A week ago the National Institute of Mental Health (NIMH) published its intention to work towards and devote research funding to a new system for mental health diagnoses as an alternative to the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association.  The various incarnations of the DSM have been dubbed the “gold standard” of diagnostic criteria for mental disorders and have provided a common framework for practitioners, researchers and insurers to relate to. 

The trouble is that the DSM has never been any good as a basis for understanding and treating mental disorders because it is built, as the NIMH announcement says, out of collections of symptoms rather than identifiable or understandable disorders.

The manic hypersexuality often characteristic of bipolar disorder and the possibility of bipolar disorder in those diagnosed with sex addiction are sometimes difficult to untangle.

According to a handful of studies reported in the National Alliance for Mental Illness (NAMI) article “Opening the Door on Hypersexuality,” the prevalence of hypersexuality among people with bipolar disorder is anywhere from 25 to 80% with an average estimate of 57%.  NAMI states:

If you have ever tried to relate to a serious narcissist you will realize that there is something different about it.  Because narcissists are deeply insecure they need to constantly establish their power and worth.  They are not like hypnotists they literally are hypnotists.  It’s how they relate.  The normal feelings you get with someone you like, feeling like you have “good chemistry” or feeling like you “hit it off” bear no resemblance to falling under the spell of a true narcissist.

Some people can look at internet pornography now and then and not become porn addicts.  Others get hooked on porn very quickly and spend hours online, often jeopardizing their work, neglecting their families and wrecking their relationships.

Why are some people more at risk for internet porn addiction?

There is an old recovery saying that you can’t get sober if you are too smart, too rich or too good-looking.   Anyone working with sex addicts knows that these attributes can sometimes present challenges.

I’m not saying that looks brains and money cause sex addiction but I can see some of the ways they might operate to prevent the addict getting better.

As a therapist I have noticed that partners of sex addicts frequently have characteristics of love addicts.  This is not always the case of course.

Partners of sex addicts may be innocent bystanders.  But I think there are some reasons to suggest an affinity between love addicts and sex addicts.

There are underlying similarities between sex addicts and love addicts in terms of brain chemistry, intimacy issues, abandonment fear and co-dependentence.  Both tend to have early childhood trauma and attachment issues.

However, I think it is the separate, distinct characteristics of each that attract them to each other.

Here are my thoughts on how this pairing might come about and what function  it might serve for the addict and the partner.

Trauma and addiction go hand in hand.  Recent research points to the conclusion that all addictions, drugs, alcohol, sex, gambling, etc, share common patterns in neurobiology, genetics and childhood attachment history.  Traumatic experiences in childhood are believed to be a major risk factor for sex addiction and other addictions by virtue of the way they affect brain development, emotion regulation, attachment patterns and coping mechanisms in general.

A book about trauma, addiction and healing

Reflective Meditations is a spare, elegantly presented series of reflections on many of the most important ideas in trauma and addiction theory and treatment.  It is presented in a series of short paragraphs along with lovely original photography by the author.  The book is an interesting mixture in that it is a primer on the basic information about the topic, presented as a series of daily meditations and indirectly built on Tait’s own experience.

We think of addicts as supremely self-indulgent, and sex addicts especially so.  But every sex addict has an opposite tendency toward self deprivation.  In their acting out behavior sex addicts are selfish, reckless, deceitful and often rebellious.  They are usually repeating patterns of behavior that reflect traumatic experiences from early life. Sometime these were experiences of sexual trauma but often there were other stressful experiences that have become sexualized along the way.

Sex addiction is known to be a disease of extremes.  Sex addicts swing between out-of-control behavior and over-controlled behavior in an ineffective effort to bring balance to their lives.

Where does compulsive self-deprivation come from?

As clinicians we know that the sex addict doesn’t fall too far from the family tree.  Or as a friend of mine put it: “Sex addiction comes barreling down the generations like a locomotive!” 

So addictions run in families, but what part of this is due to genetics, to life experiences, and to other personality variables?  And can the genetic research on other addictions be applied to sex addicts?

Researchers have been investigating the genetic factors in drug and alcohol addiction for many years using identical twins vs. non-identical twins. It is reported that approximately 50% of the predisposition to addiction was accounted for by genetic factors.  More recent studies use brain science and genetic factors to help understand why addiction is heritable.

A large number of sex addicts have attention deficit hyperactivity disorder (ADHD)

Dr. Rory Reid of UCLA did research in 2007 and 2011 in which groups of men in treatment for sex addiction were assessed for ADHD and in which 23%-26% were found to meet the criteria for adult ADHD.  Almost all of these (97%) were of the “predominantly inattentive type” rather than being predominantly hyperactive. (The prevalence of ADHD in the general population is 3-5% according to Reid.)

Can impulsivity or low self-concept explain the correlation?

Dr. Reid also gathered evidence about whether ADHD might be “driving” sex addiction due to the impulsivity of people with attention deficit as children.