A diagnostic term is always a provisional construct, a tool for organizing information about phenomena we are trying to understand and work with. A construct will be “correct” as long as it is optimally useful.
A recent study at UCLA came out with the conclusion that that people with problematic porn use may not be “sex addicts” and that they might just have a high “sexual desire.” They admitted this was a very tentative conclusion, and they hinted that no useful conclusions about sex addiction are yet supported by the data they collected. But the headlines sound so important. Sex addiction doesn’t exist!
The study did an EEG test on people who reported problems with porn use and found that their brains did not respond the way the researchers hypothesized they would. From this the researchers concluded that people with problem porn use may not be addicts. This is a gross oversimplification of a study that is too convoluted and confusingly designed to go into in any detail without putting you and myself to sleep.
The response to this study was that it was, to say the least, no big deal. An article in PsychologyToday.com by a colleague of the researcher brings out some of the many questionable aspects of the study. Other articles such as a critique by Dr. Rory Reid, and a critique on PornStudySkeptics, have attempted to actually address the problems with the study such as the lack of a control group, the use of certain questionnaires, the limitation of the subjects to porn use rather than including other forms of sexually addictive behavior, the use of still photos as sexual stimuli, the use of content that was one woman and one man having sex, and the use of the comparison with a past study of the same EEG response in cocaine addicts viewing pictures related to drugs.
The question that we need to ask is “is the term sex addiction the most useful way to describe a set of behaviors and experiences from a clinical and research standpoint?” I think the answer at this point in history is “yes”.
When we use words to describe phenomena in science and medicine we look for a construct that can be consistently tied to some quantifiable data and that works as an accurate description of the specific set of facts we are trying to work on. Then we use that term as long as it is the most productive construct around, productive in terms of helping us understand things and organize our research questions in such a way as to push our knowledge forward. That construct will be correct as long as it is useful. (I am deliberately leaving out consideration of the DSM criteria for addiction, tolerance, withdrawal etc. as they may or may not end up being critical to the research and treatment issues.)
I believe that the term sex addiction is by far the most useful and productive way to think about the phenomenon and that the alternatives are misleading in terms of how we use the terms in clinical work and research.
“Hypersexuality” is a useful way to describe a symptom more than it is a description of a disease entity. It is a symptom of dozens of other disorders including everything from bipolar disorder to brain damage. It has no “face validity,” meaning it doesn’t seem like it alone can describe what our patients are experiencing. It may have seemed like a way to get sexual addiction into the DSM which would have been useful in its own right had it happened.
“High sexual desire” and “high sex drive” are similarly not very useful. Sex is overly important to sex addicts but to apply the label “high desire” has no established explanatory power in this area and in fact is circular.
Some of our colleagues argue that the person who struggles with the shame and ravages of sex addiction is simply amoral or irresponsible. This position is totally useless and does nothing to push forward the frontiers of knowledge. (See also my blog “Sex Addiction Deniers: What Makes Them So Mad?’)
Some important features of “sex addiction” as a diagnosis
There is a saying that “sex addiction isn’t about sex, it’s about pain.” For sex addicts sex is a drug to kill pain and escape unpleasant emotions. It may function like “speed” through amping up general level of arousal, as when engaging in risky activities like hook-ups with strangers or illicit behaviors. Or it may be used to numb out as with the addict who gets lost in fantasy or porn. It becomes the addict’s drug of choice.
Addiction has for many years been described as being a pathological relationship with a substance or behavior. Concepts like hypersexuality appear to be inside the patient. Presumably someone could have a heightened sex drive without ever doing anything in particular. Sex addiction is understood as a damaging way of relating to something.
Sex addiction researchers have found that those experiencing sex addiction usually also suffer from other co-addictions as well. They believe there is a common underlying process that involves the loss of control over the behaviors. In fact the treatment approach is one that looks for a “primary” addiction but assumes that the person’s other addictions need to be addressed as part of the same treatment process.
Attempting to find a new construct which distinguishes sexually addictive behavior from its fellow-travelers means failing to make use of the great and increasing body of work in the general field of addiction research. Much useful information can be transposed from findings about gambling, smoking and so on. And useful hypotheses may emerge from this body of work in the investigation of sex addiction in particular. But research showing that there is no parallel on one measure does not prove anything. In fact it would be a tedious and pointless endeavor to try to take all the research findings about addiction over many decades and prove that they do not apply to sex addiction. And who would want to do that?
See also the recent article on brain science and compulsive sexual behavior: Pornography addiction — a supranormal stimulus considered in the context of neuroplasticity by Donald L. Hilton Jr., MD