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    Sex Addiction - Still Not A Real Thing
    By Hank Campbell | July 20th 2013 07:30 AM | 9 comments | Print | E-mail | Track Comments
    About Hank

    I'm the founder of Science 2.0®.

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    Is sex as addictive as cocaine or alcohol?

    It depends on who you ask. Obviously there is an entire industry built up around the idea that it is, just like there is an industry build around homeopathy and curing gay people, but that doesn't mean the NIH should be funding those things.

    A new study sets out to puncture the notion that sex addiction is an actual physical addiction rather than a new label created in an era when psychologists and psychiatrists had set out to over-pathologize everything (which may be coming to a close - the NIH said they are not going to use DSM 5 for anything more than light reading, so there is no longer an incentive to create new diseases which will be valid on insurance claims) - of course the study examining the reality of sex addiction uses another questionable method; hooking people up to a machine and measuring a response and comparing it to survey results.

    Dr. Brian Mustanski interviewed the senior author of a new study of sex addiction at Psychology Today:
    We found that the brain’s response to sexual pictures was not predicted by any of three different questionnaire measures of hypersexuality. Brain response was only predicted by a measure of sexual desire. In other words, hypersexuality does not appear to explain brain differences in sexual response any more than just having a high libido.
    What should make people happy: Dr. Nicole Prause wrote, "If our study is replicated, these findings would represent a major challenge to existing theories of sex addiction" - those first five words tell us we are dealing with someone serious. 

    Are examinations of the brain, in this case EEGs because they wanted to see when something is happening rather than where, valid? Typically, imaging studies suffer from being underpowered and the analysis team uses methods that don't control the level of false positives very well. When results look plausible, mistakes are not caught (see a nice overview by author and neuroscientist Daniel Bor) because the researchers have both 'skewed incentives' (1) and no standard ways to measure what brain responses mean. In the case of the study Prause did, they were matching a baseline physical response to answers to survey questions.

    They might be fighting an uphill battle examining the existence of sexual addiction. Obviously mainstream media rewards flashy papers - science journalists love to print stories where specific areas of the brain are linked to specific behavior - and that is an incentive for researchers too. For example, if someone creates a study linking fMRI and surveys to liberals being smarter than conservatives, how many publications will rush to print that?  Well, that has happened, so we know just about all of them - and even better if there is mumbo-jumbo about epigenetics in there. (2) It may also be that science journalists have become so consumed with 'science acceptance' that they don't want to look like they are skeptical of anything and are afraid to ask the awkward questions of scientists that they should be asking.

    Luckily, fellow neuroscientists are not afraid to ask those awkward questions - they are the ones highlighting the big concerns of imaging studies. They just get a tiny fraction of the coverage that the imaging claims themselves get.

    Do Mustanki and Prause have it in for sex addiction? Perhaps. When psychologists put psychological concepts in quotes, they are often meant to be scare quotes, the same way most people intend them that way, so even using the term sex "addiction" means they are not buying it, but a little skepticism is needed in social science so that's fine.  We just have to try and calibrate it. If a skeptical researcher were to discuss Mustanski's bio and write Mustanski's research focuses on understanding the "development" of sexual orientation (my quotation marks) it would be done to make the audience know that they do not believe sexual orientation develops, so quotes can often be a caution for the reader about the intention of the writer.
    What does this mean for those in treatment for sex addiction now?

    Nothing. The study needs to be replicated. Alternative explanations need to be explored. If the wrong model is currently being used to provide treatments, we must find the right model to help people struggling with their sexual behaviors. We’re working on it!
    That has to warm your heart about the future of the field. No self-help book in the works, no 'only center in the world to offer X Brand Name Treatment for Disease Y' stuff.  Let's reproduce it and if it holds up, go after the proper issue rather than making all behavior exculpatory - the way 'I have a disease' claims and analogies are used now to make suspect behavior a little more acceptable. In The Onion's hilarious form:

     I'm Like A Chocoholic, But For Booze



    Do some people have self-destructive behavior about sex? Well, sure, just like some people are 'addicted' to watching "TMZ" every day at 5 PM or finding the Holy Grail too. (3) That doesn't make them their own clinical issues, it is just symptomatic of something else. Psychiatry will join the 21st century and leave symptom-based diagnosis behind, like the rest of medicine has.  And some critical self-awareness in the field is a good start.

