Sexual Addiction

In the U.S., more than 30 million people suffer from sex addiction.

• Sexual addiction, also often referred to as hypersexuality, sexual dependency, and compulsive sexual behavior disorder, is a condition that involves the sufferer becoming excessively preoccupied with thoughts or behaviors that give a desired sexual effect.
• More than 30 million people suffer from sexual addiction in the United States alone.
• Paraphilias are disorders that involve the sufferer becoming sexually aroused by objects or actions considered less conventional and/or less easily accessible to the sex addict.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) classifies sexual addictions as specific paraphilic disorders or as other specified paraphilic disorders.
• No one factor causes sexual addiction, but there are thought to be biological, psychological, and social factors that contribute to the development of these disorders.
• Sex addicts suffer from a negative pattern of sexual behavior that leads to significant problems or distress.
• As is true with virtually any other mental health diagnosis, no one test definitively indicates that someone has a sexual addiction. Therefore, healthcare practitioners diagnose these disorders by gathering comprehensive medical, family, and mental health information to distinguish sexual addiction from medical and other mental health disorders.
• Many people with a sexual addiction benefit from the support and structure of recovery groups or cognitive behavioral therapy (CBT). When compulsive sexual behaviors become severe, the sufferer may require inpatient treatment or participation in an intensive outpatient treatment program.
• Serotonergic (SSRI) antidepressants, antiseizure medications, naltrexone, and medications that decrease male hormones decrease the compulsive urges and/or impulses associated with sexual addictions for some sufferers.
• The prognosis of sexual addiction depends on several factors.
• Prevention of sexual addiction may involve interventions that enhance self-esteem and self-image, addressing emotional problems, educating children about the dangers of excessive internet use, monitoring and limiting computer use, and screening pornographic sites.
• Sex addiction is associated with several potential medical, occupational, legal, social, and emotional complications.
• Research on sexual addiction includes exploring potential risk factors and developing accurate screening and assessment tools for these disorders.

Hypersexuality, sexual dependency, and compulsive sexual behavior disorder are other names for sexual addiction. As with other dependencies, sexual addiction is a condition that involves the sufferer becoming excessively preoccupied with thoughts or behaviors that give a desired effect. It involves spending an exorbitant amount of time thinking about and/or engaging in sexually addictive behaviors.

• Examples of sexual behavioral addictions may involve easily accessible or less accessible (paraphilic) behaviors.
• Examples of more easily accessible addictive acts may include having one-night stands or multiple affairs, contact with prostitutes, viewing pornographic pictures or videos, or compulsive masturbation. The sufferer may engage in behaviors like frequenting chat rooms, engaging in personal ads, or making obscene phone calls.

Statistics show that a small percentage of college-aged people suffer from a sex addiction at any one time. In the general adult population, about 12 million people have a sex addiction.

Paraphilias are disorders that involve the sufferer becoming sexually aroused by objects or actions that are less conventional or less easily accessible to the addict. Examples of paraphilias include:

• Fetishism (arousal by objects or specific body parts)
• Voyeurism (arousal by watching sexual behaviors)
• Exhibitionism (arousal by having others view his or her sexual behaviors)
• Pedophilia (arousal by sexual contact with children)

When paraphilias include the sufferer having obsessions about the object of their desire, they may be considered sexually addicted. The Diagnostic and Statistical Manual of Mental Disorders (DSM) only refers to nonparaphilic sexual addictions in the category of sexual disorder, not otherwise specified.

Sexually addictive behaviors have been described in modern times for more than 100 years. During the 19th century, people described sex addicts as frenetic masturbators and as having nymphomania (primarily ascribed to women), satyriasis (primarily assigned to men), compulsive sexuality, and sexual intoxication.

Though no single factor causes sexual addiction, there are biological, psychological, and social factors that contribute to the development of these disorders. For example, the intoxication associated with sexual addiction is the result of changes in certain areas and chemicals in the brain elicited by compulsion.

Research differs somewhat in terms of gender-based patterns of sexual addiction. For example, some studies describe males who are introverted and highly educated as more inclined to develop an internet addiction, including sexual internet addiction. Other studies indicate that middle-aged women using home computers were more at risk for Internet sexual addiction.

Psychological risk factors for sexual addiction include depression, anxiety, and obsessive-compulsive tendencies. The presence of a learning disability increases the risk of developing a sex addiction as well. As people with a history of suffering from drugs, porn, or any other addiction are at risk for developing another addiction, being dependent on something else makes it more likely for sexual addiction to occur.

