Is Sexual Addiction the Real Deal
Controversy exists over what some mental health experts call “hypersexuality,” or sexual “addiction.” Namely, is it a mental disorder at all, or something else? It failed to make the cut in the recently updated Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, considered the bible for diagnosing mental disorders. Yet sex addiction has been blamed for ruining relationships, lives and careers.
Now, for the first time, UCLA researchers have measured how the brain behaves in so-called hypersexual people who have problems regulating their viewing of sexual images. The study found that the brain response of these individuals to sexual images was not related in any way to the severity of their hypersexuality but was instead tied only to their level of sexual desire.
In other words, hypersexuality did not appear to explain brain differences in sexual response any more than simply having a high libido, said senior author Nicole Prause, a researcher in the department of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA.
“Potentially, this is an important finding,” Prause said. “It is the first time scientists have studied the brain responses specifically of people who identify as having hypersexual problems.”
The study appears in the current online edition of the journal Socioaffective Neuroscience and Psychology.
A diagnosis of hypersexuality or sexual addiction is typically associated with people who have sexual urges that feel out of control, who engage frequently in sexual behavior, who have suffered consequences such as divorce or economic ruin as a result of their behaviors, and who have a poor ability to reduce those behaviors.
But, said Prause and her colleagues, such symptoms are not necessarily representative of an addiction - in fact, non-pathological, high sexual desire could also explain this cluster of problems.
One way to tease out the difference is to measure the brain’s response to sexual-image stimuli in individuals who acknowledge having sexual problems. If they indeed suffer from hypersexuality, or sexual addiction, their brain response to visual sexual stimuli could be expected be higher, in much the same way that the brains of cocaine addicts have been shown to react to images of the drug in other studies.
What Is Sexual Addiction?
Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual thoughts and acts. Like all addictions, its negative impact on the addict and on family members increases as the disorder progresses. Over time, the addict usually has to intensify the addictive behavior to achieve the same results.
For some sex addicts, behavior does not progress beyond compulsive masturbation or the extensive use of pornography or phone or computer sex services. For others, addiction can involve illegal activities such as exhibitionism, voyeurism, obscene phone calls, child molestation or rape.
Sex addicts do not necessarily become sex offenders. Moreover, not all sex offenders are sex addicts. Roughly 55 percent of convicted sex offenders can be considered sex addicts.
About 71 percent of child molesters are sex addicts. For many, their problems are so severe that imprisonment is the only way to ensure society’s safety against them.
Society has accepted that sex offenders act not for sexual gratification, but rather out of a disturbed need for power, dominance, control or revenge, or a perverted expression of anger. More recently, however, an awareness of brain changes and brain reward associated with sexual behavior has led us to understand that there are also powerful sexual drives that motivate sex offenses.
The National Council on Sexual Addiction and Compulsivity has defined sexual addiction as “engaging in persistent and escalating patterns of sexual behavior acted out despite increasing negative consequences to self and others.” In other words, a sex addict will continue to engage in certain sexual behaviors despite facing potential health risks, financial problems, shattered relationships or even arrest.
The Diagnostic and Statistical Manual of Psychiatric Disorders, Volume Four describes sex addiction, under the category “Sexual Disorders Not Otherwise Specified,” as “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used.” According to the manual, sex addiction also involves “compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships and compulsive sexuality in a relationship.”
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By MICHAEL HERKOV, PH.D
The study involved 52 volunteers: 39 men and 13 women, ranging in age from 18 to 39, who reported having problems controlling their viewing of sexual images. They first filled out four questionnaires covering various topics, including sexual behaviors, sexual desire, sexual compulsions, and the possible negative cognitive and behavioral outcomes of sexual behavior. Participants had scores comparable to individuals seeking help for hypersexual problems.
While viewing the images, the volunteers were monitored using electroencephalography (EEG), a non-invasive technique that measures brain waves, the electrical activity generated by neurons when they communicate with each other. Specifically, the researchers measured event-related potentials, brain responses that are the direct result of a specific cognitive event.
“The volunteers were shown a set of photographs that were carefully chosen to evoke pleasant or unpleasant feelings,” Prause said. “The pictures included images of dismembered bodies, people preparing food, people skiing—and, of course, sex. Some of the sexual images were romantic images, while others showed explicit intercourse between one man and one woman.”
The researchers were most interested in the response of the brain about 300 milliseconds after each picture appeared, commonly called the “P300” response. This basic measure has been used in hundreds of neuroscience studies internationally, including studies of addiction and impulsivity, Prause said. The P300 response is higher when a person notices something new or especially interesting to them.
The researchers expected that P300 responses to the sexual images would correspond to a person’s sexual desire level, as shown in previous studies. But they further predicted that P300 responses would relate to measures of hypersexuality. That is, in those whose problem regulating their viewing of sexual images could be characterized as an “addiction,” the P300 reaction to sexual images could be expected to spike.
Instead, the researchers found that the P300 response was not related to hypersexual measurements at all; there were no spikes or decreases tied to the severity of participants’ hypersexuality. So while there has been much speculation about the effect of sexual addiction or hypersexuality in the brain, the study provided no evidence to support any difference, Prause said.
“The brain’s response to sexual pictures was not predicted by any of the three questionnaire measures of hypersexuality,” she said. “Brain response was only related to the measure of sexual desire. In other words, hypersexuality does not appear to explain brain responses to sexual images any more than just having a high libido.”
But debate continues over whether sex addiction is indeed an addiction. A study published in 2012 by Prause’s colleague Rory Reid, a UCLA assistant professor of psychiatry, supported the reliability of the proposed DSM-5 diagnostic criteria for hypersexual disorder. However, Prause notes, that study was not focused on the validity of sex addiction or impulsivity, and did not use any biophysiological data in the analysis.
“If our study can be replicated,” she said, “these findings would represent a major challenge to existing theories of a sex ‘addiction.’ “
Other authors on the study included Dr. Timothy Fong, associate professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA and director of the UCLA Impulse Control Disorders Clinic; Vaughn R. Steele of the University of New Mexico; and Cameron Staley of Idaho State University. Funding was provided by an Idaho State University Graduate Student Committee grant (Staley).
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Vaughn R. Steele, Cameron Staley, Timothy Fong, Nicole Prause. Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images. Socioaffective Neuroscience & Psychology, 2013; 3 (0) DOI: 10.3402/snp.v3i0.20770