(Today’s post talks about sexual addiction, whether it’s a genuine mental health issue and whether ‘addiction’ is the right word. To keep this readable, I’ve used ‘addicts’ to mean people who report trouble controlling their sexual behavior.)
Like sex? Vaughn R. Steele, Cameron Staley and others in the Southwest U.S. ran MRIs on people who really like sex (1). They tested two groups – people who reported trouble limiting the time they spent on porn, and those who reported powerful libidos, but denied it caused them any trouble.
Steele, et al watched how the brainwaves changed as the subjects looked at various pictures – neutral, pleasant, unpleasant and pornographic images. For their study, the researchers focused on the P300 – a section of the brain wave that swells when we evaluate something. Mention alcohol, and it will grab an alcoholic’s attention – you can tell by the way their P300 increases in amplitude. When the porn addicts viewed sexy images, their P300 didn’t – at least not more than for those who reported only strong sexual desire. Moreover, there didn’t seem to be any pattern of greater or lesser P300 amplitude in those who reported greater or lesser degrees of compulsive sexual behavior.
This means sex addiction isn’t a legitimate problem, right? Maybe. The debate has gone on long enough to be discussed on Cartoon Network (NSFW). The most common points of view can be condensed like so:
If it Walks Like a Duck and Quacks Like a Duck…:
Thesis: Of course it’s an addiction. Around the world, thousands of people report they used sex to cope with anxiety, continued to do so despite negative consequences, but could stick to healthy limits with addiction-model treatment and twelve-step groups.
Pros: Describes the sex addicts’ experience with a clear, compassionate metaphor
Cons: This study, which found very non-duck-like brainwaves.
No Addictive Substance? No Addiction:
Thesis: Addiction isn’t a pattern of behavior, it’s a state of the brain. If you aren’t introducing an addictive substance to the body, then you don’t have an addiction.
Pros: Adheres to a formal biological definition of addiction
Cons: The brain produces showers of neurotransmitters like dopamine and norepinephrine during sexual arousal – and they’re substances.
There Ain’t No Such Animal #1:
Thesis: There’s no addiction, just selfish, greedy people trying to excuse their irresponsibility.
Pros: Speaks to our values of self-reliance and self-control. Based on careful, clinical assessment of gossip-column items, it seems to fit celebrities well.
Cons: Doesn’t actually explain the recovering addicts who couldn’t take responsibility on their own, but did with the help of addiction-model treatment.
There Ain’t No Such Animal #2:
Thesis: There’s no addiction and really, no problem – just a bunch of self-appointed bluenoses who insist anyone who takes pleasure in what’s pleasurable must have a disease.
Pros: Reminds us not to pathologize behavior of which we disapprove.
Cons: Doesn’t actually explain the recovering addicts who report they got zero pleasure from their behavior, but couldn’t stop without support.
Steele and his fellow researchers argue their findings mean these problems might be treatable by lowering sexual desire. They’re willing to believe those who say their sexual behavior stretches out of their control, but they don’t believe it’s an addiction.
Does it have to be?
There’s those who insist cheerleading is a sport, because it requires intense stamina, training and physical effort. That’s also true of the trapeze and ballet, and neither will be in the Olympics any time soon. There’s a fifth common viewpoint on sex addiction; one that matches sex addicts’ subjective reports, isn’t contradicted by these findings, and elides some of the debate on phraseology:
“Behavioral Addictions” are Actually Compulsions:
Thesis: Gambling, eating, shopping and sexual behavior become compulsive when they are the main tool for coping with stress and unhappiness. If a behavior that pushes the pleasure button in the brain is someone’s only way to get by, that behavior will be repeated again and again, long after rewards stop coming and self-esteem crumbles.
Pros: Addicts reports they consistently engage in sexual behavior to maintain emotional and physiological stability, despite negative consequences. That’s (about) as good a definition of a compulsion as you could ask for.
Cons: Compulsions usually involve the belief the behavior will keep one safe. Sex addicts report they often break the limits they planned to hold when triggered. This makes it seem more like an impulse-control problem than a compulsion – and also matches addicts’ descriptions of their relapses.*
“We should be careful to get out of an experience all the wisdom that is in it — not like the cat that sits on a hot stove lid. She will never sit down on a hot lid again — and that is well; but also she will never sit down on a cold one anymore.” – Mark Twain
Our knowledge of the brain has grown so fast, our vocabulary hasn’t kept up. When you start with, “Can this fairly be described as addiction?” the conversation turns to an ethical debate of, “Does this word mean addicts avoid responsibility or accept it?” before it becomes a semiotic dispute of, “What do you mean when you say ‘real’?” As Rory C. Reid, PhD, assistant professor of psychiatry at UCLA and colleague of one of the researchers points out, the larger question isn’t, “Is this an addiction?” but “What is an addiction?”
Neurology may add so much to our knowledge that terms like ‘addiction’ and ‘compulsion’ will blow apart from within. In science, this is a good thing. Read Psychiatric Times‘ article (2) on distinguishing impulsivity from compulsivity, and you’ll notice the authors refer to “sexual compulsion” and “compulsive shopping”, while explaining these are considered impulsivity problems. When newer, precisely-defined, empirically-validated constructs are ready, tangled tongues won’t complicate our understanding. Until then, let’s be careful that, “This doesn’t fit the clinical definition,” isn’t mistaken for, “There ain’t no such animal.”
* Thanks to Karen E. Engbretsen PsyD, LLC who pointed out the important components of impulsivity in sex addiction.
(1) Steele, Vaughn R. ; Staley, Cameron ; Fong, Timothy & Prause, Nicole (2013). Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images. Socioaffective Neuroscience and Psychology 2013, 3: 20770 – http://dx.doi.org/10.3402/snp.v3i0.20770
(2) Berlin, H., Hollander, E. (2008, July 1). Understanding the Differences Between Impulsivity and Compulsivity. Psychiatric Times
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