Is sex-addiction a behavioral-addiction or only a term for those whodiffers from the prevailing standard?
Summary
I'm investigating what the current understanding of sex-addiction is, what the cause is or what increases the chance of getting an addiction, what influence having an (sex-) addiction has on he life of the addict and if there are differences between men and women. With different search engines I found a lot of scientific articles and books which give me an answer to my questions. I found that addiction, according to the DSM-IV, must meet certain conditions and different researches have different conditions concerning sex-addiction. Most sex-addicts have childhood traumas, know no/not much intimacy, and/or have a multiple addiction which causes more trouble. Concerning all results I think there should be more research be done about sex-addiction, but the concept is already plausible enough to been considered as a behavioral-addiction.
Introduction
These days a lot is known about addictions. There are several institutions dealing with education campaigns and addiction treatment in the Netherlands exapmle: The GGZ, Addiction-care North-Netherlands and the Trimbos institute. Besides this also media gives attention to different addictions. Before they mainly focused on alcohol-, eating- and drug-addictions, today there is a lot attention to internet-addiction. From gaming-addiction to Social media-addiction.Recently, Net 5 gave attention to sex addiction, a less openly discussed addiction, with a TV program 'Sex Rehab with Dr. Drew'. In this a few addicts followed the rehab program in a clinic headed by Dr. Drew Pinsky.
Even though sex-addiction is not a common subject to talk about, excessive sexual behavior has been described for a long time. Indeed with different terms like hyperphilia, hypersexual disorder, paraphilia-related disorder, compulsive sexual behavior, sexual addiction, impulsive, compulsive sexual behavior or even simple'' running out of control sexual behavior''.(Kaplan en Krueger, 2010)
Sex addiction is not taken seriously. Levine and Troiden (1988) say that "sexual addiction" is only a stigmatizing label which is associated with sexual behavior that differs from the prevailing norm. Also Kaplan and Krueger (2010) suggest that one should take into account many factors including social values, cultural norms and ethnic and religious beliefs. In particular, women are negatively treated when they deviate from the norm. A phenomenon which is generally known. The result is that one does not know what a sex addiction is and that sex addicts are not taken seriously.
Hence, I wondered whether sex addiction really exists or is it, as many people say, just a term for people who deviate from the norm. To answer my question I researched the obtainable information about sex addiction and looked at the similarities and differences with other addictions.
Questions in my research:
1. When is behavior considered to addiction?
2. What does the currently used term “sex addiction” mean?
3. What causes an addiction or dependency and sensitivity? What problems are there with an addiction or what underlies addiction, one is more sensitive?
4. How does the addiction effect the life of an addict? The impact of addiction on the life of an addict also says a lot about whether it really is an addiction.
5. Is there a difference between male and female sex addicts? Since it is well known that especially young men have a higher libido than women, I see if there are differences between male and female addicts.
In the discussion, a general overview of the similarities and differences between addiction and sex addiction.
Results
1. When is behavior considered an addiction?According to Eisenman, Dantzker and Ellis (2004) addiction is one end of a continuum with on the other hand self-regulation. The term "addiction" when used in generally can be seen as a feeling dependent of something. But this feeling of dependence often indicates a feeling that one no longer has control. There is some evidence that when a person has less controle in one area, problems in other areas will also arrive and bad experiences can lead to more/further problems in other areas of life. Eiserman at al. (2004) did research on the extent to which particular addictions like drugs, sex, love and food correlate? But also the differences between male and female addicts. More about their research is discussed further in question four and five.
According to the American Psychiatric Association (2000) addiction means dependence on the As-1 from clinical disorders. Medium Dependence is diagnosed when three or more symptoms occur simultaneously within twelve months before:
- The occurrence of tolerance, which means that more and more of the addictive substance is needed to achieve the desired effect or that less and less effect occurs when using the same amount of the addictive substance.
- You may experience withdrawal symptoms, specifically for that product or similar products will be taken to cope with the withdrawal symptoms
- The drug is taken in increasing amounts over a longer time than was planned.
- There is the urge to stop using the drug, several (unsuccessful) attempts were made to stop or cut down.
- A lot of time time is spent in obtaining the drug and / or the use of the drug.
- Important social activities, work and / or leisure activities are being abandoned or reduced for substance use.
