Sexual addiction

Sexual addiction is a controversial term to describe sexual behaviour that is characterized at least by two key features: recurrent failure to control the behavior and continuation of the behaviour despite harmful consequences. While this condition is not universally accepted and there is some debate, experts in this field have defined sexual addiction in terms of WHO's and DSM's guidelines. Psychiatrists and Therapists closely associate sexual addiction with Pornography addiction.

Those who do use this term have described sex addicts as people who repeatedly and compulsively try to connect with others through highly impersonal intimate behaviors: masturbation, empty affairs, frequent visits to prostitutes, voyeurism, and the like. There is an adrenaline rush that can be achieved through this obsessive, highly ritualized patterns of sexual behavior. [cite book
author = Ralph Earle
coauthors = Gregory M. Crow, Kevin Osborn
title = Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents
year = 1989
pages = pp.2-3
publisher = Simon & Schuster] Some therapists and experts have compared sexual addiction with alcoholic and drug addiction. Sexual addiction is seen as a worldwide problem—"Sexual Addiction and Compulsivity: The Journal of Treatment and prevention" has devoted an entire issue to AIDS and sex addiction as a worldwide problem. [cite book|last=Carnes|first=Patrick|title=Out of the Shadows|date=2001|pages=p.xii|chapter=Preface to 2001 Edition]

Definition

The book, "Substance Abuse" defines Sexual addiction is defined as a condition in which some form of sexual behaviour is employed in a pattern that is characterized at least by two key features: recurrent failure to control the behavior, and continuation of the behaviour despite harmful consequences. [cite book
last = Lowinson
first = Joyce H.
authorlink =
coauthors = Pedro Ruiz, Robert B. Millman, John G. Langrod
title = Substance Abuse
publisher = Lippincott Williams & Wilkins
date = 2004
location =
pages = p.508
url =
doi =
id =
isbn = 9780781734745 ] Although there is still debate about the definition of addiction, it is argued that most professionals in the field to agree with the World Health Organization's definition of "addiction". [cite book
last = Carnes
first = Patrick
authorlink = Patrick Carnes
coauthors = Kenneth M. Adams
title = Clinical Management of Sex Addiction
publisher = Psychology Press
date = 2002
location =
pages = pp.345-346
url =
doi =
id =
isbn = ] cite book
last = Bechtel
first = Stefan
authorlink =
coauthors = Larry Stains, Laurence Roy Stains
title = Sex: A Man's Guide
publisher = Rodale
date = 1996
chapter = Sex Addiction
location =
pages = p.381
url =
doi =
id =
isbn = 9780875962993
quote = To define sex addiction precisely is difficult, admits Julius P. Lundy, Ph.D., a sex therapist in San Antonio, Texas. But to say that sex addiction doesn't exist is clearly wrong. Most experts concur that it is a legitimate, actual problem, and is at least similar to drug and alcohol addiction.] Other researchers like Levine argue that the idea of "sexual addiction" is not universally accepted [Levine, M. P., & Troiden, R. R. (1988). The myth of sexual compulsivity. "Journal of Sex Research, 25," 347-363.] Other terms, such as "sexual compulsivity" have also been used.cite web
last = Mayo Clinic staff
first =
authorlink =
coauthors =
title = Compulsive sexual behavior
work = Mental Health Center
publisher = Mayo Clinic
date = September 29, 2005
url = http://www.mayoclinic.com/health/compulsive-sexual-behavior/DS00144/DSECTION=1
format =
doi =
accessdate = 2007-01-31 ] Other researchers like Richard Irons, and Jennifer P. Schneider have argued, "Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence."cite journal|last=Schneider|first=Jennifer P. |coauthors=Richard Irons|date=1996|title=Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV|journal=Sexual Addiction & Compulsivity|publisher=Sexual Addiction & Compulsivity|volume=3|issue=3|pages=pp 7-21|url=http://www.jenniferschneider.com/articles/diagnos.html] It is also argued that Sexual addiction is a form of Obsessive Compulsive Disorder. [cite book|last=Francoeur|first=Robert T. |title=Taking Sides: Clashing Views on Controversial Issues in Human Sexuality|publisher=Dushkin Pub. Group|date=1994|pages=p.25|isbn=9781561342495] Experts believe that sexual addiction is a form of psychological addiction, with the behavior of sex addicts compared to the behavior of alcoholics and drug addicts. [Citation
last = Cline
first = Dr.Victor B.
author-link = Victor Cline
title = Treatment and Healing of Sexual and Pornographic Addictions
url = http://www.obscenitycrimes.org/vbctreat.cfm
quote = I found that once addicted, whether to just the pornography or the later pattern of sexual acting out, they really lost their "free agency." It was like a drug addiction. And in this case their drug was sex. They could not stop the pattern of their behavior, no matter how high-risk for them it was.] cite book|last=Francoeur|first=Robert T. |title=Taking Sides: Clashing Views on Controversial Issues in Human Sexuality|publisher=Dushkin Pub. Group|date=1994|pages=p.25|quote = some therapists have borrowed the label addiction from alcohol and substance abuse and applied it to the behavior that the patient, the therapist, or society labels "promiscuous."]

