Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model

Journal of Sex Research, August, 2004 by John Bancroft, Zoran Vukadinovic

Toward a Theoretical Model

Our data, together with our understanding of the literature, suggest that in striving to understand out of control sexual behavior, we should be expecting a range of etiological mechanisms associated with different behavioral patterns that share the two key features of addictive behavior as described by Goodman (1997): a recurrent failure to control the sexual behavior and continuation of the behavior in spite of harmful consequences.

Goodman's (1997) integrated theoretical model has three principal components: (a) impaired affect regulation, (b) impaired behavioral inhibition, and (c) aberrant function of the motivational reward system. This provides a reasonable framework for our theoretical discussion.

The role of affect. We regard the role of affect to be important in most, if not all, cases of out of control sexual behavior. For most people whose capacity for sexual interest and response goes down in states of depression and anxiety, such mood-related mechanisms are not relevant, and indeed this may explain why their sexual behavior is less likely to get out of control. We should be cautious, however, in interpreting the association between negative mood and sexual acting out as a form of mood regulation, or the deliberate use of acting out to improve mood. In some circumstances, when sexual connection with another person is motivated by the need to make personal contact or the need for self-validation or improvement of self-esteem, mood improvement may be the driving force. However, an alternative pattern possibly relevant to much of sexual acting out is that the negative mood, particularly if associated with increased arousal (i.e., anxiety), leads to sexual arousal by means of excitation transfer. Once sexual arousal is established, there will be an intrinsic drive toward sexual release through orgasm, which will have the incentive of transient pleasure and post-orgasm calming. Such a sequence may then become reinforced and established by conditioning, with the individual learning to think sexual thoughts (or seek out sexual stimuli) when feeling such negative mood. This explanation is consistent with the fact that more often than not the individual knows in advance, as a result of experience, that the transient reward will be outweighed by the longer term negative consequences. We would therefore move beyond a simple notion of the sexual behavior as a mood regulator to define three affect-related patterns, each of which requires a certain relationship between affect and sexuality. The possibility of such different patterns underlines the likely variability of etiological determinants in out of control sexual behavior.

Pattern 1 involves the capacity to retain one's sexual interest or responsiveness in states of depression, which allows the pursuit of sexual contact with another person to meet depression-related emotional needs. Such needs may include establishing personal contact through sex, feeling validated by another person, or enhancing one's self-esteem by feeling desired by another person. Pattern 2 involves the use of sexual stimulation to distract one's attention from issues that when thought about induce negative mood. This assumes that negative affect is being kept at bay by the distraction. As Baumeister and Heatherton (1996) put it, "the source of emotional distress is not present in the immediate situation, but is highly available in memory (e.g., just after a major rejection or failure experience). Under such circumstances, people will seek to distract themselves to prevent themselves from thinking about the upsetting event" (p. 5).