The issue of sex addiction as a behavioural addiction has been hotly debated over the last decade. A recent contribution to this debate is a review by Shane Kraus and his colleagues in the latest issue of the journal Addiction that examined the empirical evidence base for classifying compulsive sexual behaviour (CSB) as a behavioural (i.e., non-substance) addiction. The review raised many important issues and highlighted many of the problems in the area including the problems in defining CSB, and the lack of robust data from many different perspectives (epidemiological, longitudinal, neuropsychological, neurobiological, genetic, etc.).
As my regular blog readers will know, I have carried out empirical research into a wide variety of different behavioural addictions (gambling, video gaming, internet use, exercise, sex, work, etc.) and have argued that some types of problematic sexual behaviour can be classed as sex addiction depending upon the definition of addiction used. I was invited by the editors of Addiction to write a commentary on the review and this has just been published in the same issue as the paper by Kraus and colleagues. This blog briefly looks at the issues in that review that I highlighted in my commentary.
For instance, there are a number of areas in Kraus et al.’s paper that were briefly mentioned without any critical evaluation. For instance, in the short section on co-occurring psychopathology and CSB, reference was made to studies claiming that 4%-20% of those with CSB also display disordered gambling behaviour. I pointed out that a very comprehensive review that I published with Dr. Steve Sussman and Nadra Lisha (in the journal Evaluation and the Health Professions) examining 11 different potentially addictive behaviours also highlighted studies claiming that sex addiction could co-occur with exercise addiction (8%-12%), work addiction (28%-34%), and shopping addiction (5%-31%). While it is entirely possible for an individual to be addicted to (say) cocaine and sex concurrently (because both behaviours can be carried out simultaneously), there is little face validity that an individual could have two or more co-occurring behavioural addictions because genuine behavioural addictions consume large amounts of time every single day. My own view is that it is almost impossible for someone to be genuinely addicted to (for example) both work and sex (unless the person’s work was as an actor/actress in the pornographic film industry).
The paper by Kraus et al also made a number of references to “excessive/problematic sexual behavior” and appeared to make the assumption that ‘excessive’ behaviour is bad (i.e., problematic). While I agree that CSB is typically excessive, excessive sex in itself is not necessarily problematic. Preoccupation with any behaviour in relation to addiction obviously needs to take into account the context of the behaviour, as the context is far more important in defining addictive behaviour than the amount of the activity undertaken. As I have constantly argued, the fundamental difference between a healthy excessive enthusiasms and addictions is that healthy excessive enthusiasms add to life whereas addictions take away from them.
The paper also appeared to have an underlying assumption that empirical research from a neurobiological and genetic perspective should be treated more seriously than that from a psychological perspective. Whether problematic sexual behaviour is described as CSB, sex addiction and/or hypersexual disorder, there are thousands of psychological therapists around the world that treat such disorders. Consequently, clinical evidence from those that help and treat such individuals should be given greater credence by the psychiatric community.
Arguably the most important development in the field of CSB and sex addiction is how the internet is changing and facilitating CSB. This was not even mentioned until the concluding paragraph yet research into online sex addiction (while comprising a small empirical base) has existed since the late 1990s including sample sizes of up to almost 10,000 individuals. In fact, there have been a number of recent reviews of the empirical data concerning online sex addiction including its treatment including ones by myself in journals such as Addiction Research and Theory (in 2012) and Current Addiction Reports (in 2015). My review papers specifically outlined the many specific features of the Internet that may facilitate and stimulate addictive tendencies in relation to sexual behaviour (accessibility, affordability, anonymity, convenience, escape, disinhibition, etc.). The internet may also be facilitating behaviours that an individual would never imagine doing offline such as cybersexual stalking.
Finally, there is also the issue of why Internet Gaming Disorder was included in the DSM-5 (in Section 3 – ‘Emerging measures and models’) but sex addiction/hypersexual disorder was not, even though the empirical base for sex addiction is arguably on a par with IGD. One of the reasons might be that the term ‘sex addiction’ is often used (and arguably misused) by high profile celebrities as an excuse to justify their infidelity (e.g., Tiger Woods, Michael Douglas, David Duchovny, Russell Brand), and is little more than a ‘functional attribution’. For instance, the golfer Tiger Woods claimed an addiction to sex after his wife found out that he had many sexual relationships during their marriage. If his wife had never found out, I doubt whether Woods would have claimed he was addicted to sex. I would argue that many celebrities are in a position where they are bombarded with sexual advances from other individuals and have succumbed. But how many people would not do the same thing if they had the opportunity? Sex only becomes a problem (and is pathologised) when the person is found to have been unfaithful. Such examples arguably give sex addiction a ‘bad name’, and provides a good reason for those not wanting to include such behaviour in diagnostic psychiatry texts.
Dr. Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
Bocij, P., Griffiths, M.D., McFarlane, L. (2002). Cyberstalking: A new challenge for criminal law. Criminal Lawyer, 122, 3-5.
Cooper, A., Delmonico, D.L., & Burg, R. (2000). Cybersex users, abusers, and compulsives: New findings and implications. Sexual Addiction and Compulsivity, 6, 79-104.
Cooper, A., Delmonico, D.L., Griffin-Shelley, E., & Mathy, R.M. (2004). Online sexual activity: An examination of potentially problematic behaviors. Sexual Addiction and Compulsivity, 11, 129-143.
