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Some healthcare professionals do not feel that sex "addiction" is the appropriate terminology for this disorder, but most agree that the syndrome is a real one.
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Physicians specializing in the field of addiction are in general agreement concerning applicability of treatment to those with addiction to drugs, such as alcohol and heroin, and to gambling, which has similar characteristics and has been well described in the scientific literature. There is less agreement concerning definition or treatment of other so-called addictive behavior such as sexual addiction and internet addiction, such behaviors not being marked generally by physiologic tolerance or withdrawal.
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Not everyone agrees that hypersexual behavior is indicative of a clinically significant disorder. The Diagnostic and Statistical Manual (DSM-IV 2001) of the American Psychiatric Association does not specifically list sex addiction, or compulsive sexual behavior, as a clinically significant disorder.
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Some behaviors can be attributed to mood and affect state, while others were attributed to depression. Yet other behaviors, such as compulsive masturbation, can be attributed to feelings of sexual anxiety.
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Is sex addiction truly an addiction? Or is it really just an impulse control problem? Can sexually acting out be the result of some chemical imbalance in the brain? On the other hand, is it simply a matter of willpower and self-control?
Regardless of the underlying biological, psychological, or social causes, sexually compulsive behavior has been, and continues to be, the subject of much controversy.
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Sexual compulsive behaviors cannot be considered addictive - eating, drinking, sleeping, and sex are all part of the human survival drive. Overindulgence in these behaviors, is more indicative of appetitive deregulation. Many repetitive non-paraphelic sexual episodes may better be explained by another diagnosis - such as substance use, anxiety, or depression.
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obsessive-compulsive disorder; affective disorders, such as bi-polar disorder; attention deficit disorder; brain injury; and hormonal imbalance, imbalances in neurochemical activity?
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An addictive disorder is one that is caused directly by the effect on the brain of an ingested, injected, or inhaled mood-altering chemical. An excessive, out-of-control behavior such as compulsive gambling, compulsive overeating, or compulsive sexual behavior cannot be an addiction than...
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http://www.freespeechcoalition.com/FSCView.asp?action=preview&coid=133
The psychological and psychiatric community does not recognize “sexual addiction” and the related notion of “pornography addiction” as a distinct psychological disorder. The descriptive terms “sexual addiction” and “pornography addiction” do not appear in the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
According to Goodman any behavior that is used to produce gratification and to escape internal discomfort can be engaged in compulsively and can constitute an addictive disorder. This would presumably mean that those who engage in obsessive Saturday afternoon college football viewing, Sunday afternoon professional football exposure, playing computer games, playing basketball to work up endorphins, as well as obsessive workaholics are all experiencing addictive disorders by this definition.
So-called sexual addiction may be nothing more than learned behavior that can be unlearned; labels such as “sex addict” may tell us more about society’s prejudices and the therapist doing the labeling than the client; scientists who have undertaken scientifically rigorous studies of exposure to sex materials report that despite high levels of exposure to pornography in venues such as the Internet, few negative effects are observed.
The self-medication hypothesis states that addicts have an underlying psychological, emotional, or mental disorder that they are treating themselves with a medication that they have discovered on their own. Their underlying problems, then, are seen as the cause as well as the driving force behind the active addiction. To treat an addiction, a professional would have to help the person identify and fix the underlying problems. Once the roots of the addiction have been worked on, the addictive behavior will no longer be needed by the addict and will be discarded.
A person's use of addiction is a poor and rather dysfunctional method of coping, and needs to be replaced with more adequate and appropriate means of coping with stress. When this new learning has been accomplished, the addict will have no more need for the addiction.
The cognitive/behavioral approach views addictions as overlearned responses. Actually, behavioral therapists have been traditionally unconcerned with the origin of the behavior, and instead have focused on changing dysfunctional behavior.
