Sexual addiction

Sexual addiction, also sometimes called sexual compulsion, is a postulated form of psychological addiction to sexual intercourse and other sexual behavior.

Diagnosis
There is no consensus in the medical community that sexual addiction actually exists, and it is not presently included in the Diagnostic and Statistical Manual of Mental Disorders. Those who support its diagnosis describe it as being in many ways similar to other addictions, where the activity comes to be used as a way to manage mood or stress and may become more severe with time. Diagnostic criteria have been suggested that are closely analogous to those the DSM provides for other addictions.

Epidemiology
The prevalence of sexual addiction is not accurately known, in part because addicts are secretive. However, it is claimed to be commonly seen in combination with other addictions as well as mood and stress disorders. Sexual addiction has in the past been considered a largely male problem, but more recent work suggests it is also prevalent in women, although usually manifesting in different ways.

Manifestation
Sex addiction appears to be a psychological addiction, although it can be argued that the hormones released while engaging in the behaviour creates a physiological response.

Sexual addicts use widely varying activities. Even masturbation can become obsessive, being done to the point of injury or to the point that it interferes significantly with ordinary life, even to the point where the addict prefers masturbation over actual sex. Pornography or other sexual/romantic literature can be addictive, and addicts may spend huge amounts of money on it. Employment of prostitutes is also common for sexual addicts. But in contrast to fetishism, sexual addiction is seldom sharply focused on a single activity.

A key feature of sexual addiction is its obsessive, unmanageable nature: a normal person might stare as they happen to drive past an attractive person, but an addict will drive around the block to stare again; and perhaps again. Addicts can spend an extraordinary amount of time and money on their habit, entirely lacking control. They often experience an almost trance-like state in which acting out can go on for many hours. As with other addictions, some addicts experience episodic binges (between which they may believe there is no problem), while others experience more continuous problems.

Some addicts act in more intrusive ways, or progress to them as they experience diminishing returns for their original activities. A second level might include voyeurism and exhibitionism, and rubbing against people in public places. A third level involves much more serious and intrusive sexual offenses, and has more harmful consequences.

Patrick Carnes, the most prolific author on this subject, states that specific activities are not what identify addiction. Even a rapist may not necessarily be a sexual addict. Rather, it is the compulsive nature of the behaviors that demonstrates addiction.

Addicts have tried often to stop, and failed. Their behavior generally conforms to a cycle:


 * 1) Preoccupation -- the addict becomes completely engrossed with sexual thoughts or fantasies.
 * 2) Ritualization —- the addict follows special routines in a search for sexual stimulation, which intensify the experience and may be more important than reaching orgasm.
 * 3) Compulsive sexual behavior -— the addict's specific sexual acting out.
 * 4) Despair —- the acting out does not lead to normal sexual satisfaction, but to feelings of hopelessness, powerlessness, depression, and the like.

To escape these negative feelings, the addict soon becomes preoccupied with sexual thoughts and fantasies again, restarting the addictive cycle. Risk factors for the addict include unstructured time, need for self-direction and demands for excellence, because they all push the addict toward restarting the cycle.

A variety of questionnaires and tests have been devised to evaluate sexual addiction, but few if any have been formally evaluated, normed, or proven accurate. The cycle and beliefs above strongly characterize the sexual addict, however. In addition, Carnes proposes a basic test for whether a particular sexual behavior has become addictive:


 * 1) It is a secret.
 * 2) It is abusive or degrading to self or others.
 * 3) It is used to avoid (or is a source of) painful feelings.
 * 4) It is empty of a caring, committed relationship.

Treatment
People selling spiritually-based methods of treatment claim to provide an effective treatment. For example, Sex Addicts Anonymous, Sexaholics Anonymous, and Sex and Love Addicts Anonymous, are large groups based on the 12-step system of Alcoholics Anonymous. Therapists also use cognitive-behavioral therapy, and medications may be of value particularly in overcoming depressive states that lead to increased acting out. It is also important to distinguish between sexual addiction and sexual anorexia, as both can present similar behaviors, but effective treatment may be quite different. Aside from depression, it also must be established whether or not the presenting behaviors are due to obsessive-compulsive disorders, bipolar disorders, etc.

Controversy
There are many people and organizations who do not acknowledge sexual addiction as a valid form of addiction. There is an argument as to whether the term has any true meaning for describing human sexual behavior. Many view sexual addiction as an excuse for acting out in this fashion. Other distinctions are difficult to make in a clinical sense, as in between promiscuity and sexual addiction as the main difference lies within the motivation of the act.

