My Name Is John and I Am a Sex Addict. (Or Maybe Not)

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Is it or isn’t it? A new study undermines the theory that sex addiction is a brain-based disorder similar to other addictions.

For most of the public, the concept of addiction is pretty straightforward — it involves taking something or doing something that brings you pleasure and that you can’t control. But scientifically, addiction means something much more specific, if not precisely quantifiable.

For much of the 20th century, psychiatrists and laypeople defined addictions as use of substances or behaviors that required ever-increasing doses to maintain a satisfying “high.” These addictions also conspired to form some type of physiologic dependence, which led to physical symptoms such as vomiting and diarrhea when the addictive substance or activity was stopped.

But these criteria failed to capture the compulsive quality of addiction, or the craving that drives relapse long after withdrawal symptoms have dissipated. So today’s expert consensus — as laid out in the psychiatric community’s Diagnostic and Statistical Manual of Mental Disorders (DSM) — defines both substance and behavioral addictions, like gambling, as compulsive behaviors that interfere with normal functioning and continue despite negative consequences.

(MORE: Naomi Wolf’s Vagina Aside, What Neuroscience Really Says About Female Desire)

By that definition, excessive sexual behavior also qualifies as an addiction, and a study published last year found that applying these criteria did indeed distinguish people with sex addictions from those with other psychiatric problems. However, the editors of the latest edition of DSM-5 didn’t believe there was enough evidence to support defining hypersexuality as an addiction and decided not to define it as such in the new volume.

At issue is the broader question of what makes behaviors addictive. Since compulsive behavior may have roots in how the brain interprets rewarding or satisfying behaviors, Nicole Prause, a research scientist at the University of California, Los Angeles, and her colleagues decided to start with brain-wave activity to better understand the nature of compulsive sexual behavior.

They studied 39 men and 13 women, all of whom met criteria for hypersexuality, who responded to ads for a study involving people who had trouble controlling their use of pornography. Each of the participants agreed to have their brain activity measured via a noninvasive electroencephalogram, or EEG, while they looked at pictures ranging from pleasant images of couples caressing to sexually explicit scenes, as well as both pleasant and disturbing images of nonsexual activities. Prior to the brain-wave tests, they also completed questionnaires to assess their levels of compulsiveness and control over their sexual impulses.

The researchers focused on brain-wave patterns that occurred about 300 milliseconds after the participants viewed an image, or p300, which measured how interesting or attractive they found that picture. Previous work involving p300 with drug addicts showed that drug-related pictures were far more compelling than other depictions. Finding similar surges in p300 after the participants viewed sexually explicit images would suggest that excessive sexual activity, like some drug use, might be addictive.

Instead, however, Prause and her colleagues found tolerance — unlike drug addicts, the sex addicts in this study didn’t find the sexual cues more compelling than other images. “They look just like normal people with high sex drive,” says Prause. “People who write about sex addiction would say, ‘It’s not just high drive: they are out of control, they can’t stop and their brains are [changed].’ We just don’t see any evidence for them being different.”

(MORE: Study Supports Sex Addiction as a Diagnosis-Worthy Condition)

That doesn’t mean that excessive or compulsive sexual behavior can’t be seriously problematic. “I don’t think this means that they don’t deserve help or are faking or just being jerks,” she says. But she thinks adding the label addiction could pathologize normal variation and induce pessimism. “I don’t know that we need the overlay of addiction,” she says.

Rory Reid, a research psychologist at UCLA and a colleague of Prause who was not associated with the study, believes the results don’t close the door on the idea of sex addiction or on hypersexual disorder as a diagnosis. Reid was a principal investigator in research that suggested that the criteria for hypersexual disorder qualify it for a psychiatric diagnosis.

He says that the lack of an association between p300 and measures of sexual compulsion isn’t enough to discredit the idea that it’s a brain disorder. “We can’t really assert that,” he says. Just because p300 doesn’t vary in relation to symptoms like loss of control doesn’t mean that other signals, which Prause’s group did not measure, would not. Reid also suggests that Prause’s participants, who were not in rehab programs, may not have been as severely affected as patients in treatment — and that the images used may not have been extreme enough to generate extra interest the way drug images do in addiction.

Why is it so important to determine whether hypersexuality is an addiction? Reid believes it may be more of a research issue than one that has clinical merit, at least for now. “For the patient who comes in after his third job loss because he can’t stop masturbating to porn at work, he doesn’t care what we call it; he just wants to know how to change and function more adaptively,” Reid says.

But determining if common brain pathways are responsible for sexual compulsion and drug addiction could lead to more effective ways of treating sexual desires that start to interfere with daily life. If sexual addiction is similar to cocaine addiction, for instance, the same medications or talk therapies might be useful and the same brain areas could be targeted for treatment.

