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What is Sex/Pornography Addiction?

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

Sexual addiction refers to a preoccupation with sexual thoughts or sexual behavior to the extent that this preoccupation continues even though it causes substantial harm. This harm may include: 1) risky, dangerous, or unhealthy sexual behaviors; 2) damage to relationships, 3) avoidance of meaningful intimate relationships; 4) financial consequences; 5) legal consequences, or 6) a failure to fulfill important life roles such as employee, student, spouse, parent, friend, etc. Sexual addiction does not refer to any particular type of sexual behavior. Likewise, sexual addiction does not refer to a high degree of sexual desire, or frequency of sexual activity. Sexual addiction is indicated when someone experiences a reduced control over sexual behavior despite negative consequences. Ordinarily, negative consequences serve to decrease or diminish the behaviors that cause them. In the case of addictions, these behaviors continue despite negative consequences. Examples of these consequences include: arguments with a partner over excessive pornography use; losing a job because of inappropriate sexual behavior in the workplace; and health, legal, and financial problems.

Sexual addiction falls into a specific category of addictions called activity addictions. Sexual addiction meets the definition of addiction that we discuss in our topic center on addiction. We defined addiction as follows:

 

Addiction is the repeated involvement with a substance or activity, despite the substantial harm it now causes, because that involvement was (and may continue to be) pleasurable and/or valuable. 

Sexual addiction is not a diagnostic term currently recognized by the American Psychiatric Association.  Instead, clinicians use non-specific diagnostic labels such as unspecified impulsive control disorder, unspecified paraphilic disorder, or unspecified sexual dysfunction.  However, the use of the later diagnosis is controversial as sexual addiction is not the same as sexual dysfunction. Some addictive activities may lead to sexual dysfunction.  For instance, it is not uncommon for heavy users of pornography to become unable to achieve an erection with a partner. The diagnosis of sexual addiction is discussed in a later portion of this center.

It may be difficult to understand how someone can become addicted to an activity such as sex. When people develop an addiction, they become addicted to the release of certain brain chemicals. It doesn't matter what causes this release of brain chemicals. It could be a drug or an activity that causes this release. Like drugs and alcohol, sexual activity increases levels of dopamine in the brain. Dopamine is the primary neurotransmitter in the brain's reward system. Because sex is an activity that promotes the survival of the species, the brain rewards this activity with dopamine. Dopamine creates pleasurable feelings. People are motivated to repeat behaviors that create pleasurable feelings. Unfortunately, the brain's reward system makes us vulnerable to addiction.

Like all addictions, sexual addiction causes changes to the brain's prefrontal cortex. Unfortunately, these changes also make the discontinuation of the addiction more difficult. These brain changes account for two characteristics of sexual addiction: impulsivity and compulsivity. Impulsivity is the inclination to act upon sudden urges or desires without considering potential consequences. Sometimes people describe impulsivity as living in the present moment without regard to the future. Impulsivity is evident in the early stages of addiction. During this phase, people impulsively act on powerful urges to experience sexual pleasure. The future consequences of those activities are not considered. Anxiety is not associated with the urges during these early stages.