Sexual addiction is a social addiction that is often either uncomfortably laughed at, or written off as an activity engaged in, by the immoral. It is characterized by a loss of control over sexual desires and involves engaging in risky practices, without regard for the psychological, emotional, or biological consequences that ensue.[1] This can include practices such as promiscuity, infidelity, or even an extremely reliance on pornography. Though there has been plenty of research conducted into this particular behaviour, there is often a lot of stigma that attends this particular problem, which exacerbates the recovery process for affected individuals.

Sexual addiction was originally published as part of the DSM-III-R [2], but was subsequently removed from the DSM-IV-R. Though there is an entry known as Sexual Disorders Otherwise Not Specified [3], there is controversy surrounding whether sexual addictions is a disorder unto itself.


Developmental Factors

Childhood Maltreatment


Sexual addiction arises from a much earlier problem of emotional neglect by a primary caregiver during childhood which develops into a disturbed attachment style in conjunction with the disorder [4]. 78% of individuals suffering from sexual addiction come from “rigidly disengaged” families. Though disengagement may not be as destructive as physical or sexual abuse from a primary caregiver, the neglect suffered by the child does seem to inflict serious psychological damage [5].
The Tronick’s still face experiment involves a mother maintaining eye contact with her baby, while being devoid of any emotion and in the absence of any vocalizations [6]. During such trials, the infant initially responds with a sad facial expression, followed by an averted gaze. When such responses fail to evoke comforting behaviour from the mother, the child then tends to comfort himself by either touching his face or head, or by sucking his fingers (using the right-brain controlled left hand) [7]. The final behaviour response ends with the child losing postural control and bodily collapse (which is an indication of trauma). Studies show that chronic episodes of abandonment lead to traumatization of the child [8].
A more recent study conducted in 2006 by Field, Diego and Hernandez-Reif looks at the stress levels of infants with depressed or withdrawn mothers versus infants with intrusive mothers [9]. The results seem to indicate that perhaps, neglect is much more destructive on an infant’s development than the poorly regulated attention provided by an intrusive caregiver. The extrapolations from this study indicate that when an infant seeks emotional regulation but fails to attain it, the infant actually undergoes a state hyper-arousal [10]. Extended states of hyper-arousal will eventually lead the infant to enter a state of parasympathetic arousal wherein the infant conserves energy by protecting oneself from their feelings [11]. Therefore, it appears that not only violent sexual and physical abuse, but even passive disengagement when chronic is capable of stunting emotional maturity and self-regulation abilities [12].
Research seems to indicate that the lack of emotional support and regulation during these pivotal years of development in an infant’s life lead to deformed attachment styles that set up a mind state, favouring sexual addiction in the adult life [13]. An inability to properly develop attachment styles seems to not only cause deficits in emotional maturity, but involve deficits in the ability to integrate information, attention, use and understanding of language, abstract thinking, executive decision making abilities, understanding of morality, and self-monitoring abilities [14].


Effects on CNS, ANS & HPA-Axis Development


The central nervous system (CNS), autonomic nervous system (ANS) (which includes the sympathetic and parasympathetic subsystems) and the hypothalamus-pituitary-adrenal system (HPA Axis) are largely responsible for the monitoring and responding of all forms of sensory stimuli to and from the body.
Thus when an infant is distressed, the initial reaction is the increase of cortisol concentration in the blood. This results in the infant seeking the care-giver for comfort, and in failure of that event, the infant enters a fight or flight response. The increase in cortisol levels occurs via the hypothalamus which initially releases corticotrophin releasing hormone (CRH) and arginine vasopressin (AVP) into the anterior pituitary gland [15]. The anterior pituitary gland in turn releases adrenocorticotropic hormone (ACTH) which stimulates the adrenal glands to produce and release cortisol into the bloodstream [16].
MISSING A PARAGRAPH

However, in the event of a caregiver’s failure to down regulate cortisol levels in an infant, the infant goes into parasympathetic withdrawal [20]. This causes the infant to undergo dissociation, wherein the child habituates to stressors by not responding to them at all and withdrawing internally. Physiologically, this results in chronically high levels of cortisol and the inability to down regulate cortisol during development usually leads to anxiety, depression, aggression and/or dissociation in the individual, in adult life [21].



