Sexual Addiction (1) Definition of the Disorder:

The addict is in an illusion where they believe that they have absolute control based on the claim that as a person they are fine, but they are powerless against the addiction. So the definition of addiction could be that an addiction is something against which the human will is totally powerless. (Schaef, 1989) The simplest definition is that proposed by Patrick Carnes who is the pioneer in the analysis of addiction. According to him, there must be two conditions met- one being that there must be a pathological relationship with a mood altering substance or behavior. The criteria are that the relationship must be pathological and sick. And in the addiction it must be used as a mood altering behavior. These two activities that go hand in hand and the compulsion to perform the act on account of the pathological condition is the fundamental identification of the disease. (Ferree; Laaser, 2010)

The definition is true both for alcoholism and sexual addiction and hence the system of diagnosis can be the same for both. Males appear to be more addicted than women although latest researches show that a number of women appear to suffer from the disease. (Ferree; Laaser, 2010) The society is becoming more liberal and sexual activities are being considered as a personal choice. The difference between the normal person and the sex addict is that in the case of the addict they have no choice. They have no control over their thinking or behavior and they are controlled entirely by their addiction. It is a compulsion that causes harm to many -- broken families, molestations and many crimes. The individual addict is also affected because at the conscious level they judge their activities in terms of the society and are haunted by the feelings of inadequacy, and thus live in pain and alienation. Being convinced that they are not normal they eschew society and live in deep pain. (Carnes, 2001) It is an addiction that is spreading rapidly.

(2) Prevalence Rates:

In a study by Patrick Carnes in 1991 using 700 adults and questionnaires it was revealed that of the interviewed people 64% of the subjects were in a pathological condition that bordered on addiction and many reported having sex without protection and 38% men and 40% women contacted diseases. Sexual activities were pursued to the point of exhaustion by 59% and many had also committed crimes. Juveniles and young people seem to have used birth control pills and condoms in indulging in sex and of these 40% were unplanned sexual encounters. Many seem to have had multiple partners and all seemed to be ignorant or uncaring of communicable diseases. (Essau, 2008) Thus the situation is slowly reaching epidemic proportions and therefore the addiction is to be considered seriously and its symptoms discussed and diagnosed early.

(3) Symptoms:

The symptoms are more psychological and deviant behavior beginning with low self-esteem and depression. The sex addict and the alcoholic have many things in common and this trauma is also same. The alcoholic also is isolated and lonely because the alcoholic also feels adequate with the drink on which she or he depends for establishing a primary relation with the social setup. In the sexual addict the addiction is similar to the alcohol addict. There is a substitution of a sick and often unethical relationship that the addicts create and this alters their mood and it becomes central to their existence. They tend to move away from reality and spontaneity and move into a darker world where illusions are substituted for real relationships. (Carnes, 2001)

Sexual addiction progress by four identifiable stages- The first is the preoccupation stage where the patient begins to be all engrossed with sex and then the mental stimulation makes the person seek an appropriate outlet. The second stage is where the addict ritualizes some behavior and creates a pattern for sexual gratification which then becomes insensitive and becomes a major behavior and at this stage the addict loses control over his or her behavior. This leads to compulsion and compulsive behavior and the sex act becomes the ultimate end of the addicts' preoccupation and there is no control at all. This finally leads to desperation and the addict knowing and realizing the vice like grip of the addiction feel hopeless and become despondent. They then tend to look at every other human being and situations in terms of sexual gratification. (Carnes, 2001) There is thus no single symptom that can be used for treatment. For diagnosis thus a number of problems...

There have also been criticisms. Treating sexual problems as addictions have found critics who say that the term sex addict simply means that the person feels that sexual activity is more important than any other activity in life. There are thus 14 million sex addicts in the U.S. By this definition. Thus if people whose sexual activities have become 'unstoppable' have to be called sex addicts, then it is argued most adolescents are sex addicts because they have unstoppable sexual fantasies. Likewise the persons who have excessive indulgence in sex but are not otherwise impaired in their social behavior or jobs would have to be brought into this group. That is patently wrong. (Berecz, 1999)
Sexual behaviors are a result of moral choice. Thus the basis of the deviation could be a lack of character or moral values. Alcoholism is a disease and therefore medical science views it with concern and the community is bent upon helping the alcoholics and their families cope. However the sex addict has a lot in common with the alcoholics and while sexual mores are still in the morality basis, it can be proved that sex addiction is always related to the family and environment. For example, sexual promiscuity can be traced back to the relatives of the sufferers and it is found to run in families. (Carnes, 1989)

While this is an argument that shows that the background of the individual addict must be the basis for diagnosis, there is also the theory that some individuals are prone to getting addicted to pleasures more than the normal person and the pain and pleasure principle operates in the case. Yet another set of scientists have classified addition into three stages, one the arousal addictions, where there is risk involved like gambling, sex and so on, the second where there is a compulsive disorder -- like over eating caused by either drugs, depression or alcohol and the third is fantasy addictions caused by drugs and other stimulants that create fantasies and stimulation. (Carnes, 1989)

These addictions can be found in isolation as well as in a system as a single entity. Both heterosexual and homosexual behavior can become addictive and can meet the criteria for addiction. (Goodman, 1998) There must be a model that can take into consideration the wide range of sexual behavior and deviant behavior and both being normal and also found in the case of addicts the excessive indulgence must be marked. There must once the excessive behavior is identified, be a method of finding if the individual has lost all control. Once this is established the culture from which the patient comes must be studied and the social habits and customs of the community must be studied in detail before coming to a conclusion about the addiction and if it is pathological. (Carnes, 1989)

Lastly the systems that the addict has created inside must be studied and the external support systems that he or she depends must also be studied and a composite model of the situation arrived at. Only after these steps yield verifiable results can the pathological condition be determined. (Carnes, 1989) The pathology and etiology then determine the treatment.

(5) Treatment:

The existence of co-morbidity especially psychic co morbidity like depression and addiction symptoms as in the case of alcoholics has to be looked for. Treatment suggested would be a very careful use of serotonin reuptake inhibitors which in theory would cause scrotogenic dysfunction and in laboratory mice the presence of testrotone showed remarkable sexual activity. So this is expected to reduce the libido for males and females. Four weeks of this treatment in controlled conditions for males increases the time of orgasm and consequently the treatment serotonin may help control the impulses of the addict. Another medicine is Naltrexone that is used for treating alcoholism and it reduces the euphoria that is felt and disburses tension felt in the sexual addicts much as in the alcohol addicts (Ries; Miller; Fiellin; Saitz, 2009) Some exhibited symptoms will largely increase the effective interventions and the prognosis of the disease at the beginning is a help.

(6) Prognosis:

A poor self-image can be the beginning of diagnosis. The sex addict has a very poor self-image. (Laaser, 2009) Those with poor self-image are thus likely to turn to some form of addiction. The forms of diagnosis or symptoms in prognosis can include unusual behavior…