
Medical
studies and related opinions vary among professional psychologists,
sociologists, clinical sexologists and other specialists on sexual addiction as
a medical physiological and psychological addiction, or representative of a
psychological/psychiatric condition at all. Proponents of the sexual addiction
model draw analogies between hypersexuality and substance addiction or negative
behavioral patterns similar to gambling addiction, recommending 12-step and
other addiction-based methods of treatment. Other explanatory models of
hypersexuality include sexual compulsivity and sexual
impulsivity.
Sexologists
have not reached any consensus regarding whether sexual addiction exists or, if
it does, how to describe the phenomenon Some experts regard sexual addiction as
a medical form of clinical 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. Still
other experts believe that sex addiction is itself a myth, a by-product of
cultural and other influences. Some who have expressed doubts about the
existence of sex addiction argue that the condition is instead a way of
projecting social stigma onto patients.
An example
of how far this critique sometimes goes is Marty Klein's claim that "The concept
of sex addiction provides an excellent example of a model that is both
sex-negative and politically disastrous." Klein singles out a number of features
that he considers crucial limitations of the sex addiction model
pathology
oriented
pathologize non-problematic behavior
clinically
incomplete
without context (both individual and situational)
culturally
bound
politically exploited
Klein states
that the diagnostic criteria for sexual addiction are easy to find on the
Internet Drawing on the Sexual Addiction Screening Test, he states that "The
sexual addiction diagnostic criteria make problems of nonproblematic
experiences, and as a result pathologize a majority of
people."
Origin
Sex
addiction as a term first emerged in the mid-1970s when various members of
Alcoholics Anonymous sought to apply the principles of 12-Steps toward sexual
recovery from serial infidelity and other unmanageable compulsive sex behaviors
that were similar to the powerlessness and un-manageability they experienced
with alcoholism. This resulted in the creation of new support groups that all
seemed to independently surface spontaneously within this same era. Sex and Love
Addicts Anonymous (S.L.A.A.) was founded first in Boston in 1976, followed by
Sex Addicts Anonymous (SAA) in 1977, Sexaholics Anonymous in 1979, and later,
Sexual Compulsives Anonymous (SCA) and Sexual Recovery Anonymous (SRA). Together
these are known as the “S” programs or S-fellowships because they all focus on
sexual recovery. They tend to differ on what constitutes sexual
"sobriety".
There are
various online and phone support meetings for these groups as well as meetings
in many cities and towns all over the world.
There are
also programs for those who regard themselves as the traumatized or otherwise
affected partners of sex addicts such as COSA and
CO-SLAA.
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."
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.
DSM
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." The reference to
sexual addiction was subsequently removed, The current version, published in
2000 (DSM-IV-TR), no longer mentions sexual addiction as a mental disorder. 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.) Even this
still-present diagnostic definition does not mention sexual addiction, but
focuses on the patient's distress as to their sexual behavior (contrary to the
pattern of denial in addiction as mentioned below), not on the sexual behavior
itself.
Hypersexuality, by itself, can also be 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; however, sexual addiction has been rejected for inclusion in the DSM-5,
expected out in 2013. Darrel Regier, vice-chair of the DSM-5 task force, said
that "lthough 'hypersexuality' is a proposed new addition... was not at the
point where we were ready to call it an addiction." The proposed diagnosis does
not make the cut as an official psychiatric diagnosis due to a lack of
substantial empirical evidence, according to the American Psychiatric
Association.
ICD
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).
Symptoms and
proposed diagnostic criteria
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." 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. 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.
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.
Carnes
Patrick
Carnes believes that people become addicted to sex in the same way they become
addicted to alcohol or drugs. He proposes using:
1.Recurrent failure
(pattern) to resist impulses to engage in acts of sex.
2.Frequently engaging
in those behaviors to a greater extent or over a longer period of time than
intended.
3.Persistent desire or unsuccessful efforts to stop, reduce, or
control those behaviors.
4.Inordinate amount of time spent in obtaining sex,
being sexual, or recovering from sexual experience.
5.Preoccupation with the
behavior or preparatory activities.
6.Frequently engaging in sexual behavior
when expected to fulfill occupational, academic, domestic, or social
obligations.
7.Continuation of the behavior despite knowledge of having a
persistent or recurrent social, academic, financial, psychological, or physical
problem that is caused or exacerbated by the behavior.
8.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.
9.Giving up or limiting social,
occupational, or recreational activities because of the
behavior.
10.Resorting to distress, anxiety, restlessness, or violence if
unable to engage in the behavior at times relating to SRD (Sexual Rage
Disorder).
