How Science is Uncovering the Truth About Sex Addiction

Researchers have had a difficult time reaching a consensus about whether or not sex addiction is actually a real thing. While the condition was considered (and rejected) for inclusion in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, scientists remain unsure what causes a clinical addiction to sex — or whether it's actually possible to develop a clinical addiction to sex to begin with, the same way one can develop an addiction to drugs or alcohol. 

According to a study published in the journal Psychoneuroendocrinology this week, however, researchers might be one step closer to determining whether sex addiction is a thing — and if so, what actually causes it. 

The study: Researchers at the Karolinska Institutet in Sweden sought to measure the physiological factors that might lead to hypersexual disorder, the clinical term for sex addiction that's characterized by compulsive sexual behavior and an obsession with sexual thoughts. As the study in Psychoneuroendocrinology makes clear, sex addiction could very well be "comorbid," or concurrent with, other mental illnesses like depression. 

The Swedish researchers set out to evaluate the possible physiological causes of hypersexual disorder with a stress test. They looked at the stress hormone levels of 106 men, 67 of whom had been diagnosed with hypersexual disorder and 39 "healthy" volunteers who acted as controls, using the drug dexamethasone, a cortisone drug that suppresses the immune system and allows researchers to measure the body's stress levels. 

What the investigators discovered is that men who had been diagnosed with hypersexual disorder had higher levels of the stress hormones cortisol and Adrenocorticotropic hormone (ACTH) than their "healthy" counterparts, even after controlling for other issues such as past childhood trauma or depression.

"Aberrant stress regulation has previously been observed in depressed and suicidal patients as well as in substance abusers," Jussi Jokinen, a psychiatrist and one of the researchers involved in the study, said, according to ScienceDaily. (Mic reached out to the researchers for comment and did not hear back at press time.) 

Jokinen and his colleagues found elevated stress hormones might well be a physiological factor contributing to compulsive sexual behavior. But the findings aren't quite conclusive. 

Sex addiction is controversial. Psychologists, neurologists and addiction specialists alike have long debated whether or not compulsive sexual behavior is the result of an "addiction," or merely an indicator of higher-than-average levels of sexual desire. 

A 2013 study led by Nicole Prause, a former researcher at the University of California, Los Angeles Semel Institute for Neuroscience and Human Behavior, has been instrumental in refuting the existence of sex addiction. The study, which investigated why some people are unable to moderate or control their viewing of sexual images, found that participants' brain responses to such imagery could no better be explained by hypersexual disorder than they could be by having a high libido. 

Other studies, however, have found that people who experience compulsive sexual behaviors do exhibit different responses to sexual stimuli when compared to their "healthy" counterparts. A 2014 study from the University of Cambridge showed that when viewing pornography, sex addicts' brains underwent activation patterns similar to those displayed by drug addicts in the presence of drugs. 

A question without an answer: Beyond the fact that there's little consensus over whether sex addiction is real in the first place, the study had a few other issues, such as the fact that it only surveyed men. Sex addiction is often considered exclusively a men's disorder, a belief rooted in gender stereotypes that men are unable to control their sexual impulses, while women simply aren't interested in sex at all. By only including men in the study, the report fails to consider the underpinnings of sex addiction in women or to acknowledge the possibility of its existence at all. 

According to Prause, the study also doesn't do much to make the case for sex addiction by acknowledging that it could be comorbid with another condition. "Comorbidity is not an argument for the existence of a disorder," she told Mic. "For example, many papers have argued sex addiction is 'comorbid' with depression or similar [conditions]. Comorbidity actually means hypersexuality may not actually be different from the entity they claim is comorbid." 

While the findings could be "potentially interesting," Prause said, the study failed to control for anxiety's effect on stress hormone levels, which tend to be elevated as a result of the condition. That means "the differences [the researchers] have attributed to hypersexuality may actually be due to anxiety instead," Prause said. 

It also overlooks other nonbiological factors that might just as well contribute to compulsive sexual thoughts and actions. Research has shown, for instance, that religious views and the social stigma associated with sexuality can play a significant role in identifying as a sex addict.  

"It seems very likely to me that the shame, conservative values and other anxiety known to be elevated in people who identify as hypersexual (or sexually addicted), none of which were controlled in the current study," Prause said, "may explain the pattern of results better than an invented diagnosis."

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