Diagnosis

According to the book "Synopsis of Psychiatry", Sex addicts are unable to control their sexual impulses, which can involve the entire spectrum of sexual fantasy or behavior. Eventually, the need for sexual activity increases, and the person's behavior is motivated solely by the persistent desire to experience the sex act and the history usually reveals a long-standing pattern of such behavior, which the person repeatedly has tried to stop, but without success. Although a patient may have feeling of guilt and remorse after the act, these feelings do not suffice to prevent its recurrence and the patient may report that the need to act out is most severe during stressful periods or when angry, depressed, anxious, or otherwise dysphoric. Eventually, the sexual activity interferes with the person's social, vocational, or marital life, which begins to deteriorate.cite book|last=Sadock|first=Benjamin J. |coauthors= Harold I. Kaplan, Virginia A. Sadock|title=Kaplan & Sadock's Synopsis of Psychiatry|publisher=Lippincott Williams & Wilkins|date=2007|chapter=21.3 Paraphilias and Sexual Disorder Not otherwise specified]

Patrick Carnes, a proponent of the idea of sexual addition, proposed using:cite book
author = Patrick Carnes
coauthors = David Delmonico, Elizabeth Griffin
title = In the Shadows of the Net
year = 2001
pages = p.31]
# Recurrent failure (pattern) to resist impulses to engage in extreme acts of lewd sex.
# Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended.
# Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors.
# Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience.
# Preoccupation with the behavior or preparatory activities.
# Frequent engaging in violent sexual behavior when expected to fulfill occupational, academic, domestic, or social obligations.
# Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
# Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect, or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk.
# Giving up or limiting social, occupational, or recreational activities because of the behavior.
# Distress, anxiety, restlessness, or violence if unable to engage in the behavior.

ymptoms

Schneider, [(1994, p.19-44)] identified three indicators of sexual addiction. These indicators are Compulsivity, Continuation despite consequences and Obsession.

* Compulsivity: This is the loss of the ability to choose freely whether to stop or continue a behavior [(Carnes, Delmonico and Griffin, 2001, p. 18)] .

* Continuation despite consequences: When addicts take their addiction too far, it can cause negative effects in their lives. They may start withdrawing from family life to pursue sexual activity. This withdrawal may cause them to neglect their children or cause their partners to leave them. Addicts risk money, marriage, family and career in order to satisfy their sexual desires. [(Arterburn, 1991, p.123)] Despite all of these consequences, they continue indulging in excessive sexual activity.

* Obsession: This is when people cannot help themselves from thinking a particular thought. Sex addicts spend whole days consumed by sexual thoughts. They develop elaborate fantasies, find new ways of obtaining sex and mentally revisit past experiences. Because their minds are so preoccupied by these thoughts, other areas of their lives that they could be thinking about are neglected.

Epidemiology

Sexual addiction is hypothesized to be (but is not always) associated with Obsessive-compulsive disorder (OCD), Narcissistic personality disorder,cite book|last=Ulman|first=Richard B. |coauthors=Harry Paul|title=The Self Psychology of Addiction and Its Treatment|publisher=Psychology Press|date=2006] [cite book|first=Ralph Earle|coauthors=Gregory M. Crow, Kevin Osborn|title=Lonely All the Time: Recognizing, Understanding, and Overcoming Sex Addiction, for Addicts and Co-dependents|date=1989|pages=p.57] and manic-depression. [cite book|last=Williams|first=Terrie M. |title=Black Pain: It Just Looks Like We're Not Hurting|publisher=Simon & Schuster|date=2008|pages=p.114 | quote= [..] diagnosed as bipolar or manic-depressive, but his depressionfirst started manifesting itself as sexual addiction.] There are those who suffer from more than one condition simultaneously (known as a dual diagnosis or a co-occurring disorder), but traits of addiction are often confused with those of these disorders, often due to most clinicians not being adequately trained in diagnosis and characteristics of addictions, and many clinicians tending to avoid use of the diagnosis at all.cite book|last=Hollander|first=Eric |coauthors= Dan J. Stein|title=Obsessive-compulsive Disorders|publisher=Informa Health Care|date=1997|pages=p.212] cite book|first=Linda Berg-Cross|coauthors=Marcia Hill|title=Couples Therapy|publisher=Haworth Clinical Practice Press|date=2001|pages=p.375 | quote= They found that sexual narcissism is more common among men ... These characteristics are also central to the person with a sexual addiction]

Specialists in obsessive-compulsive disorder (OCD) and addictions use the same terms to refer to different symptoms. In addictions, obsession is progressive and pervasive, and develops along with denial; the person usually does not see themselves as preoccupied, and simultaneously makes excuses, justifies and blames. Compulsion is present only while the addict is physically dependent on the activity for physiological stasis. Constant repetition of the activity creates a chemically dependent state. If the addict acts out when not in this state, it is seen as being spurred by the obsession only. Some addicts do have OCD as well as addiction, and the symptoms will interact.

