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Sexual Desire Disorders - Sexual Addiction

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

Sexual addiction refers to a preoccupation with sexual thoughts or sexual behavior to the extent that this preoccupation continues even though it causes substantial harm. This harm may include:

  • risky, dangerous, or unhealthy sexual behaviors
  • damage to relationships
  • avoidance of meaningful intimate relationships
  • financial consequences
  • legal consequences
  • a failure to fulfill important life roles such as employee, student, spouse, parent, friend, etc.

Sexual addiction does not refer to any particular type of sexual behavior. Likewise, sexual addiction does not refer to a high degree of sexual desire, or frequency of sexual activity. Sexual addiction is indicated when someone experiences a reduced control over sexual behavior despite negative consequences. Usually negative consequences serve to decrease or diminish the behaviors that cause them. In the case of addictions, these behaviors continue despite negative consequences. Examples of these consequences include: arguments with a partner over excessive pornography use; losing a job because of inappropriate sexual behavior in the workplace; and health, legal, and financial problems.

Sexual addiction falls into a specific category of addictions called activity addictions. Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable.

Sexual addiction is not a diagnostic term currently recognized by the American Psychiatric Association. Instead, clinicians use diagnostic labels such as unspecified impulsive control disorder, unspecified paraphilic disorder, or unspecified sexual dysfunction. However, the use of the later diagnosis is controversial as sexual addiction is not the same as sexual dysfunction. Some addictive activities may lead to sexual dysfunction. For instance, it is not uncommon for heavy users of pornography to become unable to achieve an erection with a partner.

It may be difficult to understand how someone can become addicted to an activity such as sex. When people develop an addiction, they become addicted to the release of certain brain chemicals. It doesn't matter what causes this release of brain chemicals. It could be a drug or an activity that causes this release. Like drugs and alcohol, sexual activity increases levels of dopamine in the brain. Dopamine is the primary neurotransmitter in the brain's reward system. Because sex is an activity that promotes the survival of the species, the brain rewards this activity with dopamine. Dopamine creates pleasurable feelings. People are motivated to repeat behaviors that create pleasurable feelings. Unfortunately, the brain's reward system makes us vulnerable to addiction.

Like all addictions, sexual addiction causes changes to the brain's prefrontal cortex. Unfortunately, these changes also make the discontinuation of the addiction more difficult. These brain changes account for two characteristics of sexual addiction: impulsivity and compulsivity. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences. Sometimes people describe impulsivity as living in the present moment without regard to the future. Impulsivity is evident in the early stages of addiction. During this phase, people impulsively act on powerful urges to experience sexual pleasure. The future consequences of those activities are not considered. Anxiety is not associated with the urges during these early stages.

Treatment of Sexual Addiction

There are four basic approaches to addictions treatment: Biological, Psychological, Socio-Cultural, and Spiritual. People can combine these various approaches to match their individual needs and circumstances as they work to develop their own individualized, custom-tailored approach to recovery.

1. Biological approaches to addictions treatment attempt to correct or modify the presumed underlying biological causes of addiction. This approach follows a logical rationale. If we know what caused something to become broken, we can fix it. Then, we can repair or restore the broken "thing" to its original purpose and function. According to biological models of addiction, a "broken" or damaged brain causes addiction. For example, perhaps someone's brain chemistry makes sex a little bit too enjoyable. Perhaps other ordinary pleasures cannot be enjoyed because of underlying depression. The solution is to fix the faulty brain chemistry. This is accomplished via the addition of corrective chemicals; i.e., medications.

2. Psychological approaches to sexual addiction aim to increase a person's motivation for change. Helping people to accurately appraise the costs and benefits of their addiction increases their motivation. Once a person is motivated to change, they must actually take steps to change. It seems rather obvious, but wanting to change is not the same thing as completing said change. People in recovery must make some very difficult changes in the way they think, feel, and behave. In this way, they can make wiser, healthier choices. Psychological approaches are ideal for helping people to make these needed changes.

In addition to changing thoughts, feelings, and behaviors individuals embracing recovery may also need to restructure their social world. Our relationships with other people greatly determine whether addiction or relapse is likely. Thus, another psychological approach helps people to evaluate whether or not their social circle is supportive of the changes they wish to make. Psychotherapy may also help addicted individuals to correct for developmental immaturity.

It is difficult to change behavior. It requires a significant amount of motivation. Therefore, strengthening the motivation for recovery is very helpful. One such approach is called Motivational Interviewing. There are also several effective types of psychotherapy. These are: Relapse Prevention Therapy; Contingency Management; Cognitive-Behavioral Therapy; Dialectical Behavioral Therapy; Acceptance and Commitment Therapy.

3. Socio-cultural approaches to addictions recovery emphasizes the important influence of social groups on individuals as they attempt to recover. There are several socio-cultural approaches to sexual addiction treatment. These include: 1) couples and family therapy, and 2) the social support approach to addictions treatment.

Social support groups (or simply "support groups") refer to groups of people who meet to share their common problems and experiences. Support groups are not the same as therapy groups. Trained professional lead therapy groups with a specific therapeutic purpose. In contrast, support groups are led by non-professional volunteers. Social support groups include two basic types. There are self-empowering support groups and 12-step support groups such as Sex Addicts Anonymous, Sexaholics Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous.

4. Spiritual approaches to sexual addiction recovery are based on research that has repeatedly demonstrated that spirituality can have a positive effect on recovery from many diseases and disorders. It is unknown the precise source of this effect. Recovery may indeed originate because of a "power greater than ourselves" (aka, God). Alternatively, recovery may be due to the psychological benefit of hope that such a belief instills. In any case, the fact remains that many people's health is benefitted by their spiritual beliefs and practices. As God and related concepts do not lend themselves to scientific research, we are in no position to comment upon the reasons for this effect. What we can say is that research has indicated that a spiritual faith or practice can be beneficial in the recovery from many diseases and disorders.

The most well-known spiritual approaches to addictions recovery are the 12-step support groups modeled after Alcoholics Anonymous (AA). However, spirituality is not limited to a belief in a power greater than oneself. Spirituality might more broadly include a belief that life has a meaning and purpose. Such a belief might provide a guideline for living according to that meaning and purpose. Restoring a meaning and purpose to life is one of the four key ingredients to any successful recovery effort.