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Scrittura
Sexual addiction
The term sexual addiction refers to patterns of involvement in sexual stimulation activities that a person is unable to control, either in pursuit of pleasure and satisfaction or despite being aware of an unwanted harmful consequence.
In general, being addicted means having lost, and being unable to regain, control over an appetitive behavior—that is, the desire to have and consume something. A situation of control exists when an individual considers the condition in which they consume an object or engage in a behavior desirable, regardless of how intense, prolonged, or risky that involvement may be. Control is lost when the behavior is repeated despite general dissatisfaction or despite damage to other areas of the individual’s life, making the behavior undesirable.
The sexual behaviors that most easily lead to addiction are those involving self-stimulation through pornographic material, “physical” aids such as mechanical objects, or various forms of autoerotic activity, ranging from masturbation to painful stimulation. This also includes behaviors practiced with other people, usually prostitutes, which are essentially freely manageable because they are “paid for” and therefore readily available and repeatable on demand.
It is not the behavior itself that is pathological, but the lack of control in relation to the gratification the individual seeks to obtain. It follows that a behavior that no longer provides satisfaction under normal circumstances should eventually cease, even if it was previously gratifying, because it has stopped being so.
If this does not happen, and the person is unable to stop perceiving the behavior as gratifying despite the actual experience being disappointing, control has been lost. Similarly, if the person is unable to organize their behavior so that it fits into their life when and how they choose—that is, freely—they eventually sacrifice the rest of their life to the urge to engage in the behavior whenever the craving arises, and thus become enslaved to it.
It also becomes increasingly difficult to obtain the resources needed to sustain the behavior itself, such as financial resources. Even if the behavior remains gratifying in itself, there is no longer any overall satisfaction, and obtaining that gratification becomes increasingly difficult because of the person’s inability to manage the desire.
For example, a person with hypersexuality may choose the pornographic material they prefer or the paid partners they prefer, whereas a person with sexual addiction may eventually spend so much time searching for these things that they no longer have substantial resources available to them—because they can no longer work or maintain a social life—and therefore may settle for the first things they find, even accepting various risks (hygienic, infectious, or environmental) in order to engage in the behavior immediately.
Sexual addiction is typically a male problem. A study examining the human brain’s responses to sexual stimuli demonstrated that pornographic scenes produce, in men but not women, a state of sexual arousal that translates into an urge to have sex indiscriminately with theoretically available partners (Hamann, 2005).
Visual stimulation, through the brain, produces an erection in the context of the activation of a genuine cycle of sexual arousal that tends toward orgasm.
This also occurs in animals, both spontaneously through the mechanisms linking mating to male attention toward female sexual areas, and experimentally. Males display “active” sexual behavior and therefore are driven to engage actively when stimulated by natural sexual images (female sexual areas), while foregoing other activities such as eating.
In addictions, so-called paraphilias, or sexual deviations, also often appear. These involve particular pathways toward sexual gratification that frequently do not include complete genital intercourse.
Paraphilias are variations in sexual fantasy or practice that do not ordinarily cause distress, although they may involve illegal or socially embarrassing behaviors or various types of risk. Paraphilias can become problematic for the individual when they acquire the characteristics of an addiction.
The person may complain both about their inability to control the paraphilia and about its intrusion into ordinary sexuality, which under normal circumstances would nevertheless have remained the central focus of their sexual activity, with the paraphilia representing only one variation of it.
Masturbation is a particular case because, rather than being a paraphilia, it represents a substitute activity. It can acquire the characteristics of an addiction through a pathway that makes it particularly gratifying, usually involving pornography, or voyeurism—that is, “live” pornography experienced through paid encounters, by watching other people engage in sexual activity, or clandestinely by spying on people engaged in sexual activities.
A person who habitually masturbates is usually troubled by the fact that they cannot have their ideal object of desire and must settle for masturbation. Sometimes, however, the person ends up socially isolating themselves or developing impaired social functioning because their sexuality has been taken hostage by masturbatory activity.
Alternatively, masturbation becomes pathological when an increase in frequency is accompanied by decreasing satisfaction, which is pursued desperately or compulsively but unsuccessfully, or when it results in a demoralizing and embarrassing condition for the person.
Pathological masturbation is commonly called “compulsive” masturbation, although this actually creates the incorrect impression that it represents a variant of obsessive-compulsive disorder.
Sexual fantasy differs from an obsession because it is actively sought, produced, and maintained as a means of gratification. Similarly, masturbatory activity is not carried out against the person’s immediate will, but rather, if anything, against their broader intentions.
Treatment approaches
Therapeutic approaches to sexual addiction generally focus on four areas:
a) Reducing the sexual drive or interfering with the orgasmic cycle.
This goal is often pursued through the use of antidepressants. While these medications can reduce active sexual desire, urgency, and excitability and can lengthen the time needed to reach orgasm, they can also, in some cases, increase impulsivity and sexual thoughts, thereby creating an even worse situation.
b) Reducing overall impulsivity through anti-impulsivity medications.
By stabilizing mood over time, these medications tend to reduce the duration, intensity, and severity of episodes of intense sexual craving.
c) Increasing internal gratification.
The aim is to make the urge to seek additional gratification less urgent and less frequent, at least in the absence of stronger external stimuli.
d) Interfering with orgasm.
The aim is to make the pleasurable component of orgasm progressively less intense, particularly in its final phase.