Sexual Addiction: Myth or Disorder?

Sexual addiction is a hotly debated topic, straddling a thin line between being labelled a severe condition or dismissed as a myth, lacking substantial evidence. This discussion has gathered momentum over the years, drawing contrasting views from experts and researchers.

Evolution of the Concept

The term "sexual addiction" surged in the 1980s, spearheaded by psychologist Dr. Patrick Carnes. His work outlined addictive patterns, describing an uncontrollable relationship with sex, leading to repetitive and risky sexual behaviours, despite adverse consequences. However, this label faced criticism from academia, highlighting the oversimplification and neglect of underlying psychological or societal factors.

Diverging perspectives

Debates about this concept led to varying terminologies like impulse control disorder, hypersexual disorder, compulsive sexual behaviour disorder and sexual compulsivity, further complicating its definition. Critically, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has not recognised sexual addiction due to insufficient empirical backing.

?Dissenting voices

Critics argue vehemently that sex/pornography cannot be classified as an addiction as it does not contain the elements of withdrawal, escalation, tolerance, and risky use - the classic hallmarks of addiction. They rightly claim that no one has ever died of an ‘orgasm overdose’ but erroneously claim this is why sex should not be labelled as an addiction. Let’s compare this statement with other recognised addictions. If you take too many drugs you will overdose; if you drink too much, you will eventually ‘black out’; if you gamble too much, you will eventually lose all your money but with pornography, there is no limit to consumption – it can be watched free of charge, 24 hours a day, 7 days a week. This in turn will keep the brain in a highly dopamine charged state and more susceptible to developing an addiction through chronic over exposure.

In her book ‘Dopamine Nation’ Dr Anna Lembke, Medical Director of Stanford Addiction Medicine, argues that high reward, high dopamine stimuli such as social media, food, gambling, gaming and ‘pornography’ – all have the potential to become addictive. Sexual arousal induces dopamine levels comparable to morphine and activates the same nerve cells hijacked by crystal methamphetamine and cocaine. With the evolution of our reward circuity, evolving, to pursue sexual stimuli this puts people who overconsume pornography at risk of becoming addicted. The sheer novelty and supernormal stimuli of pornography can keep dopamine levels raised for hours. This overrides the brains satiation mechanisms, resulting in the reward system becoming de-sensitised and the foundations for addiction are laid.

?Comparing Pathologies

Drawing parallels between gambling addiction (acknowledged in DSM-5) and pornography addiction - a subcategory of sexual addiction, reveals striking similarities.

Dr Alex Katehakis, a leading sex addiction expert from the US and author of ‘Sex Addiction as Affect Dysregulation’, offers this excellent comparative analysis between pornography and gambling addicts: both seek to win an intermittently reinforced reward; both spend hours at their task sometimes to the point of exhaustion; both activities negatively affect their personal, professional and social relationships; neither can stop; one is looking at internet pornography seeking endlessly for the right clip to ensure the most intense orgasm; the other is playing an online poker game in hopes of winning. One is masturbatory and one is monetary. One is in the DSM-5, and one is not.

Neuroscientific Backing

Neuroscientific studies suggest changes in brain structure and function among individuals with pornography addiction. Reduced gray matter in critical brain areas, akin to substance addiction, hints at a physiological basis for this behaviour.

Despite dissenting voices, mounting neuroscientific evidence aligns pornography addiction with the addiction model. Comparisons to substances like cocaine and methamphetamine, highlight its potential for addictive tendencies.

Final Thoughts

To conclude, it is worth asking if internet pornography is now the new smoking? Decades ago, smoking was a universal phenomenon, it was socially acceptable and deemed to be non-addictive. The tobacco industry blamed asphalt when tar began to present in autopsies. There was burgeoning evidence to suggest smoking was causing health problems and people were struggling to stop.

During this period tobacco companies released ‘debunking’ research showing no signs of harm or addiction. As the years progressed and addiction research became more sophisticate, it revealed the physiology of how nicotine produces addiction, and the game was up for the tobacco industry. The reality of smoking’s harmful effects could no longer be denied. Granted, people do still smoke today, but they do so making an informed choice, knowing the health risks. It’s hard to imagine that a whole generation chain smoked cigarettes without having any idea how harmful they were.

The same thing is happening today with pornography. Internet pornography is ubiquitous, anonymous, accessible and impacts the brain in the same way as cocaine and crystal meth - two of the most addictive substances on the planet. It is essential that the debate is steered back towards the neuroscience and away from unempirical arguments.

Formal recognition would lead to increased awareness, research and treatment options for individuals struggling with excessive pornography usage. It is vital that people can make an informed choice as to how to consume pornography, and be aware, as with smoking, the harmful risks it entails. ?

? Nathan Jones – London Centre for Addictions 2024

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Further Reading:

Your Brain on Porn – Gary Wilson (Commonwealth Publishing 2014)

Sex Addiction as Affect Dysregulation - Dr Alex Katehakis (W. W. Norton & Company; Illustrated edition 2017)

Out of the Shadows: Understanding Sexual Addiction – Patrick J.Carnes (Hazelden Trade 3rd Ed. 20218)

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