Page 1 of 9 Impulse: The Premier Journal for Undergraduate Publications in the Neurosciences Submitted for Publication January, 2018 The Addictive Potential of Sexual Behavior Heather Bool D’Youville College, Buffalo, New York This paper examines the addictive potential of sexual behavior through behavioral and neurophysiological mechanisms analogous to other formalized addictions. Sexual behavior refers to any action or thought preformed with the intention of sexual gratification, such as the consumption of explicit material, masturbation, fantasizing of sexual scenarios, and sexual intercourse. Addiction is defined by the presence of tolerance, preoccupation, withdrawal, dependence, and the continuation of behavior despite risk and/or harm. Sexual addiction demonstrates high relapse potential due to the frequency of reward-associated cues encountered in daily life, and the low effort and risk required for sexual pleasure. Currently, sexual addiction lacks a formal diagnosis despite behavioral, psychological, and physiological evidence. An official diagnosis recognized by a governing authority, such as the American Psychological Association, would offer greater access to treatment, funding for research, and exposure and education for the general public about this disorder. Abbreviations: None Keywords: Sexual Behavior; Addiction; Sexual Addiction; Neurophysiology; Behavioral Neuroscience Introduction “Sexual addiction” is an umbrella term Confusion remains regarding the for sexual impulsivity, sexual compulsivity, out- etiology and nosology of sexual addiction, of-control sexual behavior, hypersexual which has led to the lack of a universally behavior or disorder, sexually excessive accepted criterion and, more importantly, the behavior or disorder, Don Jaunism, satyriasis, absence of a formal diagnosis. A lack of and obsessive-compulsive sexual behavior operationalization of the disorder has severe (Beech et al., 2009; Karila et al., 2014; effects on research; due to the use of Rosenberg et al., 2014). For the purposes of this inconsistent parameters and criteria, results can paper, sexual addiction is defined by the be difficult, if not impossible, to compare. This continuation of a sexual behavior despite risk or results in ambiguous prevalence rates and harm, preoccupation, tolerance, withdrawal, recovery outlooks. Standardization of diagnostic dependence, and relapse even after prolonged criteria and conceptualization of this disorder is abstinence (Goodman, 1993, 2008; Robbins and crucial, as has been done with various other Everitt, 2002; Hyman, 2005; Kafka, 2010; Luo substance use and behavioral disorders et al., 2013), and must not fall solely under the (Association, 2013). criteria of a paraphilia (Stein et al., 2000). A The Diagnostic and Statistical Manual paraphilia is defined as atypical sexual interests of Mental Disorders (DSM-5) recognizes or behaviors that cause distress to the individual, substance use disorders relating to alcohol, though not simply as a result of societal caffeine, cannabis, hallucinogens, inhalants, standings, or that involves another party who opioids, sedatives, hypnotics, anxiolytics, suffers harm or distress as a result of the stimulants (amphetamine-type substances, paraphilic behavior (Association, 2013). cocaine, and other stimulants), tobacco, and other (or unknown) substances, and lists Page 2 of 9 The Addictive Potential of Sexual Behavior Submitted for Publication January, 2018 gambling disorder as the sole behavioral addiction (Association, 2013). Though proposed Prevalence and Comorbidity by Martin Kafka in 2010 for admission into the DSM-5 (Kafka, 2010) as “hypersexual Without universal criteria, determining disorder”, sexual addiction was rejected on the prevalence and comorbidity rates is difficult. grounds of “insufficient peer-reviewed evidence The diagnosis is up to the discretion of the to establish the diagnostic criteria and course clinician or researcher, which results in various descriptions needed to identify these behaviors definitions of the disorder and clinical as mental health disorders” (Association, 2013). representation. Estimates range from 1-6% of This position is also held by American the population, as compared to 1-4% with a Association of Sexuality Educators, Counselors, pathological gambling disorder, and 8.6% with a & Therapists (AASECT) due to a lack of substance abuse disorder (Sussman et al., 2011; empirical evidence to support the disorder’s Villella et al., 2011; Inaba and Cohen, 2014). clarification and inadequate training, treatment, With a population of over 326 million people in and education pedagogies relating to sexual the United States, a 6% prevalence rate equates addiction (American Association of Sexuality, to almost 19.7 million sexual addicts. 