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
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Griffiths, M.D. (2000). Excessive internet use: Implications for sexual behavior. CyberPsychology and Behavior, 3, 537-552.
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A number of years ago, I was asked to write an article on “The Sin of Pride” for the British Psychological Society. Before writing that article, I knew very little about the topic. To me it was the title of an record album by The Undertones that I bought in 1983 when I was 16 years old from Castle Records in Loughborough. I perhaps learned a bit more about it when I watched 1995 film ‘Seven’ directed by David Fincher and starring Brad Pitt (which coincidentally just happens to be one of my all-time favourite films).
After agreeing to write the article I did a bit of research on the subject (which admittedly meant I did a quick Google search followed by a more considered in-depth search on Google Scholar). While I’m no expert on the topic I can at least have a decent pub conversation about it if anyone is prepared to listen. Just to show my complete ignorance, I wasn’t even aware that the sin of pride was the sin of all sins (although I could in a pub quiz be relied upon to name the seven deadly sins).
I was asked to write on this topic because I was seen as someone who is very proud of the work that I do (and for the record, I am). However, I have often realized that just because I am proud of things that I have done in my academic career it doesn’t necessarily mean others think in the same way. In fact, on some occasions I have been quite taken aback by others’ reactions to things that I have done for which I feel justifiably proud (but more of that later).
At a very basic level, the sin of pride is rooted in a preoccupation with the self. However, in psychological terms, pride has been defined by Dr. Michael Lewis and colleagues in the International Journal of Behavioral Development as “a pleasant, sometimes exhilarating, emotion that results from a positive self-evaluation” and has been described by Dr. Jessica Tracy and her colleagues (in the journal Emotion) as one the three ‘self-conscious’ emotions known to have recognizable expressions (shame and embarrassment being the other two). From my reading of the psychological literature, it could perhaps be argued that pride has been regarded as having a more positive than negative quality, and (according to a paper in the Journal of Economic Psychology by my PhD supervisors – Professor Paul Webley and Professor Stephen Lea) is usually associated with achievement, high self-esteem and positive self-image – all of which are fundamental to my own thinking. My reading on the topic has also led to the conclusion that pride is sometimes viewed as an ‘intellectual’ or secondary emotion. In practical (and psychological) terms, sin is either a high sense of one’s personal status or ego, or the specific mostly positive emotion that is a product of praise or independent self-reflection.
One of the most useful distinctions can be made about sin (and is rooted in my own personal experience), is what Lea and Webley distinguish as ‘proper pride’ and ‘false pride’. They claim that:
“Proper pride is pride in genuine achievements (or genuine good qualities) that are genuinely one’s own. False pride is pride in what is not an achievement, or not admirable, or does not properly belong to oneself. Proper pride is associated with the desirable property of self-esteem; false pride with vanity or conceit. Proper pride is associated with persistence, endurance and doggedness; false pride with stubbornness, obstinacy and pig-headedness.”
As I noted above, there have been times when I have been immensely proud of doing something only for friends and colleagues to be appalled. ‘Proper pride’ as Lea and Webley would argue. One notable instance was when I wrote a full-page article for The Sun on ‘internet addiction’ published in August 1997. I originally wanted to be a journalist before I became a psychologist, and my journalist friends had always said that to get a full-page ‘by line’ in the biggest selling newspaper in the UK was a real achievement. I was immensely proud – apart from the headline that a sub-editor had dubbed my piece ‘The Internuts’ – and showed the article to whoever was around.
I had always passionately argued (and still do) that I want my research to be disseminated and read by as many people as possible. What was better than getting my work published in an outlet with (at the time) 10 million readers? My elation was short-lived. One close colleague and friend was very disparaging and asked how I could stoop so low as to “write for the bloody Sun?” Similar comments came from other colleagues and I have to admit that I was put off writing for the national tabloids for a number of years. (However, I am now back writing regularly for the national dailies and am strong enough to defend myself against the detractors).
In 2006, I was invited to the House of Commons by the ex-Leader of the Conservative Party, Iain Duncan-Smith and invited to Chair his Centre For Social Justice Working Party on Gambling and write a report as part of the Conservative Party’s ‘Breakdown Britain’ initiative. Anyone who knows me will attest that my political leanings are left of centre and that I working with the Conservatives on this issue was not something I did without a lot of consideration. I came to the conclusion that gambling was indeed a political issue (rather than a party political issue) and if the Conservative Party saw this as an important issue, I felt duty bound to help given my research experience in the area. I spent a number of months working closely with Iain Duncan-Smith’s office and when the report was published I was again very proud of my achievement.
However, as soon as the report came out I received disbelieving and/or snide emails asking how I could have “worked with the Conservatives”. I have spent years trying to put the psychosocial impact of gambling on the political agenda. If I am offered further opportunities by those with political clout, I won’t think twice about taking them. I am still immensely proud of such actions despite what others may think.
Pride is ultimately a subjective experience and the two personal experiences that I outlined above will not put me off doing what I want to do. I shall continue to engage in activities where I think my work can have an impact and shall work with (and write for) those that can help me disseminate my research findings to as many people as possible.
Dr Mark Griffiths, Professor of Behavioural Addiction, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK
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Griffiths, M.D. (1997). The internuts (internet addiction). The Sun, August 13, p.6.
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Tracy, J.L., Robins, R.W. & Schriber, R.A. (2009). Development of a FACS-verified set of basic and self-conscious emotion expressions. Emotion, 9, 554-559.