What is sex addiction?

What do Americans David Duchovny, Michael Douglas, Tiger Woods, and Charlie Sheen have in common? In addition to their fame, all have hit the headlines because of their addiction to sex.

Nymphomania, Don Juanism, compulsive and impulsive sexual behavior, loss of sexual control, hypersexuality disorder or compulsive sexual behavioral disorder… The medical literature does not lack terms to describe sexual addiction.

And for good reason : sexuality pathological has always existed. Until now, however, it was not officially specified in disease classifications. But things are changing, since the World Health Organization (WHO) will soon include, in its 11^and international classification of diseases, the diagnostic of “compulsive sexual behavior disorder”, based on criteria identical to those proposed to identify a sexual addiction.

While requests for care have increased in recent years, research is exploring this disorder, which is characterized by an abnormal sexual appetite. The reality that she puts in light is complex. What do we know exactly?

Clinically, what is sexual addiction?

Excessive sexual behavior affects between 3 and 6% of the general population in the United States, and 2 to 4% in New Zealand. The prevalence of the disorder would be higher in young adults. The average age of onset of the disorder would be 19 years, with a sex ratio of 3 to 5 men for 1 woman (there is however a female under-representation in the data; more than 3% of women are affected by the pathological hypersexuality). It should be noted that non-pathological online sexual activities concern 90% of men and 51% of women.

Sexual addiction is part of in a round, which begins with a non-specific triggering factor, such as the receipt of good or bad news for example. Obsessive sexual preoccupations ensue, such as the urge to watch pornographya naked body, a sexual act. The thoughts are parasitized by sexual images, the subject indulges in sexual rituals, compulsive behaviors related to multiple sexual activities, such as going to a streaming pornographic, engage in erotic exchanges by messaging, seek sexual partners in the virtual or real world, etc.

This last point differentiates this disorder from paraphilias (sexual deviance characterized by attraction to a person or an object unsuited to traditional practices: voyeurism, pedophilia, frotteurism, etc.), in which sexual arousal is exclusive.

The cycle ends with a triad comprising shame, guilt and despair once the sexual act is over. It repeats and can trigger at any time.

For a behavior to be qualified as a compulsive sexual behavior disorder (according to the WHO ICD-11 classification), different signs must be found for at least 6 months:

• Significant loss of time related to sexual behaviors that interfere with daily life. This is the case when looking at pornography, for example, becomes a central activity;
• Repeatedly having sexual activities in response to stressful life events;
• Repeatedly engaging in sexual activity in response to a dysphoric emotional state (intense negative feelings, sadness, anxiety, irritability…). This is the case, for example, when sexual activity has become a rigid strategy to regulate one’s mood;
• Unsuccessful attempts to reduce or stop sexual behavior;
• Loss of control after several days off;
• Continuation of sexual behavior despite the risks physical and/or emotional and/or social;
• Frequent and intense sexual behavior;
• Significant personal dysfunction in different dimensions of life.

There are various clinical forms of this pathologywhich can be expressed by activities such as excessive masturbation (the number of times a day depends on the masturbation habits of each), cybersexual activitiesand different types of sexual behavior with consenting adults live or virtual such as phone sex, excessive attendance at clubs, saunasmassage parlor, and compulsive seduction.

Risk factors and origin

Above all, it is important to underline a key point: this disorder is not induced by the use of substances (cocaine or others) or medication (antiparkinsonians for example). Nor is it the result of a bipolar disorder (manic or hypomanic episode) or a paraphilia (child pornography, for example).

In the history of sick people, certain elements are frequently found: a family history of addiction to substances or behaviors, a sexual experience begun at an early age, separated family structures, a high frequency and diversity of behaviors sexual. Men would have more dissatisfaction in their sexual life, more relational problems and would consult more for problems related to sexuality. Women would be less vulnerable than men.