- Even if the person knows that the substance that is used causes physical or psychological disorders or deterioration thereof, he or she continues its use.
2. What does the term sex addiction currently mean?
Several studies (including: Hughes, 2010; Kaplan and Krueger, 2010; Kingston & Firestone, 2008; Power, 2005) indicate that there is exists no conclusive definition of sex addiction only links to other behavioral addictions.
In particular, Patrick Carnes has begun investigating the sexual addiction concept, what this meant and how sex addicts could be helped. Initially, people were in a pathological relationship with sex, were according to him under the name of sex addicts (Carnes, 1992). Additionally defined Carnes (1992) the following characteristics as typical behavior for sex addicts:
- A pattern of uncontrollable sexual behavior despite adverse consequences.
- Constant pursuit of self-destructive and risky behavior.
- Persistent desire to limit sexual behavior.
- Sexual obsessions are a defense mechanism.
- There is more sexual experience required.
- Severe mood swings around sexual activity.
- Ignoring other aspects of life.
According to Kingston and Firestone (2008), who speak of Problematic Hypersexuality (ph) instead of sex addiction, it is a clinical syndrome characterized by loss of control over sexual fantasies, desires and behaviors that are accompanied by adverse consequences or personal stress. These researchers look critically at the existing literature on sex addiction in terms of the conceptualization and diagnosis. In addition, they point to the usefulness of a relatively new conceptualization of ph and Sexual Desire Disorders model, which corrects many of the limitations in previous explanatory models.
A critical look is thrown by Levine and Troiden (1988). She cast a glance from a sociological perspective on the concept of sex addiction, every possibility is described by them using case studies. According to them, sex addiction is rather a stigmatizing label associated with sexual behavior that differs from the prevailing norm and that "sexual addiction" represents a pseudoscientific codifications of prevailing erotic values rather than reliable clinical individuals. But also by Klein (2006) who argues that right-wing groups and psychotherapists are the primary makers of a negative sexual culture where the concept of sex addiction is thriving in the lucrative addiction industry. According to him it is an open war by the government against sex where they base the laws on the Bible to create a country where "normal sex" is narrowly defined and none has the right to alternative sex education, health, or personal expression. It would be totally unacceptable that a group of conservative Americans are trying to accomplish the same thing in America as what terrorists are trying to achieve, strict laws based on religious beliefs.
Kaplan and Krueger (2010) add that when defining should take into account things such as individual and relational variables, social values, cultural norms and ethical and religious beliefs. What according to one person or group as excessive sexual behavior can be seen by another person or group as normally. They also divide the hypersexual behaviors in different disorders, some types named, based on research of many others. The sub-types: the masturbation part type (where one compulsively masturbates), the pornographic part type (where one is compulsively busy with porn and depends on it), the sexual behavior with adults, part type (where they mainly mean promiscuity), the cybersex part type (where one tries to regulate online sex or talking about it), the phone sex part type and strip club part type (where many people spend money in a strip club to the strippers because they think that they find attractive).
In addition, they point to a proposal for the DSM-V by Kafka (2009), which partly corresponds with the part types, which to date has not been included or accepted:
A. Over a period of at least 6 months, recurrent and intense sexual fantasies, sexual urges or sexual behavior in combination with 3 or more of the following 5 criteria:
- The time used for sexual fantasies, needs and behaviors prevented the achievement of other important (non sexual) goals, activities and obligations.
- Repeatedly giving in to sexual fantasies, needs and behaviors in response to dysphoric mood states (eg anxiety, depression, boredom, irritability).
- Repeatedly giving in to sexual fantasies, needs and behaviors in response to stressful life events.
- Repeated but unsuccessful attempts to control or reduce the sexual fantasies, needs and.
- Repeatedly giving in to sexual behavior without considering the risk for physical or emotional harm to themselves or others.
C. These sexual fantasies, needs or behavior, not due to the direct physiological effect of an exogenous substance (eg, a drug or a drug of abuse). Specify:
- Masturbation
- Pornography
- Sexual conduct with consenting adults
- Cybersex
- Phonesex
- Stripclubs
- Other. (Kafka, 2009)
3. What causes addiction/ What increases the chance of a addiction?
As indicated in the study by Hughes (2010) frequently child sexual abuse can lead to excessive sexual behavior in adult life. He gives it to childhood trauma and fear of intimacy may underlie. It is also a way for people to escape from emotion. For his research Hugh asked 30 itself identified sex addicts and 30 clinicians to fill in questionnaires submitted to clarify the concept of sex addiction. His main results are that sex addiction has many similarities with other addictions, but also some differences that sex addiction is often related to frequent abuse as a child and sex addicts need a specific treatment.