Addicts often display narcissistic traits, which often clear as sobriety is achieved. Others do exhibit the full personality disorder even after successful addiction treatment. Some bipolar people are misdiagnosed as sex addicts. Some sex addicts are misdiagnosed as bipolar. Some addicts do also suffer from bipolar disorder.Fact|date=October 2008Or|date=October 2008

Manifestation

According to proponents of the concept, sexual addicts may enjoy frequent sexual intercourse and other sexual activities including sexual fantasies, but the key to this addiction is more the enjoyment of the journey rather than the destination. That is, sexual addicts do not require an orgasmic event in order to feel accomplished in the pursuit of their addiction. This is why sex addicts are sometimes referred to as "chemical addicts", because of the high dose of brain chemicals that are released during sexual activity, arousal and sexual fantasizing. This heavy dose of brain chemicals is what the sex addict is really after (although many do not even realize it). Some reports indicate that these chemicals are hundreds of times more addictive than heroin or cocaine. While sexually, and even romantically, stimulating activities are what they seek, internally the shot of brain chemicals released when they engage in these activities is what they crave. One such brain chemical released by their activities is the "feel good" neurotransmitter dopamine. Dopamine levels rise dramatically when they are engaged in romantically and sexually enjoyable activities. It is this heightened level that provides them with a feeling of euphoria. An orgasm boosts this level even higher. Certain illegal drugs also facilitate the same release, for example methamphetamines or cocaine. These drugs are believed to raise the level of dopamine in the brain to as much as thirty times that which is present during an orgasm. This makes these drugs' effects on the brain extremely enjoyable and highly desirable to people seeking mood elevation.Fact|date=February 2007

Individuals who experience mood issues and discover the soothing effects brought on by these brain chemicals quickly learn which behaviors can effectively repeat the experience. Thereafter, a cascading effect begins. Already prone toward tendencies for compulsive or obsessive behavior, the sexual addict starts repeating 'rewarding' activities with a repetition that quickly creates a conditioned response.Fact|date=February 2007 Over time, however, the constant release of these mood-elevating brain chemicals into the body causes them to lose their effectiveness and so addicts find themselves needing to increase, vary or intensify their activities more in order to achieve a similar effect. [ [http://www.postregister.com/special/pandorasboxxx/story.php?accession=1032-08262007 :Post Register - Idaho Falls, ID: ] ] (Interestingly, the brain chemical releases triggered by the sexual addict are similar to those experienced by gamblers and food addicts.)Fact|date=February 2007

According to proponents of the sexual addiction concept, the addicts' obsessive/compulsive tendencies are demonstrated by the frequency with which they use masturbation for stimulation. Quite often they will perform this activity to the point of injury or to where it interferes significantly with ordinary life. Masturbatory activities, because they are an effective and efficient path to success, combined with the sex addict's fear of truly intimate relationships, makes them a desirable alternative to sexual interactions with others. When a sexual addict does feel comfortable enough to involve other people, quite often they seek out strangers for anonymous sex or look for 'new love' through infidelity. Prostitutes are also employed because of their anonymity and non-judgmental willingness to engage in the sometimes unconventional sexual requests of sex addicts. The varying nature of a sexual addict's activities are in sharp contrast to individuals who commonly prefer more narrowly focused sexual activities such as those engaging in fetishism. But this is not to say that sex addicts cannot be found pursuing fetishes.

As mentioned before, a key feature of sexual addiction is its supposedly compulsive, unmanageable nature. Whereas a normal person might stare as they drive past an attractive person, a sexual addict will drive around the block to stare again. They may even plan future ways to spot attractive people so they can repeat the experience over and over. Addicts can spend an extraordinary amount of time and money on their habit, entirely lacking the ability to control it. 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 sexual addicts also swing into the opposite end of the spectrum, engaging in sexual anorexia, where they so tightly control themselves that they have absolutely no sexual experiences. This does not control or cure the basic compulsion but, like food addictions, is simply another manifestation of the addiction.

Some sexual addicts act in more intrusive ways, or progress to them, as they experience diminishing "highs" for their original activities. A Level 2 addict might include voyeurism, exhibitionism, and frotteurism. A Level 3 addict involves much more serious and intrusive sexual offenses, and has more harmful consequences.Fact|date=February 2007

exual addiction cycle

According to Patrick Carnes the cycle begins with the "Core Beliefs" that sex addicts hold:Patrick Cranes, "Out of the Shadows"]
# "I am basically a bad, unworthy person."
# "No one would love me as I am."
# "My needs are never going to be met if I have to depend on others."
# "Sex is my most important need."

