text: Is sexual addiction the real deal? 
   
   Nicole Prause 
   
   Controversy exists over what some mental health experts call "hypersexuality," or sexual "addiction." Namely, is it a mental disorder at all, or something else? It failed to make the cut in the recently updated Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, considered the bible for diagnosing mental disorders. Yet sex addiction has been blamed for ruining relationships, lives and careers. 
   
   Now, for the first time, UCLA researchers have measured how the brain behaves in so-called hypersexual people who have problems regulating their viewing of sexual images. The study found that the brain response of these individuals to sexual images was not related in any way to the severity of their hypersexuality but was instead tied only to their level of sexual desire. 
   
   In other words, hypersexuality did not appear to explain brain differences in sexual response any more than simply having a high libido, said senior author Nicole Prause, a researcher in the department of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA. 
   
   "Potentially, this is an important finding," Prause said. "It is the first time scientists have studied the brain responses specifically of people who identify as having hypersexual problems." 
   
   The study appears in the current online edition of the journal Socioaffective Neuroscience and Psychology. 
   
   A diagnosis of hypersexuality or sexual addiction is typically associated with people who have sexual urges that feel out of control, who engage frequently in sexual behavior, who have suffered consequences such as divorce or economic ruin as a result of their behaviors, and who have a poor ability to reduce those behaviors. 
   
   But, said Prause and her colleagues, such symptoms are not necessarily representative of an addiction — in fact, non-pathological, high sexual desire could also explain this cluster of problems. 
   
   One way to tease out the difference is to measure the brain's response to sexual-image stimuli in individuals who acknowledge having sexual problems. If they indeed suffer from hypersexuality, or sexual addiction, their brain response to visual sexual stimuli could be expected be higher, in much the same way that the brains of cocaine addicts have been shown to react to images of the drug in other studies. 
   
   The study involved 52 volunteers: 39 men and 13 women, ranging in age from 18 to 39, who reported having problems controlling their viewing of sexual images. They first filled out four questionnaires covering various topics, including sexual behaviors, sexual desire, sexual compulsions, and the possible negative cognitive and behavioral outcomes of sexual behavior. Participants had scores comparable to individuals seeking help for hypersexual problems. 
   
   While viewing the images, the volunteers were monitored using electroencephalography (EEG), a non-invasive technique that measures brain waves, the electrical activity generated by neurons when they communicate with each other. Specifically, the researchers measured event-related potentials, brain responses that are the direct result of a specific cognitive event. 
   
   "The volunteers were shown a set of photographs that were carefully chosen to evoke pleasant or unpleasant feelings," Prause said. "The pictures included images of dismembered bodies, people preparing food, people skiing — and, of course, sex. Some of the sexual images were romantic images, while others showed explicit intercourse between one man and one woman." 
   
   The researchers were most interested in the response of the brain about 300 milliseconds after each picture appeared, commonly called the "P300" response. This basic measure has been used in hundreds of neuroscience studies internationally, including studies of addiction and impulsivity, Prause said. The P300 response is higher when a person notices something new or especially interesting to them. 
   
   The researchers expected that P300 responses to the sexual images would correspond to a person's sexual desire level, as shown in previous studies. But they further predicted that P300 responses would relate to measures of hypersexuality. That is, in those whose problem regulating their viewing of sexual images could be characterized as an "addiction," the P300 reaction to sexual images could be expected to spike. 
   
   Instead, the researchers found that the P300 response was not related to hypersexual measurements at all; there were no spikes or decreases tied to the severity of participants' hypersexuality. So while there has been much speculation about the effect of sexual addiction or hypersexuality in the brain, the study provided no evidence to support any difference, Prause said. 
   
   "The brain's response to sexual pictures was not predicted by any of the three questionnaire measures of hypersexuality," she said. "Brain response was only related to the measure of sexual desire. In other words, hypersexuality does not appear to explain brain responses to sexual images any more than just having a high libido." 
   
   But debate continues over whether sex addiction is indeed an addiction. A study published in 2012 by Prause's colleague Rory Reid, a UCLA assistant professor of psychiatry, supported the reliability of the proposed DSM-5 diagnostic criteria for hypersexual disorder. However, Prause notes, that study was not focused on the validity of sex addiction or impulsivity, and did not use any biophysiological data in the analysis. 
   