Neurotransmitters & Neuroanatomical Structures


The right orbitofrontal cortex (OFC) is responsible for executive decision making as well as emotional regulation and joint attention with the caregiver [22]. Neglect during development leads the child to withdraw to themselves and engage in fantasy as a form of solitary play [23]. Thus overtime, the individual fails to learn the social skills required to develop intimacy with other individuals, and finds solace and great pleasure in the realm of fantasy, which allows the individual to derive greater pleasure from sexual behaviours later in life.

The neurotransmitters that are involved in the regulation of cortisol play a significant role in predisposing individuals to any form addiction later on in life. The right side of the brain has a high amount of opioids, and an infant undergoing chronic stress will release higher amounts of these substances, especially if undergoing parasympathetic withdrawal [24]. This relatively excessive amount of opioid in the brain provides a mild analgesic effect. An infant undergoing dissociation due to chronic neglect will eventually habituate to these levels of opioids. Repeated auto-regulation of a stressor through this mechanism predisposes these individuals to addiction, including sexual behaviours.

Milkman and Frosch proposed that addicts tend to abuse substances that complement their own style of dealing with stressors in life [25]. Milkman further went on to show that arousal-prone individuals went on to abuse stimulants, whereas relaxation-prone individuals chose opiates and fantasy-driven individuals tended to use hallucinogens. What is unique about sexual addiction however is that this behaviour encompasses all three forms of compulsion [26].

There is a symbiotic relationship between brain chemistry and behaviour such that behaviour can change brain chemistry, as much as brain chemistry can result in changes in behaviour. Clearly not everyone who engages in sexual behaviours turns into an addict. There seems to be some genetic influences (such as having a certain variant of the D4 dopamine receptor) that seem to be responsible for novelty seeking behaviour. Furthermore, one of the primary reasons sexual addiction is so potent is that different addicts get a different “high” from the various aspects involved in sexual intercourse [27]. Sunderwirth, Milkman and Jenks include an excerpt from a serial rapist who claims that he was most stimulated by the planning of the event (the fantasy), then the actual sexual intercourse itself [28]. Others tend to find the most pleasure in seeking out a novel sexual partner or experience (thus are arousal-prone) and others still get their “fix” via the relaxation phase that follows the end of sexual intercourse [29].

Dopamine


One of the main neurotransmitters involved is dopamine, which activates the nucleus accumbens (a reward center) and the amygdala [30]. When one engages in fantasy, the pleasure derived from those mental images is due to dopamine activating the nucleus accumbens [31]. Sexual addicts tend to see their sexual partners as things to be used, and generally view the process of finding a sexual partner or a new sexual encounter as a thrill-inducing “hunt” [32]. When one looks into the arousal component of sexual addiction, it activates the locus ceruleus, a structure of the brain that is activated in thrill-inducing situations (normally, in situations that involve the fight or flight reaction) [33]. For this particular structure, the neurotransmitter norepinephrine seems to play the main role in inducing a high for sexual addicts who most enjoy the “thrill of the hunt” in their sexual conquests. Furthermore, post orgasm, the brain releases an endorphin, methionine enkephalin which through a cascade induces relaxation but also further enhances dopamine flow into the nucleus accumbens.

Though these mechanisms exist in and occur for all individuals who engage in sexual intercourse, what leads to the addiction is the synaptic plasticity of the brain. The brain tends to maintain "synaptic homeostasis" and thus an influx of neurotransmitter can be down regulated using enzymatic activity, when the influx occurs temporarily[34]. However, chronic elevations of neurotransmitters in the brain cause the brain to change its homeostasis, such that it will usually produce less of the neurotransmitters to compensate for the fact there is an influx of certain neurotransmitters (also known as developing a tolerance). Thus, when an individual (in this case), tries to stop engaging in sexual intercourse, their baseline concentrations of dopamine, norepinephrine or even methionine enkephalin are below what is normally found in the brain, and these individuals find that they cannot function unless they continue engaging in their behaviors.


