Episode 33 – Sex And Porn Addiction

Transcript

Hayley: Hey everyone, my name is Hayley, and this is Straight Talk With The Doc: a podcast that dives into topics on addiction, mental health, and treatment.

We explore subjects like substance abuse and harmful mental health disorders with the help of addiction medicine specialist Dr. Bhatt. Dr. Bhatt, how are you doing today?

Dr. Bhatt: I’m good Hayley, how are you?

Hayley: I’m doing great, thank you. Today’s topic is a little controversial in the sense that some question if an accurate diagnosis can truly be given to those with this disorder. Our topic today is sex and pornography addiction.

Studies report that 3% to 5% of adults struggle with some type of addictive sexual behavior. But it can be hard to differentiate between what’s normal human behavior and what reaches that threshold of becoming a diagnosable disorder. Dr. Bhatt, can you start by explaining what sex and pornography addiction is?

Dr. Bhatt: We hear that term in clinical practice, and I think sex addiction has gained some notoriety in the media due to some famous people who have come out and been reported on.

It’s often a misunderstood and stigmatized classification, and I use that term because in many different diagnostic manuals there is not really a formal diagnostic identification for that illness. When we see sex addiction or porn addiction, it’s really a combination of compulsive behaviors that involve either watching or utilizing or engaging in sex or with pornography in ways that cause impairment and destruction and difficulties in many aspects of one’s life — and often this causes a lot of distress to people’s relationships, to their finances, and to their professional lives.

So, when under the umbrella of sex or pornography, whatever that could mean to that individual — it could be watching things, it could be engaging in relationships, it could be paying for sex, and we can talk about that further — but under that criteria, when that impairment starts to occur, and it occurs in an impulsive, compulsive way, we’ve identified that as a sex addiction — and we can go into more detail as we speak further today.

Hayley: I know right now it’s not currently recognized in the DSM-5. Why is that?

Dr. Bhatt: Let’s first of all separate the 2, when we use the word “addiction” and add “sex” or “porn” in front of it. Because when we look at addiction, when it comes to traditional substances, there’s a lot of research that’s been done and there’s a lot of neuroimaging that’s been done and there’s been a lot of behavioral studies that have been done that have shown and demonstrated a commonality between the relationships — between the neurochemistry and parts of the brain that are activated or involved in the ultimate behaviors that substance use entails.

That’s not been fully demonstrated when it comes to sex. But not only that, because sex is a normal part of everybody’s life, there’s often a difficulty in us pathologizing that — and it is a subjective appraisal of what is considered normative or abnormal.

And so, being that there’s some inconsistencies there, it’s very hard for the American Psychiatric Association, the DSM-5, and other organizations around the world that are involved in classifying mental illnesses and behavioral addictions; they have not come to a conclusive criterion for identifying them.

But that does not mean people, sex therapists, sexologists, psychiatrists (who deal with people with different types of behavioral and psychiatric illnesses) don’t see people who are suffering with this — suffering with the problem of compulsive and sexual behaviors that are affecting their lives in negative ways.

We have to recognize this constellation of behaviors, and right now it’s appreciated as sex addiction — and I think, until it evolves further, that’s the term that’s going to be used. But, if you talk to many people who just focus on that, they’ll definitely say sex addiction is a major problem for many people.

Hayley: Like you said though, sex is a common part of most people’s lives — but I want to talk about the consequences. I think the dangers of a sex addiction are fairly apparent: you can get STDs, unwanted pregnancies, or infidelity. But what about pornography addiction? How can that negatively impact someone’s life?

Dr. Bhatt: I want to go back to the first part of your question. When we talk about sex addiction, and we’ll look at it as the term that we’re speaking about, it’s not just a physical act of having sex.

Many people who have these issues are often dealing with relationship problems, and they’re dealing with the actual pursuit of romance. They’re often not just in the act of gratifying themselves.

Even under this umbrella term of these sexual behaviors there’s multiple different types or patterns of this example, and 1 of them includes looking at pornography.

We know that pornography has a lot of cultural interpretations and a lot of religious interpretations of it being good or bad or morally acceptable or not, and even if it’s within pornography — it’s just watching somebody have sex with another — but then within pornography itself there’s so many different fetishes and types of it that border on everything from traditional reproductive sex to harming other people.

So there’s a lot of deviation from just reproduction. And where does that ultimately lead in terms of gratifying the person watching it?