   "If our study can be replicated," she said, "these findings would represent a major challenge to existing theories of a sex 'addiction.' " 
   
   Other authors on the study included Dr. Timothy Fong, associate professor of psychiatry at the Semel Institute for Neuroscience and Human Behavior at UCLA and director of the UCLA Impulse Control Disorders Clinic; Vaughn R. Steele of the University of New Mexico; and Cameron Staley of Idaho State University. Funding was provided by an Idaho State University Graduate Student Committee grant (Staley). 
   
   The UCLA Department of Psychiatry and Biobehavioral Sciences is the home within the David Geffen School of Medicine at UCLA for faculty who are experts in the origins and treatment of disorders of complex human behavior. The department is part of the Semel Institute for Neuroscience and Human Behavior at UCLA, a world-leading interdisciplinary research and education institute devoted to the understanding of complex human behavior and the causes and consequences of neuropsychiatric disorders. ||||| Photos by Andy Lyons/Getty Images, Andrew Kelly/Reuters, Vincent Kessler/Reuters, and Caroline McCredie/Getty Images 
   
   Does sex addiction really exist? A new study published in last week’s journal of Socioaffective Neuroscience and Psychology suggests that maybe it doesn’t—bad news for celebrities like Tiger Woods and Russell Brand who have made it trendy in recent years to claim a clinical addiction to sex as an explanation for sexual misbehavior. 
   
   The study (which, amazingly, is the first of its kind) measured how the brains of people who struggle with sexually compulsive behavior respond to sexual images. If sex can be addictive in the clinical sense, scientists theorized, then the neural response of sex addicts to pornography should mimic the neural responses of drug or alcohol addicts to their drugs of choice. Instead, researchers found that hypersexual brains don’t react in the same way as other addicts’ brains—in fact, the neural responses to pornography only varied based on levels of sexual libido, rather than on measures of sexual compulsivity. People with higher libidos had more active brain reactions to the sexual images than people with lower libidos, but that was the only correlation. Degrees of sexual compulsivity did not predict brain response at all. If the results of this first study can be replicated, it would represent a major challenge to the notion that sex and pornography can be literally addictive. 
   
   “This is controversial territory because it represents a substantial shift in the way we view mental illness,” Dr. Nicole Prause, an assistant research scientist in the department of psychiatry at UCLA and one of the investigators involved with the study, told me. “Most people describe high-frequency sexual problems as an ‘addiction’—that’s how the public and even many clinicians talk about it. But this data challenges the addiction model and forces us to reconsider how we think and talk about these problems.” 
   
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   For the study, researchers recruited 52 people (39 men and 13 women) who reported having difficulties controlling their use of pornography and used electroencephalography (EEG) to measure their brain responses to various images. Some images were sexual in nature, such as kissing, nudity, and penetrative sex, while others were designed to be neutral or even unpleasant, such as pictures of skiers and dismembered bodies. Researchers analyzed brain response to the pictures in the first 300 milliseconds after the images appeared, commonly called a “P300.” Hundreds of neuroscience studies have relied on P300 measurements to analyze the brain’s response to various stimuli; for example, Prause said, several studies of substance addicts found increased P300 responses to images of their drugs of choice as compared to neutral images. 
   
   “We expected the brain response to sexual stimuli to be consistent with other drugs of addiction, or even other behavioral addiction studies,” said Prause. “But we just don’t see that at all. We weren’t able to find evidence for any relationship between the measures of high-frequency sexual problems and the brain response to sexual images.” 
   
   In a 2010 Psychology Today blog post, Dr. Michael Bader provocatively argued that “the addiction made me do it” is merely an excuse for people who want to avoid the difficult psychological thought and introspection required to address the real issues behind sexually compulsive behavior. Now this study has reignited the ongoing debate about whether sex and other so-called behavioral addictions—also known as process addictions, such as shopping and tanning—should be considered pathological alongside substance addictions such as nicotine, alcohol, and drugs. The third edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, released in 1987, included the term “sex addiction” under the category “Sexual Disorder—Not Otherwise Specified,” but that term was removed in subsequent editions. Hypersexual disorder was considered for inclusion in the recently released DSM-5 but was removed by the final draft. 
   
