A Case Against Sex Being Addictive
Sex addiction is a contentious topic in the academic world in both the realms of psychology and medicine. There are clear cases of people with excessive sexual appetites who are distraught by their desires and who find themselves engaged in harmful activities or neglect their self-care to appease their urges. Still, the question remains in the minds of many researchers: can sex be addictive? Many argue that hypersexuality is not truly an addiction. The detractors operate from several different views all of which point to sex addiction as not existing. Either by their definitions of addiction on their doubts about the exact cause of hypersexual behavior, those opposed to the concept raise some important points when evaluating whether or not a person could genuinely be addicted to sex.
The American Psychology Association’s Diagnostic and Statistical Manual of Mental Disorders (5th ed.) (DSM-V) identifies the common themes of dependence, tolerance, and withdrawal in assessing addiction disorders. Dependence is a perceived need to engage in an addictive behavior. Tolerance is the diminished effect of the addictive behavior or substance that occurs after prolonged exposure, thus requiring more to get the same feeling. Withdrawal refers to the discomfort and pain felt when an individual with an addiction does not engage in the addictive behavior. This paper’s analysis of sex addiction and its validity will operate under this definition of addiction as involving dependence, tolerance, and withdrawal.
Sex addiction is difficult to define since clinicians do not agree on whether there is a social or a biological cause that drives the addiction. While compulsive sexual behaviors are widely accepted to exist as a form of pathology, whether or not these actions and their underlying causes could be classified as an addiction is debatable. Research in the area and attempts to identify the exact nature of hypersexuality are rare. Clinicians are the primary authorities on hypersexuality, and their job is not to study it scientifically but to help their patients deal with the condition. Regardless of whether or not sex can truly be an addiction as classified by current standards is irrelevant to the clinician's goals of considering only what the condition means to their clients and how it affects their ability to function in society. The focus in the clinical world is not on precise classification but treatment, and as such, the fact that hypersexuality is often treated as an addiction does not necessarily mean it truly is one (Hall, 2014).
Excessive sexual behavior may be compulsory and may bring distress to the patient experiencing it, but this alone does not mean the patient has an actual addiction. Hormonal dysregulation is a biological factor that could cause hypersexuality in an individual, which is an internal factor that causes a craving in the body and is not an actual addiction. A person with such a hormonal condition would not have an addiction to sex any more than someone with polydipsia could be said to have an addiction to water. Social factors also cannot count as ways to identify addiction as these are external factors. An individual who has repeated affairs in an attempt to feel control over a toxic marriage is not addicted but rather has a motivation to act a certain way that would not be present if the situation of the relationship were to change (Rosenberg, Carnes, O’Connor, 2014).
Sex addiction was not included as a diagnosis in the DSM-V, but rather a separate diagnosis of hypersexuality was suggested which did not include the traits of dependence, tolerance, and withdrawal, which are common among addictions. Despite this change of focus from addiction to purely emphasizing the behaviors present in the proposed disorder, hypersexuality was not included in the DSM-V. The fact that the proponents of the diagnosis were willing to give up the addictive traits of dependence, tolerance, and withdrawal is strong evidence for there being no true sex addiction, but rather other biological and social factors that cause excessive sexuality (Rosenberg, Carnes, & O’Connor, 2014).
Reay, Attwood, and Gooder (2013) describe sex addiction as a cultural phenomenon that began in the 1980’s and exists for the purpose of explaining sexual behavior that is seen as inappropriate. The authors argue that the concept of sex addiction was created to re-condemn the practices that had become more common during the sexual revolution of the 1960s and 70s while adding a pathological component to help explain why these behaviors developed. The authors contend that the concept of sex addiction is another example of the twentieth-century trend to label certain sexual behaviors to categorize and marginalize them, and likens sex addiction to homosexuality and masturbation, two concepts which the authors believe were given labels for the purpose of being pathologized.
