Miscellaneous Others / From the vaults

Sex Addiction – Real and On the Rise?

On November 27, 2009, Tiger Woods crashed his car outside his home in Florida, distracted by an argument with his wife. She had been confronting him about his infidelities – and not just the occasional transgression, but a lurid string of what the red tops might term ‘romps’. Over the days that followed, a parade of porn stars, Playboy models and pancake waitresses stepped up to give the dirt, soiling an image that had once been squeaky clean.

Predictably enough, the more sanctimonious sector of the press had a field day. Here was an opportunity to shake their heads and moralise wildly, against the photographic backdrop of a montage of lingerie models. Meanwhile, Tiger himself was nowhere to be found. It was later discovered that he had checked in to the Pine Grove centre in Mississippi, a plush rehab clinic specialising in sex addiction, where he was to remain until well into the New Year.

Tiger Woods is not the first star to have proven none too puritanical in his pursuits. For the luminaries of sport, music and film, unbridled excess has generally been part of the draw.

The giveaway sign of our times, however, was the way in which Tiger’s case was framed. Very specifically, this was sex addiction: not a matter of opportunism or greed, but a psychiatric condition more along the lines of addictions to alcohol and drugs. And with this diagnosis, Tiger joined the growing ranks of self-proclaimed celebrity sex-addicts – rubbing shoulders with David Duchovny, Russell Brand and even Lord Irvine Laidlaw of Rothiema.

Phillip Hodson, a Fellow of the British Association for Counselling and Psychotherapy, is dismissive about such cases, pointing out that ‘sex addiction’ has yet to receive any official medical recognition:The sex addict diagnosis got invented to prevent promiscuous Hollywood people from receiving bad PR – and in a celebrity culture the masses have played copycat. It’s also a boast – ‘Hey, I can’t stop being irresistible, y’know!’”

Certainly, it seems that celebrities have helped move the condition into the mainstream, with more and more people conceptualising their own behaviour in this way. The LA Times recently reported a steep rise in patients seeking therapy for sex addiction, describing the expansion of the industry as ‘exponential’. And while Pine Grove is presumably out of financial bounds for most (a full course of treatment there is estimated to cost $40,000) a wave of treatments has risen up, nullifying the need for ‘official medical recognition’.

This is not just taking place in the USA. With 6% of Brits believed by some practitioners to be sex addicts, it is happening on our shores too.

…….

Worlds apart from the Pine Grove Centre, the likes of ‘wifeworriedaboutme’ and ‘needsomehelp’ are posting on an internet forum. The forum is for those who are concerned about sex addiction, and the general tenor of the posts is encroaching on the desperate. Boasts are few. More common are admissions of self-loathing, confession-box mea culpas; tirades of pain. Many tell tales of having been abused as children. These are hard to read.

Strikingly, not all or even most of the putative sex addicts are addicted to sex per se, with perhaps an equal number addicted to internet porn. Paula Hall, a Sexual and Relationship Psychotherapist, believes that the spike in those seeking therapy can be attributed precisely to the internet. “Internet pornography is the most common addiction,” she says, “because it’s so readily available – it’s like a drug addict being faced with heroin or cocaine in every store.”

Many of the porn-related stories here follow a common trajectory. Mostly, the poster started out with mainstream pornography, before finding that it no longer aroused them, at which point they gravitated towards the ever-more extreme. Against their better intentions, the quest for more hardcore material started to absorb hours of their time, culling their capacity for real-life sexual intimacy in the process. This creates the surprisingly frequent paradox of a pornography addict who is scared of actual sex.

“All of my addiction behaviors,” writes one poster, “have been isolating behaviors, such as compulsive masturbation, porn, and extreme versions of voyeurism. My experience of sexuality throughout my entire life has been a solo experience, resulting in a very warped mindset and understanding of sex.”

Other posters do indeed go down the classical path of being a chronic cheater. Still others find themselves compelled to use prostitutes, or have cyber or ‘text’ sex, or indulge in various fetishes. What is common to all, however, is a sense of abiding shame and loss of control; of wishing to stop the incriminating behaviours but finding that they can’t.

