Sex Addiction: Diagnosis, Symptoms, Signs and Research
Behavioral or process addictions involve an individual repeatedly engaging in a normally harmless, non-substance-related pleasurable activity and subsequently undergoing lasting chemical changes in a part of the brain called the pleasure center. In addition to sex, activities identified as potential factors in the development of behavior addictions include dangerously unhealthy eating patterns, compulsive shopping, using the Internet excessively and gambling. Common behavioral addiction symptoms include:
- An inability to control participation in the activity in question
- Preoccupation with the activity while doing other things
- Use of the activity as a means of escaping unpleasant feelings or situations
- Negative consequences as a result of activity participation
- Continued participation despite highly negative outcomes
People affected by sex addiction have a form of non-substance-based behavioral addiction centering on compulsive and harmful involvement in sex-related conduct, thoughts or fantasies. Sexual addiction/hypersexual disorder is an umbrella term encompassing various types of problematic behaviors including excessive masturbation, cybersex, pornography use, sexual behavior with consenting adults, telephone sex, strip club visitation and other behaviors.
Sex Addiction Facts and Stats
- An estimated 3% to 6% of the U.S. population suffers from some form of addictive sexual behavior with themselves or others.1
- Hypersexual disorder is a serious and common clinical condition that can be associated with specific morbidities, such as unplanned pregnancy, pair-bond dysfunction, marital separation and divorce, and the morbidity/mortality risk associated with sexually transmitted diseases including HIV.2
- There is a high co-morbidity between hypersexual disorder and other addictions, such as substance use disorder.3
- A study in the Netherlands on co-morbidity of substance abuse in self-identified swingers found 79% of swingers reported recreational drug use, with 46% reporting multiple recreational drug use.3
Diagnosis is a challenge because sex addiction symptoms vary in severity and manifestation, research is in its infancy and clear-cut diagnostic criteria is not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The controversy surrounding this topic has existed for more than 50 years.
There is still considerable disagreement in the behavioral health field regarding the diagnosis of sexual addiction. The American Psychiatric Association (APA) rejected the diagnosis of hypersexual disorder for inclusion in DSM-5 in October 2015 despite well-researched data supporting inclusion. Although hypersexual disorder was rejected by the APA, the use of the diagnostic codes encompassed in ICD-10 enabled its diagnosis.4 Derogatory, dated language in ICD-10 has been replaced with more accurate verbiage in proposed ICD-11 draft language, although ICD-11 is not scheduled to be implemented until 2018. The draft is similar to verbiage in Dr. Martin Kafka’s APA-commissioned position paper regarding inclusion of hypersexual disorder in DSM-5. The suggested diagnostic criteria was as follows:5
Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges or sexual behaviors in association with three or more of the following six criteria:
- Time consumed by sexual fantasies, urges or behaviors repetitively interferes with other important (non-sexual) goals, activities and obligations.
- Repetitively engaging in sexual fantasies, urges or behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom or irritability).
- Repetitively engaging in sexual fantasies, urges or behaviors in response to stressful life events.
- Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies, urges or behaviors.
- Repetitively engaging in sexual behaviors while disregarding the risk for physical or emotional harm to self or others.
Many certified sex addiction treatment specialists (CSATs) identify sexual addiction based on the following three measures:5
- Sexual preoccupation to the point of obsession.
- Loss of control over sexual urges, fantasies and behaviors (typically evidenced by failed attempts to quit or cut back).
- Negative life consequences related to compulsive sexual behaviors, such as ruined relationships, trouble at work or school, loss of interest in nonsexual activities, financial problems, loss of community standing, shame, depression, anxiety or legal issues.5
The Role of Impulsivity
Impulsive behavior is common in children and adolescents. As adulthood approaches and the final stages of brain development begin, most people experience an age-appropriate decline in their level of impulsivity. However, for a number of reasons, some adults retain an unusual amount of impulsivity and have an increased tendency to act without thinking or considering the consequences of their behavior. People with compulsive buying, gambling disorder and sexual addictions score high on impulsivity, novelty-seeking and compulsivity along with high levels in both positive and negative urgency traits.6
Sex Addiction Research
Attempts to identify neurochemical pathways for sexual or pornography addiction have been at best “speculative not scientific,” according to research published in 2012. However, progress is being made as researchers are detecting significant areas of change in the control and pleasure centers of the brain, similar to the effects in people addicted to cocaine. Moreover, researchers have found a significant negative correlation between reported pornography hours spent per week and gray matter volume.2
Imaging studies have indicated that the function of brain regions involved in desire are altered in those with substance addiction and behavioral addictions, specifically the prefrontal cortex (PFC) and subcortical reward circuits. In a brain structure and functional connectivity study published in 2014, frequent pornography exposure was associated with altered brain structure and functioning in PFC areas and researchers theorized this might lead to a tendency to search for novel and more extreme sexual material. A 2015 study scanned 23 individuals with problematic hypersexual behavior (PHB) and 22 age-matched healthy controls while they passively viewed sexual and nonsexual stimuli. Consistent with prior brain imaging studies, individuals with the behavioral characteristics of PHB and enhanced desire exhibited altered activation in the PFC and subcortical regions.7
Due to the high incidence of other addictions, treatment for sexual addiction is typically offered in the context of co-occurring disorders therapy. If you believe you are suffering from a sex addiction or are romantically involved with someone exhibiting potential sex addiction symptoms, call us today at 888-478-7519.
- Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration website. http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.htm#idtextanchor032 Published September 2015. Accessed November 15, 2016.
- Phillips B, Hajela R, Hilton DL. Sex Addiction as a Disease: Evidence for Assessment, Diagnosis, and Response to Critics, Sexual Addiction & Compulsivity: The Journal of Treatment & Prevention, 22:2, 167-192, DOI: 10.1080/10720162.2015.1036184.
- Blum K, Badgaiyan RD, Gold MS. Hypersexuality Addiction and Withdrawal: Phenomenology, Neurogenetics and Epigenetics. Muacevic A, Adler JR, eds. Cureus. 2015;7(10):e348. doi:10.7759/cureus.348.
- Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD-10 and DSM-5 despite rejection of this diagnosis by the American Psychiatric Association (2016). Your Brain on Porn website. http://yourbrainonporn.com/diagnosis-hypersexual-or-compulsive-sexual-behavior-can-be-made-using-icd-10-and-dsm-5-despite Published April 17, 2016. Accessed November 15, 2016.
- Can Therapists “Officially” Diagnose Sexual Addiction? Psych Central website. http://blogs.psychcentral.com/sex/2016/07/%E2%80%A8%E2%80%A8%E2%80%A8can-therapists-officially-diagnose-sexual-addiction/ Accessed November 15, 2016.
- Granero R, Fernández-Aranda F, Mestre-Bach G, et al. Compulsive Buying Behavior: Clinical Comparison with Other Behavioral Addictions. Front Psychol. 2016;7:914. doi:10.3389/fpsyg.2016.00914.
- Seok J-W, Sohn J-H. Neural Substrates of Sexual Desire in Individuals with Problematic Hypersexual Behavior. Front Behav Neurosci. 2015;9:321. doi:10.3389/fnbeh.2015.00321.