Evidence in Support
Despite the psychosocial component associated with sex addiction, researchers have noted changes in patients’ brains, implying a biological component. Hall (2014) points out that the reason for there being both a biological and a psychosocial component to the condition is because it is a response to relationship pressures. Compulsions are used to regulate emotions and, since addictions are primarily chronic, repetitive compulsions, they may develop in people as a way of modulating their emotional response to an ongoing situation over time. Thus, the biological change could exist due to social pressures, and this would explain why the condition seems to have multiple root causes in both the biological and psychosocial levels.
Both Hall (2014) and Rosenberg, Carnes, and O’Connor (2014) cite instances of sex addiction being treated effectively. A therapist can work with a hypersexual patient and use techniques suited to addiction therapy and yield results. The fact that patients respond to therapy as if they have an addiction is evidence that some addictive component of either dependence, tolerance, or withdrawal is at play. Should a patient’s drive be purely biological, addiction treatment would not be effective since addictions get better the longer withdrawal occurs, but underlying biological factors would not improve in this same manner.
Sex addiction may have a biological cause, but this could be said for other addictive disorders as well. Research suggests a biological factor which causes an underlying tendency toward addictive behavior. According to Rosenberg, Carnes, and O’Connor (2014), a study of 1,603 sex addicts showed a high comorbidity rate with other types of addictions which are more commonly accepted and have official DSM-V diagnoses, such as substance abuse, gambling, and eating disorders. This is strong evidence for a biological cause of an “addictive personality.” Furthermore, that sex addicts display other more accepted addictive behaviors supports the validity of their sexual acting out as having an addictive component.
After examining the relevant literature, it is this author’s opinion that there is moderate evidence against sex addiction as a valid condition. This is not to say that individuals do not suffer from hypersexuality. The efforts of Reay, Attwood, and Gooder (2013) at dispelling any notion of a pathological component to hypersexual behavior seem to be misplaced. This writer believes there is such a concept as hypersexuality and that it behaves in a way similar to addiction concerning how it is treated. The condition does not, however, meet the criteria of dependence, tolerance, and withdrawal.
Addictions, as they are described in the DSM-V, are dependencies that develop over time due to exposure to a substance or activity. As exposure continues, tolerance occurs, and the stimulus no longer has the same effect, thus requiring an increase in the activity and furthering dependence. Hypersexuality does not occur this way. Patients often report having drives in their social lives that cause their sexual acting out. Those who do not are believed to have a biological aberration causing their increased desires. But such a condition would not have been created slowly from normal levels of sexual activity that become unmanageable due to the cycle of tolerance and dependence. Additionally, such a condition would worsen over time only if the underlying biological cause worsened, which would be independent of the individual's engagement in sexual activity. An addiction would worsen based on the person engaging in sexual behaviors due to tolerance.
Literature exists both in support of and against the notion that sex can be addictive. Since addiction requires the components of dependence, tolerance, and withdrawal, hypersexuality appears to fall outside the realm of addiction. It is commonly said that anything can be addictive, and while this may be so, there exists a dearth of evidence in the relevant literature that shows cases of sexual activity that fit the criteria of addiction. Instead, most research is done on the condition of hypersexuality, which is often treated as an addiction but is a distinct mental health issue. While it is possible that people exist who have engaged in sex in such a way that the cycle of tolerance and dependence has occurred, such hypothetical people have not been mentioned in studies on the subject and therefore cannot be taken into consideration when determining if sex can be addictive. Rather, it must be concluded that there is no ample evidence suggesting an addictive quality to sex.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Hall, P. (2014). Sex addiction – an extraordinarily contentious problem. Sexual and Relationship Therapy, 29(1), 68-75.
Reay, B., Attwood, N., and Gooder, C. (2013). Inventing sex: The short history of sex addiction. Sexuality & Culture, 17, 1-19.
Rosenberg, K. P., Carnes, P., O’Connor, S. (2014). Evaluation and treatment of sex addiction. Journal of Sex & Marital Therapy, 40(2), 77–91.
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