As Paula Hall defines it, “sex addicts suffer actual or potential negative consequences, and a loss of self-respect, which is what distinguishes them from somebody who simply has a high sex drive.” She is not sure that ‘womanising’ celebrities necessarily merit the term.

Hall, who has a private practice in Leamington Spa, has worked with couples and individuals with sexual problems for nearly fifteen years. She uses a combination of psychodynamic and cognitive behavioural techniques to help sex addicts let go of their behaviours, and ultimately avoid relapse. Her own success rate is very high.

While Hall has no qualms whatsoever in using the term ‘addict’, other experts are more reticent. The Diagnostic and Statistical Manual of Mental Disorders (DSM) currently diagnoses sex addicts with ‘Sexual Disorder Not Otherwise Specified’ (SDNOS), although there is a dedicated team of psychologists working hard to revise this. They describe the category as ‘a diagnostic wastebasket that [we] would like to see diminished in scope’.

The latest edition of the manual is due out in 2013, and it looks likely to include ‘Hypersexuality’. ‘Hypersexuality’ will encompass many of the same behaviours that Hall would class as sex addiction: excessive time consumed by sexual fantasies or behaviours; unsuccessful attempts to control these behaviours; clinically significant personal distress.  But Martin Kafka, who suggested the changes, is wary of grouping hypersexuality with addictions. He claims that more research is necessary to work out whether it is an addiction ‘proper’, or a subset of other conditions like OCD.

Up until very recently, it wasn’t deemed possible to be addicted to a behaviour at all. ‘Addiction’, under the classical definition, refers to a chemical dependency, created when a psychoactive substance impacts on the functioning of the brain. When the substance is ingested, the brain’s reward systems are activated, motivating the user to repeat the process. Over time, the brain’s circuitry is rewired. For the user, taking the substance becomes less about attaining highs, and more about forestalling withdrawal with its devastating lows.

As of 2013, however, the DSM will mention behavioural addictions too. Like substance abuse, claims the justification for this revision, behavioural addictions are “related to poor impulse control and the brain’s system of reward and aggression”. Gambling addiction, however, is the only one that will be included for the time being, with sex addiction relegated to an appendix note.

For Paula Hall, the continued dismissal of sex addiction is “more political than anything else. If it were actually to be accepted as a real condition,” she says, “then the NHS would have to start providing services, and the porn and sex industries would have to be tackled – the sociopolitical implications would be huge. Basically, it would need funding.”

Phillip Hodson disagrees. “It’s a question of words,” he says – “but I think they matter.  I’d prefer to say ‘some people become sexually obsessional’ rather than ‘they turn into sex addicts’.  Yes, similar areas of the brain may light up, and the same range of hormones may be triggered.  But I think if you had two people, one addicted to heroin and the other (allegedly) to sex, you’d find more complex withdrawal problems in the former than the latter.”

According to sceptics like Hodson, the very word ‘addiction’, brings with it a whole load of semantic baggage, including the implication that sufferers have no choice in what they do. By classing some people as sex addicts, and others as mere philanderers, are we doing either category a justice? Are we simply drawing a line in the sand, on one side of which lies moral responsibility; on the other, a medically-sanctioned surrendering of free will?

One of the posts on the sex addiction forum has the title, ‘Trading my inheritance for a bowl of soup’. Alluding to the Biblical story in which a hungry Esau grabs a bowl of soup, and swaps it for his birthright, it is a nice illustration of how short-term impulses can override long-term goals.

Some would say that this dilemma lies at the nub of addiction. Others would say it characterises the contrareity of your average human being. It may be possible that compulsive and addictive behaviours are simply an accentuation of dilemmas that each of us face; rendering it misleading to suggest that, while sex addicts wholly can’t help what they’re doing, the rest of us wholly can.

While the psychiatric community struggles to come to a consensus, one thing is obvious, and that is that the field of sex addiction is becoming increasingly consumer-led. Where there is a demand for treatments, there will be pressure for official recognition, with all the political decisions that might entail.

For the Tiger Woods of this world, however, for whom the diagnosis might seem to be more a canny PR manouevre than cause for sympathy, Phillip Hodson has some choice words of advice. “I think if you want to break the world infidelity record,” he says, you should have the courage of your convictions!”

There’s many an estranged spouse who might agree.

This piece was written as part of my MA in Science Journalism

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