Attributes found in a group of sexually addicted people undergoing treatment included (Reid and Carpenter, 2009, p. 300): ‘depression, anxiety, difficulty with social norms, and difficulty managing thoughts, lowered inhibitions, behavioural control, and social alienation’. A significant percentage were plagued with doubts over self-worth. Ryan (1996, p. 330) described his craving as being most strong when:
I just couldn’t stand being in my own skin.
and explained this in terms of (p. 353):
a lifetime of desperate attempts to feel worthwhile – driving myself mercilessly, clamouring for approval and impossible sexual validation.
However, over a third of the sample studied by Reid and Carpenter exhibited no psychological problems, apart from the addiction itself. They appeared to be moved simply by the intrinsic sexual reward.
Finally, can an incentive view have anything to do with the observation that a rather high percentage of sexually addicted people were themselves victims of childhood sexual abuse? This raises the prospect that repeated traumatic flashbacks might somehow get converted into sexual incentives. Turner (2008) suggests how addiction could emerge out of childhood neglect or abuse. Children discover coping strategies such as masturbation or over-eating. She writes: ‘Whatever “escape” gives the greatest “rush” away from psychic pain and promotes survival will be used again and again until it takes a life of its own.’
Later sexual promiscuity provides a way of earning a feeling of power and worth.
Often states of high anxiety, depression, shame and guilt form part of a withdrawal syndrome that follows each sexual outlet (Schneider, 2000). The only way to gain even temporary relief is to engage in the addictive activity. For others, the state to be escaped is best described as ‘boredom’ and they get locked into an endless cycle in which behaviour is reinforced by removal of boredom (Chaney and Chang, 2005).
Stress
At one stage, Walter (see Chapter 1) was seriously troubled by financial worries and felt himself to be in complete mental breakdown. He observed the role of sex workers in alleviating distress and also the substitutability of different activities (Kronhausen and Kronhausen, 1967, p. 176):
They came to my rescue and gave me forgetfulness, a relief far better than gambling or drinking, the only other alternatives I could have recourse to.
A man reported the following experience, which illustrates both the role of stress and escalation:
My live-in girlfriend and I were going through a rough time in our relationship. She left town for a few days and I decided to look at porn on the Internet to satisfy me. Up ’til then I’d never been interested in porn. I began on a Friday afternoon looking at the free peeks. By Saturday I was into the sex chats, and by Sunday I had joined a swinger site.
(Maltz and Maltz, 2010, p. 11)
Stress often instigates or exacerbates addictions or causes relapse. Several processes would be expected to be implicated in this effect.
Stress is a negative emotion and engaging in an addictive activity can lower the level of such emotion. Therefore, a learning process is involved in which the addicted person forms an association between their activity and a lowering of negative emotion.
Extrapolating from drug addiction, stress engages conscious cognitive processing resources (Tiffany, 1990). These resources are needed in resisting temptation and their occupation by the content of the stress means that behavioural control shifts in favour of more automatic routines.
Stress triggers the release of so-called stress hormones, which sensitize the dopaminergic incentive system (Pitchers et al., 2010).
Often sexual addiction arises at times of particular stress (Schneider and Weiss, 2001) – stress is known to exacerbate chemical addictions too. Time allocation and the opportunity for capture of behaviour are crucial elements. As Carnes (2001, p. 24) observes:
Graduate school, for example, is often when addicts first encounter compulsiveness. The stress of proving one’s self in an arena where every inadequacy is evaluated is a potent flash-point for the ignition of sexual addiction. So are new jobs, promotions, and solo business ventures. Unstructured time, a heavy responsibility for self-direction, and high demands for excellence seem to be the common elements in these situations that are easy triggers for addictive behaviours.
When placed in a situation of stress, people take corrective action so as to try to reduce the stress. Sometimes they stumble upon their particular effective action by accident. One way is through taking a chemical cure in the form of drugs such as alcohol. Others discover that sexual stimulation, as in Internet pornography, is a way of lowering stress levels or soothing negative emotions of some form (Turner, 2008).
Soldiers returning from war, as in Iraq and Vietnam, often experience high levels of stress, including flashbacks to horrific experiences. Occasionally they arrive at pornography as a form of self-medication (Howard, 2007). Alas, such behaviour can then take over the person’s life in the sense that other activities are squeezed out; priorities change and a large part of the waking hours are occupied with thoughts of the activity. Addiction to consensual sexual activity among Vietnam War veterans has been frequently observed (Trachtenberg, 1989). Howard (2007) describes a veteran of the Iraq war (p. 84):
It didn’t take Jim long to make the mental association that while viewing pornography online, he didn’t think about war or combat. In fact, it was as if the war never existed.
Jim spent increasing amounts of time online, six to eight hours per day, and his family relationships deteriorated in parallel. Pornography served as a soothing balm to cope with the family disruption as well as the traumatic memories. Therapeutic intervention that only addressed the addiction might well prove inadequate. The underlying triggers needed to be addressed.
Link with drugs
Recreational drugs
The literature contains a number of accounts of the link between recreational drugs and sexual desire, as in:
I stepped up my usage of drugs and alcohol to keep myself from cheating on my wife and found instead that I could cheat when I was too high to speak coherently.