When pornography and the pursuit of pornography and the use of pornography become so intrusive and so obsessive that you’re thinking about it every day, that you’re sneaking off in the middle of work and watching it, that it interferes with the intimate relationships with a partner that you have that you can’t now be gratified by them, or it brings up negative emotional experiences — then there’s a problem. Because if you are consistently pursuing something in an obsessive way and you’re getting anxious if you’re not able to gratify yourself or obtain it, and you’re using it to the point where it’s destroying your relationships, then it’s becoming a problem.

And it doesn’t just have to be sex or porn addiction. It can be any type of obsessive or compulsive type of behavior.

Hayley: People who have a pornography addiction, do they report all having common problems in their relationships? Is there something missing in their relationships?

Dr. Bhatt: For many people, you’ll see that they often look at pornography initially without any sort of pathology. But often if there’s something missing in their relationships, then it can serve a certain purpose.

Often, for many healthy relationships, pornography can serve as a way to stimulate one another and actually experiment and do things that benefit the relationship. But, often for many people, and males for example, who might masturbate while watching pornography, they might not be able to now achieve an orgasm because they’ve been looking at unrealistic expectations of this sexual act.

And so yes: watching excessive amounts of pornography, or pornography in a way that’s been pursued, or things that are missing in your personal life, or cause impairment in your personal life? Yes, this becomes a problem.

But many people are looking at it because they are either adverse — they might have anxiety, they might not be able to engage in physical human beings (a real-life human being), so they have to now watch it on television or through the internet.

The fact that we do have the pervasiveness now, the availability of pornography, let’s just face it: pornography is now accessible. It’s available anywhere; you get on the internet and now it’s just available — so for people who may not be able to go out and meet people, it might substitute and act as a surrogate and you start having relationships there.

And being that the internet now can facilitate having relationships online, through emails, through chatrooms, and whatever, it kind of negatively self-reinforces. So if there is something missing in your life — if there’s something that’s absent from you, if you’re suffering from an anxiety disorder, if you can’t solve what’s going on with you — often that artificial mechanism with a lot of boundaries or things in the middle? It serves that purpose to have that quote-unquote “intimacy” in an almost non-intimate fashion.

Hayley: I guess it’s almost a chicken or the egg debate: are people pursuing their sexual addiction because they’re unhappy in their relationships, or is the sexual addiction causing the problems in their relationship?

Dr. Bhatt: Yeah, I think once you’re at that point it becomes bidirectional. I think it does become that one tends to worsen the other. It’s hard to pinpoint what might have come first unless you’re actually exploring an individual’s history, and then you might be able to pull that out. But once it’s starting to become prevalent, they will probably feed off one another.

Hayley: There are more reports of men having sex addiction than women. Is this a matter of women underreporting, or are there biological or social reasons why men have higher rates?

Dr. Bhatt: I think it’s all of those things that you just mentioned.

Women are stigmatized for years for even talking about their own sexual wishes and their sexual behaviors; there is a double standard that has existed in society for hundreds and hundreds of years when it comes to men versus women and the subject of sex.

Women have — out of shame, or whatever personal reasons — they’re less willing to come forth when they have a problem. And that’s unfortunate.

But that’s also, again, a responsibility that society has in making women feel that way. And then there’s also men and the hormonal issues with men and often sex drives — not that women have less of a sex drive than men — and this is not just only about sex drive; I don’t want to make this purely just biological and not psychological when they’re tied together. But I think the biggest thing is, without going into too much detail, yes: societal issues have a major role to play, and men biologically have been conditioned too: to engage or be accepted in having sex and being, again, negatively reinforced.

A man is called a stud, a man’s called cool, a man’s called whatever because of how many sexual partners or when he engages in sexual activity. But we don’t have that same nomenclature when describing a woman who is doing that.

So imagine then if you now have a problem with it and you’re being promiscuous, or you’re acting out, or you’re doing something — it becomes very hard for women to do this, so we’re going to probably have a lower collective data on this stuff. And as a result, we might perceive this as men having more of the problem than women. So everything you mentioned all correlates together as to why we see men having this more than women.

Hayley: Speaking of demographics, at what age do you most often see people presenting with a sexual or pornography addiction?

Dr. Bhatt: We’ve seen this often in younger to middle-aged adults.

People who are often in treatment — I see it often in my community because I treat predominately those who suffer with addictions in general, substance and chemical addictions, and it’s very high comorbidity in that population.

I see it in the age group between 20 and 50 — and that’s often, again, correlated with a substance of abuse. And let’s just be frank: it’s often difficult to tease out because many people use their drugs to facilitate sexual behaviors. And that doesn’t necessarily mean it’s a deviance, a deviant type of behavior or any disorder, but it does become hard to tease out because many people who are using Methamphetamines or Cocaine — they are using it to actually enhance or have more energy to engage in sexual gratification.

