The Shadowy Science of Sex Addiction
Tiger Woods' philandering has talking heads chattering about compulsive sex. But research on sex addiction is fuzzy.
By Matthew Herper, David Whelan and Robert Langreth, ForbesFind
Can you be addicted to sex?
Nobody really knows for sure—though you can certainly get treated for sex addiction if you think you have it.
Last year, X-Files and Californication star David Duchovny checked into rehab for sexual addiction. After a string of women went public with claims they were mistresses of golfer Tiger Woods (the best-paid athlete on the planet and a married man), it took only days for talking heads to speculate that Woods might be an addict. Reports indicate that he may have attended and completed a rehab program.
The idea of sex as a drug is deeply seductive to journalists and reality TV producers. But the idea of being addicted to sex is actually quite controversial. No such diagnosis is even recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), psychiatry's bible.
The DSM-IV assiduously avoids the word "addiction," preferring to talk about dependence, withdrawal and compulsion. A new condition, called hypersexuality, might be something close, but some psychiatrists bristle at the idea of talking about human sexuality as an addictive force unto itself.
"I don't buy it as a disease ... it is an excuse," says John J. Lucas, a forensic psychiatrist at Weill Cornell Medical College. In modern society, "we have an unfortunate practice of proliferating illnesses ... in response to various practices in terms of reducing the stigma of certain behaviors."
Craig Fabrikant, a clinical psychologist at Hackensack University Medical Center, says that he doesn't believe that sex addiction exists in the same way that alcohol or cocaine addiction does. Real disorders, however, might cause behavior that is interpreted as sex addiction. For example, someone in the manic phase of bipolar disorder can be overly sexual, and a person with obsessive compulsive disorder might look at pornography frequently.
The idea of sex addiction, however, got a big boost in 1983 with the publication of a book called Out of the Shadows by Patrick Carnes, Ph.D., who has treated patients with the disorder at several clinics (he currently works at a Mississippi facility). The idea is that because sex releases dopamine in the brain and provides a momentary high just as many drugs do, problematic sexual behavior could be understood as being very much like a chemical dependency.
"I see guys who start when they are 13, and now they are 30. They've never been able to stop," says David Delmonico, a professor of counseling at Duquesne University in Pittsburgh and author of In The Shadows of The Net: Breaking Free from Compulsive Online Sexual Behavior. In order to have hypersexual disorder, Delmonico says, a person must feel as if he doesn't have the ability to stop, and think about little else but sex. Delmonico favors calling the disorder hypersexuality, and notes that it isn't easy to diagnose: It takes at least two or three hours of discussion with a patient to determine if he or she is hypersexual.
As with other compulsive behaviors like gambling and drinking, Delmonico recommends therapy and 12-step programs, although antidepressants (drugs like Paxil or Zoloft) and antipsychotics (these include Abilify and Zyprexa) may help. There is a report of a single case in which Topamax, an epilepsy drug, reversed hypersexuality. Testosterone suppressors are reserved for criminal sexual offenders.
There isn't a lot of science to back up this path of treatment, though. The National Institutes of Health's PubMed database lists every article published in a major medical journal going back decades. There are 67,700 references for "alcoholism" or "alcohol dependence," but just 286 studies related to "sex addiction," "hypersexuality" or "sexual dependence."
But is compulsive sexuality really similar to pathological gambling or even compulsive shopping? One small brain-imaging study says maybe not. Researchers at the University of Minnesota compared eight people who had been diagnosed with hypersexuality with others who had been diagnosed with impulse-control disorders like gambling or attention deficit disorder. There was also a control group.
The subjects were asked to look at a flashing letter on a screen and quickly press a button if they saw any letter other than "X." Patients who have impulse disorders usually press the button more often; this held true for both the patients who had traditional problems as well as the sexually compulsive people.
Things changed, however, when the researchers had their subjects do this task inside an MRI machine. People with impulse disorders had reduced activity in the bottom front of the brain (as seen in previous experiments), but the people with sexual disorders had reduced activity at the top front of the brain, indicating that something different was going on.
Michael H. Miner, one of the University of Minnesota researchers, cautions that his study is too small to draw any firm conclusions. In his normal work, treating sexual offenders, he says that he does not believe that compulsion and bad behavior necessarily go together, and he's skeptical of calling the increased sexual behavior an addiction.
He would, however, like to do more research on it. That's difficult, he says, because there is no recognized diagnosis for people who seem sexually compulsive.
"There's a lot of conceptual writing; there's a lot of theoretical writing; there's not a great deal of empirical data," Miner says. "If this is a disorder, what is it? Is this really a disorder at all, or is it a series of
symptoms that is part of something else?"