    Study: Vaughn R. Steele, PhD, Cameron Staley, PhD, Timothy Fong, MD and Nicole Prause, PhD, 'Sexual desire, not hypersexuality, is related to neurophysiological responses elicited by sexual images', Socioaffective Neuroscience&Psychology 2013, 3: 20770 - DOI: 10.3402/snp.v3i0.20770

    Article/Interview: New Brain Study Questions Existence of “Sexual Addiction" by Dr. Brian Mustanski, Psychology Today

    NOTE:

    (1) Obviously that is not limited to brain studies.

    (2)  But a paper claiming that conservatives were smarter would be examined more critically and Knight Science Journalism Tracker would be scouring the Internet for evidence of an agenda by the researchers.   It isn't just psychology that engages in confirmation bias.

    (3) Me, and then the father of Indiana Jones for that second part.

    Comments

    First, this study was NOT about sex addiction, it was a shoddy attempt to study Internet porn addiction.

    This study is a joke. The authors manipulated data to produce their single correlation: EEG readings with sexual desire. They did this by removing questions from a standardized test called the sexual desire inventory (SDI). In fact the creator of the SDI (Ilana Spector) stated that researchers misused the test because they removed all the questions about masturbation - the very activity subjects had trouble controlling.

    In addition, the subjects were of all sexual orientations, yet they were all shown the same pictures - heterosexual sex. Does anyone think that a gay man will have the same response to heterosexual porn as a straight man?

    The authors had no control group, so they have no idea if the response was normal or not. Google - "UCLA's SPAN Lab Touts Empty Porn Study As Ground-Breaking" - for complete refutation of this bogus study.

    Your attempt to discount behavioral addictions is empty as Pathological Gambling is recognized as a true addiction, and the new DSM5 contains a behavioral addiction category. Rather than look to the DSM, I suggest hard science. Three decades and thousands of studies have identified that all addictions share the same fundamental mechanisms and brain changes. All are initiated by the transcription factor DeltaFosB, which accumulates at high levels in the nucleus accumbens to cause the addiction phenotype. In the past 3 years 50 brain studies on internet addiction (includes porn use) have found the same brain changes as seen in drug addiction.

    Hank
    I am inclined to agree with some of what you write and said "of course the study examining the reality of sex addiction uses another questionable method; hooking people up to a machine and measuring a response and comparing it to survey results."

    After that, I wouldn't count on DSM 5 for much - it isn't going to be used by anyone except people who need to find a name for behavior or truly serious and well-established issues. Saying that an image that is similar in an addiction and any behavior is not "hard science" - you don't seem to know what a hard science is, so let's just eliminate that term and move on. The same images are seen when people play video games and watch Mary Tyler Moore reruns - that does not make them addictions.
    Qoute -Saying that an image that is similar in an addiction and any behavior is not "hard science" - you don't seem to know what a hard science is, so let's just eliminate that term and move on

    This statement makes no sense. Are you trying to discuss fMRI's? If so you are dead wrong, as the 50 Internet addiction studies I'm talking about are measuring the cellular and structural changes that occur with addiction. I know you want to ignore the word hard science, but address the fact that all addictions are initiated by a singular molecular switch - deltafosb.

    And comment on the peer-reviewed studies below (use Google). All found the same brain changes as seen in drug addiction. Two of the studies followed addicts through recovery and saw a reversal of brain changes.