The social learning school believes that behaviors are learned. Cognitive therapists believe that our thought processes direct our emotional and behavioral states. The combination of cognitive and behavioral treatment of addictions examines the thinking and subsequent emotional responses that create compulsive, overlearned behavioral reactions. They then set up new modes of thinking that are associated with new behaviors so that addictive behaviors will not be reinforced.
The disease model looks at addiction as an illness. There is a biological/ medical basis to this view in that biochemistry and genetics are seen as underlying causes of addictions.
The organism is considered sick and out of homeostasis. There is an etiology, a set of symptoms, a predictable course, a treatment, and a response to that treatment which can be specified for any disease, including the disease of addiction.
There are many parallels between addiction and chronic illnesses like diabetes and depression. Nonetheless, some people strongly disagree with the disease model. The major objection seems to be that calling something a disease somehow takes away the ill individual's responsibility. We are "victims" of diseases, which place us in a powerless, helpless role. In fact, proponents of the disease model agree with this perception. The First Step of the Twelve Steps program begins, "We are powerless over [fill in the appropriate addiction]." The role of willpower is a big point of contention here. If you overdo food, love, alcohol, or sex, are you necessarily doing this against your own will? People do not choose to get diabetes or major depressions, but they do appear to volunteer for their addictions. Where is the addict's willpower? Why can't he or she choose to stop eating, loving, drinking, or having sex? Advocates of other models of addiction say that the person can stop. He or she has only to relearn new cognition strategies and behaviors, cope better with stress, or analyze the need for self-medication in order to gain control of the addictive behavior.
How can a part of life as essential, beautiful and natural as sex become an addiction?
…lack willpower and moral weakness…
Some are concern that the label "sex addiction" will be used to excuse the sexual offenders "off the hook" legally and personally.
Although an addict may not be responsible for causing the disease, certainly the addict needs to be held accountable for his or her actions, especially after proper diagnosis.
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Despite some skepticism about the existence of sexual addiction, the addiction model has proven very useful for treating compulsive sexual behaviors.
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If Sexual Addiction is not a disease, then it is not a healthcare problem.
If it is not a healthcare problem then the healthcare system that is devoted to the prevention, early identification, and treatment of disease should not become involved with those afflicted. If this is the case, where should the sex addict go to receive treatment?
“Does Sex Addiction meet the criteria of a disease?” If we call it by another name, we must still apply the same question. If we call it an addiction, we must ask the question “Does an addiction meet the criteria of a disease?” If we call it an affliction, we must ask the questions “Does an affliction meet the criteria of a disease?” If we call it an appetite habit disorder, we must ask the question “Does an appetite habit disorder meet the criteria of a disease?”
What is a “Disease”?
1. An illness, a sickness that causes an interruption, cessation, or disorder of bodily functions, systems, or organs
2. A disease is an entity characterized by at least two of these criteria:
(1) a recognized etiologic agent (or agents);
(2) an identifiable group of signs and symptoms; or
(3) consistent anatomical alterations of known body systems.
Does Sexual Addiction cause an interruption, cessation, or disorder of bodily functions, systems, or organs?
Is Sexual Addiction “an entity characterized by a recognized etiologic agent (or agents)?
Is Sexual Addiction “an entity characterized by an identifiable group of signs and symptoms?”
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In arguing against acknowledging sex as addictive, many authors address the physical dependence criteria often found with addictive substances. Apt and Hulbert (1995) asserted that "A true addiction involves a physiological dependence on a particular substance that results from the habitual use of that substance. Sex is a form of interaction, not a substance on which the body comes to depend" (p. 104).
Levine and Troiden (1988) made similar claims in advocating for the retention of the term addiction for chemical substances when they added, "Although sexual experiences may be 'mood altering,' abrupt withdrawal from sexual behavior does not lead to forms of physiological distress such as diarrhea, delirium, convulsions, or death" (p. 357).
The main argument made by these authors is that for a behavior/substance to be addictive, it must meet criteria for physical dependence, criteria exhibited by tolerance and withdrawal.
