Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model

Journal of Sex Research,  August, 2004  by John Bancroft,  Zoran Vukadinovic

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The role of inhibition. Goodman's (1997) second theoretical concept is impaired behavioral inhibition. Inhibition of sexual response is, according to our theoretical model (Bancroft, 1999; Bancroft & Janssen, 2000), an adaptive mechanism across species, and we have developed a psychometrically well validated measure of the propensity for such a mechanism (Janssen et al., 2002a). The concept of low propensity for sexual inhibition has already proved useful in explaining some aspects of high risk sexual behavior (Bancroft, Janssen, Strong, Carnes, et al., 2003b; Bancroft et al., 2004). It is also central to our theoretical model of out of control sexual behavior, both as mediator in the paradoxical relationship between negative mood and sexual arousability and as a factor enabling sexual responses in risky or problematic situations. However, we only found partial support for our inhibition-based hypothesis with our small sample of sex addicts, and mainly with those who did not use masturbation as their principal form of sexual acting out. As discussed above, we may be missing some of the key aspects of inhibition with our SIS/SES questionnaire, and should certainly be prepared to explore other inhibition-related situations with different questions.

The neurobiology and psychopharmacology of sexual inhibition is complex, with an array of mediators and neuromodulators involved (Bancroft, 1999). However, serotonin does appear to play a crucial role. Kafka (1997) has proposed that a dysregulation of central monoamine function underlies out of control sexual behavior. Goodman (1997) reminds us of the difficulties in locating complex effects within the central nervous system or particular neurotransmitters, and the case has been made for formulating "conceptual systems" in the brain based on function rather than specific neurotransmitter mediation or anatomic location (Bancroft, 1999). There is a clear need for well-designed, controlled studies of selective serotonin reuptake inhibitor (SSRI) treatment for men and women with out of control sexual behavior, in which groups are carefully selected and matched for indicators of impaired inhibition as well as other behavioral characteristics.

While direct investigation of serotonergic mechanisms in the central nervous system is difficult in humans, development in the genetics of neurotransmitters offers a new and potentially informative approach for explaining individual differences. Do individuals who develop out of control patterns of sexual behavior have lower levels of serotonin transporter gene markers (Lesch et al., 1996)? Another new approach to the study of central inhibitory mechanisms is the use of brain imaging (e.g., Redoute et al., 2000; Stoleru et al., 1999), by which certain areas of the brain are shown to be deactivated during response to sexual stimuli with arousal. Brain imaging, particularly for the study of complex processes such as sexual arousal, is at an early stage of development, but there is considerable potential here for future research.