Cooper, A., Galbreath, N., Becker, M.A. (2004). Sex on the Internet: Furthering our understanding of men with online sexual problems. Psychology of Addictive Behaviors, 18, 223-230.
Cooper, A., Griffin-Shelley, E., Delmonico, D.L., Mathy, R.M. (2001). Online sexual problems: Assessment and predictive variables. Sexual Addiction and Compulsivity, 8, 267-285.
Dhuffar, M. & Griffiths, M.D. (2015). A systematic review of online sex addiction and clinical treatments using CONSORT evaluation. Current Addiction Reports, 2, 163-174.
Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.
Griffiths, M.D. (2001). Sex on the internet: Observations and implications for sex addiction. Journal of Sex Research, 38, 333-342.
Griffiths, M.D. (2004). Sex addiction on the Internet. Janus Head: Journal of Interdisciplinary Studies in Literature, Continental Philosophy, Phenomenological Psychology and the Arts, 7(2), 188-217.
Griffiths, M.D. (2005). A ‘components’ model of addiction within a biopsychosocial framework. Journal of Substance Use, 10, 191-197.
Griffiths, M.D. (2012). Internet sex addiction: A review of empirical research. Addiction Research and Theory, 20, 111-124.
Griffiths, M.D. (2016). Compulsive sexual behaviour as a behavioural addiction: The impact of the Internet and other issues. Addiction, 111, 2107-2109.
Griffiths, M.D. & Dhuffar, M. (2014). Treatment of sexual addiction within the British National Health Service. International Journal of Mental Health and Addiction, 12, 561-571.
Kraus, S., Voon, V., & Potenza, M. (2016). Should compulsive sexual behavior be considered an addiction? Addiction 111, 2097-2106.
Orzack M.H., & Ross C.J. (2000). Should virtual sex be treated like other sex addictions? Sexual Addiction and Compulsivity, 7, 113-125.
Sussman, S., Lisha, N. & Griffiths, M.D. (2011). Prevalence of the addictions: A problem of the majority or the minority? Evaluation and the Health Professions, 34, 3-56.
Van Gordon, W., Shonin, E., & Griffiths, M.D. (2016). Meditation Awareness Training for the treatment of sex addiction: A case study. Journal of Behavioral Addictions, 5, 363–372.
Now that people are beginning to accept the idea that addictions do not necessarily involve the ingestion of a drug, today’s blog briefly overviews some of the newer addictions that are being talked about in clinical circles up and down the country.
Walking: Yes, believe it or not, there are people out there who like nothing better than to walk for hours and hours every day to get their kicks. This has been termed ‘pathological rambling’ and I hear there are a few Ramblers Anonymous groups in existence. This should not be confused with those other ramblers who are addicted to the sound of their own voice and engage in constant monologues (e.g., politicians). This is a diction problem rather than an addiction problem.
Rug making: This has been reported amongst the recently engaged and newly wed couples. Every evening after coming back from work, these couples spend hours making rugs by sowing squares of material together. A reported behavioural sign of ‘rug addiction’ is a preoccupation with needles. One of the couple is usually much less into the activity than their partner and builds up an incredible tolerance level before undergoing withdrawal. (Withdrawal effects from rug making have been reported and include feelings of happiness, normality and rational thought).
Gardening: For most people this is just an innocent pastime, but for a minority it can become an addiction. Why do some people become hooked on their garden? Theories are at present lacking but discourse analysts tell me that gardening has an established “recreational drug-related rhetoric”. Next time a gardener asks you about your “pot plants” or “grass”, or the quickest way to dispose of “weeds”, don’t make a hash of your answer.
Telling jokes: Can humour be dangerous? In a previous blog (and based on an article I had published I a 1989 issue of The Psychologist), I brought to your attention an account of ‘Witzelsucht’ (‘punning mania”) based on the work of Dr. A. A. Brill (dating back to a 1929 paper in the International Journal of Psychoanalysis). But now the discussion seems to be about the effects of ‘passive joking’. Should people have to put up with people’s joking when they go to a public place? Do they really need the pun and excitement? Passive joking certainly changes my own behaviour. I find that straight after reading a column by Stephen Fry or Charlie Brooker, I have an incredible urge to be witty myself. It’s even worse of there is a word-processor nearby…which brings me to my final addiction.
Writing addiction: It may come as a surprise but some people (including a small percentage of academics) are actually addicted to writing. Those of us that have an “ink problem” undertake ritualistic behaviour before engaging in the activity and experience immense “highs” on acceptance of an article or seeing the article in print. Tolerance occurs quickly and with writers having to write longer and longer articles or books to get intense “highs” (a stage at which the writing addict is well and truly “booked”). Irritability and withdrawal effects are experienced when they (i) get an article rejected, (ii) go more than a few days without getting anything accepted or published, (iii) run out of ideas to write about (many writers fear developing a “think problem” and some may resort to “clue sniffing” for inspiration), and (iv) are on holiday without access to a word-processor. This last consequence can sometimes be partly overcome by carrying a writing implement. Anecdotal evidence suggests writing addicts show cross-tolerance to pens and pencils but not to crayons.
So there you have it – or not – as the (clinical) case may be.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Garfield, E. (1987). The crime of pun-ishment. Essays of an Information Scientist, 10, 174-178.
Griffiths, M.D. (1989). It’s not funny: A case study of ‘punning mania’. The Psychologist: Bulletin of the British Psychological Society, 2, 272.
Griffiths, M.D. (1993). Addictions: Looking to the future. Clinical Psychology Forum, 62, 16.