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Sex Addiction Is Not So Funny

From Tiger Woods to Anthony Wiener, most bold-faced names who get caught with their pants down blame their actions on sex addiction, while the public largely scoffs at the label. But a top therapist argues that it's no laughing matter.

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You're never too young to wear sex-addict Ts. Photo via flickr

By Alexandra Katehakis

08/02/11

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In the course of a couple of weeks last spring, three of the world's most poweful politicians saw their careers, marriages and reputations crumble because of sexual improprieties. Rep. Anthony Weiner was forced to resign from Congress for sexting naked pics of himself to anonymous supporters; Arnold Schwarzenegger’s wife of 25 years, Maria Shriver, filed for divorce after learning that he had fathered an illegitimate child with their housekeeper; and Dominique Strauss-Kahn, the head of the IMF and the likely frontrunner to become president of France in the next election, was charged with raping a maid in a hotel. While the circumstances of each man’s sexual transgressions vary dramatically, and the truth of these matters may never be known, the media quickly labeled all three as “sex addicts.” Their actions provoked a flood of sensational stories (often of questionable accuracy), opinion (ditto) and, inevitably, humor of the late-night talk-show genre about what is in fact a serious mental health condition that destroys lives.

Imagine the media playing fast-and-loose with people who are addicted to alcohol or heroin or even food. One problem is that the label "sex addiction" in all too easily applied to pretty much any sexual behavior that usually results in negative consequences to successful, powerful, famous men—people who stand to lose a great deal when caught their with their pants down.

As a result, the public had developed a somewhat cynical view about the very premise of “sexual addiction,” at least as presented in the media. Many argue that applying the mental health diagnosis of “sex addict” gives badly behaving people a pass—permission to act like a jerk without assuming any responsibility for their actions. When these men seek rehab, they again become punch lines. In popular culture, rehab has become a place where celebrities go to repent in order to restore their public image rather than to engage in the hard work that's needed to confront any addiction. Our overall cultural sympathy for drug and alcohol addiction generally does not extend to men in distress from sexual addiction. Instead, they become the butt of our jokes. This confused public attitude reflects our society’s deep but unacknowledged ambivalence about what role our erotic desires play in our lives.

Yet without psychological help,people who are addicted to sex only rarely recovers on their own. For the sake of offering hope to the increasing number of sex addicts in our midst, it is important that we stop laughing about this serious mental health condition and pay it the respect that it deserves.

The Internet has escalated the availability of information and images of a sexual nature just as it has for every other category of human experience. Cybersex has become the crack cocaine of sexual addiction. The actual statistics about the prevalence of Internet porn are staggering. A Google search for “porn” turns up nearly 1.23 billion pages. Internet porn pulls in $5 billion a year in global profits. According to the Business Insider, in 2010, 12% of all websites on the Internet were porn-related, a total of 24.6 million. Some 70% of men, aged 18 to 24, visit a porn site every month. While women make up as many as one third of visitors to popular porn sites, only about 2% subscribe to pay sites. Some 20% of men admit to looking at Internet porn while at work compared to 13% of women. In June, it was widely reported that social media (Facebook) had deposed pornography (Google) as the most trafficked site. For most sex addicts, it's not the actual sex that eases the feelings of distress—it’s all the preparatory, novelty-seeking behaviors, such as the hours consumed trolling personals on CraigsList, that flood the brain’s reward system with dopamine.

In addition, an explosion of social networking websites make hookin-up for sex—and the hours spent engrossed in looking for it—easier than ever. Every day, therapists nationwide see men and women completely out of control of their sexual behaviors. They’re destroying their lives and the lives of their loved ones. And although they know their behaviors are self-destructive, they simply can’t stop themselves.

Take the 30-year-old guy who masturbates to pornography for hours on end, who is so isolated he can’t begin to have a relationship or if he does, he can’t sustain an erection. Gay men now have Grinder on their cell phones giving them 24/7 access to anonymous sex. Married people arrange anonymous dalliances on Ashley Madison all day long. But the Internet is only part of the problem. There’s the married housewife and mother of five who leaves her husband and children repeatedly for another man because she’s always seeking “the one.” White-collar professionals like doctors and lawyers pick up street prostitutes and risk losing their licenses. Business travelers go to “massage parlors” and strip clubs with great regularity to manage their anxiety while away from home.

One of the most misunderstood aspects of sex addiction is that the act of sex (whether or not it culminates in an orgasm) is in reality a by-product of the entire activity, despite the fact that it may seem to the addict to be the goal. It’s not sex itself that temporarily eases the feelings of distress—it’s the preparatory, novelty-seeking behaviors, such as the hours consumed trolling sex ads in the CraigsList personals, that flood the brain’s reward system with dopamine.

