13 N. D. Volkow, “Neurobiologic Advances from the Brain Disease Model of Addiction,” The New England Journal of Medicine 374, no. 4 (2016): 363–371.
14 Ibid.
IS THERE AN “ADDICTION GENE”?
We know genetics likely play a role in the development of alcoholism.15 Although there is speculation that genetics may also play a role in the development of sex addiction, there is as yet no clear scientific evidence to support this. Although genetics may make some people more susceptible to developing addiction, susceptibility does not translate to inevitability.
Furthermore, genetics alone cannot explain addiction. Environmental and social factors also play a role. Even when addiction is kept secret, as is typically the case with sex addiction, people with active addiction tend to be preoccupied, emotionally unavailable to their families, and frequently absent physically in order to pursue their addiction. Addicts are often so self-absorbed they are not able to give their children the care and attention they need. Children may never see evidence of a parent’s addiction but the consequent neglect, lack of emotional and often physical availability, and perhaps the imposition of demanding standards and harsh discipline may set the stage for addiction to develop as those children grow.
My therapist said I should see a psychiatrist. Why would he suggest that?
Being evaluated by a psychiatrist prior to or at the beginning of recovery is generally recommended. This is part of the “due diligence” process to either confirm or rule out other problems that may impact problematic sexual behavior. The presence of certain conditions may help explain a wide variety of behaviors including compulsive sexual behavior. Psychological risk factors include attention deficit hyperactivity disorder, mood disorders like depression and bipolar disorder, obsessive-compulsive disorder, anxiety disorders, and personality disorders.
Attention Deficit Hyperactivity Disorder (ADHD)
My wife is convinced I have ADHD. Could this cause my sex addiction?
ADHD does not cause sex addiction, but ADHD and sex addiction often co-occur. Persons with ADHD have a stimulus-seeking brain. They seek out things that are stimulating or novel. They may have difficulty reading a book if the subject matter is not particularly stimulating or if a plot develops slowly. When a person has ADHD, they may tend to procrastinate and be good at starting projects but not good at finishing them.
Persons with ADHD have multiple, even racing thoughts that can shift their interest from one subject to another in rapid succession. As their thoughts move from subject to subject they may find themselves stuck in the limbo of inaction. One physician described his ADHD by saying, “bright shiny objects distract me.”
So how does ADHD play into sex addiction? Sex is the ultimate stimulation. Fantasizing about sex may occupy hours of a person’s time. Because pornography is so visually stimulating and there is so much of it available online, someone with ADHD can easily view pornography for hours at a time.
Video games provide much the same stimulation. Some sex addicts with ADHD spend hours playing video games before venturing into sexually oriented Internet activities. Before they are aware of it, they may be totally engrossed in a wide variety of sexually oriented Internet activities.
Will taking my medication for ADHD eliminate the need for me to attend twelve-step meetings?
No. Treating all co-occurring disorders is necessary for a person to have the greatest chance of success in recovery.
What part does depression play in sex addiction, and how does sex addiction affect depression?
Substance addiction and depression frequently co-occur. One third of people with major depressive disorder engage in substance abuse.16 In the absence of studies related specifically to sex addiction, we assume the rate of co-occurring depression and sex addiction may well be as high. Our considerable experience working with sex addicts shows this to be true. Additionally, we know that the development and pursuit of sexual acting-out behaviors may predispose a person to developing significant depression. The cycle feeds on itself because sex addicts may seek relief from their depression by acting out sexually, and in the aftermath of compulsive sexual acting out, people often experience depression.
The presence of depression may make it difficult for some and impossible for others to remain sexually sober. (Sexual sobriety is achieved when one is able to live free from all of the problematic sexual behaviors that have brought harm to the addict and/or other people.) It is imperative for sex addicts who recognize symptoms of depression to be evaluated by a psychiatrist. Although any physician can diagnose and treat depression, the advanced diagnostic skills of a psychiatrist are most helpful in treating it. Treating depression will not curb sex addiction but it will make it possible for a person to engage in a successful recovery process.
I have been diagnosed with bipolar disorder. How does this impact my sex addiction?
Bipolar disorder is a mood disorder characterized by periods of elevated moods (mania) and periods of depression. To be diagnosed with Bipolar I a person needs to have at least one manic episode. Bipolar II is diagnosed if there is at least one hypomanic (literally “lesser mania” or “below mania”) and one major depressive episode.
When a person with bipolar disorder has a manic episode, he or she may engage in extravagant shopping or enter into outlandish commercial ventures. He or she may also seek sexual adventures. A sex addict with bipolar disorder may be more inclined to engage in even higher risk sexual behavior during a manic episode than when there is no mania present. Bipolar disorder is a serious mental health disorder and usually requires mood-stabilizing medication prescribed by a psychiatrist.
Raymond’s Story __________________
Raymond is a born risk taker. He thrives on adventure and enjoys the accolades that he gets from telling others about his adventures: flying, diving, racing, hang gliding, rock climbing—whatever will get the adrenaline pumping.
He found that the more risks he took with his sexual acting out, the greater the high he experienced. On several occasions, he arranged for one of his partners to be in the same restaurant while he was having lunch with his wife. He surreptitiously made eye contact with her across the restaurant and even arranged to have her meet him by the restroom where he briefly kissed her.
On another occasion, he invited a neighbor and her husband to have dinner with him and his wife. He had been grooming this woman for months with overly friendly conversations and suggestive comments. During dinner, he removed his shoe and ran his foot up and down her legs. He was thrilled when he saw her blush and then grin.
As far as Raymond was concerned, he felt he could get away with just about