Does sex addiction really exist? A new study published in last week’s journal of Socioaffective Neuroscience and Psychology suggests that maybe it doesn’t—bad news for celebrities like Tiger Woods and Russell Brand who have made it trendy in recent years to claim a clinical addiction to sex as an explanation for sexual misbehavior.
The study (which, amazingly, is the first of its kind) measured how the brains of people who struggle with sexually compulsive behavior respond to sexual images. If sex can be addictive in the clinical sense, scientists theorized, then the neural response of sex addicts to pornography should mimic the neural responses of drug or alcohol addicts to their drugs of choice. Instead, researchers found that hypersexual brains don’t react in the same way as other addicts’ brains—in fact, the neural responses to pornography only varied based on levels of sexual libido, rather than on measures of sexual compulsivity. People with higher libidos had more active brain reactions to the sexual images than people with lower libidos, but that was the only correlation. Degrees of sexual compulsivity did not predict brain response at all. If the results of this first study can be replicated, it would represent a major challenge to the notion that sex and pornography can be literally addictive.
“This is controversial territory because it represents a substantial shift in the way we view mental illness,” Dr. Nicole Prause, an assistant research scientist in the department of psychiatry at UCLA and one of the investigators involved with the study, told me. “Most people describe high-frequency sexual problems as an ‘addiction’—that’s how the public and even many clinicians talk about it. But this data challenges the addiction model and forces us to reconsider how we think and talk about these problems.”
For the study, researchers recruited 52 people (39 men and 13 women) who reported having difficulties controlling their use of pornography and used electroencephalography (EEG) to measure their brain responses to various images. Some images were sexual in nature, such as kissing, nudity, and penetrative sex, while others were designed to be neutral or even unpleasant, such as pictures of skiers and dismembered bodies. Researchers analyzed brain response to the pictures in the first 300 milliseconds after the images appeared, commonly called a “P300.” Hundreds of neuroscience studies have relied on P300 measurements to analyze the brain’s response to various stimuli; for example, Prause said, several studies of substance addicts found increased P300 responses to images of their drugs of choice as compared to neutral images.
“We expected the brain response to sexual stimuli to be consistent with other drugs of addiction, or even other behavioral addiction studies,” said Prause. “But we just don’t see that at all. We weren’t able to find evidence for any relationship between the measures of high-frequency sexual problems and the brain response to sexual images.”
In a 2010 Psychology Today blog post, Dr. Michael Bader provocatively argued that “the addiction made me do it” is merely an excuse for people who want to avoid the difficult psychological thought and introspection required to address the real issues behind sexually compulsive behavior. Now this study has reignited the ongoing debate about whether sex and other so-called behavioral addictions—also known as process addictions, such as shopping and tanning—should be considered pathological alongside substance addictions such as nicotine, alcohol, and drugs. The third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, released in 1987, included the term “sex addiction” under the category “Sexual Disorder—Not Otherwise Specified,” but that term was removed in subsequent editions. Hypersexual disorder was considered for inclusion in the recently released DSM-5 but was removed by the final draft.
So here’s where we stand: Despite the familiarity of sex addiction in pop culture, hypersexual disorder is not an officially categorized diagnosis—and studies like this suggest that won’t change anytime soon. Nevertheless, mental health professionals around the world have reported patients who come to them seeking help with sexually compulsive behavior. So a problem does exist, and people who want treatment and support deserve access to it. But the debate about sex addiction underlines important questions about how psychiatrists should categorize the difference between a clinical mental illness that can be demonstrated in a lab, such as substance addiction, and other forms of mental distress, which deserve equal care and compassion but don’t necessarily indicate a medical mental illness. If we turn every single quirk of human sexuality into a “disease,” after all, then we’re all screwed.
“We don't have a lot of information about what constitutes normative sexual behavior, so how can we conclusively determine what is deviant?” said Dr. Rory Reid, a neuropsychologist at UCLA and the principal investigator for the DSM-5 field trial on hypersexual disorder. “I don’t think there is enough evidence to conclude that patterns of hypersexual behavior constitute a bona fide disorder in the scientific realm, but we also don’t have enough evidence to dismiss that possibility. It certainly warrants further research and discussion.”
Dr. Eli Coleman, who directs the program in human sexuality at the University of Minnesota Medical School, argues that any study that looks at compulsive sexual behavior from a traditional addiction model may be missing the mark.
“One of the big problems with the term ‘sex addiction’ is that it immediately assumes that you can apply the same kinds of research methodologies and treatments that you would use for substance addiction,” said Coleman. “There are no sex receptors in the brain to develop tolerance and dependence, as there are with alcohol and drug addiction.” Hypersexuals don’t experience seizures or other physical symptoms of withdrawal when they abstain, for example, like alcohol and drug addicts do. Coleman suggests that for many people, hypersexual behavior seems to be a problem of impulse control or compulsive drive rather than a neural addiction. But, he added, even that explanation is probably too simplistic: Some people use sexual behavior to modulate mood states, and in others hypersexuality looks almost like attention deficit disorder. “It’s really very complex,” said Coleman. “And there has not been enough research to fully examine all of the underlying mechanisms.”
Previous investigations into sex addiction have only measured the brains of sexual compulsives at rest (that is, without exposure to sexual imagery) or relied entirely on self-reported questionnaires, which are likely to be influenced by social ideas about what constitutes “normal” degrees of sexual behavior or desire. This new study is the first time that scientists have measured the active responses of hypersexual brains to sexual stimuli, which seems closer to the mark if scientists want to prove or dispel the clinical case for sex addiction.
“The field is very strange, because experimental work is very rare in this area. Many people report feeling out of control sexually, but when we actually look for evidence of that in a lab, we can’t find it,” said Prause. “That’s why I’m aghast that we’re not doing more research in this area. Questionnaires are valuable, but we need to do more work to determine if what people are reporting is actually true.”
Prause points out why there haven’t been funds directed toward scientific research that might challenge the existence of sex addiction: If something is a disease, there is money to be made from treating it. (One Christian organization, for example, charges $1,275 for a three-day seminar called “Every Man’s Battle” that claims to treat men who “find themselves pulled into the use of pornography” or who “seek out sexual gratification through compulsive masturbation.”)
But Prause also emphasizes that despite the results of last week’s study, it is too early to declare the theory of sex addiction debunked. “We have not put the nail in the coffin on sex addiction,” she told me. “Because this is the first time we’ve tried to monitor brain response in this population, there may be things we missed. But I’d say this is a strong challenge to the addiction model.” So all those athletes and actors might have impulse control disorders. They might have high libidos. They might just have really good publicists. But according to this study, at least, they might not have a neural addiction to sex.