Sufferers of these disorders tend to be socially isolated and have personality traits like insecurity, impulsivity, compulsivity, trouble with relationship stability and intimacy, low ability to tolerate frustration, and a tendency to have trouble coping with emotions. People who suffer sexual abuse are at a somewhat higher risk of developing a sexual addiction.

While the DSM has yet to describe specific diagnostic criteria for nonparaphilic sex addictions, some researchers have suggested symptoms and signs that are similar to other addictions for both paraphilic and nonparaphilic sex addictions.

Specifically, sex addicts suffer from a negative pattern of sexual behavior that leads to significant problems or distress that may include the following:

• A need for more amount or intensity of behavior to achieve the desired effect (tolerance)
• Physical or psychological feelings of withdrawal when unable to engage in the addictive behavior
• The person making plans for, engaging in, or recovering from the behavior more or longer than planned
• Desire or unsuccessful attempts to decrease or stop the behavior
• Neglecting important social, work, or school activities because of the behavior
• Continuing the behavior despite suffering physical or psychological problems because of or worsened by the sexual behavior

As is true with virtually any mental health diagnosis, no one test definitively indicates that someone has a sexual addiction. Therefore, healthcare practitioners diagnose these disorders by gathering comprehensive medical, family, and mental health information. The psychiatrist, psychologist, social worker, psychiatric nurse, physician's assistant, or certified counselor will also either perform a physical examination or request that the individual's primary care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental health symptoms.

In asking questions about mental health symptoms, mental health professionals are often exploring if the individual suffers from sexual obsession or compulsions but also depression or manic symptoms, anxiety, alcoholism or other substance abuse, hallucinations or delusions, as well as some personality and behavioral disorders that may have excessive sexual activity as part of the associated symptoms. Practitioners may provide the people they evaluate with a quiz or self-test as a screening tool for sexual addiction.

Since some of the symptoms of sex addiction can also be co-occurring with other mental illnesses, the mental health screening is to determine if the individual suffers from an anxiety disorder like panic disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), or cyclical mood swings of bipolar disorder. The examiner also explores whether the person with a sex addiction suffers from other mental illnesses like schizophrenia, schizoaffective disorder, and other psychotic disorders or a drug addiction, personality, or behavior disorder like attention deficit hyperactivity disorder (ADHD).

Any condition associated with hypersexual disordered behavior, like some developmental disorders, borderline personality disorder, dependent personality disorder, antisocial personality disorder, or multiple personality disorder (MPD), may be particularly challenging to distinguish from sex addiction. To assess the person's current emotional state, healthcare practitioners perform a mental status examination, as well.

To establish a sexual addiction diagnosis, healthcare professionals will work to distinguish sexual addictions from medical conditions that may include hypersexual symptoms. Examples of such conditions include seizures, tumors, dementia, and Huntington's disease, which may involve injuries to certain areas of the brain like the frontal or temporal lobes and therefore affect behavior.

Therapy and Support Groups

Many people with a sexual addiction benefit from the support and structure of self-help recovery groups like Sex Addicts Anonymous and Sexaholics Anonymous.

Therapists often use cognitive behavioral therapy (CBT) to help individuals with sex addiction learn their triggers for sexually destructive (acting out) behaviors, reevaluate distortions in their thoughts that contribute to their acting out behaviors, and ultimately control those behaviors.

Some mental health professionals also use psychodynamic psychotherapy to address sexual addiction. That approach to treatment focuses more on the addict's basic internal emotional developmental difficulties that contribute to the development of their hypersexual disorder. These difficulties began during childhood, often as a part of the afflicted person's relationships with early caretakers.

When sexual compulsions become severe, the sufferer may require inpatient treatment centers or intensive outpatient programs.

Serotonergic (SSRI) Medications

Serotonergic (SSRI) medications that are treatment options for depressive and anxiety disorders and mood stabilizers that treat bipolar disorder also decrease the compulsive urges associated with sexual addictions for some sufferers. Examples of SSRIs include:

• fluoxetine (Prozac)
• paroxetine (Paxil)
• sertraline (Zoloft)
• citalopram (Celexa)
• fluvoxamine (Luvox)
• escitalopram (Lexapro)

Side Effects of SSRIs

People generally tolerate SSRIs well, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. However, these side effects generally go away within the first month of SSRI use.

