What is sexual addiction?
Other terms for sexual addiction are sexual dependency, hypersexuality, and compulsive sexual behavior. It is also known as nymphomania in females and satyriasis in men.
While sexual addiction shares some features with substance addiction, the person is addicted to an activity, not a substance. Treatment may help, but without treatment, it may get worse.
An estimated 12 to 30 million people in the United States (U.S.) experience sexual addiction. It affects both men and women.
- Sexual addiction prevents people from managing their sexual behavior. Why it happens is unclear.
- It can have a severe impact on a person's life, but key bodies, such as the American Psychological Association (APA), have not yet established it as a diagnosable condition.
- Typical behaviors include compulsive masturbation, persistent use of pornography, exhibitionism, voyeurism, extreme acts of lewd sex, and the failure to resist sexual impulses.
- Treatment centers and self-help groups can help with sexual addiction.
What is sexual addiction?
The American Society of Addiction Medicine describes addiction as "a primary, chronic disease of brain reward, motivation, memory, and related circuitry."
Sexual addiction is an inability to control sexual urges, leading to impaired relationships and quality of life.
A person with sexual addiction is obsessed with sex or has an abnormally intense sex drive. Their thoughts are dominated by sexual activity, to the point where this affects other activities and interactions. If these urges become uncontrollable, the person can have difficulty functioning in social situations.
In some cases, a person with a healthy and enjoyable sex life may develop an obsession. They may find themselves stimulated by acts and fantasies that most people do not consider acceptable.
In some cases, the person may have a paraphilic disorder, such as pedophilia. This is a diagnosable disorder.
A paraphilic disorder involves sexual arousal caused by stimuli that most people do not find acceptable, for example pedophilia. It involves distress and dysfunction.
Sexual addiction has not been fully established as a medical condition, although it can adversely affect families, relationships, and lives. One difficulty with identifying sexual addiction is that people have different levels of sex drive, or libido. One person may consider their partner a "sex addict" only because they have a higher sex drive.
More research is needed to determine whether or not sexual addiction exists as a disorder.
Some attempts to define the characteristics of sexual addiction have been based on literature about chemical dependency. Sexual addiction may share the same rewards systems and circuits in the brain as substance addiction.
However, people with sexual addiction may be addicted to different types of sexual behavior. This makes the condition harder to define. It also suggests that the disorder stems not from the individual acts, but rather an obsession with carrying them out.
Sexual addiction also appears to involve making rules to feel in control of the condition, and then breaking them to make new rules.
Activities associated with sexual addiction may include:
- compulsive masturbation
- multiple affairs, sexual partners, and one-night stands
- persistent use of pornography
- practicing unsafe sex
- visiting prostitutes or practicing prostitution
Behaviors and attitudes may include:
- an inability to contain sexual urges and respect the boundaries of others involved in the sexual act
- detachment, in which the sexual activity does not emotionally satisfy the individual
- obsession with attracting others, being in love, and starting new romances, often leading to a string of relationships
- feelings of guilt and shame
- an awareness that the urges are uncontrollable, in spite of financial, medical, or social consequences
- a pattern of recurrent failure to resist impulses to engage in extreme acts of lewd sex
- engagement in sexual behaviors for longer than intended, and to a greater extent
- several attempts to stop, reduce, or control behavior
- excessive time and energy spent obtaining sex, being sexual, or recovering from a sexual experience
- giving up social, work-related, or recreational activities because of a sexual addiction
- sexual rage disorder, where an individual becomes distressed, anxious, restless, and possibly violent if unable to engage in the addiction
Studies have demonstrated a strong link between alleged sexual addiction and risk-taking. Sexual addiction may cause a person to persist in taking risks even if there may be health consequences, such as sexually transmitted infection (STI), physical injury, or emotional consequences.
Other complications may include:
- family relationship problems and breakups
- financial problems
- legal consquences, if the sexual act is illegal or publically disruptive, such as in exhibitionism
The causes of sexual addiction remain unclear.
Addiction takes root in the reward center of the brain. It may occur when certain parts of the brain mistake pleasure responses for survival mechanisms.
The midbrain is the section of the brain that handles the body's reward system and survival instincts. As sexual activity creates a rush of dopamine, the "feel-good" chemical in the brain, this triggers the feeling of pleasure. The midbrain then mistakes this feeling of pleasure as being central to survival.