2016). Furthermore, comorbidity rates are estimated to The lack of empirical research regarding be almost 40% for substance use disorders sexual addiction is most likely due to negligence (Sussman et al., 2011) and is correlated with of its underlying neurophysiological and other psychiatric disorders such as anxiety and behavioral mechanisms. Patrick Carnes is one of mood disorders, personality disorders, impulse the first to introduce the concept of sexual control disorders, and schizophrenia (Goodman, addiction (Carnes, 1994, 2001) but as a 1993; Schneider and Schneider, 1996; Black et practitioner, most of his research is toward al., 1997; Kafka and Hennen, 1999; Raymond et classification and the clinical manifestation of al., 2003; Grant and Steinberg, 2005; the disorder. His prime audience, as with fellow Berberovic, 2013). author Gary Wilson (Wilson, 2014), is the general public, not academia. This is not to discredit their work, but instead to illustrate the Sexual Behavior and Natural need for further empirical research regarding Reward this disorder. The purpose of this paper is to explore For the purpose of this paper, sexual the addictive potential of sexual behavior behavior refers to any action or thought through comparison of neurophysiological and preformed with the intention of sexual behavioral mechanisms to other recognized gratification. This includes, but is not limited to: addictions. For the purpose of this paper, sexual consumption of explicit material, paying for sex, addiction will be defined by the continuation of autoerotic stimulation (masturbation), visiting the behavior despite risk or harm, locations where sexual services are offered, preoccupation, tolerance, withdrawal, soliciting prostitutes, engaging in sexually dependence, and high relapse potential. In doing driven activities, sexual intercourse, and so, this paper aims to support the argument that fantasizing of sexual scenarios. Problematic use sexual addiction should be considered for formal is defined as any instance of engaging in sexual diagnosis, which would aid in establishing a behavior when there are immediate or delayed universal criterion that would result in more negative consequences to oneself and/or others consistent and reliable research as well as (Goodman, 1993). provide greater access to treatment, prevention, As with all drugs of abuse, sexual and provide exposure and education about this reward and behavior is processed through the disorder to the general public (Association, mesocorticolimbic dopamine system, circuitry 2013). that is widely associated with reward (Komisaruk et al., 2004; Robbins et al., 2008; Olsen, 2011). Key structures include the Page 3 of 9 Impulse: The Premier Journal for Undergraduate Publications in the Neurosciences Submitted for Publication January, 2018 amygdala, nucleus accumbens (NAc), prefrontal A definitive characteristic of substance use cortex, anterior cingulate cortex, and disorders and sexual addiction is the orbitofrontal cortex which, in conjunction with continuation of sexual behavior despite a one another, have been shown to modulate persistent or recurrent social, financial, motivated behavior and executive function, psychological, or physical problem caused or regulate emotion, process reward, and assign exacerbated by the behavior (Schneider, 1991; reward salience (Chao and Nestler, 2004; Goodman, 1993; Association, 2013). Examples Hyman, 2005; Olsen, 2011). of this may be the loss of a job due to Dopamine is a monoamine inappropriate sexual advances or displays, neurotransmitter known to be released from preoccupation with sexual behavior, or absences neurons during rewarding experiences, including caused by engaging in sexual behavior. the hedonic properties of sexual behavior, drug Additionally, sexual addiction has significant use, and other natural rewards (Hyman, 2005; adverse effects on relationships (Schneider, Olsen, 2011). Dopamine has been found to play 1991; Carnes, 1994; Schneider and Schneider, a role in sexual motivation, copulatory 1996; Schneider et al., 1998; Carnes, 2001; proficiency, motor activity, genital reflexes, and Wilson, 2014). Pornography consumption is copulatory patterns in male rates(rats) (Hull et linked with lower perceptions of attractiveness, al., 2004). Furthermore, dopamine has been warmth, and intelligence in partners, as well as found to modulate synaptic activity in the lower ejaculation, orgasm, and satisfaction rates prefrontal cortex (Otani et al., 1998; Gurden et with their partner or spouse (Wilson, 2014). al., 1999; Gurden et al., 2000; Huang et al., Many experience delayed ejaculation or 2004), amygdala (Bissière et al., 2003), and premature ejaculation rates after periods of hippocampus