Both Hughes (2010) and Carnes (1994, 1996, 2001, 2005) and Lynch (2006)point to the cohesion with other addiction. Even though Hugh is not getting back on it that excessive, he refers to a research from Griffin-Shelley (1993) and Carnes (1994).
In the research of Carnes from 1991 932 addicts (as part of their recovery) state they have family members with addiction. In 22% it was the mother, in 40% the father and in 56% one of the siblings. In a later research from 2005 he show that 48% of the heterosexual men, 63% of the women and 55% of the gay men state that they have family members who are addicted.
The research of Power (2005) shows that sex-addiction usually comes with eating-addiction. When one can't sexually express themselves one will overeat, than they starve themselves so people will be attracted to them and to get sex, one looses weight at the beginning of a relationship and gains weight during it. This shows the interaction between eating- and sex-addiction. More about Power at the next question.
4. What influence does addiction have to the life of the addicted?
Different studies show different influences on different fields of life. You have the health field: A important influence in this is the cohesion with other addictions. A research from Carnes (1991) shows that 42% of the sex-addicts is addicted to chemicals, 38% stated a eating-disorder, 28% stated compulsive working and 26% stated compulsive spending. 45.8% out of 894 heterosexual men, 45.9% out of 588 women and 53,7% out of 121 gay men state alcoholism.
Besides that he in 2005, surveyed 1604 patients from a treatmentprogram for people with sexual-disorders and got the following results:
*Consideration here is that since this table is based on data from the first days of the investigation, there may be under-reporting. As treatment was further the case could be better diagnosed when the patient's situation became clearer.
Also Power (2005), who particularly researched the relation between sex-addiction and eating-disorders, shows that addictions not only cohere, they also interact with one another, increase each other and become part of one another. This causes a very powerful package that has to be treated as a interaction-disorder. Only the cohesion between other addictions alone has eleven different dimensions:
Cross Tolenrance, Whitdrawal Mediation, Replacement, Alternating Addiction Cycles, Masking, Ritualizing, intensification, Numbing, Disinhibiting, Combining en Inhibiting. These eleven dimensions are elaborated by Carnes in his later corporation with Murray and Charpentier (2004). Since Power's research is mostly about sex-and eating-addiction it't not apply to this essay.
Another influence on the health field has to do with Sexually Transmitted Diseases: According to Kaplan en Krueger (2010) sex-addicts have an increased risk for HIV and other STD's since they often have unprotected sex with different partners. Besides this women have an increased chance for pregnancy.
One also has to cope with stressors which don't promote health. The American Psychiatric Association (2000) formulated two symptoms which cohere with this: The urge to stop with the substance, when different (failed) attempts have been done to stop or reduce and the ongoing use even though one knows the substance will only cause physical or psychological conditions or the deterioration of them.
Then you have the influence on the social life field, as shown in a few of the American Psychiatric Association (2000) symptoms. One is that important social activities, work and/or leisure time spending are abandoned or reduced for substance use. This because the time put in getting the substance and using it (also a symptom). Addicts thus alienating family, friends, their partners and can not sufficiently commit to their work and obligations.
5. Differences between male- and female-addicts
Mostly Eisenman et al (2004) done research to the differences between male and female addicts. For their research they used 9,313 students (3083 men and 6230 women) from America and Canada, selected by their teachers. They had to judge 13 items on a scale from 0-100 considering their addiction susceptibility to these items.
According to them the differences mainly are in different drugs. Men showed significantly more addiction susceptibility to alcohol, amphetamines, barbiturates, cocaine, gambling, heroin and marijuana. While women showed significantly more addiction susceptibility to chocolate, cigarettes and food in general. Example of this: Heroin 0.40 women against 0.74 men. For sex-addiction the difference is minimal says Eisenman et al (2004) 49.67 for the women and 49.13 for the men. Also they saw not only the correlations between various drugs but also between the various addictions and overlap in addictions.