Dopamine creates the feeling of intensity and pleasure in the body, and helps our brain remember events that are exciting, important and novel. People act out sexually in order to pump dopamine into their reward systems. Many addicts report feeling shame and disgust after a sexual binge. In the process, they have likely blunted their reward system sensitivities over time.

When focused on getting into the sexual experience, the addict quite literally isn’t thinking. Over time, the brain becomes increasingly tolerant of dopamine levels so behaviors must escalate in order for the addict to achieve the same dopamine high, increasing the risk for self-destruction.

The preparatory stage continues to increase the feeling of being “high” as dopamine and adrenaline are released which often includes, but is not limited to, rituals such as cruising the Internet, going to a bar to “hook-up,” cruising for prostitutes, going to an adult book store, or visiting chat rooms. These rituals can last anywhere from a few minutes in duration to several weeks in length, depending on the type of acting out.

For example the business traveler may find that planning the trip is part of his ritual whereas the cybersex addict will ritualize his activities by making sure his partner is out of the house, closing the blinds, or locking doors. These rituals almost always lead to some sort of sexual acting out and are part of stoking the fire of the “high.” The escalating energy eventually leads to a sexual release, which is the shortest part of the acting out cycle.

When a surge of dopamine is released to the brain, it helps wire the circuitry of the brain towards the activity that makes a person feel good. The brain will remember this feel-good activity and the person will repeat the activity over and over again. However, once that activity is no longer novel, the brain no longer releases the same amount of dopamine when it comes in contact with it. This growing tolerance partly explains why sex addict’s tire of relationships and seek new people or experiences. In order to get the same or increased dopamine high, the brain is going to look for increasingly novel forms of it. This may also be the reason that more and more men are finding themselves looking at child pornography. Their search for a “higher high” takes them into new—and more taboo—realms, while in the end leaving them terrified of being arrested, confused by the erosion of their value systems, and disgusted at themselves.

For years, experts have debated whether people can actually be addicted to a behavior (as compared to a substance) or whether their behaviors are the result of a compulsion. No research had yet settled the debate conclusively, but it can be fruitful to examine the problem through both lensesThe argument for sex being an addiction suggests that the brain is suffering from a disease. Like all addictions, sex addiction is believed to originate in the reward and pleasure pathway in the brain. It can be useful to compare sex addiction to, say, food addiction—neither problem involves the consumption of powerful chemical substances such as heroin that alter your mental state.

Nonetheless, both activities have a profound effect on mood. Research shows that some compulsive overeaters derive pleasure from eating because it releases the “feel good” brain chemical dopamine. Studies also indicate that many compulsive overeaters have fewer dopamine receptors in the brain than those who don’t overeat. This imbalance suggests that people may become overeaters in order to compensate for this deficit in reward and pleasure. It may well be that sex addicts also suffer from having fewer dopamine receptors, which has them turning to sexually compulsive behaviors as compensation. The need for a “higher high” amplifies the sex addict’s desire to take risks and seek novelty. The inability to stop despite negative consequences and the desire for increased intensity—continued dopamine rushes—make the argument for sex being an addiction.

Sex addicts, unlike the sexual compulsive, typically spend more time during the preparatory stage of their personal cycle. They are more inclined toward inappropriate conversations with women over time in hopes of “grooming” them to be sexual with them, usually with no intention of a relationship. Other common intensity-seeking behaviors include multiple affairs, hiring escorts or prostitutes, sexual massage or frequenting strip clubs. They tend to seek human contact, often for validation of the self as much as for the physical pleasure of sex. Sexual compulsivity, on the other hand, indicates a lack of impulsive control and is often accompanied by people with avoidant personality—like the guy who identifies himself as a “hermit” or the proverbial loner. The sexual compulsive’s cycle can look very different from the sex addict—his mind is in perpetual sexual obsession. He will spend hours in chat rooms or on phone sex lines, or masturbating to pornography. If he engages in sexual acts, they’re often anonymous and include only limited, brief contact. It is presumed that the person’s mind is stuck in an obsessive loop or rife with intrusive thoughts causing them to engage in the repetitive sexual acts. 

Take the thirty-something male who has amassed multiple pornography collections over the years. He cycles through collecting magazines, sex toys, DVDs and hard drives—then purges by throwing everything away or smashing the hard drives to destroy evidence. This binge-purge cycle is much like a bulimic's with food. In extreme cases, this guy lives in isolation after having lost marriages, ties to family and friends, to his all-encompassing obsession; he looks at every kind of pornography, including children; he masturbates to the point of having blisters on his penis and bleeding; his life—like that of a serious drug or alcohol addiction—contains little more than "chasing the dragon" of the next fix. Yet still he can’t stop. After smashing, say, the tenth hard drive due to his paranoia, he comes to the conclusion that he has hit bottom and needs help.

