Sexual Desire Disorders - Sexual Addiction
Whereas Hypoactive Sexual Desire Disorder is characterized by a lack of interest in sex, Sexual Aversion Disorder includes fear, anxiety, or disgust at the mere prospect of a sexual encounter. This may be general and include all activities (i.e., kissing) that are related to sex, or it may be specific to activities that include the genitals. Less is known about the causes of sexual aversion disorder although it does appear to be related to negative attitudes regarding sexuality, or having had a traumatic sexual experience. Psychotherapy can be quite helpful in the treatment of sexual aversion disorder.
A logical question that comes to mind when we are discussing low sexual desire is its' opposite: "Can someone's sexual desire be too high?" While sexual addiction is not a disorder recognized by DSM-IV TR, it is a topic of great interest and debate. Currently there is no diagnosis for having too much sexual desire. But, is sexual addiction merely an excess of sexual desire, or does it reflect something else? This question of, "How much is too much?" is a common consideration when evaluating any addiction. When does someone merely enjoy quite a lot of alcohol and when do they become an "alcoholic"? Thus, it is not surprising that this same question applies to sexual addiction. When we consider addiction more broadly, and reflect upon what we already know about addiction to substances such as tobacco, alcohol, or cocaine, it may help us to understand sexual addiction. Essentially, when substance use becomes excessive, or produces conflict and negative consequences, we begin applying the term addiction. Therefore, addiction includes not only the desire for substance use, but reflects the continued use of the substance despite negative consequences, such as loosing one's family, job, life savings, home, etc. A person addicted to a substance doesn't just desire that substance, they must have it at all costs.
When one becomes preoccupied by sexual thoughts and/or engages in risky sexual behaviors which lead to conflict in relationships or avoidance of relationships (and other negative consequences), we could say that an individual has a sexual addiction. This is because it meets the general criteria for "addiction." Another term used to describe sexual addiction is Compulsive Sexual Behavior. While we are not certain how many people have this condition, it is estimated that between 3% and 6% of individuals in the United States suffer from sexual addiction. Compulsive Sexual Behavior typically begins in late adolescence or early adulthood and impacts men more so than women. It may be associated with substance use or other mental health conditions i.e., (depression, anxiety, personality disorders) (Kuzma, Black, Roy, & Carver, 2008). An additional mental health condition that may be associated with compulsive sexual behavior is bipolar disorder. Individuals with bipolar disorder often go through manic phases during which they may excessively engage in pleasurable activities, such as sex, without regard to their safety or well-being.
While we are not sure why some people become addicted to sex, it does appear to be more common among individuals who were sexually abused as children (Kuzma, Black, Roy, & Carver, 2008). This information does not answer the question why might sex be so addictive for some people, but not others. New research has indicated that the neurobiology of sexual arousal is very similar to that of cocaine. According to behavioral models, a "reward" causes us to repeat a behavior over and over again, so long as the "reward" keeps coming. Simply speaking, where the brain is concerned, a "reward" is a reward whether it comes directly from a chemical agent (cocaine), or a behavior (sex) that produces the rewarding chemical (Boettiger et. al., 2007). There may actually be brain impairments in individuals who have a sexual addiction which makes it so that they cannot judge the danger and negative impact of their sexual behavior. Alternatively, individuals with sexual addiction may have such impaired impulse control they immediately gratify sexual cravings without regard to the consequences. Regardless of the reasons, sexual addicts may seek out stimulation by viewing pornography, engaging in cybersex, or having sex with others, often paid, sex-trade workers. This puts them at risk for a number of life-threatening illnesses (e.g., AIDS), legal problems, (e.g., purchasing child pornography), and financial ruin.
Clearly, sexual addiction can cause great harm to relationships. Considering that sex is still a taboo, there may be a great deal of shame associated with sexual addictions. Partners of individuals who have a sexual addiction may be very distraught by their partner's dishonesty and secret life. They may feel a sense of betrayal, and fear the legal, economic, and personal repercussions, they endure as a result of their partner's addiction. To complicate matters further, the great deal of taboo associated with sex may not allow for discussion of the matter, and limits the amount of social support the individual receives. (Landau, Garrett, & Webb, Robert, 2008)
While considering the above information it is important to keep in mind that not all interest in sex is an addiction. Because sexual addiction is much more common among men, it is not uncommon for sex therapists to encounter couples in which the female is concerned that her male partner is addicted to sex. This may be particularly relevant when considering pornography. Many men (and women) enjoy viewing pornography. Certainly, viewing pornography by itself does not constitute a sexual addiction. However, if it is excessive, causes problems in the relationship, and produces negative consequences, then discussing the possibility of an addiction becomes necessary. Here are some common examples of behaviors that may indicate an addiction: 1) being unable or unwilling to have sex with your partner except while viewing pornography, 2) spending large quantities of money on sex (i.e., pornography, prostitutes, and phone sex), 3) not going to work because the majority of the day was spent engaging in sex, or viewing sexual material. Similar to other addictions, the addict may minimize or ignore the harm they are causing to themselves or others. Therefore, treatment is often delayed until some crisis occurs.
In terms of treatment alternatives, research has suggested there may be a biological component to sexual addiction; providing hope that medication may be a promising alternative for treatment. For instance, androgen reduction therapy using GNRH agonists, Pristiq ©, Lexapro ©, and Zoloft ©, have shown promise. Another proposed biologic model of addiction is that of chiropractic medicine. Some practitioners believe that compulsive disorders, such as sexual addiction, to result from an interruption in the brain reward cascade which produces a reward deficiency syndrome. The approach to treatment involves attempting to correct the "deficiency" through spinal adjustments and nutritional support.
Additionally, several psycho-therapies have been designed for the treatment of sex addicts. There are several inpatient treatment programs throughout the country that have designed treatment programs specifically for sexual addiction. The majority of these programs incorporate cognitive-behavioral therapies and 12-step programs such as Sex Addicts Anonymous, or Sexaholics Anonymous. However, some therapists argue against inpatient treatment. They believe it is more beneficial for an addicted person to remain in their own natural environment where they learn to recover while dealing with ordinary, everyday stressors.