These beliefs drive the addiction on its progressive and destructive course:
* "Pain agent" — First a pain agent is triggered / emotional discomfort (e.g. shame, anger, unresolved conflict) Sex addict is not able to take care of the pain agent in a healthy way.

* "Disassociation" — Prior to acting out sexually, the sex addict goes through a period of mental preoccupation or obsession. Sex addict begins to disassociate (moves away from his or her feelings). A separation begins to take place between his or her mind and his or her emotional self.

* "Altered state of consciousness / a trance state / bubble of euphoric fantasized experience" — Sex addict is disconnected from his or her emotions and he or she becomes pre-occupied with acting out behaviours. The reality becomes blocked out/distorted.

*"Preoccupation or "sexual pressure" — involves obsessing about being sexual or romantic. Fantasy becomes an obsession that serves in some way to avoid life. The addict's thoughts become focused on reaching a mood-altering high without actually acting-out sexually. He or she thinks about sex to produce a trance-like state of arousal in order to fully eliminate feelings of the current pain of reality. Thinking about sex and planning out how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle.

*"Ritualization or "acting out." — These obsessions are intensified through the use of ritualization or acting out. A sex addict first cruises and then goes to a strip show to heighten his or her arousal until he or she is beyond the point of saying no. Ritualization helps to put distance between reality and sexual obsession. Rituals are a way to induce trance and further separate oneself from reality. Once the addict has begun his or her ritual, the chances of stopping that cycle diminish greatly. He or she is giving into the pull of the compelling sex act.

*"Sexual compulsivity" — The next phase of the cycle is sexual compulsivity or "sex act". The tensions that the addict feels are reduced by acting on their sexual feelings. They feel better for the moment, thanks to the release that occurs. Compulsivity simply means that addicts regularly get to the point where sex becomes inevitable, no matter what the circumstances or the consequences. The compulsive act, which normally ends in orgasm, is perhaps the starkest reminder of the degradation involved in the addiction as the person realizes that he or she has become nothing more than a slave to the addiction.

*"Despair" — Almost immediately reality sets in and the addict begins to feel ashamed. This point of the cycle is a painful place where the Addict has been many, many times. The last time the Addict was at this low point, they probably promised to never do it again. Yet once again, they act out and that leads to despair. He or she may feel he or she has betrayed spiritual beliefs, possibly a partner, and his or her own sense of integrity. At a superficial level, the addict hopes that this will be the last battle.

According to Cranes, for many addicts, this dark emotion brings on depression and feelings of hopelessness. One easy way to cure feelings of despair is to start obsessing all over again. The cycle then perpetuates itself. [Patrick Cranes (2006) "Facing the Shadow"]

Etiology

Proponents of sexual addiction theorize the following factors to be involved in the etiology of the condition:
*Trauma
*Neurochemistry
**Neural pathways, e.g. Mesolimbic pathway
**Relationship of depression, anxiety, OCD, and Attention Disorders to Sexual Addiction
*Social conditioning and imprinting
*Developmental impairments
*Interaction of loneliness, anger, boredom, and spiritual rebellion
*Psychodynamic Perspective:The psychodynamic perspective is a very effective system to use when explaining sexual addiction. This perspective places very much importance on early childhood development. The way that a child is treated by his or her parents and his or her peers during his childhood and youth has a great impact on his or her later life. Negative events and maltreatment that occurs during this period can scar the rest of a child’s life. The impression that these elements have on someone’s life are very hard to later eliminate.

Patrick Carnes (2001, p.40) argues that when children are growing up, they develop “core beliefs” through the way that their family functions and treats them. If a child is brought up in a family where his or her parents take proper care of him or her, he or she has good chances of growing up, having faith in other people and having self worth. On the other hand, if a child grows up in a family where he or she is neglected by his or her parents he or she will develop unhealthy and negative core beliefs. He or she will grow up to believe that people in the world do not care about him or her. Later on in life, the person will have trouble keeping stable relationships and will experience feelings of isolation. Generally, addicts do not perceive themselves as worthwhile human beings (Carnes, Delmonico and Griffin, 2001, p. 40). They cope with these feelings of isolation and weakness by engaging in excessive sex (Poudat, 2005, p.121).

The development of a sexual addiction theoretically, for some, starts early in life through adolescent experimentation, the discovery of self-stimulation, or early exposure to pornography and other sexual stimulants. Sex becomes a powerful, exciting obsession very early on and the addiction accelerates. For others it may start later in life—during graduate school, divorce, or when stresses become so great that an escape is needed. It becomes a way to self-medicate and cope with the pressures of life and the guilt and shame that follow the addictive behavior.

