Sexual addiction, also sometimes called sexual compulsion, is a postulated form of psychological addiction to sexual intercourse and other sexual behavior.
Diagnosis
There is no consensus in the medical community that sexual addiction actually exists, and it is not presently included in the Diagnostic and Statistical Manual of Mental Disorders. Those who support its diagnosis describe it as being in many ways similar to other addictions, where the activity comes to be used as a way to manage mood or stress and may become more severe with time. Diagnostic criteria have been suggested that are closely analogous to those the DSM provides for other addictions.
Epidemiology
The prevalence of sexual addiction is not accurately known, in part because addicts are secretive. However, it is claimed to be commonly seen in combination with other addictions as well as mood and stress disorders. Sexual addiction has in the past been considered a largely male problem, but more recent work suggests it is also prevalent in women, although usually manifesting in different ways.
Manifestation
Sex addiction appears to be a psychological addiction, although it can be argued that the hormones released while engaging in the behaviour creates a physiological response.
Sexual addicts use widely varying activities. Even masturbation can become obsessive, being done to the point of injury or to the point that it interferes significantly with ordinary life, even to the point where the addict prefers masturbation over actual sex. Pornography or other sexual/romantic literature can be addictive, and addicts may spend huge amounts of money on it. Employment of prostitutes is also common for sexual addicts. But in contrast to fetishism, sexual addiction is seldom sharply focused on a single activity.
A key feature of sexual addiction is its obsessive, unmanageable nature: a normal person might stare as they happen to drive past an attractive person, but an addict will drive around the block to stare again; and perhaps again. Addicts can spend an extraordinary amount of time and money on their habit, entirely lacking control. They often experience an almost trance-like state in which acting out can go on for many hours. As with other addictions, some addicts experience episodic binges (between which they may believe there is no problem), while others experience more continuous problems.
Some addicts act in more intrusive ways, or progress to them as they experience diminishing returns for their original activities. A second level might include voyeurism and exhibitionism, and rubbing against people in public places. A third level involves much more serious and intrusive sexual offenses, and has more harmful consequences.
Patrick Carnes, the most prolific author on this subject, states that specific activities are not what identify addiction. Even a rapist may not necessarily be a sexual addict. Rather, it is the compulsive nature of the behaviors that demonstrates addiction.
Addicts have tried often to stop, and failed. Their behavior generally conforms to a cycle:
- Preoccupation -- the addict becomes completely engrossed with sexual thoughts or fantasies.
- Ritualization -- the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
- Compulsive sexual behavior -— the addict's specific sexual acting out.
- Despair -- the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.
To escape these negative feelings, the addict soon becomes preoccupied with sexual thoughts and fantasies again, restarting the addictive cycle. Risk factors for the addict include unstructured time, need for self-direction and demands for excellence, because they all push the addict toward restarting the cycle.
A variety of questionnaires and tests have been devised to evaluate sexual addiction, but few if any have been formally evaluated, normed, or proven accurate. The cycle and beliefs above strongly characterize the sexual addict, however. In addition, Carnes proposes a basic test for whether a particular sexual behavior has become addictive:
- It is a secret.
- It is abusive or degrading to self or others.
- It is used to avoid (or is a source of) painful feelings.
- It is empty of a caring, committed relationship.
Treatment
People selling spiritually-based methods of treatment claim to provide an effective treatment. For example, Sex Addicts Anonymous, Sexaholics Anonymous, and Sex and Love Addicts Anonymous, are large groups based on the 12-step system of Alcoholics Anonymous. Therapists also use cognitive-behavioral therapy, and medications may be of value particularly in overcoming depressive states that lead to increased acting out. It is also important to distinguish between sexual addiction and sexual anorexia, as both can present similar behaviors, but effective treatment may be quite different. Aside from depression, it also must be established whether or not the presenting behaviors are due to obsessive-compulsive disorders, bipolar disorders, etc.
Controversy
There are many people and organizations who do not acknowledge sexual addiction as a valid form of addiction. There is an argument as to whether the term has any true meaning for describing human sexual behavior. Many view sexual addiction as an excuse for acting out in this fashion. Other distinctions are difficult to make in a clinical sense, as in between promiscuity and sexual addiction as the main difference lies within the motivation of the act.
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