Although these arguments may have had merit in the past, current research refutes such assertions. O'Brien (1996) stated that "Modern concepts of addictive disorders emphasize the compulsive and relapsing drug-taking behaviors rather than tolerance and physical dependence" (p. 677). Potenza et al. (2002), through a comprehensive study discussing the merits of designating gambling as an addictive disorder rather than as an impulse control disorder, found that behavioral addictions can be "considered an addiction without exogenous substance
use" (p. 722).
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Many would grant that sexual behavior can become excessive, but, as with any phenomenon which exists on a continuum, it is hard to define the point at which normal becomes excessive. It is not possible to determine a universally agreed upon normal amount of sexual behavior, but the statistic known as total sexual outlet does provide some guidance. Total sexual outlet, originally defined by Kinsey and colleagues13 as the number of orgasms per week, is one way to define hypersexuality.
Kafka defined someone as hypersexual if they have >7 orgasms per week for >6-month period after 15 years of age. This level was chosen based on surveys which show only between 2% and 8% of men, including adolescents, report having persistently >7 orgasms/week.
Kinsey and colleagues found that only 7.6% of American males (adolescence to 30 years of age) had a mean total sexual outlet/week of >7 for at least 5 years. In the most recent survey of sex in American males, 14.5% masturbated 2–6 time/week for the current year, 1.9% masturbated daily, and an additional 1.2% masturbated more than once a day during the past year.
Therefore, community samples show that males with a total sexual outlet of >7 comprise between 2% to 8% of males. What is the total sexual outlet of males with impulsive-compulsive sexual behavior? Is it higher than normal?
Individuals presenting for treatment of impulsive-compulsive sexual behavior have a high total sexual outlet when compared to the total sexual outlet of the average American male; however, this does not imply that individuals with high total sexual outlet are pathologically sexual. No assessment has been made of people with high total sexual outlet to determine if they have impulsive-compulsive sexual behavior or comorbid Axis I or II pathology.
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Researchers have argued that it is problematic to categorize impulsive-compulsive sexual behavior as an addiction. They argue that it is unjustified because there are no studies to document that a physiological withdrawal syndrome occurs. Therefore, it is argued that the presence of tolerance or withdrawal phenomena. As an aside, it is worth noting that addiction is not a category in the DSM-IV-TR. Substance use disorders are categorized as abuse, dependence, withdrawal, and intoxication. Of these categories, dependence with physiological dependence (with evidence of tolerance or withdrawal) is most likely equivalent to addiction.
Although individuals with impulsive-compulsive sexual behavior may experience some psychic and autonomic distress (heart pounding, sweaty) if prevented from engaging in sex, this does not qualify as physiologic withdrawal. Does that mean that they do not have an addiction? This is a point worthy of debate. Using the current DSM-IV-TR, an individual can qualify for alcohol dependence without experiencing withdrawal or tolerance. If this is true of alcohol dependence, why can it not be true of impulsive-compulsive sexual addiction? Further, the National Institute on Drug Abuse has considered behavioral addictions, such as impulsive-compulsive buying, to be “cleaner” and more homogeneous models of substance addictions because these conditions may share clinical features and perhaps underlying brain circuitry, and these features and circuitry are not altered by the ingestion of exogenous substances.
Another objection raised to classifying impulsive-compulsive sexual behavior as an addiction has been formulated by Martin and Petry. They argued that any bad habit can be labeled an addiction if one relaxes the boundaries for tolerance and withdrawal far enough, and gave an example of excessive television watching in children. Watching too much television causes impairment in family and school functioning. Its sedentary nature results in health consequences such as weight gain. It has relapses “that are often precipitated by fatigue or boredom, or the airing of favorite program.” Excessive television watching has many phenomenological similarities to an addiction. So do many bad habits. In the absence of other evidence, labeling a bad habit an addiction has the consequence that it “medicalizes its symptoms ... (and may result in) removing responsibility from the individual, family”.
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Sunday, October 12, 2008.
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