A research from Lynch (2006) shows that women are as vulnerable to drugs as men, but they experience more social constraints. It is less socially acceptable for women and they often have social restrictions such as taking care of children. This can be seen as a protective factor in deciding not to use drugs or to stop earlier. In addition, she sees a difference in the fact that women are more likely to meet the characteristics of addiction but at the same time also seek help and start with a recovery program more quickly. Her research however, is focused only on drug addictions.
Research after sex-addition done byBlack, Kehrberg, Flumerfelt and Schlosser in 1997 shows that the majority of the sex-addicts are male. Their research had 36 participants from who 28 (78%) was male and 8 (22%) was female. The only significant difference found in this study was that man had a average of 59.3 sexual partners where women had 8.
Carnes en Delmonico (1996) Reported in their research on the connection between child-abuse and having multiple addictions also a difference of 80% men against 20% women. But a later research of Carnes Delmonico, Griffin & Moriarity (2001) on sex-addicts, and mainly internet-sex-addicts showed a percentage of 40% women.
Raymond, Coleman, & Miner (2003)states that 8% of the addicts were female, and a research of Briken, Habermann, Berners, & Hill (2007)(sex-addiction, how to diagnose and treat) stated that 30% of the addicts were female.
Similarities with other addictions:
- According to Hughes (2010), several precursors, characteristics and consequences are common with other addictions, including; exposure, access, interaction with the addiction and the combination of social and biological factors that tend to create addiction in an individual.
- The typical characteristics associated with substance dependence as described in the DSM-IV (American Psychiatric Association, 2000) correspond to the characteristics of sexual addiction as originally defined by Carnes (1992) and are also seen by almost all others.
- Sex addiction corresponds in that sense with eating disorders that it is necessary and of course good for people, not to renounce such as alcohol or drugs. With both, addicts have to learn to cope in healthy ways.
- All studies show that both men and women can be sex addicts, as with other addictions there can be male and female addicts.
Differences with other addictions:
- Of course the first thing to be mentioned here is that sex addiction is not yet an accepted addiction in contrast to alcohol- or cocaine addiction.
- There is not a physical substance like with alcohol, drugs and gambling addiction. In addition alcohol, drugs and the like are external to the human body; hence total abstinence is possible for these substances unlike sex.
Whether sex addiction really exists is still debated, especially Troiden & Levine (1988) and Klein (2006) are against the concept of sex addiction because according to them it’s no more than a stigmatizing label associated with sexual behavior that differs from the prevailing norm. Kaplan and Krueger (2010) align themselves more or less by pointing to the fact that consideration must be given to standards and values that differ by group. The biggest problem here is how the definition should be achieved, because who determines when the sexual desire or act are too much and on what grounds? In my view, a decision coming in the conceptualization as my results shows that the concept of sex addiction is clinically useful as a behavioral addiction and should be accepted.
About the cause of sex addiction really only Carnes (all) and Hughes (2010) have acknowledged that it has to do with traumas in childhood. Further studies are insisting on consistency with other addictions also recognized by Carnes. The last reason given by Carnes (1991) is having addicted relatives.
When we take a look at what different researched state about the influence on life there is a connection between many different addictions. A given problem here is sex-addiction isn't that much recognized since there is not enough known about it. There have to come better guidelines when it comes to recognizing multiple addictions. Besides that a few researches show that there is much time spent on getting the drug (whether it's the substantial version or the sexual version) which disadvantages other (social) obligations(American Psychiatric Association, 2000 en Carnes, 1992). But a really solid research on this is still missing. I think one should look at the influence of different characteristics on the health and the relationship between neurotransmitters and the brain if it comes to recognizing addiction.
As seen men and women are equally vulnerable to addiction only in different fields. If it comes to the percentages researches contradict each other. With Carnes and Delmonico (1996) the distribution is 80%men- 20%women while a other study shows 60%men- 40%women. With Black, Kehrberg, Flumerfelt and Schlosser in 1997 the distribution is like 78% men against 22& women which approximates the results of Carnes and Delmonico(1996) while Raymond, Coleman, &a Miner(2003) state that only 8% of the sex-addicts is female. More and better research on the real statistics would be appropriate here.
If we consider the proposed characteristics it would be a behavioral-addiction. And the for now proposed characteristics are recognized by all investigators.