(Trachtenberg, 1989, p. 266)
The persistence of symptoms is also evidenced by the number of Casanovas who are multiply addicted, who not only womanize but gamble, drink or take drugs and who sometimes attain momentary relief from one disorder only to plunge headlong into another.
(Trachtenberg, 1989, p. 267)
Once I started to feel a bit more confident, and realised there was now a great gaping hole in my life that wasn’t filled by drugs and booze any more, my tendency to pursue women – which had always been quite rapacious – somehow became enhanced further.
(Brand, 2007, p. 379)
Often addictions co-exist (Orford, 2001; Washton, 1989). For example, the sexually addicted individual not uncommonly has simultaneously an addiction to alcohol or illicit drugs. This suggests that there is a ‘common incentive process’ that gets captured and exploited by more than one addiction, with cross-sensitization between them. Given the known effects of addictive drugs in sensitizing dopamine systems (Robinson and Berridge, 1993), it is not surprising that drug-taking can sensitize sexual addiction. As noted earlier, if we can extrapolate from rats, sexual activity can sensitize drug-seeking (Pitchers et al., 2010). It appears that the chances of relapse in sexual addiction are increased by taking certain drugs, including alcohol (Maltz and Maltz, 2010). As an additional factor, drugs, for example alcohol, can impair inhibitory processes. Sex and cocaine are sometimes exploited only in combination and specifically use of prostitution and gambling are not uncommonly found together.
Many people taking cocaine or methamphetamine discover that it increases their sexual desire, fantasies and stamina, while lifting inhibitions (Washton and Zweben, 2009). Such hypersexuality is found particularly in male drug-users. The combination of drug and sex yields a ‘super-high’ brought by interlocking rewards and having an addictive potential that is stronger
than sex or the drug alone. Not surprisingly given the longer-lasting effect of methamphetamine as compared to cocaine, the sexual effects last longer for methamphetamine and are sometimes associated with ‘marathon sexual binges’ of up to seventy-two hours. Sexual experimentation is occasionally initiated in association with these drugs, as in group sex, high-risk unprotected sex, using sex workers, or homosexual behaviour by otherwise exclusively heterosexual individuals.
For some people addicted to cocaine or methamphetamine, sexual stimuli are a particularly potent trigger to drug-craving (Washton and Zweben, 2009). Even sexual fantasies can trigger intense drug-craving. If such a person wants to quit drugs, not only do trigger cues to drugs need to be avoided but so do sexual triggers. This is of course easier said than done, particularly when the triggers can arise in the imagination. However, triggers that might be successfully avoided could include erotic Internet sites, pornographic books, and advertisements for escort services.
Concerning relapse to drug-use, a cocaine-addicted patient of Washton and Zweben, (2009 p. 137), who was trying to quit, recorded:
At first I didn’t throw out every bit of my paraphernalia. I kept a little memento – a collector’s item – just to remind me of my foolishness, so I thought. When I finally admitted this to my therapist, she said I was playing with fire – trying to keep my relationship with cocaine alive and keep the door open for an easy return to the drugs and sex scene. I guess she was right. I went back and threw out the little rubber fixture from my freebase pipe, a porno DVD that would set off my sexual compulsion, and the phone numbers of escorts and drug dealers. I felt greatly relieved after getting rid of one more set of temptations.
A problem amongst some people with a combined sex–drug addiction is that the prospect of drug-free sex (‘ordinary sex’), for example with a regular partner, seems boring by comparison with drug-fuelled sex (Washton and Zweben, 2009), again pointing to the role of expectations and desired levels of hedonism.
Not all users of cocaine or methamphetamine find their drug use gets locked into interaction with sexual desire. For some, the desire is for the drug alone and hence sexual desire might get downgraded. Presumably, the chances of the drug setting up a combined desire with sex would depend upon, amongst other things, the level of sexual desire and engagement prior to drug-taking as well as the frequency of holding erotic thoughts in the conscious mind while under the influence of the drug. Indeed, a prior history of sexual addiction increases the likelihood of a combined addiction (Washton and Zweben, 2009).
Drugs taken to treat Parkinson’s disease
As noted in Chapter 8, some Parkinson’s disease patients, who are being treated with dopamine replacement therapy, develop addictions (Lawrence et al., 2003). Sometimes the object of the addiction and the associated craving is for the medicine itself. In other patients, the object is gambling or shopping, compulsive eating or particular sexual incentives. Heightened aggression is another possible outcome. In accordance with incentive theory, it appears that elevated dopamine activity locks into interaction with one of several possible behaviours – shopping, gambling or sex – depending presumably upon prior predilections and chance associations between brain activity and the presence of the target activity in the outside world or the imagination.
In one sample of patients with Parkinson’s disease and sexual addiction, the majority also developed other addictive activities, gambling, smoking, alcohol abuse, in response to dopamine-boosting medication (Klos et al., 2005). (Three developed OCD.) Again, this points to a dopaminergic process that is common to a number of addictive activities.