Treatment

The initial therapeutic intervention for sexual addiction needs to include an assessment for other addictions.Fact|date=October 2008 It is impossible to expect treatment for one addiction to be beneficial when other addictions co-exist.Fact|date=October 2008

The behavior of sex addicts has profound effects on partners, children, parents and siblings. The addict is usually partially or totally unaware that their behavior has affected their loved ones. Families develop unhealthy coping skills as they strive to adapt to the addict's shifting moods and behavior. Curiously some addicts may act out in solo isolating behaviors leading to feelings of family abandonment.Fact|date=October 2008 For these reasons, friends and families will often need to be involved in the recovery process.

Those who do not attend 12-step meetings have a much more difficult time recovering, if they do at all.Fact|date=November 2007 In many ways recovery from significant sexual addiction can be more difficult than recovering from some of the other addictions. The heavy prevalence of sexual abuse in the backgrounds of sex addicts is one reason. In addition, sexual addiction fundamentally involves a problem with intimacy, something important for successful recovery.

Self-help groups such as Sex Addicts Anonymous, Sexaholics Anonymous, and Sex and Love Addicts Anonymous are popular with proponents of the sexual addiction concept. These are large groups based on the 12-step system of Alcoholics Anonymous. There are various online support forums as well as real-life help through an out- or in-patient program or private counsellor. Some intensive programs work with both the addict and the addict's partner.

Professional help:
* Individual therapy
* Group therapy

Therapists also use cognitive-behavioral therapy, and medications may be of value particularly in overcoming conditions or disorders that lead to increased acting out.

It is important to distinguish between sexual addiction and sexual anorexia not related to sexual addiction, 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.Fact|date=October 2008

It is highly imperative the addict finds an experienced, trained counsellor to help with their addiction. Addicts suffering from other disorders in addition to sexual addiction (Narcissistic Personality Disorder, Borderline Personality Disorder, etc.) rarely reach and maintain a sober recovery without highly trained assistance.Fact|date=October 2008

Supposedly, the longer a sex addict has been acting out and the higher the level an addict they are, the lower the chances of a successful, sober recovery being maintained.Fact|date=October 2008 Unless a sexual addict hits bottom (much like a drug addict) they will rarely seek recovery on their own. Other related, untreated psychological conditions or disorders can also reduce the chances of the addict maintaining a sober recovery.

It is also important that the partner of a sexual addict seek their own, individual counselling to help them learn how to deal with their partner's addiction.Fact|date=October 2008 There are also online support groups in addition to real-life help.

Controversy

Scientists specializing in sexual behavior generally agree on what constitutes out-of-control sexual behavior, but they disagree over whether it is appropriately diagnosed as an addiction or as a symptom of an underlying obsessive-compulsive disorder, which can cause sexual obsessions and in some cases acting out of the obsessions. For opposing positions in this debate, see the two special issues on Medical Aspects of Sexual Addiction/Compulsivity of the American Journal of Preventive Psychiatry and Neurology, dated May 1990 and Spring 1991.

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.

Other interpretations of sexual addiction (other than addiction): a compulsion, an impulse control disorder, a sexual desire disorder, a lack of morals and willpower, a form of obsessive compulsive disorder, a disease.

Those who do recognize sexual addiction often equate it to food, gambling addiction, and shopping addictions, where an outside substance isn't used to create the "high."

Diagnostic criteria

Since there is no diagnostic criteria established in the DSM IV, there is some controversy regarding the existence of sexual addiction and regarding standard treatment. A good abstract on the problem of the DSM IV's failure to include sexual compulsive behavior is outlined in: "Differential Diagnosis of Addictive Sexual Disorders Using the DSM-IV", "Sexual Addiction & Compulsivity" 1996, Volume 3, pp 7-21, 1996.by Richard Irons, M. D. and Jennifer P. Schneider, M.D., Ph.D.

*ABSTRACT The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) describes certain sexual disorders which are characterized by, or include among their features, excessive and/or unusual sexual urges or behaviors. Common disorders in the differential diagnosis include paraphilias, impulse disorder not otherwise specified (NOS), sexual disorder NOS, bipolar affective disorder, cyclothymic disorder, post-traumatic stress disorder, and adjustment disorder. Infrequent disorders in the differential diagnosis consist of substance-induced anxiety disorder, substance-induced mood disorder, dissociative disorder, delusional disorder (erotomania), obsessive-compulsive disorder, gender identity disorder, and delirium, dementia, or other cognitive disorder. Addictive sexual disorders which do not fit into standard DSM-IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence.

The American Psychiatric Association (APA) does not yet recognize sex addiction as a mental illness; however, the APA has classifications that are helpful for understanding sexual behavior disorders. These disorders are called paraphilias. The most common include: pedophilia, exhibitionism, voyeurism, sexual masochism, sexual sadism, transvestic fetishism, frotteurism, etc. All of these disorders are characterized by recurrent, intense, sexually arousing fantasies, sexual urges or behaviors involving:
* non-human objects;
* the suffering or humiliation of oneself or one's partner, children or other nonconsenting persons; and
* clinically significant distress in social, occupational or other important areas of functioning caused by the behavior, sexual urges or fantasies.