The sexual compulsive’s cycle can look very different from the sex addict—his mind is in perpetual sexual obsession. He will spend hours in chat rooms or on phone sex lines, or masturbating to pornography.

It’s hard to say why some people turn to sex rather than heroin, say, or food as their chosen method of soothing the self. As with most human traits, it is most likely a combination of nature and nurture. Many sex addicts report coming from families where one parent was hypersexual or where there were family secrets about extramarital affairs, early exposure to pornography or overt or covert incest. Any type of inappropriate exposure to sex or sexual material is usually symptomatic of family dysfunction. In other cases, they report coming from emotionally disengaged or rigid families where nothing sexual occurred and nothing sexual was talked about. In either case, the generational cycle gets passed down because children and teens in such a system will turn to sex—or fantasy—as a way to manage anxiety, depression or other bad feelings. Family dysfunction coupled with extremely accessible Internet pornography and social networking sites increases susceptibility to sexual addiction.

Typically, addicts come from families where their dependency needs weren’t met as kids. These needs may be basic such as a need for validation or soothing when under duress. The cycle of addiction for sex addicts typically begins with upset feelings, boredom, or by an adverse situation such as an argument with a spouse or boss. Because the addict is not in the habit of relying on trusted others for comfort, they will move into sexual fantasy about a person or thing in service of making painful feelings go away.

In the current version of the Diagnostic and Statistical Manual of Mental Disorders, or DSM—a therapist’s diagnostic bible—sexual addiction is not recognized as a mental illness. Due to the lack of scientific data to corroborate sex as an addiction, a new diagnostic category that does have scientific backing—Hypersexual Disorder—has been proposed for the next edition due out in 2013. Darrel Regier, vice-chair of the DSM-5 task force, told USA Today, “Although ‘hypersexuality’ is a proposed new addition...[the condition] was not at the point where we were ready to call it an addiction.” This disorder would include symptoms such as failing to control sexual behaviors, using sex to deal with emotional dysregulation (such as anxiety or depression), and continuing to engage in problematic sexual behaviors despite negative consequences. The list of behaviors includes masturbation, pornography, sex with consenting adults, cybersex, telephone sex and strip clubs.

Any entry in the DSM that supports out-of-control, destructive sexual behaviors would be a huge milestone in recognizing—and ultimately destigmatizing—this serious mental health condition. If what is popularly called sexual addiction is classified as hypersexual disorder, one very important benefit is that people who suffer from it will be able to use insurance to help pay for therapy.

Therapists know well that impaired judgment and out-of-control sexual behaviors authenticate a self-centeredness that excludes thinking about anything but getting into the sexual experience. The need for dopamine stimulation to escape feelings of anxiety, depression and emptiness override the addict’s better judgment about negative consequences. This self-centered way of being, known as pathological narcissism, is what destroys his relationships, his career, even his own health. Ultimately, the underlying mechanisms that leave a person feeling so profoundly inadequate must be addressed in long-term therapy in order to achieve lasting change. In early treatment, the sex addict may have to consider psychotropic medication to remediate the underlying depression or anxiety that drives the addictive behaviors, while the sexually compulsive will more likely have to begin a course of medication to assist in stopping the obsessive-compulsive loop he lives in.  

In addition, a range of 12-step programs under various names, such as Sex Addicts Anonymous and Sex and Love Addicts Anonymous, have sprung up nationwide over the past 30 or 40 years, with similar structures but different standards for what constitutes sexual “sobriety.” 

As a culture, we’re in the midst of a major sexual revolution. With more freedom of choice and sexual expression than ever before—mainly driven by the technological advances of the Internet—we’re in a stage of fervent experimentation, of trial and error. As we mature, we’ll learn that our brains are wired for connection. Because of an infant’s total dependence on his or her mother, human psychology is organized around attachment to another. Yet when it comes down to really being intimate, which requires facing ourselves and our demons in close proximity to another, many of us run instead to the quick fix of fantasy sex—which is, in the end, what Internet porn, anonymous hook-ups and most other modes of sexual addiction come down to.

Until we acknowledge the early trauma, depression, dopamine deficits and other mood problems that usually  plague most sex addicts, we'll have a difficult time addressing their problems. Yet whether you label it sexual addiction, sexual compulsion or hypersexual disorder, it carries the same pain—both for the sufferers and the many people who care about them.

Alexandra Katehakis is a licensed marriage and family therapist, a certified sex addiction therapist/supervisor, the clinical director of the Center for Healthy Sex in Los Angeles, and the author of Erotic Intelligence: Igniting Hot Healthy Sex While in Recovery From Sex Addiction.

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