   So here’s where we stand: Despite the familiarity of sex addiction in pop culture, hypersexual disorder is not an officially categorized diagnosis—and studies like this suggest that won’t change anytime soon. Nevertheless, mental health professionals around the world have reported patients who come to them seeking help with sexually compulsive behavior. So a problem does exist, and people who want treatment and support deserve access to it. But the debate about sex addiction underlines important questions about how psychiatrists should categorize the difference between a clinical mental illness that can be demonstrated in a lab, such as substance addiction, and other forms of mental distress, which deserve equal care and compassion but don’t necessarily indicate a medical mental illness. If we turn every single quirk of human sexuality into a “disease,” after all, then we’re all screwed. 
   
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   “We don't have a lot of information about what constitutes normative sexual behavior, so how can we conclusively determine what is deviant?” said Dr. Rory Reid, a neuropsychologist at UCLA and the principal investigator for the DSM-5 field trial on hypersexual disorder. “I don’t think there is enough evidence to conclude that patterns of hypersexual behavior constitute a bona fide disorder in the scientific realm, but we also don’t have enough evidence to dismiss that possibility. It certainly warrants further research and discussion.” 
   
   Dr. Eli Coleman, who directs the program in human sexuality at the University of Minnesota Medical School, argues that any study that looks at compulsive sexual behavior from a traditional addiction model may be missing the mark. 
   
   “One of the big problems with the term ‘sex addiction’ is that it immediately assumes that you can apply the same kinds of research methodologies and treatments that you would use for substance addiction,” said Coleman. “There are no sex receptors in the brain to develop tolerance and dependence, as there are with alcohol and drug addiction.” Hypersexuals don’t experience seizures or other physical symptoms of withdrawal when they abstain, for example, like alcohol and drug addicts do. Coleman suggests that for many people, hypersexual behavior seems to be a problem of impulse control or compulsive drive rather than a neural addiction. But, he added, even that explanation is probably too simplistic: Some people use sexual behavior to modulate mood states, and in others hypersexuality looks almost like attention deficit disorder. “It’s really very complex,” said Coleman. “And there has not been enough research to fully examine all of the underlying mechanisms.” 
   
   Previous investigations into sex addiction have only measured the brains of sexual compulsives at rest (that is, without exposure to sexual imagery) or relied entirely on self-reported questionnaires, which are likely to be influenced by social ideas about what constitutes “normal” degrees of sexual behavior or desire. This new study is the first time that scientists have measured the active responses of hypersexual brains to sexual stimuli, which seems closer to the mark if scientists want to prove or dispel the clinical case for sex addiction. 
   
   “The field is very strange, because experimental work is very rare in this area. Many people report feeling out of control sexually, but when we actually look for evidence of that in a lab, we can’t find it,” said Prause. “That’s why I’m aghast that we’re not doing more research in this area. Questionnaires are valuable, but we need to do more work to determine if what people are reporting is actually true.” 
   
   Prause points out why there haven’t been funds directed toward scientific research that might challenge the existence of sex addiction: If something is a disease, there is money to be made from treating it. (One Christian organization, for example, charges $1,275 for a three-day seminar called “Every Man’s Battle” that claims to treat men who “find themselves pulled into the use of pornography” or who “seek out sexual gratification through compulsive masturbation.”)
target: – The term "sex addiction" might get tossed around a lot these days as a way to explain some not-so-classy behavior of the Anthony Weiner-Tiger Woods variety, but is it really an addiction on par with drugs or alcohol? The first study to explore brain responses in people who describe themselves as hypersexual suggests otherwise, reports UCLA. Researchers there showed the subjects—39 men and 13 women—sexual images, and discovered that their brains didn't respond in the same way that, say, a cocaine addict would respond to images of cocaine. “Most people describe high-frequency sexual problems as an ‘addiction’—that’s how the public and even many clinicians talk about it," one of the researchers tells Slate. "But this data challenges the addiction model and forces us to reconsider how we think and talk about these problems.” The subjects have higher libidos, or sexual desire, but not necessarily a clinical medical problem. They still need help, but if further studies verify this first one, then the type of help they'll get will be affected. All of which might be OK, writes Jillian Keenan at Slate. "If we turn every single quirk of human sexuality into a 'disease,' after all, then we’re all screwed." The study is in the journal Socioaffective Neuroscience & Psychology.