Both sexual anorexia and sex addiction can co-exist.
In his most recent post, Dr. Ley confides that he’s bit worried “that scientists and researchers and theorists are agreeing that sex addiction is real.” He thinks politics are at play, but gives no reason why addiction researchers, the same ones who haven’t yet studied the brains of porn addicts, would make such a bold claim.
Perhaps these addiction neurobiologists are depending on science and not hidden puritanical leanings. Dr. Ley continues to ignore basic physiological principles on which these researchers base their conclusion that sex addiction is real. In particular, he is ignoring these basic tenets:
1) Drugs of abuse only amplify or decrease normal physiological mechanisms.
This means that evolved mechanisms for addiction already exist in the brain (to keep us eating, mating, drinking water, and bonding to one another). Addictive drugs simply hijack these mechanisms and circuits. Is Dr Ley suggesting that a separate, undiscovered brain circuit exists for sex or Internet porn use?
2) A collection of specific signs and symptoms point to underlying pathological changes. When a diagnosis is given, it indicates that a specific collection of anatomical and physiological abnormalities have occurred. Clinical diagnosis is based upon these simple concepts. This was the primary message from ASAM: a collection of signs, symptoms, and behaviors represent a specific set of brain alterations.
The “four C’s” are one way to assess addiction:
- Inability to Control use
- Compulsion to use
- Continued use despite adverse Consequences
- Craving – psychological/physical
Men on our forum who self-identify as porn addicts manifest withdrawal symptoms when they stop using porn, and exhibit all four C’s of addiction.
It’s illogical to suggest that a porn user with all the signs, symptoms and behaviors of addiction cannot have the brain changes found in all those with chemical and behavioral addictions who are showing similar signs and symptoms.
The argument that porn addicts’ brains have yet to be scanned (not completely true) is immaterial, as doctors don’t use brain scans to diagnose addiction. Furthermore, other brain conditions such as Alzheimer’s and Parkinson’s disease are commonly diagnosed without the aid of brain scans.
3) All addictions involve the same major changes in the same neural pathways. The major changes found in all addictions include:
a) Desensitization: Involves a decline in D2 receptors and dopamine. This manifests as experiencing less pleasure from natural rewards, leaving the addict less sensitive to pleasure, and “hungry” for dopamine-raising activities/substances of all kinds.
b) Sensitization: The strengthening of synaptic transmission leading to abnormally high dopamine release in response to using and addiction-related cues.
c) Hypofrontality: Involves a decline in frontal cortex gray matter and metabolism, and derangement of white matter. The frontal cortex is the seat of executive function, impulse-control, and the ability to foresee consequences.
The above brain changes reflect adaptations to excessive stimulation of the reward circuitry. It was once thought that these changes were caused by the toxic effects of drugs, but new research shows they also occur in those with food addiction, gambling addiction, and yes, Internet addiction.
If all research points in one direction, it is illogical to search for another cause of a characteristic set of behaviors. This is why ASAM (whose membership includes some of the top addiction researchers in the world), emphatically states that sexual-behavior addictions exist.
The obvious question for Dr. Ley is this: If a self-identified Internet porn addict has all the signs, symptoms and behaviors common to all addictions, what possible brain changes are causing this collection of symptoms? (Addiction test by APA)
- Please explain what physiological mechanisms are involved if not addictive brain changes.
- Then explain how it is that porn or sex addiction is the one and only exception to the rule.
Is it not political to ignore basic physiology and clinical evidence so you can make one exception to the rule?
Sexual Anorexia and Hypersexuality Co-existing?
Dr. Ley: The definition of sex addiction includes both sexual excess as well as “sexual anorexia,” defined as “behavior that is compulsively aversive to sexual activity.” How can you argue against or disprove a diagnosis that encapsulates both the presence of a symptom and its absence?
This question reflects a lack of understanding of basic addiction neurobiology. It’s like asking why a morbidly obese food addict no longer cares for celery sticks, or why a cocaine addict no longer enjoys lazy strolls in the park.
Answer: both sensitization and desensitization are at work in the brain of the porn addict.
I think Dr. Ley is referring to the survey by the Italian Society of Andrology and Sexual Medicine, which found copulatory impotence and “sexual anorexia” in otherwise healthy young men. As the urologist reported, these men suffered porn-induced ED, yet recovered through abstaining from porn use.
I guess Ley is saying the “hypersexuality” half of his question would be the men continuing to use porn despite negative consequences (i.e. copulatory ED). This is sensitization at work.
Sensitization involves structural changes in which the addiction, or addiction-related cues, stimulate the reward circuitry far more than other rewards. This is the basis for cravings. Brain studies reveal that cues (seeing a crack pipe) can jack up dopamine as much as taking the drug. With many Internet porn addicts, sensitized pathways lead to a far greater rush in response to porn cues than to other natural rewards, including sex with an actual partner. It’s not really “hypersexuality”; it’s an addiction. Internet porn is not sex. It is 2-D screens and rapid-fire novelty, which have no relation to real sex with a partner.
The “anorexia” half of the equation would be the inability to maintain an erection for a real life sexual partner. This is desensitization at work.
Addictions cause a decline in baseline dopamine sensitivity and a muted dopamine response to other natural rewards. Think of desensitization as a numbed pleasure response. Dopamine is behind excitement, but also behind libido and erections. (A numbed pleasure response is one reason why all major addictions inhibit sexual desire.) As a porn addiction progresses, lower and lower baseline dopamine make it difficult to get excited for the real deal.
Summary:
Sensitization = Higher than normal dopamine response to Internet porn
Desensitization = Much lower dopamine response to natural rewards, including sex
Addiction = Seeking dopamine
UPDATE:
- See “Why Do I Find Porn More Exciting Than A Partner?” for a more complete discussion of the distinction between sensitization and desensitization.
- An official diagnosis? The world’s most widely used medical diagnostic manual, The International Classification of Diseases (ICD-11), contains a new diagnosis suitable for porn addiction: “Compulsive Sexual Behavior Disorder.” (2018)
- Porn/sex addiction? This page lists 39 neuroscience-based studies (MRI, fMRI, EEG, neuropsychological, hormonal). They provide strong support for the addiction model as their findings mirror the neurological findings reported in substance addiction studies.
- The real experts’ opinions on porn/sex addiction? This list contains 16 recent literature reviews & commentaries by some of the top neuroscientists in the world. All support the addiction model.
- Signs of addiction and escalation to more extreme material? Over 30 studies reporting findings consistent with escalation of porn use (tolerance), habituation to porn, and even withdrawal symptoms (all signs and symptoms associated with addiction).
- Debunking the unsupported talking point that “high sexual desire” explains away porn or sex addiction: At least 25 studies falsify the claim that sex & porn addicts “just have high sexual desire”
- Porn and sexual problems? This list contains 26 studies linking porn use/porn addiction to sexual problems and lower arousal to sexual stimuli. The first 5 studies in the list demonstrate causation, as participants eliminated porn use and healed chronic sexual dysfunctions.
- Porn’s effects on relationships? Almost 60 studies link porn use to less sexual and relationship satisfaction. (As far as we know all studies involving males have reported more porn use linked to poorer sexual or relationship satisfaction.)
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