Sex addiction

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at December 2, 2016
StartDiseasesSex addiction

Sex addiction (also known as compulsive sexual behavior or hypersexual disorder) can have a devastating effect on a person's life. When the pursuit of sex becomes compulsive, it can destroy relationships, affect job performance, impact finances, or cause legal problems.

Contents

Definition & Facts

Among other benefits, sex can provide physical pleasure and emotional intimacy. However, the compulsive sexual behaviors characteristic of hypersexual disorder are similar to behaviors exhibited among those who struggle with substance-related disorder or compulsive gambling.

The compulsive desire for sex takes over every aspect of a person's life. Even when a person's behavior has negative consequences or puts their health at risk, those with this condition cannot stop these behaviors on their own.

Acts of gratification may be followed by guilt, self-loathing and a renewed promise to change. Sex addiction can strike both men and women of all sexual preferences, but it is more prevalent among men. 

The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not include sex addiction in its list of mental disorders. How best to define and categorize compulsive sexual behavior remains a provocative and contentious subject.

Symptoms & Complaints

The following symptoms could indicate sex addiction if they are recurring and uncontrollable:

  • Spending large amounts of time fantasizing about sex or planning sexual encounters
  • Using sex as a means of coping with loneliness, stress, or other unpleasant moods
  • Trying unsuccessfully to resist sexual urges
  • Engaging in risky sexual behavior
  • Acting on urges even when doing so is emotionally or physically harmful to others
  • Having sex to make oneself feel better rather than to express love or intimacy
  • Feeling powerless over thoughts or behavior
  • Losing interest in family activities, friendships, work, school, sports or hobbies 
  • Having professional, legal or financial problems due to sexual behavior
  • Paying for sex or online sexual services
  • Becoming obsessed with porn films, erotic materials or masturbation
  • Having uncharacteristic interest in sadism, masochism or voyeurism

Causes

Every sex addiction is unique, and exact causes can be difficult to pin down. There are many contributing factors, and it’s hard to say why some people become addicted and others don’t. However, health professionals find striking similarities across all kinds of addictions. Genetic factors and a family history of mental illness, almost always come into play.

Family dynamics during one's childhood can also impact mental health. Having parents who are emotionally distant or overly strict can be damaging. There are organic causes as well. People who behave compulsively may have a chemical imbalance in the brain. Neurotransmitters that help regulate mood, such as dopamine, may be at elevated levels.

Hormones that affect libido may be overactive. Brain damage caused by multiple sclerosis, dementia, or other conditions could play a role. Other possible triggers include brain lesions and the side effects of certain medications.

Physical trauma or emotional trauma is often an underlying cause. Exposure to violence, job loss and divorce are common in people with sex addiction. A high percentage of sex-addicted adults have a history of sexual abuse.

Diagnosis & Tests

There is no formalized set of diagnostic criteria because compulsive sexual behavior remains excluded from the DSM. Nevertheless, questionnaires exist such as the sexual addiction screening test (SAST). Generally speaking, therapists rely heavily on mental health history, symptoms, and sexual behavior.

When hypersexual disorder is suspected, the patient is typically given a detailed questionnaire. This screening tool is designed to expose patterns that are red flags for the disease. Does the patient think about sex almost constantly? Has he viewed porn or participated in online sex forums while at work? Is he ashamed of his sexual behavior? Does it create problems in his family or intimate relationships? Does he feel irritable, fatigued or depressed when he tries to quit his habit? Are any of his sexual activities illegal? Have friends or loved ones expressed concern about his behavior?

The therapist makes a careful assessment of the answers in order to reach a diagnosis. That’s why it’s crucial for patients to answer honestly and completely. Around 40 percent of all sex addicts have at least one other mental disorder, so dual diagnosis is highly likely.

Treatment & Therapy

Professional treatment can help people overcome sex addiction. Clients do best when distractions and opportunities for unhealthy behavior are removed. That’s why residential or inpatient care can be most effective in treating the condition.

A variety of approaches may be taken, but psychotherapy has a proven track record. Cognitive behavioral therapy is a common form of psychotherapy or talk therapy that is used to treat mental disorders. In one-on-one sessions, therapists address negative thoughts and attitudes. They also work to uncover anger or emotional pain that triggers addictive behavior.

Group sessions with peers can also be helpful. They may be monitored by counselors. These meetings can provide a safe place to openly share struggles and be held accountable. Newcomers benefit from the support and experience of others who are in more advanced stages of recovery.

Couples and families can attend counseling to better understand sex addiction, resolve conflicts and recognize enabling behavior. Attending 12-step meetings or other support programs long term is highly encouraged.

In many cases of sex addiction, medication is effective. Some drugs target sex hormones to decrease urges. Antidepressants and mood stabilizers can reduce compulsive behavior and help with anxiety or depression.

Prevention & Prophylaxis

Prevention starts with knowing one’s own risk factors. Relatives may be reluctant to talk about mental illness in the family, but it’s vital that they do. The importance of confronting problems can't be overstated.