Such instances suggest sensitization of particular sexual incentives and thoughts by the increased levels of dopamine activity.
Link with love
Fisher (2004, p. 53) raises an interesting issue: ‘Is romantic love an addiction? Yes; I think it is – a blissful dependency when one’s love is returned, a painful, sorrowful, and often destructive craving when one’s love is spurned.’ There are clearly some similarities between sexual and love addictions and they can sometimes merge into one, as suggested by the name of the charity ‘Sex and Love Addicts Anonymous’. However, love addiction is usually more closely associated with an addiction to one special individual, at least at any given time. By contrast, sexual addiction is more impersonal and might relate to any number of people or to no particular person, as in an insatiable desire for novelty in searching for pornographic images.
Throughout history, poets, song-writers and novelists have portrayed the swing between the ecstasy when being with a loved one and the despair at being separated. That is, heightened energy as in a hypomanic phase can alternate with anhedonia and irritability. This cycling pattern has features of addiction (Reynaud et al., 2010). However, the kind of love under consideration would need to lead to overall and long-term harmful consequences to qualify as an addiction. Falling in love repeatedly but without any reciprocity would exemplify an aspect of this. Love addiction seems to be more common in women, whereas sexual addiction is more common in men (Reynaud et al., 2010).
Reynaud et al. (p. 263) consider when love becomes addictive:
The shift from normal passion to addiction may be barely perceivable because dependence and need for the other are present in love passion. Addiction would be defined as the stage where desire becomes a compulsive need, when suffering replaces pleasure, when one persists in the relationship despite knowledge of adverse consequences (including humiliation and shame).
Pointing to the interaction between sex and love addiction, it appears that the chances of love switching into addiction are stronger the greater the intensity of the initial phase, for example a sexually intense period of first encounter (Reynaud et al., 2010).
In summary
In an exaggerated form, sexual addiction illustrates a number of features of sexual desire and its translation into action.
Long-term negative consequences of addictive activity prove no match for immediate sexual reward.
Behaviour is captured by a particular highly arousing type of incentive or a range of incentives, whether real, in books or in cyberspace.
An altered state of consciousness can be attained.
Habituation can set in with an associated escalation of the intensity of the sought experience.
The addicted individual’s sexual experience is sometimes compared against a perfectionist standard and attempts made to close the gap.
An increase in some general sexual drive is not a useful way of viewing addiction.
The reward deriving from behaviour can be in terms of not just sexual reward but also the lifting of negative emotion, such as that characterized by stress, anxiety or depression.
Stress can trigger the addictive behaviour.
Sexual addiction can sometimes be best understood in terms of its interactions with other addictive activities, such as those of emotional regulation, drug-taking and romantic attachment.
Eighteen Variations in desire: general principles
When I took off my shoes, Paulus became ecstatic about my feet. In later years, I often said that if I hadn’t walked barefoot with him that day, we would never have married. That was after I had learned that his preoccupation with feet had always been extraordinary. One of his most erotic sensations – a memory from childhood – was of the mother of a friend of his who behaved unconventionally, not to say audaciously, by walking barefoot in the sand at the ocean.
(Hannah Tillich, wife of theologian Paul (‘Paulus’) Tillich, in Tillich, 1973, p. 87)
The phenomena
This chapter examines variations in the form of behaviour, where it is idiosyncratic. Some of these forms are perfectly harmless exaggerations of ‘normal’ desire, as in the above, or where some individuals are sexually excited by particular items of clothing, most usually shoes. However, at the other extreme, some are ‘all-engaging’ and extremely dangerous. One person’s desires are fuelled by coercion and violence, whereas mo
st of us are horrified by this. To most, a reciprocating and empathetic human is essential to sexual desire, but a few seek sex with terrified victims or even corpses. Another’s fantasies are mainly masochistic. Others are drawn to peeping through their neighbours’ windows to glimpse a naked body, whereas some want their own exposed genitals to be displayed. Some of the best known such ‘paraphilias’ these days, such as voyeurism, fetishism and exhibitionism, are apparently little if at all evident in traditional societies (Gebhard (1971). They might arise in societies where people are able to remain anonymous.
How can we understand these outliers of desire? Chapters 18–21 look at various forms of desire ‘at the fringes’ and the kind of underlying processes that appear to give rise to them. I cannot provide definitive answers to why someone exhibits a particular ‘fringe desire’, but there are now some strong pointers. The incentive-based model developed in Chapter 4 can serve as a framework for understanding.
The term ‘paraphilia’ derives from the Greek para (beyond) and philia (love). It is a blanket term for conditions in which a person can only be aroused by stimuli that are outside normal bounds. It describes some widely different forms, with doubtless rather different underlying processes and thereby explanations. Some are inherently violent, whereas others are not. For example, someone might feel sexual desire only for children, or be fired disproportionately or even exclusively by a particular dress worn by his partner. An activity might only be classed as a paraphilia if the particular object is necessary for arousal to occur. Thus, an individual might engage in sex with, say, children not out of a preference for them but for lack of any other outlet.
How Sexual Desire Works- The Enigmatic Urge Page 40
