Predisposition,Vulnerability and Web in Sex Addiction

Conceptualizations About Sex Addiction

The conceptualization of sex addiction is an argument that has drawn together many clinicians throughout the years, with an ever-growing debate to define possible guidelines about behavioural manifestations of this disturbance.

Hypersexuality as a nosographic category forces some critical issues, notably underlined by Carnes ¹ :

‘It is difficult to distinguish between normal and abnormal sexual behaviours’;

‘It is difficult to establish whether one loses control’;

‘It is difficult to assess society’s role upon this matter’.

Diagnostic classifications and defining criteria have followed one another in different forms over the years. Kafka, a member of the Sexual Gender Identity Disorder Working Group of the American Psychiatric Association working on DSM-5, has introduced the diagnosis of hypersexuality disorder, which does not require criteria such as addiction, tolerance or abstinence. ² The classification proposed by Kafka is not included in the final version of the DSM-5, nonetheless, it can provide an idea about thoughts and behaviours correlated to the clinical setting. Diagnostic criteria imply the presence of fantasies or severe and frequent sexual behaviours which last up to six months. These might be drives that lead to dedicating a huge time to spawning sexual behaviours, and they generate either due to a dysphoric mood shift or subsequently stressful events in everyday life. Moreover, it’s difficult to control behaviours and fantasies, and there is no cure for the risks which derive from the execution of said conduct. As established, this classification, aside from being built on an insufficient layer of research, stirs the question about how hard it is to point out when a level of desire is to be considered pathological.

A recent classification has been included in the last edition of ICD ³ (International Classification of Diseases 11th Revision), in 2022, modified the criteria for the evaluation of this pathology. Compulsive sexual behaviour disorder (CSBD) is considered an impulse control disorder, defined as ‘a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour’. ⁴ Its classification bounds are defined by specific criteria. First of all: the excessive amount of time spent in sexual activities has a negative impact on other important personal matters (health, hobbies, self-care). Moreover, it is difficult to control sexual acts, to the point where one cannot reduce them. This conduct persists even when there is little satisfaction from it, or bears negative consequences. In the presentation of this disorder, it is underlined how stress connected to moral judgements and disapproval regarding urges, behaviours and sexual desires is not enough to meet the requirements for a diagnosis. At any rate, the presence of a paraphilic disorder excludes the possibility of diagnosing CSBD. ⁴

Vulnerability and Development of Sex Addiction in Adolescence

What are the predisposing factors leading an individual to generate a sex addiction? As for other addictions, the topic offers plenty of room for debate in literature. Could it be genetic predisposition? How much does the social environment weigh in? Furthermore … how relevant are the first experiences in pinpointing this phenomenon?

Genetically, according to recent studies, at the roots of addictive behaviour, there are multiple alterations which lead a subject to an increased vulnerability to addiction. ⁵ Specifically, although not determinative, a predictive factor would be the altered presence of gene DRD4 in a percentage of patients diagnosed with substance or behavioural addictions. ⁶

Anyway, this predisposition does not suffice in activating a pathology recognizable as an addiction.

What truly concurs in making a person more vulnerable are life experiences, both in childhood and adolescence.

Analyzing in detail sex addiction in different steps of patients’ treatment, it becomes clear how getting in touch with specific pornographic content at a young age might lead a subject to an increased vulnerability. Quantity and quality are realistically the aspects that mark the resources that both in preadolescence and adolescence will be used by the future patient.

By quantity, it is implied an unlimited access to sexual stimuli. The time of paper is far gone, outclassed in every aspect by digital supports. According to ‘Enough is Enough’—no profit organization—which mission is to ensure safe internet surfing for children: ‘porn sites draw more visitors than Amazon, Netflix and Twitter combined’ ⁷ ‘30% of internet is porn’. ⁸ This instance is supported by many different types of research such as the one made by ExtremeTech regarding the most notorious porn sites (at the time) known to the public: Xvideos and YouPorn. According to this research Xvideos ‘produces 4.4 billion of seen pages per month: tenfold New York Times’ pages and thrice CNN’s’ and YouPorn 2.1 billion of seen pages per month, around 4000 per second. ⁹ As underlined by ‘Affari Italiani’ magazine: ‘Xvideos is the third most searched site after Google and Facebook’. ¹⁰

Helping out on switching from the use to abuse of pornography is the plenitude of devices, connected 24/7 to the net, portable and granted with almost free access to porn content. Moreover, most porn sites offer a wide range of sexual acts, categorized by age, gender, toys, context etc. Sex is often presented as an immediate interaction between two or more participants, often strangers, sprung by a simple glance or gesture. The span of the intercourse lasts often way longer than the well-known standards from scientific literature and with that comes also the consent to start again the act. The result is a misrepresentation of the sexual realm, well at odds with its real counterpart.