But again, when we’re dealing with mental illness and we’re dealing with sex addiction and we’re dealing with substance use disorders, there is a relationship between all of them. So in our clinical population you’re going to see the comorbidities exist, but with the age group that I’m talking about I see it between 20 and 50 years old — and often one helps promote the other.

One other thing I would like to add is that it’s not just about the physical act of sex. For many women that we see it’s often the pursuit of that love addiction, the pursuit of the actual engagement of wanting to be in a relationship, and feeling that lust, feeling that wanted-ness, feeling that whole high and that euphoria and feeling well, and that’s where that dopaminergic surge comes, the feel-good pleasure chemical, the reward chemical for that.

It often plays out in cycles and, after that initial phase goes away, then we see the relationship fall off — and then the pursuit to be in another relationship again because we have to pursue the high. So again, I know we’re calling this sex addiction, but that doesn’t necessarily mean it has to do with the physical act of sex. It can involve intimacy, it can involve love, and it can involve just being in a relationship. There’s nuances to this.

Hayley: Are those who have a compulsive sexual addiction more likely to abuse substances than those who don’t?

Dr. Bhatt: In some studies I’ve seen it high, like 40% of people who have some sort of obsessive sexual behaviors do have co-occurring substance use disorders. I’ve seen people with eating disorders, gambling disorders — there are those co-occurrences that are there — but chemical dependency seems to be the highest when it comes to obsessive types of sexual behaviors.

Hayley: What types of therapies exist to treat these disorders?

Dr. Bhatt: There are many types of psychotherapeutic interventions. If it’s affected couples, couples therapy is a big one, and those who are certified in treating sexual addiction are often focused on this.

So psychotherapies exist and cognitive behavioral therapies exist to help realign certain types of thoughts into more healthy behaviors; that’s where the cognition and the behavioral comes together.

There are also medications that can be used depending on what type of sexual behavior we’re talking about. There are Antidepressants and anti-anxiety agents that have shown to benefit, especially in certain people who might have hypersexuality or people who have the need for gratification all the time. Medications can help.

There are also support groups, sex addict support groups that mimic 12-step models or are based on the 12 steps and help people with overcoming this and supporting one another, and process is huge in this.

One thing that goes with any sort of behaviors that are often destructive or damaging to one’s mental health or environment or their lives is that they have often unresolved conflicts, unresolved issues — whether it be trauma, abuse, depression, anxiety, some physical ailment, some issue that’s happened in their life that hasn’t been processed well — and it can often be having to deal with how they were brought up and issues with how they’ve identified with males or females.

But the point is there are multifaceted therapies that are out there and that people do focus on, so for people who do suffer with watching pornography too much or engaging in sex too much (or somewhere in their lives where this is becoming a dysfunction or impairment and causing distress) there are treatments and modalities out there for people to get help.

Hayley: Is there anything else on this topic that you think people should be aware of?

Dr. Bhatt: There’s this taboo, again; there’s a lot of shame that has to go with this because there’s so many cultural and religious and just societal views on sex and pornography and anything that’s related to this.

It’s often a very, very embarrassing topic and I think it’s one of the most underreported — and I think we, as mental health practitioners and people who work in substance abuse, as I said, because there is a high co-occurrence there, we have to help, we have to explore, and we have to screen for it too.

I do believe there is often this interplay between trauma and certain behaviors that may result, that we do have a role. Regardless of if it’s in primary care, if it’s in pediatrics, if it’s going in to the addiction and treatment world for substance use, there is a place and a role in an appropriate screening type of thing that does fit the discipline that I just mentioned that can either be in a primary, secondary, or tertiary type of prevention that can help people who suffer with — let’s call these obsessive sexual behavioral issues — sex addiction, so that people who may be embarrassed, who are filled with shame, don’t go untreated or unaddressed.

I think we have responsibility here in this case, as well as obviously encouraging people to — although it may be embarrassing and may be something that they’re ashamed of — to please go out and seek that help.

Hayley: Absolutely. Thank you for going over all of this, Dr. Bhatt.

If you want to learn more, we have more information on sex, love, and porn addiction at addictioncenter.com (as well as more podcast episodes). Episodes are also available on Spotify, Apple, and Google Podcasts, so make sure to check those out — and thank you for tuning in to this episode of Straight Talk With The Doc.