The Relationship Between Sexual Addiction and Sexual Dysfunction (1992)

128 Presentation THE RELATIONSHIP BETWEEN SEXUAL ADDICTION AND SEXUAL DYSFUNCTION JUNE DOBBS BUTTS, Ed.D. Assistant Professor Department of Psychiatry and Behavioral Sciences Meharry Medical College 1005 D.B. Todd Boulevard Nashville, TN 37208 Sexual addiction is a relatively new term describing ancientbehavior which seems to be increasing exponentially worldwide, perhaps as an indicator of the generalized violence in modern life. The chief characteristic of this group of human sexual behaviors is its compulsivity. Formerly labelled perversions and later hypersexuality, these out-of-control and clearly antisocial behaviors are now medically and legally classified as paraphilias (disorders characterized by recurrent intense sexual urges and fantasies involving suffering or humiliation of one's self or partner, a child or other nonconsenting partner, or involving nonhuman objects). For the purposes of this discussion, such compulsive sexual behaviors are termed "sexual addiction." What, then, do we mean by sexual dysfunctions? These behaviors are largely impaired states of so-called normal sexual functioning. I use the wellknown labels such as impotence, premature ejaculation, and anorgasmia (failure to experience orgasm in sexual intercourse), although recent medical and legal classifications describe either low sexual desire or inhibitions in psychophysiologic functioning. Somehow these impaired states were never labelled hyposexuality, perhaps to spare a patient further embarrassment. Today's psychiatric nomenclature recognizes the compulsive, addictive quality of certain sexual behaviors, as opposed to the impaired state of otherwise "normal" sexual dysfunctions, with the dichotomy set forth in the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IIIR ): Journal of Health Care for the Poor and Underserved, Vol. 3, No. 1, Summer 1992 _____________________________Butts__________________________129 The Sexual Disorders are divided into two groups. The Paraphilias are characterized by arousal in response to sexual objects or situations that are not part of normative arousalactivity patterns and that in varying degrees may interfere with the capacity for reciprocal , affectionate sexual activity. The Sexual Dysfunctions are characterized by inhibitions in sexual desire or the psychophysiologic changes that characterize the sexual response cycle.1 The key words in the description of the paraphilias are reciprocal and affectionateÂ—two blind spots in the personalities of sexual addicts. These patients seem not to care about the feelings of other people, but to be uniquely focused upon their own sexual needs and fantasies. It is interesting that public opinion has always accorded the utmost sympathy to people suffering from sexual dysfunctions, though such is not the case for people suffering from sexual addiction. The truth is that those who are addicted to sex often develop sexual dysfunctions, adding insult to injury. Most people find that the addict places sex as his or her raison d'Ãªtre, with all other facets of lifeÂ—family, home, career, self-esteem, community involvementÂ— considered secondary and a source of hostility if they "get in the way." Predictably, the addict eventually finds that sex is unfulfilling. As the "high" fades (typified by cocaine anhedonia) depression grows. The addict's attempt to alleviate this by further sexual activity of a ritualistic and compulsively repetitive nature crystallizes into a full-blown addition. Contrary to the popular image that sex addicts engage in blatant illegal behavior, the true picture is that people suffering from this sexual disorder seldom even get arrested. They continue to lead tortured, secret sex lives until an accident of fate (usually death) stops their compulsive sexual activities. They continue to feel driven and worthless, even upon completion of the very sex acts which they originally felt compelled to accomplish. And then the self-loathing grip of depression sets in. It has been said, with bitter humor, that sexual addiction is "the athlete's foot of the mind," because scratching (i.e., satisfaction) only intensifies the pain. AddictionsÂ—regardless of the form they take in human behaviorÂ— cannot be understood by direction, or object, or method, or any other extrinsic feature of the behavior. Addictions are characterized by their intrinsic compulsivity. An analogy may be found in recent psychiatric literature on phobias. Once thought to be separate entities, phobias are now evaluated as component parts in a global concept of fear. Similarly, sexual behavior is being re-evaluated as a primary source of addiction because it has...