On the plan cerebralthere are microabnormalities of the frontal lobe (inducing behavioral disinhibition), of the lobe temporal (inducing excessive sexual conduct). There is also damage to the ventral striatum, the structure involved in the movement voluntary, the center of motivation, which becomes more active when physical activity and mental effort are mixed; this induces an irrepressible desire for sex (“craving”). The anterior cingulum dorsalwhich plays a role in affective states, is also affected, which induces an impairment of the motivation to do things by an alteration of the affects.

From anomalies are also seen in the amygdala, leading to impairment of memory and learning (the amygdala plays a role in modulation emotional memory: this structure of the brain is essential to our ability to feel and perceive in others certain emotions, such as fear and all the bodily changes it brings). Finally, the corpus callosum, which therefore ensures the transfer of information between the two hemispheres and thus their coordination, also presents structural anomalies (and sexual abuse may have been associated with such anomalies of the corpus callosum).

Physiologically, there are abnormalities of the axis of the stress, serotonin levels, involved in the regulation of eating and sexual behavior, the sleep-wake cycle, thermoregulation, pain, anxiety or motor control). Finally, on the emotional and relational level, there is a drop in self-assertion, sexual esteem, satisfaction and sexual control, alterations in attachment. Affected individuals are much more prone to anxiety and depression.

A number of studies on the genetic and sexual behaviors have been conducted, but the results are still insufficient to be able to draw conclusions regarding the issue of sexual addiction.

The environment also plays an important role, especially Internet and online sexual activity.

British physician and psychiatrist John Bancroft and his colleagues mentioned 2 types of sexual behaviors at risk of loss of control : masturbation and excessive use of the Internet in search of sexual gratification. A number of men and women use the Internet in this sense. Tool available, anonymous, it allows to have sexual supports online quickly for men while for women, cybersexual interactions are also indirect. There has also been an increase in the prevalence of addictive disorder since the appearance of the Internet and new adult industry markets.

A growing problem with the emergence of the Internet

Subject to the laws of the market, to the rules of marketing, initially dominated by everything related to the film business, the sex industry has become a lucrative market.

Today, 90% of legal American pornography is shot in the San Fernando Valley of California, the “Porn Valley”, but other American states also produce sexual content, as well as many European countries. The “sex GAFAs”, namely Pornhub, Tukif, Xhamster, Xvideos and Xnxx, are among the most visited websites annually, the last two being in the top 15 worldwide. Trends and themes vary according to the results of statistical analyses, and products are distributed and sold by all “e-media”, including the Darknet.

The list of pornographic media and products, used alone or in combination by people with this disorder, is long and varied: magazines, K7 VHS, DVD, Blu-Ray, video on demandstreaming, online games, erotic phone conversations, love store in line, webcamsonline prostitution, swinger clubs or saunas, massage parlors, sexodrome (all-inclusive hotel formula for adults), sexual use of social networkswebsites or apps meeting…

The exposure to thousands of new images and new sexual experiences is multiplied to infinity today. The productions of the sex industry are the main driver of sexual addictions for vulnerable people, due to their ability to generate new forms of immediate gratification thanks to new technologies.

Many consequences and associated diseases

The consequences of sexual addiction are similar to those found in other types of addiction. There are risks ofsexually transmitted infections related to unprotected sex (HIV, chlamydiagonorrhea, syphilis…), risks of pregnancy unwanted.

Patients with sex addiction may also have co-addictions to tobacco,alcohol or to drugs illicit (for example, cocaine, gamma-butyrolactone or GBL, new synthetic products, etc.). The use of chemsex must also be sought by the practitioner during the consultation. At men’s, Gambling and gambling addictions are particularly prevalent.

Sexual addiction is also associated with psychiatric pathologies such as mood disorder, anxiety disorder, personality disorder, or Obsessive Compulsive Disorder.

The doctor William Lowensteinspecialist in internal medicine, addictologist and president of SOS Addictionscontributed to the writing of this article.