One possibility is that, in people with sexual addiction, the frontal cortex, or the brain's center of logic and morality, is impaired by the midbrain.
Studies on rats have linked lesions of a section of the brain called the medial prefrontal cortex (mPFC) with compulsive sexual behavior. This may shed some light the causes of hypersexuality in humans.
Some studies have found a higher frequency of addictive sexual behavior in people from dysfunctional families. A person with sexual addiction is more likely to have been abused than other people.
A significant number of people recovering from sexual addiction have reported some type of addiction among family members. It can occur alongside another addiction.
Symptoms of sexual addiction may resemble those of other addictions, but the diagnostic criteria for sexual addiction remains in dispute. For this reason, there are different sets of criteria for diagnosing the condition.
Hypersexuality is not a formal diagnosis, according to the American Psychiatric Association's (APA's) Diagnostic and Statistic Manual of Mental Disorders, 5th Edition (DSM-V), due to a lack of evidence supporting its existence as a condition.
However, the International Classification of Diseases, Tenth Edition (ICD-10) provides a category into which hypersexuality can fit: "F52.8: other sexual dysfunction not due to a substance or a known physiological condition."
Excessive sexual drive, nymphomania, and satyriasis are all included under this category.
"Experience repeated sexual fantasies, behaviors, and urges that last upwards of 6 months, and are not due to factors, such as medication, another medical condition, substance abuse, or manic episodes linked to bipolar disorder."
As more examples of sexual addiction and its consequences have emerged, the disorder has become more widely accepted as a legitimate mental condition.
Sexual addiction or advanced libido?
One challenge is to distinguish sexual addiction from a high sex drive.
Two key features can help health professionals to do this:
- consistent failure to control the behavior
- continuation of the behavior despite the harm caused
A qualified psychiatric doctor will be able to distinguish between an advanced libido and a pattern of dependency on sexual stimulation or other paraphilic disorder that requires medical attention.
Dr. Aviel Goodman, director of the Minnesota Institute of Psychiatry, has proposed criteria similar to those used in substance addiction.The criteria would diagnose sexual addiction when significant damage or distress is caused by a pattern of behavior.
To receive a diagnosis, a person should show at least three of the following traits during a 12-month period. The behaviors relate to tolerance and withdrawal issues. They would not adjust to the changing personal circumstances caused by sexual addiction.
- The behavior needs to increase in frequency and intensity to achieve the desired effect.
- Continuing at the same level or intensity fails to produce the desired effect.
- Discontinuing the behavior leads to withdrawal syndrome, including physiological or psychological changes.
- Similar behavior is engaged in to relieve or avoid withdrawal symptoms.
Other possible criteria include:
- engaging in the behavior for a longer time or at a higher intensity or frequency than intended
- having a persistent desire to cut down or control the behavior, or making unsuccessful efforts to do so
- spending a lot of time on activities needed for preparing to engage in and recovering from the behavior
- giving up or reducing important social, occupational, or recreational activities because of the behavior
- continuing the behavior despite knowing that it is likely to cause or worsen a persistent physical or psychological problem
Addiction can be difficult to treat, as a person with an addiction will often rationalize and justify their behaviors and thought patterns. People with a sex addiction may deny there is a problem.
Sexual addiction can be controlled by attending self-help meetings.
Current treatment options aim to reduce any excessive urges to engage in sexual relations and to encourage the nurturing of healthful relationships.
The following treatment options are available:
- Self-help organizations, such as Sex Addicts Anonymous, Sexaholics Anonymous, Sexual Compulsives Anonymous, and Sex and Love Addicts Anonymous, offer 12-step programs to help the individual in self-managing the condition.
- Residential treatment programs are available for individuals with various addictive disorders. These are in-patient programs, during which the individual lives on-site at the facility and receives care from specialized therapists.
- Cognitive behavioral therapy (CBT) provides a variety of techniques that help the individual change their behavior. CBT can equip a person to avoid relapses and reprogram harmful sexual behaviors.
- Prescription medications, such as Prozac, may be prescribed to reduce sexual urges, but the drug has not been approved by the U.S. Food and Drug Administration (FDA) to treat this condition.
The support of friends and family is crucial for a person recovering from an addiction. Sexual addiction, due to its behavioral nature, can be difficult for others to understand and tolerate, especially if it has already led to damage in relationships.
However, a strong support network helps to reduce destructive behavior and the risk of relapse.