Proponents of the sexual addiction concept state that sex addiction may include some obsessions and behavior caused by these disorders. Sexual addiction itself, however, is generally conceptualized as most typically involving conventional, or non-paraphiliac, sexual behaviors that, when taken to an extreme, can interfere with daily functioning and produce guilt, shame and recurrent harm to oneself or others.

The DSM-IV describes one example under the heading of "Sexual Disorders Not Otherwise Specified" as "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used." Other examples include: compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship.

Not all sexual behaviors that cause problems necessarily reach a diagnostic threshold.Criteria proposed by Eli Coleman to define nonparaphilic compulsive sexual behavior(Compulsive sexual behavior: What to call it, how to treat it? SIECUS Report. New York: Jun/Jul 2003.Vol.31, Iss. 5; pg. 12):

a. involves recurrent and intense normophilic (nonparaphilic) sexually arousing fantasies, sexual urges, and behaviors that cause clinically significant distress in social, occupational, or other important areas of functioning; and

b. is not due simply to another medical condition, substance use disorder, or a developmental disorder

It is important not to label "problems" prematurely and ignore intra-/inter-sociocultural considerations that might better explain the behavior.

Clinically relevant criteria for diagnosing sexual addiction proposed by Goodman (Goodman, 2001, pp. 195-196)

A maladaptive pattern of behavior, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in thesame 12-month period:

1. tolerance, as defined by either of the following:

a. a need for markedly increased amount or intensity of the behavior to achieve the desired effect

b. markedly diminished effect with continued involvement in the behavior at the same level or intensity

2. withdrawal, as manifested by either of the following:

a. characteristic psychophysiological withdrawal syndrome of physiologically described changes and/or psychologically described changes upon discontinuation of the behavior

b. the same {or a closely related) behavior is engaged in to relieve or avoid withdrawal symptoms

3. the behavior is often engaged in over a longer period, in greater quantity, or at a higher intensity than was intended

4. there is a persistent desire or unsuccessful efforts to cut down or control the behavior

5. a great deal of time spent in activities necessary to prepare for the behavior, to engage in the behavior, or to recover from its effects

6. important social, occupational, or recreational activities are given up or reduced because of the behavior

7. the behavior continues despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the behavior

Portrayal in popular culture

Some sexual addiction proponents have commented that the concept 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.
*In the television show, Nip/Tuck, one of the main characters in some seasons, Gina Russo is portrayed as being a sex addict. She meets Christian Troy, who also has been diagnosed as having a sexual addiction by psychologist Grace Santiago, at a sexaholics anonomyous meeting, after which he sleeps with her after she was 8 months celibate. She later contracts HIV.
*Caveh Zahedi's documentary film "I Am A Sex Addict" addresses, as the title implies, his personal obsession with prostitutes and the subsequent destruction of short-term relationships that initiate in bar/club scenes. In the film Zahedi re-enacts and reminisces on his struggles with sex addiction and his recovery from it.
*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.
*"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", 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.
*"Love Creeps", a novel by Amanda Filipacchi, describes the romantic relationship between a stalker and a sex addict.
*"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.
*"Blades of Glory", a 2007 film, features Will Ferrell as Chazz Michael Michaels, who repeatedly claims to suffer the burden of sex addiction and attends a meeting of Sex Addicts Anonymous.
*"The Riches", a 2007 TV series, focuses on a family of con artists. In one episode, the mother, Dahlia Malloy/Cherien Rich (Minnie Driver), is forced to pretend to be a sexual addict while conning a former baseball player (who attends Sexaholics Anonymous) into "investing" the scheme her husband Wayne Malloy/Doug Rich (Eddie Izzard) is using to avoid getting fired.
*"Black Snake Moan" , a 2007 film directed by Craig Brewer, tells the story of how a Southern farmer named Lazarus, played by Samuel L. Jackson, takes in and looks after a young woman name Rae, played by Christina Ricci, in order to cure her of her sexual addiction.
* Josh's agent in the episode 'Hard Ball' of the television show 30 Rock confides to Jack that he "needs the money, he has a really bad sex addiction". Jack is sympathetic.
* DS Phil Hunter of the UK television show The Bill confesses he is a sex addict and secretly picks up a pamphlet during one of his work visits to a doctor.
* In the television show Cheers, the main character and owner of the Cheers bar Sam Malone (played by Ted Danson) is a notorious womanizer. However in an episode of the show Frasier in which Sam makes a cameo, it is revealed he actually suffers from sexual addiction and has been attending meetings to help him. This plan backfires however, as Sam merely meets a new girlfriend at the meetings who is also a sex addict.
* In the book My Booky Wook by Russell Brand, the first and later chapters detail his time in a Sex Addiction clinic.
* The Ugly Betty character Daniel Meade is portrayed as a sex addict throughout the first season

