Saturday, November 14, 2009

Pornography and Sexual Addiction

I recently supervised a psychologist on a case in which I was introduced to a verb that was new to me - porning. This was a word that was used by the patient to describe his compulsive engagement in online pornography and masturbation. He revealed that he would spend hours and hours 'porning' at the expense of other activities and at the expense of engaging in real relationships.

Pornography has grown exponentially over the last decade, encouraged by cultural shifts around issues of sex and sexuality and by the expansion of technology and the internet. As a result, more and more patients are presenting with primary or secondary concerns around compulsive sexual behaviors, which sometimes includes the use of pornography.

Some of these compulsive sexual behaviors include compulsive masturbation, anonymous or near-anonymous sexual encounters, frequent and indiscriminate 'hooking up', frequent visitation to strip clubs and 'massage' parlors, voyeurism, exhibitionism, sadomasochism and the compulsive use of internet pornography.

According to recent statistics, 40 million people regularly visit pornography sites; 72% male and 28% female. Every second, approximately $3100 is spent on pornography. Asian countries, like China, South Korea and Japan, make a total revenue of $75 billion per year on internet pornography alone. The United States makes a total revenue of about $15 billion per year on internet pornography. According to some statistics, an astonishing 12% of all website are considered to be pornographic, and 20% of these are considered to be child pornography.

With such increasing access to sexual images, sexual addictions appear to have become more commonplace than ever before. In fact, in many ways, our culture has moved towards glorifying such compulsive behaviors, evidenced by the success of such television shows as 'Californication' and 'Sex and the City'. These shows have served to normalize compulsive sexual behavior in both men and women, allowing for a more open discussion of the issue.

Sexual addictions, like all addictions, arise from the combination of satisfying a physiological desire and a psychological need. Like other addictions, the pleasure centers of the brain (specifically, the nucleus accumbens), play a significant role. In addition to cocaine and amphetamine, almost every recreational drug has been shown to increase dopamine levels in the nucleus accumbens. Thus activating this part of the brain by engaging in these compulsive behaviors, results in dopamine release deep within the limbic system of the brain. This is the true physiologic addiction.

Of course, there are significant psychological factors that contribute to sexual addiction. Many psychologists understand that sexual addiction often emanates from an attempt on the part of the patient to self regulate and self soothe. While some patients become orally fixated and utilize alcohol or food to compulsively provide this soothing, a person's genital can sometimes become a substitute to compulsively gratify these early needs. Sometimes this genital/sexual preoccupation results from neglect, where the child has been left with only his or her sexual pleasure for comfort. At other times, this genital/sexual preoccupation occurs as a result of trauma. While experiences such as childhood sexual abuse or traumatic sexualization serve to compound the possibility of sexual addiction, sexual addiction is not a necessary sequelae of sexual abuse. However, for those with such a history of trauma and resulting sexual compulsivity, their compulsive sexual behavior can be described as 'abuse reactive'. That is, their compulsive sexual behavior remains some way of perpetually re-enacting and/or attempting to re-work their earlier traumatic experiences.

One patient described her compulsive masturbation which resulted in her spending entire weekends locked in her apartment, masturbating and binge eating. For this patient, her feelings of extreme deprivation and need for gratification were enormous and were reflected in her insatiable appetites. This, behavior of course, was followed by tremendous feelings of guilt, shame and self-loathing, which ultimately resulted in a greater need for self-soothing. Psychotropic medication to address the patient's impulsivity and powerful need for dopamine in her brain's pleasure centers, coupled with three times a week psychotherapy, led to a significant decrease in this patient's compulsive masturbation and binge eating.

Another patient presented in couples therapy to address the impact of his chronic cheating behaviors. The patient, who had justified his frequent cheating as part of his culture and his 'natural' large sexual appetite, was having to face the destructive relationship consequences of his sexual escapades. Further work revealed a history of premature (and ultimately traumatic) sexualization, which resulted in cementing the patient's identity around his sexual prowess.

Treatment for sexual addictions has become more commonplace, with the increase in the number of treatment facilities aimed specifically at sexual addictions. 12-Step self-help groups like SAA (Sex Addicts Anonymous) and SLA (Sex and Love Addicts Anonymous) have also grown in membership as people are less ashamed to acknowledge their addictions. A string of high profile people forced to acknowledge sexual addiction (e.g. former NY Governor Eliot Spitzer, TV actor David Duchovny) and former President Bill Clinton's documented struggle around sexual behavior have served to highlight the pervasiveness of this problem.

Untreated sexual addiction, like any other addiction, ultimately results in numerous personal consequences for the addict, but also results in significant social problems for any society. As sexual boundaries become more diffuse, and as sexual addiction more pervasive, all of us (and our children) become increasingly at risk for being exploited to meet the addict's needs. Parents should, therefore, pay special attention to their children's online use and openly address internet pornography use as well as their children's developing sexuality. Parents should not assume that this issue does not affect their child. Statistics indicate that the average age at which a child is likely to first encounter online pornography is 11 years. Children are able to become addicted to pornography in the same ways that they are able to become addicted to drugs, and parents should, therefore, give importance to this growing problem. They, too, might be out there, porning.

1 comment:

  1. I do agree that parents should pay attention with their children everytime they were on the internet so that they help their children to avoid accessing in the porn site.

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