Misunderstanding Sexual AddictionIn a nationally distributed, recently published study a group of researchers argued that what is often called “sexual addiction” or “sexual compulsivity” could be better understood as a pathological variation of “high sexual desire.” After the publication of this article, released with great fanfare to the broadcast and print media, a multitude of media outlets suggested that the conclusions of this study demonstrate that there is no scientific basis for the diagnosis of sexual addiction. This response occurred despite the study being the first of its kind, riddled with methodological errors, and at best inconclusive. Nevertheless, the research has garnered a great deal of media attention, most likely because it addresses volitional problematic human sexual behavior, which is always a media attention -grabber (former US Congressman Anthony Weiner, former San Diego Mayor Bob Filner, etc.)

In this study, researchers, using EEG (electroencephalograph) technology, monitored the brain activity of 52 men and women who self-reported as having “problems controlling their viewing of sexual images.” The researchers asked these 52 people to look at more than 225 still photos – pictures of everything from violence to people skiing to men and women being sexual together – while an EEG measured their brain activity. Participants also completed several questionnaires regarding sexual desire and sexual activity. Essentially, the researchers were looking for a correlation between EEG readings and participants’ scores on the various questionnaires, thinking that any correlations might shed light on whether problematic porn use is caused by addiction (a neurobiological dysfunction) or merely a high libido.

Since the study’s release, critics have repeatedly expressed concern regarding numerous, profound flaws both in the method of data collection and the study sample itself – the most concerning issue being that the sample group of volunteer subjects differs significantly from those who would typically seek treatment for problem patterns of sexual behavior, primarily because participants were recruited exclusively from Pocatello, Idaho.

So here’s the rub: Pocatello, according to the latest US census, has a population of just under 55,000 people. Ninety percent of those people attend religious services “on a regular basis,” and 75 percent of them are Mormon. This population sample varies significantly from the population of most US cities of a similar size, where only about half the people attend religious services on a regular basis, and only about 2 percent of the population is Mormon. Needless to say, the cultural understanding of pornography in Pocatello is probably influenced rather heavily by the views of the predominant church/community in town, and that church believes viewing pornography is a serious sin, equivalent to marital infidelity, for which a person can be excommunicated. In short, the test subjects were without question a biased and skewed population sample. Disconcertingly, the researchers did not report these facts or take them into account when formulating their findings.

Additionally, there are serious questions about the methodology used to score one of the instruments in the study, both invalidating the measure and distorting the statistical result. This methodological error occurred in the research team’s misuse of the Sexual Desire Inventory (SDI). Basically, the researchers decided to use only part of that very comprehensive questionnaire – inexplicably ignoring questions in the SDI related to solo sexual activity, even though solo sexual activity was the very behavior being assessed by the EEG scans.

Feeling confused? So are we.

As if this weren’t enough, the pre-screening of test subjects was wildly inadequate. The study lumped everyone who reported concerns about porn use into the same category. This means that some of the subjects were not likely porn addicts at all, but merely ashamed or fearful about their use of porn, while others may have actually been severely addicted. Adding to the quagmire is the fact that the researchers chose vastly different test subjects – men, women, heterosexuals, and homosexuals – and then showed them all the same heterosexually oriented imagery.

Another criticism of the study is the researchers’ reliance on EEGs to measure subjects’ brain activity. Yes, EEGs are a useful scientific tool, but only to a certain extent. The simple truth is EEGs measure brain activity from outside the skull, making them the neurological equivalent of a blunt instrument. They are hardly a definitive way to monitor the complicated interplay of the numerous brain regions involved in the creation and expression of sexual desire (reward, mood, memory, impulsivity, decision-making, etc.)

To their credit, the researchers did not overtly indicate that addictive sexual behavior lacks a biological basis. Instead, they argue that the problem is “not an addiction,” and that it should be conceptualized as “high sexual desire.” However, these researchers did not study the same areas of the brain or use the same technologies that have been utilized in previous research looking at process (behavioral) addictions. In an article released in the journal Socioaffective Neuroscience and Psychology, Dr. Donald Hilton summarizes much of the brain research that does lead scientists to believe that sex (and other natural processes like compulsive overeating) can mirror substance-based addictions. For a thorough review of this scientific literature, see his article here. None of the brain regions looked at in Dr. Hilton’s work or the studies he cited were discussed or examined in the recently released research.

Despite poor study design, faulty execution, and other obvious limitations, the researchers chose to formulate their conclusions and publish, even sending out an international press release touting their “achievement.”

At this point we find ourselves wondering: When two articles come out, one supporting the utilization of an addiction framework to understand hypersexual behavior (Dr. Hilton’s) and one that questions the concept of additive sexuality (the UCLA study), why is it that the media hones in on one and distorts its conclusions for shock value? Do media members not understand the potential repercussions for the tens of thousands of patients whose reality is denied and invalidated by their misguided statements? Remember, in the 1980s sex addicts were told by mental health practitioners that their problem didn’t exist. Well, it did exist, and because therapists didn’t help them they created their own support groups, and now that network of “S-fellowships” provides critical care to tens of thousands of people daily. So while we as clinicians can continue to argue whether this is an addiction, a compulsion, an impulse control problem, or high sexual desire, we should not be arguing that the problem doesn’t exist. And the media shouldn’t either.

A similar phenomenon occurred with alcoholism at the turn of the century. In the past, addiction to alcohol was seen as a “moral failing” brought on by a “lack of willpower.” Later, the DSM referred to alcoholism as a personality disorder, the same as borderline and narcissistic personality concerns. It wasn’t until many years later, after Betty Ford “came out” publically as being alcoholic, that research funding began flowing through the NIH and university research systems, allowing us to more fully understand the disease concept of addiction.

Does the field of sexual addiction require more research before the disease is “officially” sanctioned by the likes of the DSM? Yes, absolutely. I have written about this need for research in numerous articles, blogs, and social media posts over the past several years. We particularly need more research on women and the LGBT communities in regard to sexual addiction. Even the author of the proposed Hypersexual Disorder diagnosis that was considered but ultimately rejected for the recently released DSM-5, Dr. Marty Kafka of Harvard, is clear in the idea that much more research is needed. This need for research, however, does not mean that sexual addiction does not exist or that we shouldn’t be treating it as best we can.

 

Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He has developed clinical programs for The Ranch in Nunnelly, Tennessee, Promises Treatment Centers in Malibu, and the aforementioned Sexual Recovery Institute in Los Angeles. He has also provided clinical multi-addiction training and behavioral health program development for the US military and numerous other treatment centers throughout the United States, Europe, and Asia.

 

 


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    Last reviewed: 11 Sep 2013

APA Reference
Weiss LCSW, R. (2013). Misunderstanding Sexual Addiction. Psych Central. Retrieved on September 20, 2014, from http://blogs.psychcentral.com/sex/2013/09/misunderstanding-sexual-addiction/

 

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