Subjects most susceptible to this supply are adolescents. Approaching sex often implies interaction with peers. Between 11 and 13 boys and girls start to grow feelings for their sport or school mates, with them being peers or older. First dates, awkward kisses and progressively a shared discovery of the patterns of one’s body are started. Sex is used as a tool to confront, get to know and gain experience in the external world. Such an experience goes missing for an important share of teenagers. Subjects with fewer social interactions, often introverts or presenting greater trouble trying to interact with peers tend to live most of their time in closed contexts, markedly using digital tools and unchecked net access. Most of their needs, some of which are still developing, are conveyed into the net. Social networks, games, knowledge and last but not least, sex.

First impression generates conflicting emotions and feelings. Pleasure, overwhelming pleasure locked behind a click, curiosity, surprise, the desire to repeat an experience. On the other hand, disbelief, perplexity often arise from a contrast between information about sex learnt from people of same age and what is found online. The adolescent tends to split, to disconnect what derives from daily scholastic context and the few interactions with their schoolmates from what they perceive online, especially on sexual matters. All of this, and even more. There is a lack of delusion due to a refusal from another adolescent, there is no need to get involved or to postpone one’s desires. Internet, to some adolescents, becomes an everlasting fuel. Most susceptible subjects turn progressively into insatiable users. The pursuit of gratification which markedly contributes to impulsiveness, a peculiar feature of an adolescent, combined with an increased activity of dopaminergic neurons, compared to those of an adult, leads to a poor inhibitory capacity against excitatory behaviours. ¹¹

It would seem, according to some studies, that a correlation between sex, web and addiction could function as a mixture to withstand a strong relational loneliness, proper of many modern-day adolescents. ¹²

Prolonged surfing and prolonged exposure to pornographic material heavily mark a teenager’s identity: as it emerges from research said teenagers suffer since first sexual experiences from performance anxiety and low excitability. The reason for this low level is due to previous experiences: ‘because stimuli do not match images embedded thanks to an early and prolonged access to pornography’. ¹³ Another not marginal feature which eases the uprising of the addiction is the intensity of the stimulus.

As claimed by Abraham in 2003: ‘[T]he greater the pleasure the shorter it lasts’. ¹⁴ Often teenagers seek a lasting pleasure experience taking usually more time to activate and/or reactivate excitement, to prolong effects at the cost of repeating erotic practices to exhaustion. Sex is progressively defined as a behaviour with specific parameters distinguished by heavily exciting stimuli, prolonged binging and an increasing distancing from social context. Most vulnerable subjects find themselves caught up by this condition.

Preadolescence, according to Pellai: ‘is perhaps the most susceptible phase to hyper-stimulation, excessive excitement and a lack of regulations applied to online activities’. ¹⁵

Furthermore, given that adolescence are present ‘immature cognitive control mechanisms’ in terms ‘might lead to a greater incidence of affective disorders and addictions in teenagers’. ¹⁶

What emerges from interviews with patients being treated for sex addiction are often stories of lonely adolescents, with scarce role models. Finding out about sex is often occult, with it being discussed with peers but afterwards deepening online. The topic is step by step turned into a family taboo. Many patients’ parents have conveyed the message that sex is in its every form ‘dirty’ and therefore banned in any discussion or family context. This brings forth a huge discrepancy between the need to experience and find out pleasures, easily available at home but also a great shame immediately afterwards.

Conclusions

More than 50 years have gone by since psychiatrist Krafft-Ebing R. introduced the concept of sex addiction in his book ‘Psychopathia sexualis’, first published in 1965. It is a well-known fact that sex addiction has long existed before internet entered our lives. ¹⁷ Most likely the net has increased the rise of this disease in a growing portion of subjects; most likely some individuals would not have highlighted this addiction and in others, it could perhaps have been contained. Internet, compared to other video or paper resources introduces new variants worthy of attention: more time spent on online pornography, a wider spread and access granted by any device, guaranteed anonymity and a smaller inhibition due to intense sexual stimuli. ¹⁸ In addition the net serves a double function to a sex-addicted patient: both in unlimited resources and as a tool to identify other people to share vigorous sexual experiences in the real world. It is often difficult in literature to formulate a diagnosis discerning precisely between sex addiction, cybersex and internet addiction. ¹⁹ As a matter of fact, the wide pornographic offer, an increasing closure of many teenagers as well as some adults towards social context in the real world, combined with the COVID-19 pandemic has promoted the rise of sex addiction. Focused interventions, targeting different ages, prioritizing preadolescence and adolescence, could most likely encourage treated patients to experience sex as a pleasant practice, chosen and lived with times and frequencies imposed by gratification instead of merely feeding the craving.

The ongoing professional trend, both in public and private treatments is to offer interventions that make use of the net, in order to prevent unhealthy or risky behaviours and, most importantly, aimed at teenagers, instead of promoting sexual welfare. ²⁰ It is challenging to tackle this wide selection of online pornography; it is instead more viable to spread an idea of sexual experience lived and chosen in freedom, disconnected from misconceptions and exploiting that very same tool: the net.