Treatment


There are various forms of treatment available for sexual addictions. Pharmacological treatments usually fall into one of two categories that include antiandrogen agents and affect regulating agents [35]. Medroxyprogesterone acetate (MPA) and cyproterone acetate are two of the most common antiandrogen drugs prescribed to reduce sexual drive[36]. Unfortunately, there are numerous side effects to these drugs, and the dropout rate are often over 50 percent for individuals who are put on these medications [37]. Since mood disorders tend to be highly comorbid with sexual addiction, generally antidepressants are also used to treat these individuals[38]. Particularly, selective serotonin re-uptake inhibitors (SSRIs) seem to be especially helpful for recovery as they tend to improve the mood of the patients, as well as reducing sex drive.

However, considering that sexual addictions have an underlying problem involving attachment styles, a talk therapy approach with a therapist may yield more satisfying results for some individuals [39]. It is recommended that treatment for sexual addicts should address relationship insecurity [40], alongside a 12 step program or group therapy yields positive results [41]. Though group therapy, and family therapy is sometimes recommended, most professionals think individual therapy is the best form of therapy to overcome sexual addictions [42].

One of the major problems involving treatment of sexual addictions is that human beings are sexual creatures. Therefore, unlike most other rehabilitation programs for addictions (such as Alcoholics Anonymous); it is hard to impose a complete abstinence from engaging in sexual practices. Thus, the treatment for sexual addiction must be much more rigorously moderated because recovering individuals need to overcome their reliance on sexual intercourse, while trying to maintain relationships and socially be functional as well.

Extra Links

http://www.globalnews.ca/video/women+suffering+sex+addiction/video.html?v=2200017495#health





References

[1] - Ragan P. & Martin P. The Psychobiology of Sexual Addiction, Sexual Addiction & Compulsivity. The Journal of Treatment and Prevention, 7(3): 161-175 (2000).

[2] - American Psychiatric Association. Diagnostic and statistical manual of mental disorders (3rd ed., rev.). Washington, DC: Author (1987).


[3] - American Psychiatric Association. Diagnostic and statistical manual of mental disorders (fourth edition, text revision). Washington, DC: Author (2000).


[4] - Katehakis A. Affective Neuroscience and the Treatment of Sexual Addiction, Sexual Addiction & Compulsivity. The Journal of Treatment and Prevention, 16(1): 1-31. (2009).

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[9] - Field, T., Diego, M., & Hernandez-Reif, M. Prenatal depression effects on the fetus and newborn: A review. Infant Behavior and Development, 29: 445–455 (2006).

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[15] - Tarullo, A. R., & Gunnar, M. R. Child maltreatment and the developing HPA axis. Hormones and Behavior 50(4): 632–639 (2006).

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[23] - Sunderwirth S., Milkman H., & Jenks N. Neurochemistry and sexual addiction, Sexual Addiction & Compulsivity. The Journal ofTreatment and Prevention, 3(1): 22-32 (1996).

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[36] - Ragan P., & Martin P. The Psychobiology of Sexual Addiction, Sexual Addiction & Compulsivity. The Journal of Treatment and Prevention, 7(3): 161-175 (2000).

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[40] - Zapf, J. L., Greiner, J., & Carroll, J. Attachment styles and male sex addiction. Sexual Addiction & Compulsivity the Journal of Treatment and Prevention, 15: 158–175 (2008).

[41] - refer to [4]

[42] - Swisher S. Therapeutic interventions recommended for treatment of sexual addiction/ compulsivity, sexual addiction & compulsivity. The Journal of Treatment and Prevention, 2(1): 31-39 (1995).