Notes

Further reading

*Feeney, Judith and Patricia Noller. "Adult Attachment." Thousand Oaks, CA: Sage Publications, 1996.
*Kasl, Charlotte Davis. "Women, Sex, and Power: A Search for Love and Power." New York, NY: Harper and Row, 1990.
*Schaumburg, Harry W. "False Intimacy: Understanding the Struggle of Sexual Addiction." Colorado Springs, CO: NavPress 1997.
*Kort, Joe "10 Smart Things Gay Men Can Do To Improve Their Lives" (chapter on sexual addiction relating to gay men) ISBN 1555837824 Alyson, 2003
*Earle, Ralph and Crow, Gregory "Lonely All The Time: Recognizing, Understanding and Overcoming Sex Addiction, for Addicts and Co-Dependents" New York, New York: Pocket Books 1989

Science based (research based) books on sexual addiction:
*Sexual Addiction: an integrated approach, AVIEL GOODMAN, Madison, CT, International *Universities Press, Inc. 1998,ISBN 0 8236 6063
*Carnes, P. (1983). Out of the shadows: Understanding sexual addiction. Minneapolis, MN: CompCare.
*Carnes, P. ( 1991). Don't call it love: Recovery from sexual addiction. New York: Bantam Books.
*Carnes P., Kenneth M. Adams (2002). Clinical Management of Sex Addiction.
*Cooper, PhD, Al Cybersex: The Dark Side of The Force A Special Issue of Sexual Addiction & Compulsivity.
*Cooper, PhD, Al Sex and the Internet: A Guidebook for Clinicians
*Earle, Ralph, and Marcus Earle Sex Addiction: Case Studies and Management New York: Brunner Mazel, 1995.
*Jennifer Schneider, M.D., Ph.D. and Robert Weiss, M.S.W., C.A.S. Cybersex Exposed.
*Milkman. H., & Sunderwirth, S. (1987). Craving for ecstasy: The consciousness and chemistry of escape. New York: Lexington Books.
*Schaeffer, Brenda Is It Love or is it Addiction? Second Edition Center City, MN: Hazelden, 1997.

