Sex addiction: Is it a lifestyle choice or psychiatric disorder?
MICHAEL Douglas said he had it, and that it may have contributed to his throat cancer, from which he is now, thankfully, in remission. Russell Brand, comedian and film actor said he has it, Charlie Sheen and Tiger Woods also claimed to be sufferers.
Women are apparently not immune either and Ulrika Jonsson, Lindsay Lohan and actress Denise Welch are numbered among those with the condition. This mysterious condition is sex addiction, or as it is now called 'hypersexual disorder'.
The condition sprung from the work of psychoanalysts who identified the need for external objects to ward off depression and heighten self-esteem. So, according to their reports, one person might be addicted to food, another to shopping and another to sex.
They argued that it was not primarily the inherent value of the object that was important but the supply. So the supply of food was what was important to the food addict rather than its aesthetic. Similarly with sex addiction, it is not the character of the partner that takes precedence but the continuing access to sexual acts.
In 1983 the work of psychologist Patrick Carnes (Out of the Shadows: understanding Sexual Addiction) marked the first use of the term. Before that is was called hypersexual arousal but the use of the word 'addiction' placed it firmly in the addiction arena. This resulted in the development of 12-step programmes as a therapy for this.
Underpinning this is the belief that it stems from an intense need to love and be loved that only becomes visible when the person refrains from their compulsive sexual activity. So the hypersexuality is seen as a thwarted form of intimacy.
A number of features of the syndrome have been described.
Among these are participating in behaviours like masturbation, cybersex, consensual sex and excessive pornography, as well as sex with anonymous partners, multiple affairs and so on. These sexual behaviours and urges must not be related to some other condition such as bipolar disorder or substance misuse.
It is estimated that 3pc to 5pc of the American population experiences difficulties with compulsive sexual activity – and sexual orientation is no barrier. And with the advent of the internet such behaviour has taken on a new dimension with cybersex and hardcore pornography use emerging as an increasingly prominent problem.
The difficulty is that there is uncertainty as to whether the behaviour that is called 'sex addiction' is in fact a mental health disorder. Is it simply a lifestyle choice that is disapproved of and garnished with the dressing of a psychiatric disorder?
Perhaps it is culture bound, and related to the increasing objectification of sex that marked the 20th and now the 21st Century that has now culminated in internet sex in its various guises.
I do not have an answer to this debate. I have seen, and referred for psychological treatment, those with clear histories of the type of hypersexual behaviour described above. It is extremely distressing to them and to their partners (especially when the relationship is unilaterally monogamous). Some have benefited from psychological interventions, others have not.
The so-called Bible of psychiatric diagnosis, the Diagnostic and Statistical Manual (5th edition), published by the American Psychiatric Association, has not included sexual addiction in this compendium. Moreover, studies are showing conflicting results.
When the symptoms and behaviours required to make the diagnosis are examined they seem to identify a clear group who can be diagnosed with sex addiction. Yet a study published last week from the Semel Institute for Neuroscience and Human behaviour at UCLD and authored by Dr Nicole Prause found that the brain activity of addicts exposed to images of a sexual nature behaved differently to the brain of those addicted to cocaine in other studies.
The investigation into sexual addiction is clearly an evolving one and it remains to be seen what the outcome will be. If it emerges that there is no evidence that the behaviour, currently characterised as sex addiction, is such, then taking responsibility for one's activities will be the path forward.