Sex-addiction is usually in people who have traumas from their childhood, who suffered from childabuse (sexual or violent), which makes them not know what real intimacy (in non-sexual way) is. Most of the times sex-addiction comes with other addiction or because addicted family members.
Next to the accompanied by other addictions there is a influence (consequence) in many aspects, in social life, at work and for the health.
There is no significant difference found between men and women in the addiction sensitivity for addiction in men and women. For the becoming addicted/stay addicted are mostly social factors which explain the difference that are found.
Overall I think that sex addiction should be included as a behavioral addiction, more thorough investigation should be made to various aspects of it and that more information must be given!
Original article and literaturelist available on request for interested.
Read also: Aantal seksverslaafden in NL neemt toe
Different studies show different influences on different fields of life. You have the health field: A important influence in this is the cohesion with other addictions. A research from Carnes (1991) shows that 42% of the sex-addicts is addicted to chemicals, 38% stated a eating-disorder, 28% stated compulsive working and 26% stated compulsive spending. 45.8% out of 894 heterosexual men, 45.9% out of 588 women and 53,7% out of 121 gay men state alcoholism.
Besides that he in 2005, surveyed 1604 patients from a treatmentprogram for people with sexual-disorders and got the following results:
Also Power (2005), who particularly researched the relation between sex-addiction and eating-disorders, shows that addictions not only cohere, they also interact with one another, increase each other and become part of one another. This causes a very powerful package that has to be treated as a interaction-disorder. Only the cohesion between other addictions alone has eleven different dimensions:
Cross Tolenrance, Whitdrawal Mediation, Replacement, Alternating Addiction Cycles, Masking, Ritualizing, intensification, Numbing, Disinhibiting, Combining en Inhibiting. These eleven dimensions are elaborated by Carnes in his later corporation with Murray and Charpentier (2004). Since Power's research is mostly about sex-and eating-addiction it't not apply to this essay.
Another influence on the health field has to do with Sexually Transmitted Diseases: According to Kaplan en Krueger (2010) sex-addicts have an increased risk for HIV and other STD's since they often have unprotected sex with different partners. Besides this women have an increased chance for pregnancy.
One also has to cope with stressors which don't promote health. The American Psychiatric Association (2000) formulated two symptoms which cohere with this: The urge to stop with the substance, when different (failed) attempts have been done to stop or reduce and the ongoing use even though one knows the substance will only cause physical or psychological conditions or the deterioration of them.
Then you have the influence on the social life field, as shown in a few of the American Psychiatric Association (2000) symptoms. One is that important social activities, work and/or leisure time spending are abandoned or reduced for substance use. This because the time put in getting the substance and using it (also a symptom). Addicts thus alienating family, friends, their partners and can not sufficiently commit to their work and obligations.
5. Differences between male- and female-addicts
Mostly Eisenman et al (2004) done research to the differences between male and female addicts. For their research they used 9,313 students (3083 men and 6230 women) from America and Canada, selected by their teachers. They had to judge 13 items on a scale from 0-100 considering their addiction susceptibility to these items.
According to them the differences mainly are in different drugs. Men showed significantly more addiction susceptibility to alcohol, amphetamines, barbiturates, cocaine, gambling, heroin and marijuana. While women showed significantly more addiction susceptibility to chocolate, cigarettes and food in general. Example of this: Heroin 0.40 women against 0.74 men. For sex-addiction the difference is minimal says Eisenman et al (2004) 49.67 for the women and 49.13 for the men. Also they saw not only the correlations between various drugs but also between the various addictions and overlap in addictions.
A research from Lynch (2006) shows that women are as vulnerable to drugs as men, but they experience more social constraints. It is less socially acceptable for women and they often have social restrictions such as taking care of children. This can be seen as a protective factor in deciding not to use drugs or to stop earlier. In addition, she sees a difference in the fact that women are more likely to meet the characteristics of addiction but at the same time also seek help and start with a recovery program more quickly. Her research however, is focused only on drug addictions.
Research after sex-addition done byBlack, Kehrberg, Flumerfelt and Schlosser in 1997 shows that the majority of the sex-addicts are male. Their research had 36 participants from who 28 (78%) was male and 8 (22%) was female. The only significant difference found in this study was that man had a average of 59.3 sexual partners where women had 8.