• Some patients experience sexual side effects, such as decreased sexual desire (decreased libido), delayed orgasm, or an inability to have an orgasm.
• Some patients experience tremors with SSRIs.
• The so-called serotonergic (meaning caused by serotonin) syndrome is a serious neurologic condition associated with the use of SSRIs. High fevers, seizures, and heart rhythm disturbances characterize the serotonergic syndrome. This condition is very rare and appears only in very ill psychiatric patients taking multiple psychiatric medications.

Mood Stabilizers

Mood stabilizers like carbamazepine (Tegretol), divalproex sodium (Depakote), and lamotrigine (Lamictal) sometimes treat OCD, particularly in individuals who also suffer from bipolar disorder. They may also help decrease the impulsive behaviors suffered by some sex addicts.

Side Effects of Mood Stabilizers

The side effects that professionals look for tend to vary depending on the prescribed medication. Healthcare professionals tend to watch for mild side effects like sleepiness when using Depakote or Tegretol or stomach upset when using one of those medications or Lamictal. Healthcare professionals also monitor patients for serious side effects like severely low white blood cell count in people taking Tegretol or severe autoimmune symptoms like Steven Johnson's syndrome in those taking Depakote and Lamictal.

Naltrexone

Naltrexone, a medication that decreases the effects of narcotic medications, may be useful for decreasing the sexual compulsions, sex drive, or arousal of some sex offenders. That may be particularly important for people who have a sexual addiction and seek celibacy to abstain from their compulsive sexual activity. That has also been found for medications that decrease male hormones, called anti-androgens. One example of an anti-androgenic medication is medroxyprogesterone acetate (MPA), also known by its trade name Depo-Provera.

Studies show that the prognosis of sexual addictions depends on several factors, including the type of addiction, whether or not it involves paraphilic behaviors or, sexually violent behaviors, or if the person with the hypersexual disorder who engages in sexually violent behaviors suffers from another mental health diagnosis.

For sexual offenders, factors that indicate a poor treatment prognosis include a higher number and more than one kind of sexual offense, having a previous criminal history, offending against boys outside their own family, low empathy for their victim, increased anger at the time of the offense, violent sexual fantasies, and attitudes that their victim enjoys it. Choosing an occupation that puts the offender near potential victims and the use of sadomasochistic or pedophilic pornography is also associated with a worse prognosis.

There are several potentially devastating complications of sexual addiction. Possible medical complications include contracting sexually transmitted diseases, including the potentially fatal human immunodeficiency virus (HIV) or hepatitis B or C. Examples of occupational consequences include decreased work performance or attendance due to preoccupation with the addiction. If the behaviors result in unwanted sexual advances on others, legal problems like sexual harassment or rape perpetration may result. Individuals whose sexual addiction involves attraction to minors might engage in child molestation.

Depending on the financial demands of the addiction, the sufferer of sexual addiction may incur a great deal of debt or engage in illegal or otherwise unsafe activity associated with the behavior. Emotionally, individuals with sexual addiction are at risk for terrible guilt and shame at their actions and the secrecy involved. They are also more likely to experience broken relationships, separation, divorce, and the many challenges involved.

As the driving forces for sexual addiction seem to be more poor self-esteem rather than excessive thrill-seeking, interventions that enhance self-esteem and self-image appear to be key in preventing these disorders.

Suggestions for preventing Internet addiction may be useful in the prevention of sexual Internet addiction and include parents educating their children about the dangers of such behaviors, monitoring and limiting computer use, screening out pornographic Internet sites, offering other activities that do not involve computer use, and having a therapist address emotional problems like depression and anxiety, which are risk factors for developing a sexual addiction.

National Addiction Hotline
866-701-0102
http://www.nationaladdictionhotline.com

Sexaholics Anonymous
PO Box 3565
Brentwood, TN 37024
E-mail: [email protected]
Phone: 615-370-6062
Toll-free: 866-424-8777
Fax: 615-370-0882
http://www.sa.org

Sex and Love Addicts Anonymous
http://www.slaafws.org

Sexual Addiction Anonymous
U.S./Canada: 800-477-8191
http://www.saa-recovery.org

Sexual Compulsives Anonymous
USA and Canada: 800-977-HEAL
PO Box 1585, Old Chelsea Station
New York, NY 10011
http://www.sca-recovery.org

Sexual Recovery Anonymous
General Service Board, Inc.
PO Box 178
New York, NY 10276
http://www.sexualrecovery.org
Email: [email protected]

Research on sexual addiction includes developing accurate screening and assessment tools for these disorders. Medical researchers are exploring the possibility that some paraphilias run in families.