Engaging in sex and eroticism, and viewing pornography, are considered normative behaviors that find expression in our culture and public discourse. In recent decades, however, there has been an increase in engagement with exaggerated sexual behaviors, described by terms such as compulsive sexual behavior, nymphomania, satyriasis, and hypersexuality.
Given the widespread use of the Internet for sexual purposes, online sexual activity has been defined as engaging in the following activities online: the search for sexual information, the consumption of sexual entertainment, the purchase of sex toys, involvement in sexual relationships, and membership in sexual communities. Viewing pornography is another type of online sexual activity.
While there is still disagreement over a diagnostic definition that would distinguish between excessive and addictive behavior, there is widespread agreement that sexual behaviors can be compulsive, marked by loss of control and difficulty controlling impulses.
According to various estimates, the number of pornographic website surfers is greater than the number of users of Netflix, Amazon and Twitter combined, and about 35% of all Internet downloads occur on pornographic sites. The largest pornographic site in the world, Pornhub, has tens of billions of views each year. Not least, according to various estimates, 34% of Internet users are exposed to pornographic content without their choosing, through advertisements, sponsored content, and pop-ups.
Although the cause of compulsive sexual behavior is not clear, it is hypothesized that, like other addictions, this behavior is linked to an imbalance of neurotransmitters, such as serotonin, dopamine and norepinephrine, high levels of which are associated with sexual behavior. It is also argued that compulsive sexual behavior, like other types of addictions, may induce changes in the brain's neural circuits and affect the reward pathway.
A bit of history
The term “sex addiction” first appeared in the public discourse in the mid-1970s, following the rise of 12-step programs, which were originally established by Alcoholics Anonymous as a way to deal with alcoholism. Other groups subsequently adopted the 12-step format, including Overeaters Anonymous, Narcotics Anonymous, and Sexaholics Anonymous. In 1987, the American Psychiatric Association (APA) published a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), which included the term “sexual addiction.” In 2000, however, a new edition of the DSM was released (DSM-IV-TR), in which the term was eliminated. Prior to its publication in 2013, attempts were made to include the concept of hypersexuality in the DSM-5, but they were rejected on the grounds that there is "insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders." Today, the diagnosis of hypersexual disorder is considered controversial, and is not included in the latest edition of the DSM (DSM-5). However, the term sex addiction, as mentioned, is commonly used, and refers to people who engage in sex compulsively, including masturbation, sexual exploitation, exhibitionism, and viewing pornography.
Is there a difference between sex addiction and pornography addiction?
While there is still no agreed upon diagnosis for either in the DSM, and still no consensus on terminology (hypersexuality versus sex addiction), experts around the world affirm that the phenomenon exists, and that there are addicts who need help. The problem of sex addiction, thus, is defined broadly as increased sexual activity, without the ability to restrain or control the preoccupation with sex, whether in practice or just in terms of thoughts and fantasies, even when the increased sexual activity negatively affects one’s life, work, marital and family relationships, and despite understanding the increased risk of contracting sexually transmitted diseases. Although not included in the DSM-5, hypersexuality is characterized by an array of symptoms, which were suggested for official diagnosis, and which studies have shown to be valid and reliable criteria for identifying the disorder:
- Repeated and recurring experiences of intense sexual fantasies, urges, or behaviors.
- Amount of time spent on sexual fantasies, urges, or behaviors consistently interferes with other activities and everyday life.
- Sexual fantasies, urges, or behaviors occur as a response to stressful situations, such as anxiety, depression, boredom, and irritability.
- Difficulty reducing sexual fantasies, urges, or behaviors.
- Engaging in sexual behaviors regardless of physical or emotional harm that is caused to oneself or others.
- Frequency of sexual fantasies, urges, or behaviors causes distress and guilt.
- Loss of pleasure from the sex act itself.
The consumption of pornographic content, on the other hand, is a kind of release that many men and women engage in out of curiosity or during challenging and lonely periods. Viewing pornography is considered a problem or disorder when there is an increased need to watch it more frequently; when the habit becomes uncontrollable, unable to be deferred or delayed; or when the consumption takes place in an unsuitable environment (e.g., in the office during work hours, in the presence of children, etc.). When a person’s interest in pornography increases over time, it can begin to affect his or her relationships with sex partners, and the need to conceal the activity rises. Some believe that pornography addiction is just one type of sex addiction, similar to other compulsive sexual behaviors, such as buying sex services, masturbation, voyeurism and exhibitionism.
What are the causes of sex addiction?
- Genetic: A genetic predisposition to certain psychological disorders (such as anxiety and depression), personality disorders, and difficulty controlling impulses can trigger the need to engage in excessive or dangerous sexual behaviors.
- Hormonal: Higher levels of sex hormones, such as testosterone or estrogen, can affect libido and stimulate increased sexual desire.
- Environmental: Early environmental factors, such as abuse or exposure to sexual content, can encourage some of the underlying characteristics that drive sexual behavior. Social difficulties and social isolation may also underlie increased sexual drive.
- Trauma and psychological disorders: Approximately 40% of Israelis who suffer from post-traumatic stress disorder (PTSD) from military service are vulnerable to sex addiction. Moreover, the data show that the rate of sexual addiction among those who suffer from psychological disorders, such as anxiety and depression, is tens of percentage points higher than that in the general population.
What are the adverse health effects of sex addiction?
According to published reports in the United States, about 38% of men and 45% of women with sex addiction have contracted at least one sexually transmitted disease (STD). About 70% of these women reported unwanted pregnancies. Other reports point to sex addiction as a cause of social and marital crises and harm, decreased concentration and productivity in the workplace, and psychological disorders, such as anxiety and depression.