Ava Answers: Sex Addiction

 

*Ava Answers is a column exploring the science of sex by Ava Mainieri, a PhD student studying women’s health at Harvard University.

 

The behaviors associated with a supposed sex addiction are so common that most everyone can check off at least a few on the list: unsafe sex, daily pornography use, one-night stands, cheating, serial dating, etc. While still considered controversial, the majority of the scientific community believes that the term “sex addiction” is a vice disguised as a pathology. Despite numerous studies, there’s still not enough evidence that high rates of sex lead to tolerance or withdrawal—hallmark symptoms of addiction—or that watching hours of porn, compulsive masturbation, or cheating on partners can be classified as a psychiatric disorder.

The last big push to include sex addiction in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the Bible of psychiatric diagnoses, was led by Martin Kafka in 2010. Even though he presented hundreds of case studies and epidemiological data, the psychiatric association rejected his proposal, citing insufficient experimental evidence and a potential misuse of the diagnosis in legal settings.

The scientific community is skeptical that an individual can develop an “addiction” to sex, as the brain responds differently to drug and alcohol abuse than it does to an orgasm—bad news for Harvey Weinstein and Anthony Weiner, who both claim to be addicts. 

Sex addiction, in theory, sounds plausible. Whenever you do something that feels great, like having sex or eating a piece of chocolate cake, your body releases the neurotransmitter dopamine that teaches your brain to crave that behavior. Experiencing pleasure is your brain’s way of encouraging you to repeat that behavior. Eat a burrito when you’re hungry? Pleasure. Hug your grandma when you’re feeling down? Pleasure. Have sex with that attractive barista and increase your chances of reproducing? Pleasure. If it feels good, you are more likely to crave it. Dopamine is one of the most hyped up hormones—linked to everything from exercise to our obsession with social media. However, while dopamine can cause you to pursue an action, it does not create pleasure itself. It may provoke us to keep checking our phones, but dopamine is not responsible for the actual feelings of delight we get when we receive a new like on Instagram. 

Liking something, or experiencing pleasure, actually comes from opiods—hormones our bodies naturally create. Dopamine, on the other hand, makes us want something. Though wanting and liking something are two neurobiologically separate functions, they are often firmly linked together. We like the things we want and we want the things we like. But because they are different brain circuits, they can be controlled independently. Scientist Kent Berridge discovered that in addiction, wanting and liking can become uncoupled, so that you feel an extreme wanting without a reciprocal increase in pleasure. A study found that dopamine actually peaks in the brain just before, not during or after addicts were given cocaine.

Drugs like heroin and meth release abnormally higher levels of dopamine than natural rewards, like sugar or sex. Over time, your body deals with this influx by reducing how much dopamine is released and its effect in the brain. These changes lower your brain’s response to the drug, which is how tolerance is built. This means that the ability to feel pleasure from any activity is lowered, which leaves you feeling lonely, sad, and as a result, seeking the drugs that flood your brain with dopamine.

Sex does not fit into this model of addiction. Compulsive sexual behaviors may be fostered by a dysfunction of dopamine, serotonin, and a multitude of other neural circuit processes, but it’s a different physiology with drug addiction. 

From the perspective of the brain, orgasming creates a high that can temporarily provide relief from depression or anxiety. Researchers at the Kinsey Institute demonstrated in 2004 that people who self-identified as sex addicts had an increase in sexual behaviors when they were feeling depressed. The drive to get off is a fundamental aspect of being human and large parts of our brain are responsible for regulating our libido and how and when we want it. However, orgasming is not akin to a foreign substance being introduced to your body, but rather a natural process deeply rooted in our biological makeup.

Just because sexual pleasure involves dopamine and reward, does not mean it creates an addiction. There are thousands of behaviors that involve dopamine—from watching TV to petting a dog. If we start calling  the compulsion to engage in these kind of activities an addiction, then the word begins to lose its meaning. The label of a sex addiction is unfortunately a scientifically inaccurate way to describe a more complicated scenario. Depression, anxiety, borderline personality disorder, or obsessive-compulsive disorder may be the principal illnesses which foster hyperactive sexual behaviors. For others, problematic sexual behaviors develop as a way to deal with trauma, like sexual abuse or violence. This may manifest itself as a heightened absorption with getting your rocks off that disrupts daily life.

Some people may just be ashamed of their fetishes. In a large study comprised of 6,000 men examining their sexual behavior, the 170 men who believed they were sex addicts were actually getting laid and masturbating as often as the rest of the subjects. Another study looked at thousands of porn watchers over a two year period, and concluded that the reasoning behind those who identified as porn addicts was based more in whether they had “moral scruples around pornography,” than in how much porn said individuals actually watched. 

As I have said before, there is no “normal’” human behavior—your goal should be becoming comfortable with who you are sexually. The controversy surrounding sex addiction comes down to an issue of classification. From a scientific standpoint, mislabeling compulsive sexual behavior as an addiction is not constructive to finding a cure to the symptoms of these “addicts.” 

 

If you find yourself using sex and porn to escape from your problems, don’t feel ashamed to share what you are going through with a professional. Helplines are a free and non-judgmental way to offer support and resources. Sex Addicts Anonymous (1-800-477-8191) is open to people of any gender and sexual identity and SAMHSA’S National Helpline (1-800-662-HELP) can provide referrals to local treatment facilities.