Articles in scientific journals:
* Treating the Sexually Addicted Client: Establishing a Need for Increased Counselor Awareness
*W Bryce Hagedorn, Gerald A Juhnke. Journal of Addictions & Offender Counseling. Alexandria: Apr 2005.Vol.25, Iss. 2; pg. 66.
* Boredom Proneness, Social Connectedness, and Sexual Addiction Among Men Who Have Sex With Male Internet Users
*Michael P Chaney, Andrew C Blalock. Journal of Addictions & Offender Counseling. Alexandria: Apr 2006.Vol.26, Iss. 2; pg. 111, 12 pgs
* SEXUAL ADDICTION AND MARRIAGE AND FAMILY THERAPY: FACILITATING INDIVIDUAL AND RELATIONSHIP HEALING THROUGH COUPLE THERAPY, Mark H Bird. Journal of Marital and Family Therapy. Upland: Jul 2006.Vol.32, Iss. 3; pg. 297, 13 pgs
*'The snake and the seraph'--Sexual addiction and religious behaviour. Thaddeus Birchard. Counselling Psychology Quarterly. Abingdon: Mar 2004. Vol. 17, Iss. 1; p. 81
* Sexual Addiction, Sexual Compulsivity, Sexual Impulsivity, or What? Toward a Theoretical Model John Bancroft, Zoran Vukadinovic. The Journal of Sex Research. New York: Aug 2004.Vol.41, Iss. 3; pg. 225, 10 pgs
* Addictions without substance series part II: Sexual addiction, Thaddeus Birchard. Drugs and Alcohol Today. Brighton: Jul 2006.Vol.6, Iss. 2; pg. 32, 3 pgs
* Understanding sexual addiction, Patrick Carnes. SIECUS (Sex Information and Education Council of the U.S.) Report. New York: Jun/Jul 2003.Vol.31, Iss. 5; pg. 5
* Carnes, P., Nonemaker, D., & Skilling, N. (1991). Gender differences in normal and sexually addicted populations. American Journal of Preventive Psychiatry and Neurology, 3, 16-23.
* Cooper, A. (1998). Sexuality and the Internet: Surfing into the new millennium. CyberPsychology and Behavior, I, 187194.
* Cooper, A, Delmonico, D., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity, 7(1-2), 5-29.
* Cooper, A., Scherer, C., Boies, S., & Gordon, B. (1999). Sexuality on the Internet: From sexual exploration to pathological expression. Professional Psychology: Research and Practice, 30, 154-164.
* Corley, M., & Schneider, J. (2002). Disclosing secrets: Guidelines for therapists working with sex addicts and co-addicts. Sexual Addiction and Compulsivity, 9, 43-67.
* Delmonico, D., & Carnes, P. (1999). Virtual sex addiction: When cybersex becomes the drug of choice. CyberPsychology and Behavior, 2, 457-463.
* Dodge, B., Reece, M., Cole, S., & Sandfort, T. (2004). Sexual compulsivity among heterosexual college students. Journal of Sex Research, 41, 343-350.
* Eisenman, R., Dantzker, M., & Ellis, L. (2004). Self-ratings of dependency/addiction regarding drugs, sex, love, and food: Male and college female students. Sexual Addiction and Compulsivity, 11, 115-127.
* Griffiths, M. (2001). Sex on the Internet: Observations and implications for Internet sex addiction. Journal of Sex Research, 38, 333-342.
* Kafka, M., & Hennen, J. (1999). The paraphilia-related disorders: An empirical investigation of nonparaphilic hypersexuality disorders in outpatient males. Journal of Sex and Marital Therapy, 25, 305-319.
* Kafka M., & Prentky R. (1992). A comparative study of nonparaphilic sexual addictions and paraphilias in men. Journal of Clinical Psychiatry, 53, 345-350.
* Kalichman, S., & Cain, D. (2004). The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. Journal of Sex Research, 41, 235-241.
* Kort, Joe (2004). Covert Cultural Sexual Abuse of Gay Male Teenagers Contributing to Etiology of Sexual Addiction, Sexual Addiction and Compulsivity, Vol 11, 287-300.
* Quadland, M. ( 1985). Compulsive sexual behavior: Definition of a problem and an approach to treatment. Journal of Sex and Marital Therapy, II, 121-132.
* Raviv, M. (1993). Personality characteristics of sexual addicts and pathological gamblers. Journal of Gambling Studies, 9, 17-31.
* Reece, M., & Dodge, B. (2004). Exploring indicators of sexual Compulsivity among men who cruise for sex on campus. Sexual Addiction and Compulsivity, II, 87-113.
* Ross, C. (1996). A qualitative study of sexually addicted women. Sexual Addiction and Compulsivity, 3, 43-53.
* Schneider, J. (2000a). A qualitative study of cybersex participants: Gender differences, recovery issues, and implications for therapists. Sexual Addiction and Compulsivity, 7, 249-278.
* Schneider, J. (2000b). Effects of cybersex addiction on the family: Results of a survey. Sexual Addiction and Compulsivity, 7, 31-58.
* Schneider, J., & Schneider, B. (1990b). Marital satisfaction during recovery from self-identified sexual addiction among bisexual men and their wives. Journal of Sex and Marital Therapy, 16, 230-250.
* Schneider, J., & Schneider, B. (1996). Couple recovery from sexual addiction/co-addiction: Results of a survey of 88 marriages. Sexual Addiction and Compulsivity, 3, 111-126.
* Schwartz, S., & Abramowitz, J. (2003). Are nonparaphilic sexual addictions a variant of obsessive-compulsive disorder? A pilot study. Cognitive and Behavioral Practice, 10, 372-377.
* Sprenkle, D. (1987). Treating a sex addict through marital sex therapy. Family Relations: Journal of Applied Family and Child Studies, 36, 11-14.
* Swisher. S (1995). Therapeutic interventions recommended for treatment of sexual addiction/compulsivity. Sexual Addiction and Compulsivity, 2, 31-39.
* Wan, M., Finlayson, R., & Rowles, A. (2000). Sexual dependency treatment outcome study. Sexual Addiction and Compulsivity, 7, 177-196.
* Weiss, D. (2004). The prevalence of depression in male sex addicts residing in the United States. Sexual Addiction and Compulsivity, II, 57-69.
* Young, K., Griffin-Shelley, E., Cooper, A., O'Mara, J., & Buchanan, J. (2000). Online infidelity: A new dimension in couple relationships with implications for evaluation and treatment. Sexual Addiction and Compulsivity, 7, 59-74.
* Yoder, V., Virden, T, & Amin, K. (2005). Internet pornography and loneliness: An association? Sexual Addiction and Compulsivity, 12, 19-44.

ee also

*Addiction
*Antisexualism
*Content-control software
*Cybersex
*Disease model of addiction
*Hypersexuality
*Involuntary celibacy
*Obsessive-compulsive disorder
*Pornography addiction
*Self-help groups / programs: 12 steps:
**Sexaholics Anonymous
**Sex and Love Addicts Anonymous
**Sexual Compulsives Anonymous
**Sex Addicts Anonymous
*Sexual obsessions

External links

* [http://iml.jou.ufl.edu/projects/Spring05/Schultz/index.html Does Sex Addiction Exist?] by Lynne Schultz
* [http://www.saahelp.com/ Sexual Addictions: contains characteristics of the condition and recovery advice]
* [http://www.clearhavencenter.com/addictions-research/sexual-addiction/ Sexual Addictions Statistics] - Statistics surrounding internet searches for sexual addiction and pornography.