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 motivational reward system. Goodman's (1997) third theoretical concept is aberrant function of the motivational reward system. So far, we have little to say about how reward and incentive mechanisms may help to explain out of control sexual behavior. However, we are open to the possibility that some changes in sensitivity of the incentive reward system may occur as part of the establishment of an out of control pattern, changes comparable to those associated with chronic use of addictive drugs (Robinson & Berridge, 1993) and that may be relevant to "behavioral addictions" of various kinds (Holden, 2001). Once again, such mechanisms are difficult to study in humans, but brain imaging offers possibilities for the future (e.g., Breiter, Aharon, Kahneman, Dale, & Shizgal, 2001). However, until we have further understanding of such mechanisms, we should regard the concept of sexual addiction as no more than an analogy that may have beneficial effects, at least for some individuals, in therapeutic programs.

Self-regulatory failure. In addition to Goodman's three components, general issues of behavioral regulation deserve attention. To what extent is out of control or unregulated sexual behavior similar to other out of control behaviors like binge eating or overspending? Baumeister and Heatherton (1996) provided a useful theoretical approach to failure of self-regulation, which they described as a multifaceted process that can break down in several different ways. They paid little attention to sexual behavior in this article, but their theoretical analysis is relevant in several respects. They described three ingredients of self-regulation: (a) standards, (b) monitoring, and (c) the operative phase of regulation. Standards are of interest for our study, in particular the dilemma of conflicting or incompatible standards, which can undermine regulation. For five of our male sex addicts, religion was very important. It is not difficult to see how, in such cases, the unquestionable moral unacceptability of most types of sexual behavior would conflict with one's sexual impulses to undermine any sensible pattern of regulated sexual behavior. Thus, an individual who believes masturbation is evil and who has strong impulses to masturbate using the Internet will be unable to see that a regulated pattern of masturbation can be a responsible way of dealing with one's sexual needs. Coleman (1986) proposed that highly restrictive attitudes about sexuality result in inability to conform, starting off the cycle of guilt, pain, and compulsivity. We would suggest that such mechanisms might be important in some cases.

Monitoring is clearly important to effective self-regulation, and Baumeister and Heatherton (1996) suggested that alcohol as well as fatigue and stress can impair normal monitoring. Sexual arousal may also have this effect, and we have examined this closely in heterosexual and gay men in relation to sexual risk management (Strong, Bancroft, Carnes, Davis, & Kennedy, 2003). On the other hand, our theoretical model discussed above proposes that inhibition of sexual arousal may be an adaptive mechanism that could facilitate self-regulation. If correct, this could set sexual behavior apart from other types of behavior requiring self-regulation. Nevertheless, the individual with low propensity for inhibition of sexual arousal will be faced with the same self-regulatory challenge posed by other behaviors, such as eating.