Sexual Addiction

Exploitative sex

- A forceful act of engaging another person in sex (includes rape and molestation)

Voyeuristic sex

- Addict becomes the observer of sexual acts via pornography books, magazines, pictures, Internet, peep shows - Usually includes forms of masturbation

Seductive roles sex

- Addict uses the tools of manipulation and flirtation to coerce others into sex. - Not about loving connection, rather about succeeding in the challenge of manipulation - Gives the sex addict the sense of power and control

Level 2 of sexual addiction

- All these behaviors are considered forms of victimization - They include voyeurism, exhibitionism, indecent phone calls, taking liberties on individuals

Fantasy sex

- An obsessive type of sex addiction. - Involves obsessive, intrusive, and disruptive thoughts on specific sexual fantasies - Fantasies create impossible standards for the addict

Level 1 of sexual addiction

- Behaviors falling within the "normal" range - To a non-addict, these behaviors are victimless, and therefore are not labeled as an addiction - However, for a sex addict, these same behaviors have a way of resulting in negative consequences due to the compulsive nature of the sex behavior, or if they involve the victimization of others - These behaviors include use of porn, visiting strip shows, masturbation, purchasing prostitution

Social costs of sexual addiction

- Due to the highly secretive nature of this disorder, sex addicts will suffer socially by distancing themselves from family, friends, and loved ones in order to continue their double life. - Dishonesty, lying, and infidelity cause a loss of relationships.

Emotional costs of sexual addiction

- Emotionally, sex addicts will suffer from the anxiety and stress of hiding their addiction. - There is a high level of shame and guilt resulting from their sexual behaviors and also from prior pain or trauma experienced. - Extreme mood changes (highs and lows, shifting from euphoria to shame and guilt, from anxiety to dissociation) are identified during clinical assessment, and they correspond to the addict's position in the addiction cycle.

Exhibitionistic sex

- Flashing mostly in public, and involvement in sex in public. - Euphoria stems not from the sex act itself, but the excitement of getting caught or being watched by others

Susceptibilities and vulnerabilities

- Genetics (could be linked to dopamine) - Developmental trauma (coping with trauma, physical or sexual abuse) -- If this happened early on in life, it could lead to developmental abnormalities in the prefrontal cortex. - Environmental risk factors, such as social modeling (= modeling behaviors of peers)

Pain exchange (also known as sadomasochism)

- Involves inflicting or receiving pain - Usually consensual - Excitement comes from the balance of power (i.e., being dominant or submissive)

Intrusive sex

- Involves using someone's power or authority (through work or hierarchical position) to touch others in a sexual manner

Defense mechanisms against shame (5)

- Rage: to keep others at distance. - Contempt: blaming others - Power-seeking behavior: to gain false sense of control due to low self-esteem and cognitive distortions. - Perfection seeking behavior: to hide the shame and the addiction. - Internal withdrawal: avoiding others.

Why do people become addicted to sex?

- Repetitive increased/decreased sexual behaviors are used to escape and soothe feelings of significant shame, stress, pain, or trauma in a person's life. - These compulsive sexual behaviors often lead to negative consequences.

Anonymous sex

- Sex addict engages in sex with strangers - Unknown factors elicit a sense of arousal, but the goal is to keep the sex impersonal

Is sex addiction co-morbid with other addictions?

- Sex addiction is a sign of a "poor prefrontal cortex" that promotes poor decision-making all across the board. - If the sexual addiction is very domain specific, then it could be related to the intensity of the "reward" systems (In that case, the rewards systems would override the prefrontal cortex ONLY when faced with sexual behaviors, but not when it involves other kinds of decisions)

Paying for sex

- The addict treats sex as a purchase - Includes phone sex, prostitution, online sex

Level 3 of sexual addiction

- These are considered serious forms of victimization - Can be illegal, and considered criminal - They include child molestation, incest, rape, and physical violence.

Is sex addiction in the DSM?

- Yes, but not considered an addiction in the DSM. - Labeled under impulse control disorders - Perhaps this is mostly due to the disagreements or difficulties of defining what is within "normal" range, and what is "abnormal" sexual behavior.

Co-morbid conditions w/sexual addiction

-Substance use disorders -Trauma (97% of sexual addicts have been emotionally abused as children - contributes to abnormal development of prefrontal cortex and proper functions of decision-making and impulse control) -Pathological gambling -Eating disorders (anorexia, bulimia, and binge eating)

Other contributors to sexual addiction (same neural systems implicated in other addictions)

1. A reward circuit: mesolimbic dopamine 2. A decision-making and self control circuit: prefrontal cortex. 3. Memory and learning circuit: amygdala and hippocampus. 4. Motivational drive and urge/craving circuit: insula

First 3 criteria that must exist for sexual addiction diagnosis

1. Failure to resist the urge to act out in a sexual behavior. 2. The presence of tension or anxiety before or following the sexual behavior 3. A sense of euphoria or numbness (relief) at the time of the sexual behavior.

10 types of sexual addiction

1. Fantasy sex 2. Seductive roles sex 3. Anonymous sex 4. Paying for sex 5. Trading sex 6. Voyeuristic sex 7. Exhibitionistic sex 8. Intrusive sex 9. Pain exchange 10. Exploitative sex

At least 5 of the following criteria must be witnessed or reported for diagnosis:

1. Frequent preoccupation with sex behavior 2. Frequent engagement in sex behavior to a greater extent or longer than intended 3. Repeated efforts to reduce, control, or stop the sex behavior 4. A great deal of time spent in activities necessary for the sex behavior 5. Frequent engagement in sex behavior when expected to fulfill occupational, academic, domestic, or social obligations 6. Giving up important social, occupational, and recreational activities because of the sexual behavior 7. Continuation of the sex behavior despite knowledge of having persistent or recurrent social, financial, psychological, or physical problems caused by the sex behavior 8. Tolerance: Need to increase the intensity or frequency of sex behavior in order to achieve the desired effect 9. Restlessness or irritability if unable to engage in sex behavior 10. Persistence of some of these symptoms for at least 1 month or have occurred repeatedly over a longer period of time

Prevalence of sex addiction in U.S.

3-6%

Trading sex

A method used by the sex addict as a means of working to pay a debt (e.g., having sex for drugs)

Is sexual addiction like other addictions (to alcohol/substances)?

Generally, yes. Key difference is that, similar to gambling addiction, there is a lack of involvement of external chemicals.

One of the main biological molecule that has been discussed in sexual addiction

Oxytocin

Sex addicts and oxytocin

Sexual addicts may have deficiency or abundance in this hormone

What is oxytocin?

This is a hormone that acts peripherally: -Uterine contraction during birth -Milk ejection after birth But it also acts centrally, and it has been linked to complex behaviors, such as: -Attachment and maternal behavior -Trust -Human sexual response -Obsessive-compulsive behaviors

Definition

an intimacy disorder manifested as a compulsive cycle of preoccupation, ritualization, sexual behavior, and despair