Sexual Addiction May Be Real After All

By Tara Berman, MD

The debate over whether sex addiction actually exists may be put to bed by a new study that peers into the brains of those with compulsive sexual behaviors.

Researchers at the University of Cambridge used functional magnetic resonance imaging (fMRI) brain scans to compare the brain activity of 19 people with compulsive sexual behaviors to that of the same number of healthy subjects while both groups watched pornography.

What they found was that the brains of those with the compulsive sexual behaviors "lit up" in a different way from those without such compulsions. Interestingly, the patterns of brain activation in these people mirrored those seen in the brains of drug addicts when they were exposed to drugs. Moreover, the three particular regions that lit up more in sex addicts' brains - the ventral striatum, dorsal anterior cingulate and amygdala - are regions known to be involved in reward, motivation and craving.

The findings may lend weight to the concept of sex addiction as a legitimate disorder.

"There is no question [these people] are suffering," said lead study author Dr. Valerie Voon. "Their behavior is having a negative impact on multiple levels of function, especially social function, and… they are unable to control their behaviors."

According to Voon, as many as one in 25 adults may be affected by compulsive sexual behavior - an uncontrollable obsession with sexual thoughts, feelings or actions. Those who experience it often deal with feelings of shame and guilt, and treatment options are limited.

Currently there is no formally accepted definition of this condition. It had not yet been acknowledged in the DSM-5 - often referred to as the "bible" of psychiatric conditions. Until compulsive sexual behavior is recognized in this way, it will be hard for those with this condition to get the help and treatment that a growing number of psychological experts say they need.

"I think [ours is] a study that can help people understand that this is a real pathology, this is a real disorder, so people will not dismiss compulsive sexual behavior as something moralistic," Voon said. "This is not different from how pathologic gambling and substance addiction were viewed several years ago.

"People are experiencing a disorder they need help for and resources should be put towards funding this and treating this."

Psychological experts not involved with the research said the study may prove to be an important step in sexual addiction receiving the same degree as legitimacy as other behavioral addictions, such as compulsive gambling.

Dr. Richard Krueger, associate clinical professor of psychiatry at Columbia University, said he believes the research will be a "seminal study" in the field.

"It's one, but one very substantial, bit of evidence," said Krueger, who from 2008 to 2013 served on the physician committee involved in proposing hypersexual disorder be added to the DSM-5. "[The study] supports the notion that this is a disease, in my view, and will influence experts and have some significant impact now through expression in the media."

However, Dr. Reef Karim, an associate clinical professor and psychiatrist at UCLA, said the results should be interpreted with caution. Specifically, he said, the results would have to be shown in a larger, more diverse group of people in order to be verified.

"Aside from increasing the demographics from heterosexual men to women and those with different sexual orientations, you have to rule out other mental health issues that may cause people to act out sexually," said Karim, who is also director of the Control Center in Beverly Hills, a Mental Health Center that treats sex addiction, among other addiction disorders. He added that there are sometimes other conditions - such as bipolar disorder, ADHD and OCD - that drive patients to act out sexually.

Doctor's Take

While this may be an important study that peers into the minds of those with sexual compulsions, more research will be needed to further define sexual addition - as well as how it can be treated.

It is clear, however, that there are many people whose lives are negatively affected by these obsessions and compulsions. And despite how we label it, these people need help.

"The bottom line is that this is increasingly identified as source of distress in people and needs further characterization to develop better treatment for it," Krueger said.