In general, addiction involves continuing a certain behavior even in the face of negative consequences. Common characteristics of addiction include difficulty stopping the behavior even when desired, experiencing physical or mental withdrawal symptoms without the behavior, and hiding the behavior from others.
Given that definition, there is disagreement in the medical community as to whether sex addiction is a diagnosable addictive disorder or a compulsive behavior. For this reason, it has not been formally classified as a disorder and is not listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association (APA). The DSM is used by health care professionals as a guide to diagnose mental disorders, including substance use disorders.
The Mayo Clinic states, “Compulsive sexual behavior is sometimes called hypersexuality, hypersexuality disorder or sexual addiction” and describes the behavior as “an excessive preoccupation with sexual fantasies, urges or behaviors that is difficult to control.”
In chapter 9 of the book, Behavioral Addictions, the authors describe the “two most notable diagnostic labels to date for persistent excessive sexual behaviors are Hypersexual Disorder (HD) and Sexual Addiction (SA).”
How does addiction affect the brain?
The Latin root word addict—to “sell out, “betray,” or “be enslaved by”—helps us better understand the term and why addiction is so difficult to overcome. Addiction is a chronic disease that affects, and may permanently rewire, the brain.
The American Society of Addiction Medicine (ASAM) defines addiction as “a primary and chronic condition of the brain which stimulates the reward, motivation and memory related circuitry.” The ASAM expands on the definition by stating those with an addiction are “pathologically pursuing reward and/or relief by substance use and other behaviors.”
When we have a pleasurable experience, the brain releases dopamine and other “feel good” chemicals. Dopamine is tied to our brain’s pleasure and reward center and reinforces the message that what we just experienced felt good. Because addictive substances and behaviors tend to trigger higher than normal amounts of dopamine, the experience registers as especially enjoyable, reinforcing the desire to experience those feelings again.
Once the brain adapts to the higher levels of dopamine in the brain, the more firmly entrenched the addictive behavior becomes. As the brain becomes desensitized, it requires higher and higher levels of these pleasure-inducing chemicals to be released, leading to fewer inhibitions, riskier behavior, more complex substance use disorders and problem behaviors like sex addiction.
Studies have shown that sex addiction or compulsion shares traits similar to clinical addiction. A 2014 study by the Department of Psychiatry at the University of Cambridge found that “pornography triggers brain activity in people with compulsive sexual behavior — known commonly as sex addiction — similar to that triggered by drugs in the brains of drug addicts.”
One addictive behavior can lead to another addictive behavior. Researchers have found that those who take stimulant drugs are more likely to engage in compulsive sexual behaviors. The cycle of cravings and compulsive behavior feeds on itself and becomes increasingly more difficult to break.
Signs of sex addiction
According to the Mayo Clinic, signs of sex addiction, which they define as compulsive sexual behavior, may include:
- Excessive masturbation
- Participation in online sex, phone sex, or public sex
- Multiple sexual partners
- Use of pornography
- Paying for sex
- Regularly visiting sex clubs
While these signs don’t necessarily signal a sex addiction, when they reflect the characteristics of addictive behavior mentioned above, they may indicate a problem.
For those wondering if they have a sex addiction or compulsion, the Mayo Clinic suggests honestly answering the following questions:
- Do you focus much of your time on sexual fantasies, urges and behaviors and feel as if you can’t control your participation?
- Do you experience a release of tension from compulsive sexual behavior, yet also feel guilt or remorse?
- Have you unsuccessfully tried to control your sexual fantasies and behaviors?
- Do you use compulsive sexual behavior to escape from loneliness, depression, anxiety or stress?
- Do you engage in risky sexual behaviors that may result in getting or giving someone else a sexually transmitted infection, the loss of important relationships, trouble at work, financial strain, or legal problems?
- Do you have trouble establishing and maintaining healthy and stable relationships?
How is sex addiction diagnosed and treated?
Although sex addiction, or compulsive sexual behavior, does not have a specific diagnostic category in the DSM, it can be diagnosed as an impulse control disorder or behavioral addiction.
Treatment includes approaches used for substance use disorder or alcohol use disorder and typically includes psychotherapy, some form of a 12-step program and support groups. Treatment may take place at an inpatient residential facility or on an outpatient basis. It’s important that those with compulsive sexual behavior and a dual diagnosis of substance use disorder or other mental health disorder be treated for all disorders simultaneously.
According to the Mayo Clinic, psychotherapeutic approaches for resolving compulsive sexual behavior may include:
- Cognitive behavioral therapy (CBT) – helps you to identify negative beliefs and behaviors and learn emotionally healthy ways to cope and replace behaviors.
- Acceptance and commitment therapy – a form of CBT that emphasizes acceptance of thoughts and urges and mindfulness strategies to better align actions and values.
- Psychodynamic psychotherapy – helps you increase awareness of unconscious thoughts and behaviors, better understand the motivating force behind your actions, and develop stronger conflict resolution skills.
Turning Point of Tampa believes that people with dual diagnoses/co-occurring disorders are best served through “integrated treatment.” Integrated treatment addresses the mental and substance use disorders at the same time, which in turn creates better outcomes. Learn more about our philosophy and levels of care.
Turning Point of Tampa’s goal is to always provide a safe environment and a solid foundation in 12-Step recovery, in tandem with quality individual therapy and groups. We have been offering Licensed Residential Treatment for Addiction, Eating Disorders and Dual Diagnosis in Tampa since 1987.