Although
Patrick Carnes’s theory has become popular in recent years, it remains quite
controversial and many other theories exist
Goodman
Aviel
Goodman, M.D., proposed a maladaptive pattern of sexual 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:
1.tolerance, as defined by either of the following: 1.a need for
markedly increased amount or intensity of the behavior to achieve the desired
effect
2.markedly diminished effect with continued involvement in the
behavior at the same level or intensity
2.withdrawal, as manifested by either of the following:
1.characteristic psychophysiological withdrawal syndrome of physiologically
described changes and/or psychologically described changes upon discontinuation
of the behavior
2.the same (or a closely related) behavior is engaged in to
relieve or avoid withdrawal symptoms
3.the sexual
behavior is often engaged in over a longer period, in greater quantity, or at a
higher intensity than was intended
4.there is a persistent desire or
unsuccessful efforts to cut down or control the behavior
5.a great deal of
time spent in activities necessary to prepare for the behavior, to engage in the
behavior, or to recover from its effects
6.important social, occupational,
or recreational activities are given up or reduced because of the
behavior
7.the sexual behavior continues despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely to have
been caused or exacerbated by the behaviour
Schneider
Jennifer P.
Schneider, MD, PhD identified three indicators of sexual addiction:
compulsivity, continuation despite consequences, and
obsession.
1.Compulsivity: This is the loss of the ability to choose freely
whether to stop or continue a behavior.
2.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. Despite all of these consequences, they
continue indulging in excessive sexual activity.
3.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 experiences. Because
their minds are so preoccupied by these thoughts, other areas of their lives
that they could be thinking about are neglected.
Causes
Sexual
addiction is hypothesized to be (but is not always) associated with
obsessive-compulsive disorder (OCD), narcissistic personality disorder, and
bipolar disorder. 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.
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.
According to
proponents of sexual addiction as a disorder, addicts often display narcissistic
traits; these are said to often clear as sobriety is achieved, although others
exhibit the full personality disorder even after successful addiction
treatment.
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, and the like.
Neurochemical theories
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.
Psychological distress theories
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)
According to
Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts
hold
1."I am basically a bad, unworthy person."
2."No one would love me
as I am."
3."My needs are never going to be met if I have to depend on
others."
4."Sex is my most important need."
These
beliefs drive the addiction on its progressive and destructive course:
Pain
agent — First a pain agent is triggered / emotional discomfort (e.g. shame,
anger, unresolved conflict). A sex addict is not able to take care of the pain
agent in a healthy way.
Dissociation — Prior to acting out sexually, the sex
addict goes through a period of mental preoccupation or obsession. Sex addicts
begin to dissociate (moves away from his or her feelings). A separation begins
to take place between his or her mind and his or her emotional self.
Altered
state of consciousness / a trance state / bubble of euphoric fantasized
experience — Sex addict is emotionally disconnected and is pre-occupied with
acting out behaviours. The reality becomes blocked
out/distorted.
Preoccupation or "sexual pressure" — This involves obsessing
about being sexual or romantic. Fantasy is an obsession that serves in some way
to avoid life. The addict's thoughts focus on reaching a mood-altering high
without actually acting-out sexually. They think about sex to produce a
trance-like state of arousal to eliminate the pain of reality. Thinking about
sex and planning out how to reach orgasm can continue for minutes or hours
before they move to the next stage of the cycle.
Ritualization or "acting
out" — These obsessions are intensified by ritualization or acting out.
Ritualization helps distance reality from sexual obsession. Rituals induce
trance and further separate the addict from reality. Once the addict begins the
ritual, the chances of stopping that cycle diminish greatly. They give into the
pull of the compelling sex act.
Sexual compulsivity — The next phase of the
cycle is sexual compulsivity or "sex act". The tensions the addict feels are
reduced by acting on their sexual feelings. They feel better for the moment,
thanks to the release that occurs. Compulsivity simply means that addicts
regularly get to the point where sex becomes inevitable, no matter what the
circumstances or the consequences. The compulsive act, which normally ends in
orgasm, is perhaps the starkest reminder of the degradation involved in the
addiction as the person realizes they are a slave to the addiction.
Despair
— Almost immediately reality sets in, and the addict begins to feel ashamed.
This point of the cycle is a painful place where the Addict has been many, many
times. The last time the Addict was at this low point, they probably promised to
never do it again. Yet once again, they act out and that leads to despair. They
may feel they have betrayed spiritual beliefs, possibly a partner, and his or
her own sense of integrity. At a superficial level, the addict hopes that this
is the last battle.
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.
Dr. Carnes
mentions that:
Al Cooper (one of the original researchers in internet sex)
described internet sex as the ‘crack cocaine’ of sexual addiction because it is
an accelerant for adults of all stages of the lifespan. He felt that people
would never have the problem if it had not been for the
internet.
