Sex addiction or Hypersexual Disorder is a clinical entity characterized by increased frequency and intensity of sex-related fantasies, recurrent arousal, urges, and non-paraphilic sexual activity, associated with a component of impulsivity, resulting in significant distress or sustained social or occupational impairment over time (Kafka, 2010).
It is an entity not recognized by the APA within its most recent classification system for sexual disorders (DSM-V), while ICD-10 includes it as “excessive sexual drive” but within paraphilias.
What causes sex addiction?
At the biological level, attempts have been made to relate the problem to an abnormality in androgen levels, but no study has been conclusive.
As with other addictions, it is believed that it may be related to the reinforcing effects produced by the release of endorphins consequent to the addictive behavior, which causes the behavior to be repeated in search of this sensation again.
Different psychoanalysts have hypothesized that sex addiction could be a defense mechanism to fight castration, fight depression, restore self-esteem and avoid feelings of guilt and shame, with insufficient empirical support.
Other psychoanalysts have observed that children who have suffered sexual abuse or aggression in childhood frequently present sexual disorders in adulthood. In the case of sexual addiction it has been hypothesized that hypersexuality could be a way of reproducing the trauma experienced in childhood, but in an inverted form and in a more controlled environment. Sex addiction has also been proposed as a way of controlling the emotions related to abuse, through the symbolic dominance of the abuser. But none of these hypotheses has been sufficiently tested.
In others, on the other hand, the trigger for hypersexuality may be a dramatic breakup in adulthood.
The lack of research, coupled with the risk of misuse of this diagnosis as a mitigating factor in legal expert opinions, has meant that the disorder has not been included in the classification of the American Psychiatric Association.
Symptoms of sex addiction
According to Carnes and other authors (Coleman, Earle and Crown, Pincu, Schwartz and Brasted), the main symptoms associated with sexual addiction can be divided into behavioral and cognitive symptoms:
Behavioral symptoms of Hypersexual Disorder:
- Frequent sexual contacts
- Compulsive masturbation
- Seeking new sexual contacts to escape the boredom quickly brought on by previous ones
- Repeated and unsuccessful attempts to stop or reduce excessive sexual behaviors
- Engaging in sexual activities without psychological arousal
- Judicial problems related to sexual behavior
- Frequent use of pornography
Cognitive and emotional symptoms of Hypersexual Disorder:
- Obsessive thoughts concerning sexuality and sexual relationships.
- Feelings of guilt about excessive and problematic sexual activities
- Loneliness, boredom or feelings of anger as triggers
- Depression and low self-esteem
- Shame about one’s own sexual behaviors
- Indifference to regular sexual partners
- Lack of control in general, in life (not exclusively with sexual behavior)
- Desire to flee or suppress unpleasant emotions
- Preference for anonymous sex
- Habit of dissociating private life from sexuality
Is there a cure for sex addiction?
Sex addiction has no definitive cure, but it can be controlled and remitted for extended periods of time, allowing the addict to lead a completely normal life.
In fact, the symptoms may even subside completely and for life, especially if the patient has undergone a good treatment accompanied by a powerful relapse prevention phase.
Psychological treatment of sex addiction
Once the addict identifies the problem, he/she should contact a specialist psychologist for guidance. In order to start recovery, it is essential to have a previous evaluation of the problem by an expert, since he/she will be the one to consider which are the most appropriate techniques and therapies adapted to the patient’s particular problem.
Pharmacologically, the so-called chemical castration is sometimes administered with the use of anti-androgens. Serotonin reuptake inhibitors may also be prescribed, with only partial success.
At the psychotherapeutic level, the interventions that have shown the greatest efficacy are:
- Cognitive Behavioral Psychotherapy
- Family Therapy
- Couple Therapy
- Sexual Therapy
- Group Therapy, often following the Alcoholics Anonymous 12-step model.