    Influence of excessive internet use on auditory event-related potential (2008)
    Decision-making and prepotent response inhibition functions in excessive internet users (2009)
    Gray Matter Abnormalities In Internet Addiction: A Voxel-Based Morphometry Study (2009)
    Impulse inhibition in people with Internet addiction disorder: electrophysiological evidence from a Go/NoGo study (2010)
    Differentiation of Internet addiction risk level based on autonomic nervous responses: the Internet-addiction hypothesis of autonomic activity (2010)
    Increased regional homogeneity in internet addiction disorder a resting state functional magnetic resonance imaging study (2010)
    Reduced Striatal Dopamine D2 Receptors in People With Internet Addiction (2011)
    Microstructure Abnormalities in Adolescents with Internet Addiction Disorder. (2011)
    Preliminary study of Internet addiction and cognitive function in adolescents based on IQ tests (2011)
    P300 change and cognitive behavioral therapy in subjects with Internet addiction disorder: A 3 month follow-up study (2011)
    Enhanced Reward Sensitivity and Decreased Loss Sensitivity in Internet Addicts: An fMRI Study During a Guessing Task (2011)
    Male Internet addicts show impaired executive control ability evidence from a color-word: Stroop task (2011)
    Pornographic Picture Processing Interferes with Working Memory Performance (2012)
    Effects of electroacupuncture combined psycho-intervention on cognitive function and event related potentials P300 and mismatch negativity in patients with internet addiction (2012)
    Abnormal White Matter Integrity in Adolescents with Internet Addiction Disorder: A Tract-Based Spatial Statistics Study (2012)
    Reduced Striatal Dopamine Transporters in People with Internet Addiction Disorder (2012)
    Abnormal brain activation of adolescent internet addict in a ball-throwing animation task: Possible neural correlates of disembodiment revealed by fMRI (2012)
    Impaired inhibitory control in internet addiction disorder: A functional magnetic resonance imaging study. (2012)
    Impaired Error-Monitoring Function in People with Internet Disorder: An Event-Related fMRI Study (2013)
    Comparison of Psychological Symptoms and Serum Levels of Neurotransmitters in Shanghai Adolescents with and without Internet Addiction Disorder: A Case-Control Study (2013)
    Resting-state beta and gamma activity in Internet addiction (2013)

    Hank
    This statement makes no sense.
    I was showing you that the way you use the term 'hard science' is not correct. Psychology is not a hard science, nor is any aspect of neuroscience, including fMRIs. Documenting a bunch of instances where fMRIs are used is also not - obviously using scans and implying cause and effect is flawed, since there are zero standards for how they are used. It doesn't mean they are wrong by default but they are not, as a group, validating anything simply by being the methodology.

    Using fMRI I can find a telepathy center in the brain. So if you believe in telepathy...SCIENCE!  Otherwise, no.
    You don't seem to grasp that thousands of animals studies over the last 30 years have identified the specific mechanisms and cellular alterations that lead to the addiction phenotype. Within the limits of technology, changes have been identified in human and primate subjects. Unlike vague mental processes addiction can be induced and ameliorated by activating and deactivating specific genes. Try that for telepathy.

    Still not citing anything or addressing the science given. All addictions, both behavioral and chemical are initiated by the same molecular switches (deltafosb, BDNF), which lead to the same shared set of brain changes, which are reflected in behaviors, signs, and symptoms of addiction.

    Thanks for the empty answer.

    Gerhard Adam
    Yet, one question in terminology that seems to not be addressed is distinguishing between a true addiction versus simply self-indulgence.
    Mundus vult decipi
    Bonny Bonobo alias Brat
    Ha ha, now that is such a Gerhard comment!
    My article about researchers identifying a potential blue green algae cause & L-Serine treatment for Lou Gehrig's ALS, MND, Parkinsons & Alzheimers is at http://www.science20.com/forums/medicine
    As the Principal Investigator for the DSM-5 Field Trial on Hypersexual Disorder that was submitted to the American Psychiatric Association, I respectfully disagree with the conclusions being drawn from the findings in this study conducted by my colleague Dr. Prause at UCLA (whose office incidentally is right next to mine here at UCLA) While her results are certainly interesting, they fall short of discounting the legitimacy of hypersexuality among treatment seeking patients. I’ve posted my critique of her study on my website: http://www.rory.net/Pages/PrauseCritque.html

    Dr. Rory Reid
    Assistant Professor / Research Psychologist
    UCLA Department of Psychiatry

    Hank
    Hi Rory, it's an open science community, you can get an account and post it here, if you think it stands up to worldwide scrutiny. To me, "If the wrong model is currently being used to provide treatments, we must find the right model to help people struggling with their sexual behaviors" seemed pretty reasonable on Prause's part.