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Sex addiction divides mental health experts

Is extreme sexual acting out an obsessive-compulsive disorder, a sign of depression or just bad behavior? 'If we are looking at a disorder, it's not clear what that disorder is,' one expert says.

March 01, 2010|By Shari Roan
  • Tiger Woods is said to be receiving treatment in Mississippi at a center that specializes in sex addiction.
Tiger Woods is said to be receiving treatment in Mississippi at a center… (Pool )

Tiger Woods, who recently admitted to multiple extramarital affairs, said he is receiving treatment. David Duchovny, who plays a sex-obsessed professor on the TV show "Californication," underwent rehab in 2008. Dr. Drew Pinsky has launched a reality series dealing with the subject.

Sex addiction talk seems to be everywhere. But mental health experts are split on what underlies such behavior.

The American Psychiatric Assn. has proposed that out-of-control sexual appetites be included as a diagnosis in the next edition of the psychiatrists' bible, the Diagnostic and Statistical Manual of Mental Disorders, to be published in 2013.

Unlike compulsive gambling, which also is proposed for addition to the new DSM (to be called DSM-5), the proposed diagnosis -- hypersexual disorder -- stops short of categorizing the problem as an addiction, and for a reason.

"If we are looking at a disorder, it's not clear what that disorder is," said Michael Miner, a professor of family medicine and community health at the University of Minnesota who advised the DSM-5 committee on sexual disorders. "There is not an agreed-upon name. The research is in its infancy."

Patterns of extreme sexual acting out are described variously by therapists as an addiction, as a type of obsessive-compulsive disorder or as a symptom of another psychiatric illness, such as depression.

The lines specialists draw between what is sexually normal or abnormal have long been in flux. Some behaviors, such as pedophilia, are almost universally considered abnormal and have been described in the DSM for decades. Homosexuality was once considered deviant, but that reference was dropped from the DSM decades ago.

Therapists who see patients -- mostly men -- with problems caused by repetitive sexual behaviors, whether sex with consenting adults, pornography or cyber-sex, said the addition of a hypersexual behavior category was long overdue.

"There is no doubt in my mind that this condition exists and that it's serious," said Dr. Martin P. Kafka, an associate clinical professor of psychiatry at Harvard University who was a member of the DSM-5 work group on sexual disorders.

"There are definitely men who are consumed by porn or consumed by sex with consenting adults -- who have multiple affairs or multiple prostitutes. The consequences associated with this behavior are very significant, including divorce, pregnancy" and sexually transmitted disease, he said.

Some studies suggest that hypersexual behavior is indeed similar to an addiction, akin to the loss of control that seizes compulsive gamblers or shoppers.

For example, in a 1997 survey of 53 self-identified sex addicts in a 12-step recovery program, 98% said they had three or more withdrawal symptoms, 94% that they had tried unsuccessfully to control their behavior and 92% that they spent more time engaging in sexual behavior than they intended to.

In addition, screening tests designed for sexually addicted individuals have also been shown to accurately identify people with substance abuse problems, implying that the disorders have similarities.

Based on the addiction model, several sex addiction treatment centers have opened in recent years -- including Pine Grove in Hattiesburg, Miss., where rumors have placed Woods. Twelve-step programs, often the foundation of substance abuse treatment, are a staple of such facilities.

But they may not reach far enough, Kafka said. Many patients with hypersexual behavior relapse after 12-step programs, he said, because they haven't addressed other issues in their lives. He believes that certain moods or psychiatric conditions cause sexual behavior to become disinhibited and abnormal.

In a 2004 study of 31 self-defined sex addicts, for example, researchers at the Kinsey Institute for Research in Sex, Gender and Reproduction at Indiana University found that most of the individuals had an increased interest in sex when they were in depressed or anxious emotional states.

The ramped-up sexual behavior may be linked to changes in levels of key brain chemicals, such as serotonin, that occur when people experience mood disorders, some scientists think. These chemical changes might lift sexual inhibitions.

Impulsivity scores are also higher in sexually overcharged men, Miner and colleagues found in a study comparing eight men with compulsive sexual behavior to a control group.

The report, published in November in the journal Psychiatry Research, was one of the few studies to examine the brain physiology of such individuals. It showed that the hypersexual men had distinct patterns of activity in the frontal lobe region of the brain. The pattern, however, did not match that of patients diagnosed with other kinds of impulse control problems.

Maureen Canning, director of the sexual disorders program at the Meadows treatment center in Wickenburg, Ariz., has another theory.

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