Sex addiction: conceptualization, how to identify it and treatment

Nowadays, sex addiction it is not recognized as such, although it may be considered a behavioral addiction.

In any case, it seems relevant that we dedicate clinical attention to it, since there is a specific, sufficient and growing demand from the population, linked to the abundant consequences and discomfort caused by this pathology.

    What is behavioral addiction?

    Before specifying what sex addiction consists of, it is worth recalling these aspects that characterize a behavioral addiction. First, the loss of control over behavior and, second, addiction.

    It is also important to underline that addictive behaviors, initially, are controlled by positive reinforcers, that is to say that they are carried out for the pleasure that they generate; while as the addiction develops, the behaviors become controlled by negative reinforcers or, what amounts to the same thing, they are carried out in order to reduce the discomfort.

      Characteristics of Sex Addiction

      Oh well, we could define sex addiction as excessive sexual desire (sex-related fantasies, recurrent arousal, urges and sexual activity) related to components of impulsivity and compulsiveness, which lead to a pathological inability to control said desire and which are related to both a deficit of the inhibitory control system and to an overactivity of the dopaminergic receptor system, such as for the search for sensations, pleasure and positive reinforcement.

      When identifying a possible sexual addiction, it is necessary to know if a series of criteria are met. First of all, time spent in sexual activity must interfere with the fulfillment of the person’s obligations and responsibilities.

      Second, sex should be used either as a way to regulate dysphoric moods, such as anxiety, irritability, or depression, or as a a response to stressful life events.

      Likewise, as we said at the beginning, there must be an inability to control or reduce sexual activity.

      Lately, it must be assessed whether the behavior persists despite the fact that it generates social problems, emotional or physical to the individual or the people around him. In this sense, it is common to find that people with this pathology show higher levels of risky behaviors.

        Other keys to detecting sex addiction

        As with drug addiction, in sex addiction the symptoms of tolerance (progressively more intense or frequent sexual activity is necessary to achieve initial satisfaction) and abstinence (after a period of sexual abstinence, symptoms appear which, in this case, become emotional in nature – irritability, anxiety, depression, etc.).

        People addicted to sex usually show an anxious-avoidant attachment, which leads them to live relationships with insecurity and fear of abandonment, as well as understanding that others are not trustworthy, so the person’s reaction is to try not to bond too much with others. Therefore, they tend to seek out sexual activity that does not contain an emotional component.

        On the other hand, at the cognitive-emotional level, it has been observed that they show high cognitive rigidity, poor judgment and emotional regulation deficits.

          How to treat sex addiction?

          Although not all behavioral addictions are the same, nor are the people who suffer from them, there are commonalities regarding motivation for treatment, setting treatment goals, and choosing intervention techniques.

          The treatments most contrasted and supported by empirical research are those of the courts cognitive-behavioralas well as support groups.

          Unlike other types of addictions, such as drug addiction or pathological gambling, in sex addiction it is not possible to consider absolute abstinence as a goal, because, although it is an uncontrolled behavior, it is necessary in everyday life. The main therapeutic objective will therefore be the relearning of behavior control, in order to be able to make rational use of it.

          One could say that the end result of the treatment is a change in the lifestyle of the person, however, for this, another series of specific objectives must be achieved first.

          There must first be a motivation for the treatment, which results from the individual’s awareness of the problem, the establishment of an appropriate therapeutic alliance, and the breakdown of the resistance presented by the patient through the evaluation of the pros and cons of the behavior. In addition, the person must assume the need for outside help.

          Once these first steps have been taken, we can contemplate the person’s readiness for change, and then focus on it. behavioral relearning. For this, a stimulating control is carried out, by means of which the stimuli associated with the uncontrolled behavior in question are avoided (eg restriction of access to the Internet and pornographic pages). At the same time, adequate coping responses must be learned before situations that may trigger consumption.

          Then it is necessary for the individual to start a gradual and controlled exposure to different risky situations and stimuli. This means that the person can, initially under external control and later through their own self-regulation, begin to engage in sexual behaviors. With this, he seeks to obtain by means of a mechanism of habituation that the desire for the behavior is extinguished.

          Finally, it will be necessary to establish a relapse prevention planwhich considers the identification of risky situations, the modification of cognitive distortions, the change of expectations regarding the consequences of problematic behaviors, the control of impulses, the planning of free time and the resolution of specific problems through the application of strategies adequate adaptations.

          Bibliographic references

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          • Reid, RC, Carpenter, BN, Hook, JN, Garos, S., Manning, JC, Gilliland, R.,… Fong, T. (2012). Report of the results of a DSM-5 field trial for hypersexual disorder. The Journal of Sexual Medicine, 9(11), 2868–77.
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