Diagnostic criteria
Since there is no diagnostic criteria established in the DSM IV, there is much controversy regarding the existence of sexual addiction and regarding standard treatment.

Healthy sexuality
One issue in discussing the topic of sexual addiction is that sexuality encompasses a broad spectrum of topics, including reproduction, physical contact, interpersonal relationships, and concepts of beauty.

The word "addiction" in the phrase "sexual addiction" implies that the problem is too much of a particular sexual behavior. Since sexuality is important to life, the symptoms of sexual addiction could simply be the function of a person seeking to fulfill a sexual necessity of life. Some of these necessities are addressed in the diagnosis of sex addiction. To date there have been no studies that examine the correlation between the treatment of sexual addiction, and its impact of healthy sexuality.

The informal diagnostic criteria is also imprecise as it could be interpreted to indicate sexual addiction in a normal relationship issues.


 * Secrecy: Being secretive about one's sexual behavior can be a standard social behavior, and one which is accepted by many cultures and subcultures. This behaviour is then suspect as a diagnostic criteria for sexual addiction.


 * Abusive or Degrading: The term "abuse" is often a euphemism by societies for a wide variety of taboo sexual activities. This is typically in order to stigmatize the person who initiated the activity or the person who participated. "Degradation" refers to a reduction of one's self-esteem. Some people seek out degrading behaviours in order to feel vulnerable, for catharsis or for penitent reasons which are not sexual in nature.


 * Painful Feelings: Personal emotions in interpersonal and especially sexual relationships, can be quite difficult. Many couples exhibit behaviour which either is at the source of painful feelings, like "sex with the ex", or to avoid painful feelings, where sex is used to escape problems.


 * Empty Relationships: Any relationship which is not working out well can easily turn into a relationship which is empty of caring. There are many reasons why a person might choose to break off or abstain from commitment in a relationship.

Given that all these diagnostic issues can be a part of otherwise normal relationships, and given that a need for a sexual relationship is a part of a healthy adult's life, some people could conclude that sexual addiction could be an unnecessary diagnosis for the real problems that could underlie these behaviours and symptoms.

Portrayal in Popular Culture
Sex Addiction faces many obstacles to being viewed seriously by the general public. One of these obstacles is the manner in which it is portrayed in popular media. Daily media sources sensationalize and denigrate people who are reported to be sex addicts. This portrayal typically extends into fictional television shows and movies.

I Am A Sex Addict
Caveh Zahedi's documentary film "I Am A Sex Addict" addresses, as the title implies, Zahedi's obsession with prostitutes and the subsequent destruction of his first two marriages. In the film Zahedi re-enacts and reminesces on his struggles with sex addiction and his recovery from it.

Six Feet Under
Brenda, a character from HBO's Six Feet Under, was a sex addict, and while the portrayal may seem to be accurate to a point, the problem also seemed to disappear almost as fast as it appeared. Sex addicts may relate to periods where Brenda was having lots of dangerous and anonymous sex, but may disagree with her recovery resulting from very little counselling or intervention. This contributes to the idea that sex addiction is not a true addiction as it can be cured quickly with marriage or discipline.

Nip/Tuck
The character Christian Troy in Nip/Tuck has been diagnosed as having a sexual addiction by psychologist Grace Santiago. The character Gina Russo was also attending group therapy for sexual addiction, eventually contracting HIV.

A Dirty Shame
This 2004 movie entitled A Dirty Shame starring Tracy Ullman as Sylvia Stickles is about a conservative housewife who suffers a concussion and is passed "the gift of sex addiction" by Ray Ray Perkins (Johnny Knoxville). While the movie refers directly to Sylvia as being a sex addict, the movie does not accurately represent sexual addiction and rather mocks the stereotype of the condition.

Choke
Choke, a novel by Chuck Palahniuk, shows how the main character, Victor Mancini, snoops around groups similar to Sexaholics Anonymous, not only recovering from his own sex addiction, but also to find possible sex partners.

Slaughter Disc
Slaughter Disc, written and directed by David Quitmeyer, is a modern horror film where the main character is a college-aged porn addict. The ghost of a murdered porn star seeks revenge by using a porn addict's gravitation towards explicit sexual content to kill them off and enslave their souls. This film has caused controversy amongst horror film fans as it depicts gore, graphic violence and actual explicit hardcore sex acts.