Carnes en Delmonico (1996) Reported in their research on the connection between child-abuse and having multiple addictions also a difference of 80% men against 20% women. But a later research of Carnes Delmonico, Griffin & Moriarity (2001) on sex-addicts, and mainly internet-sex-addicts showed a percentage of 40% women.
Raymond, Coleman, & Miner (2003)states that 8% of the addicts were female, and a research of Briken, Habermann, Berners, & Hill (2007)(sex-addiction, how to diagnose and treat) stated that 30% of the addicts were female.
Discussion
- According to Hughes (2010), several precursors, characteristics and consequences are common with other addictions, including; exposure, access, interaction with the addiction and the combination of social and biological factors that tend to create addiction in an individual.
- The typical characteristics associated with substance dependence as described in the DSM-IV (American Psychiatric Association, 2000) correspond to the characteristics of sexual addiction as originally defined by Carnes (1992) and are also seen by almost all others.
- Sex addiction corresponds in that sense with eating disorders that it is necessary and of course good for people, not to renounce such as alcohol or drugs. With both, addicts have to learn to cope in healthy ways.
- All studies show that both men and women can be sex addicts, as with other addictions there can be male and female addicts.
Differences with other addictions:
- Of course the first thing to be mentioned here is that sex addiction is not yet an accepted addiction in contrast to alcohol- or cocaine addiction.
- There is not a physical substance like with alcohol, drugs and gambling addiction. In addition alcohol, drugs and the like are external to the human body; hence total abstinence is possible for these substances unlike sex.
Whether sex addiction really exists is still debated, especially Troiden & Levine (1988) and Klein (2006) are against the concept of sex addiction because according to them it’s no more than a stigmatizing label associated with sexual behavior that differs from the prevailing norm. Kaplan and Krueger (2010) align themselves more or less by pointing to the fact that consideration must be given to standards and values that differ by group. The biggest problem here is how the definition should be achieved, because who determines when the sexual desire or act are too much and on what grounds? In my view, a decision coming in the conceptualization as my results shows that the concept of sex addiction is clinically useful as a behavioral addiction and should be accepted.
About the cause of sex addiction really only Carnes (all) and Hughes (2010) have acknowledged that it has to do with traumas in childhood. Further studies are insisting on consistency with other addictions also recognized by Carnes. The last reason given by Carnes (1991) is having addicted relatives.
When we take a look at what different researched state about the influence on life there is a connection between many different addictions. A given problem here is sex-addiction isn't that much recognized since there is not enough known about it. There have to come better guidelines when it comes to recognizing multiple addictions. Besides that a few researches show that there is much time spent on getting the drug (whether it's the substantial version or the sexual version) which disadvantages other (social) obligations(American Psychiatric Association, 2000 en Carnes, 1992). But a really solid research on this is still missing. I think one should look at the influence of different characteristics on the health and the relationship between neurotransmitters and the brain if it comes to recognizing addiction.
As seen men and women are equally vulnerable to addiction only in different fields. If it comes to the percentages researches contradict each other. With Carnes and Delmonico (1996) the distribution is 80%men- 20%women while a other study shows 60%men- 40%women. With Black, Kehrberg, Flumerfelt and Schlosser in 1997 the distribution is like 78% men against 22& women which approximates the results of Carnes and Delmonico(1996) while Raymond, Coleman, &a Miner(2003) state that only 8% of the sex-addicts is female. More and better research on the real statistics would be appropriate here.
Conclusion
As seen, people still disagree about the actual existence of sex addiction, so there is no specific definition and classification for hands.If we consider the proposed characteristics it would be a behavioral-addiction. And the for now proposed characteristics are recognized by all investigators.
Sex-addiction is usually in people who have traumas from their childhood, who suffered from childabuse (sexual or violent), which makes them not know what real intimacy (in non-sexual way) is. Most of the times sex-addiction comes with other addiction or because addicted family members.
Next to the accompanied by other addictions there is a influence (consequence) in many aspects, in social life, at work and for the health.
There is no significant difference found between men and women in the addiction sensitivity for addiction in men and women. For the becoming addicted/stay addicted are mostly social factors which explain the difference that are found.
Overall I think that sex addiction should be included as a behavioral addiction, more thorough investigation should be made to various aspects of it and that more information must be given!
Original article and literaturelist available on request for interested.
Read also: Aantal seksverslaafden in NL neemt toe
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