11 comments
quando25
quando25

This is a great article and I found it to be very interesting... Sex addiction would seem like it is fairly common these days but then again it is hard to class what is a sex addict as everyone loves to have sex... I guess it just comes down to how frequently one feels the need to be sexual which is the determining factor... http://freshbreathblog.weebly.com/

Tomcaat
Tomcaat

I am in the psychology field and feel we need more middle ground - and not just keep going far left and right all the time.  Some would say you either stand for something or you lie down..I don't see it this way much of the time, I 'stand' for both sides to find more ways in coming together. I can't say I care for many of the euphemisms or changing how we see things these days to the extent we seem to be going sometimes either. If it's a spade - call it a spade.  This however doesn't mean we shouldn't keep going with eliminating some of the labels society has used for some of the things out there where the term has unnecessarily affected some with an often negative tone. Simple example: 'mentally retarded' ..and calling someone a 'retard'. The DSM has rightfully altered this and other similar examples along the way.  If anyone feels we over complicate some of these things - just put yourself in the shoes of some of the people who are in fact mentally disabled - but not so profoundly as to not feel some sting when they hear the 'retard' portion of the 'mentally retarded' reference.

This unfortunately could also spill into pertaining to anybody who views porn perhaps a little too frequently - they know it - and don't necessarily feel right about it and think they probably should bring their psychologist into the picture .. yes, they may have some issues that need tending to by consulting a professional ...but how many may be reluctant to do so for fear of an unintended party catching wind of their issue..and now they are a.. pervert?



GregWiens
GregWiens

At one time this was called perverted and unhealthy behavior.  Now it is "normal". 

This is just one part in the attempt to change societal ideas about sexuality by normalizing it even though there is much evidence that these types of sexual behaviors are emotionally and physiologically harmful.  


marshalldon
marshalldon

This study is a joke. 

1) The authors manipulated data to produce their single correlation: EEG readings with sexual desire. They did this by removing questions from a standardized test called the sexual desire inventory (SDI). In fact, the creator of the SDI (Ilana Spector) stated that researchers misused the test because they removed all the questions about masturbation - the very activity subjects had trouble controlling.

2) In addition, the subjects were of all sexual orientations, yet they were all shown the same pictures - heterosexual sex. Does anyone think that a gay man will have the same response to heterosexual porn as a straight man? No wonder their scores didn't correlate with anything.

3) The authors had no control group, so they have no idea if the response was normal or not. 

4) Unlike other addiction studies, they did not pre-screen subjects for addiction. In fact, the authors admitted that some subjects had severe problems, while others had few problems with porn. No wonder the scores didn't correlate with anything. 

Google - "UCLA's SPAN Lab Touts Empty Porn Study As Ground-Breaking" - for complete refutation of this bogus study.

IgnacioSanabria
IgnacioSanabria

The neurotransmitter dopamine, the LAPH and the amygdala hold the key regarding any ''addiction''

TrickyWizard
TrickyWizard

 Sounds like two opposing views without any real proof of a physiological ailment. Calling something, an addition, when it hasn't physiologically been proven yet is irresponsible & dangerous; especially to those who think they might "have it".

There is a pall over addiction & its behaviors in the US. It's dangerous for people to be labeled as an addict no matter what the addiction is. Addiction being a compulsion, I think it's quite possible that hypersexuals have to be in a state of negative stress for it to manifest itself.

I don't think Hypersexuality is an addiction, I think it's a response to negative stress. I think they use sex because they control their own sexuality, as I control what I eat. With porn they have control of how much stress they can abate and with frequent sex or multiple partners they can use it for the same thing. Either way they use it as an anti-anxiety tool. I don’t think that’s addiction, that's coping.

Openminded1
Openminded1

@GregWiens You must live a very boring life, or maybe just a holy roller who is most likely more perverted then the so called normal sexual human.

Tomcaat
Tomcaat

@TrickyWizard  I'd be all for having a better, more appropriate term than 'addiction' if need be.  In the meantime I suppose the label will continue to stick in many ways in where if any given behavior causes abnormal 'fixations' to render such strikingly similar results in consequences, they'll give it the 'addiction' tag.  We know all about the cultural aspects as to how a certain culture can actually be a force in how some of these behaviors are determined normal or abnormal - much of the U.S. not excluded.  This is in part what I believe goes on with this particular issue as well. From cases I've seen, the so-called sex addiction certainly doesn't equate with the substances but do have some of the same characteristics for psychological consequences which can be every bit as much undesirable - but..you are correct I think in requiring better physiological proofs. 

DeweySayenoff
DeweySayenoff

@TrickyWizard When someone's coping mechanism interferes with their ability to live a normal life, that's a disorder at the very least.  If someone can not help or can not stop what they do that interferes with their ability to live a normal life, that's an addiction based on behavior.

Psychology is almost entirely about behaviors and modifying or changing them.  There are many approaches to doing that.  It doesn't matter what someone thinks as much as it does how they act - at least in our society.  The former can lead to doing something bad, of course, but it's the bad behaviors that cause the problems.  No one ever has been stigmatized based on an unvoiced or un-acted upon thought.  But when it is voiced or acted upon, that's when people notice the problem and work to change the behaviors.

So, yes, it's an addiction.  Eating can be an addiction as well if the eating behaviors cause someone to not be able to live a normal life.  The lack of physiological substantiation from one particular test doesn't mean that a physiological reaction isn't going on.  It just hasn't been found yet.  I'd like to see functional brain scans and hormone level tests, myself.  EEG's are extremely limited in what they reveal and are subject to serious misinterpretation (like thinking a concussion is epilepsy).  But because of our morals police in the U.S., who see all behaviors as completely voluntary and under full control and only a matter of a lack of moral fiber and the need for "religion" to "fix" the problem, it's unlikely funding to study the issue will be forthcoming anytime soon.  Especially one to study THIS disorder.