In 2011, then Congressman Anthony Weiner tweeted out a sexually explicit photo to a female follower. This lapse cost him his seat in Congress. When Weiner repeated this behavior in 2013, it cost him the chance to become mayor of New York City. Last month, a third transgression cost him his marriage. Trying to understand why someone would destroy his career and marriage for a cheap thrill is no small task. Most of us can’t fathom his motives. Is he an idiot? A masochist? A pervert? Certainly if he could control it, he would, right? He must have something so strongly pushing him to do this that, despite his best efforts, he can’t resist, right? So he must be a sex addict, right? Wrong.
Despite popular headlines and self-promoting TV doctors’ proclamations to the contrary, sex addiction isn’t real. Let me be clear from the outset, I’m not saying that people cannot and do not destroy their lives based on impulsive and risky sexual behavior. There is no doubt that some people have trouble regulating their sexual thoughts, desires, and behaviors. But addiction has a real meaning and a real clinical definition. In recent years, that definition has been aided by our ability to view the brain of addicts. When addicts, including those addicted to drugs, alcohol, smoking, and gambling, are shown pictures of their drug of choice there is a clear and uniform response in their P300 brain waves, which are usually activated when we see something of particular interest or desire, as well as increased late positive potential (LPP) response, which measures the intensity of the brain’s response to a specific thing at a given moment.
However, when UCLA researchers studied the response to viewing sexually explicit images in people who self-defined as being unable to regulate their porn viewing, the results showed no similar response in either brain measure (Steele, Staley, Fong, & Prause, 2013; Prause, Steele, Sabatinelli, & Hajcak, 2015). In fact, they found the only thing correlated with brain wave activity was sexual desire such that the higher their self-reported sexual desire, the more brain wave activity they showed. The authors concluded that there was no evidence to say that even problem sexual regulation fit the definition of addiction as defined by brain response and that these people simply had high sex drives.
In addition, one of the studies’ authors, Nicole Prause, said at the 2016 meeting of the Society of Personality and Social Psychology, that sex addiction misses another major hallmark of addiction, namely response to the addictive object over time. Specifically, people who develop addictions initially show high levels of response in the pleasure centers of the brain. Over time, as addiction takes hold, these parts of the brain no longer light up. In other words, one of the hallmarks of true addiction is that the pleasure received from the object of the addiction wanes over time as the person no longer wants the object but, rather, needs the object. In contrast, even people who report very strong “addiction” to sex continue to show activation of the pleasure centers of the brain when viewing sexually explicit images. This response is similar to the response people have to chocolate, ice cream and other highly desired pleasures. Prause concluded that “sex addiction” was no more than high libido coupled with low impulse control.
Given this growing body of research, the American Psychiatric Association, removed mention of sex addiction from the DSM-V, which is considered the definitive resource on mental disorders, including for insurance companies when considering reimbursements. In addition, they rejected a milder version, labeled hypersexuality, citing lack of empirical evidence to warrant its inclusion.
Yet, by looking at news headlines and TV shows, you would never know it. The highly respected Dr. Drew Pinsky has made a career of addiction. In fact, at one time he had four shows on simultaneously dealing with addiction in various forms. He has been, and remains, a strong pusher of sex addiction as a real addiction. In fact, one might imagine how he would respond to the Anthony Weiner case based on a 2009 interview he gave with Larry King in which he said, “When many of these cases are examined it is often the case that Sex Addiction is a prominent feature. Here once again it is very easy for the public to decry the transgressions as merely the excesses of wealth and power but the fact is that it is often the behavior of someone who is not well.” And in 2012, Dr. Drew argued to Bill Maher that sex addiction was a real addiction.
In addition, despite the DSM-V removal of sex addiction in its volume, many therapists and recovery programs still declare treatments and cures for sex addiction. For example, the Society for the Advancement of Sexual Health which bills itself as “the only non-profit organization dedicated to….helping those who suffer from out of control sexual behavior and sex addiction” has a board made up of therapists dedicated to treating sex addiction, including Todd Love, who states in his bio that he is the co-author of a chapter in a medical textbook on Sex Addiction. And most telling, of the 13 sponsors of their upcoming annual conference, ten are addiction recovery centers. By the looks of it, none of these folks seem to have gotten the message that sex addiction doesn’t exist.
One might argue that this is all simply a matter of semantics. Who cares if we call it sex addiction or high sex drive coupled with low impulse control? The truth is it matters a lot. Words have meaning. And in the realm of science, those meanings are not subjective. But words also lead to certain collective social expectations. When I say two cars bumped into each other you get a very different picture than when I say two cars smashed into each other. The words bumped and smashed are not interchangeable at will. As a society we have strayed far from adhering to the scientific meaning of words and this has resulted in a culture that abdicates personal responsibility by pathologizing what used to fall within the realm of normalcy. For example, in a 2006 American College Health Association Survey, 45% of women and 36% of men reported depression so bad that it was difficult to function. But reporting you have depression isn’t the same thing as being diagnosed with depression. We don’t self-diagnose cancer or diabetes. There are clinical markers for these and we leave the diagnosis to science. Why then do we allow for the subjective diagnosis of mental health?
Think about the ACHA numbers. Depression has a meaning—a true scientific definition—and true depression is very rare. It didn’t used to mean that I had a crummy day or I failed my exam or my boyfriend broke up with me. Clinical depression was a chemical imbalance in the brain—it did not wax and wane depending on whether or not you got invited to a party this weekend. Everyone feels depressed. It is a normal part of life and, as my friend, Dr. Jo Olson says, sometimes life hands you a shit sandwich and it sucks. But I call that little “d” depression. You can be depressed without having Depression. It used to be that when life sucked you had to deal with it and learn coping skills.
This continued pathologizing removes not only the need to handle the normal burdens of life, it abdicates your responsibility for your bad behavior—I failed my test but I can’t help it; I was depressed. I cheated on my wife but I can’t help it; I have a sex addiction. If you feel that you aren’t responsible for your behavior—it’s something that just happens to you because of x, y or z—you won’t own your responsibility to change it. It is time for the pendulum to swing back toward the side of taking responsibility for our actions and owning our choices, good or bad. I plan to start with me, just as soon as I can wean myself off my bipolar-anxiety-ADHD-depression-OCD meds.