Ramirez, Jocelyn

07/27/19

Introduction

Sex Addiction

This paper examines the effects of depression on sex addiction and the role dopamine

plays in both sex addiction and depression. Sex addiction is, in fact, a controversial topic because

some say that the idea of sex addiction is used to justify irresponsible sexual behavior. (New

Scientist. 2018) Further research has been done on whether or not compulsive sexual behaviors

should be classified as an addiction. The common belief was that addictions were caused by

mind-altering substances, not by behaviors. The article, Should Compulsive Sexual Behavior Be

Considered an Addiction explains that the Diagnostic and Statistical Manual of Mental Disorders

(DSM–5) regrouped behavior disorders with substance abuse disorders, with this change the

question as to whether certain excessive behaviors such as gambling, sex and shopping can be

parallel to substance abuse disorders came about. However, the findings in this article suggest

that further research needs to be done to thoroughly understand compulsive sexual behavior and

successfully classify it as an addition alongside substance addiction. Those who do believe to

have sex addiction describe this behavior as being out of control (Paula 2014) When therapist

encounter patients who believe they have a sex addiction, they also have to assess if their use of

the word addiction is being used to justify their poor morality, a mask for their childhood trauma,

a need for attention etc. In the article, Sex Addiction – an Extraordinarily Contentious Problem,

Paula Hall, used two models to study sex addiction, the BERSC model and the OAT model with

clients who claim to be sex addicts. The BERSC model is used to explain the complexity of sex

addiction. This model further studies the five influences that are related to sex addiction, biology,
emotion, relationship, society, and culture and their relation to sex addiction. Addictions are

often used to regulate one’s emotions and compulsive behaviors in a relationship may be the

cause of trying to regulate intimacy (Paula, Hall 2014) When using this model during a therapy

session, the therapist has to assess both partners and decide how big the problem is and to which

partner the problem is more of an issue. The second model used is the OAT model indicated that

there are three primary drives to sex addiction, opportunity induced, attachment induced or

trauma-induced. By evaluating which factor relates to the client, the therapist can develop an

effective treatment plan appropriate for their issue.

Depression

Depression is another common topic that has been studied for many years. Dopamine is

known as a chemical substance released in the brain that plays a role in reward and pleasure. An

interesting area of study is to explore how depression and dopamine can be related. There are

four different dopaminergic pathways in the brain, which are essential for dopamine

transmission. These pathways are responsible for the regulation and release of dopamine in the

brain. Studies have shown a relationship between the transmission of dopamine and depression.

For instance, patients who suffer from depression showed to have a downregulation of dopamine

transporters to compensate for the patient’s dopamine deficiency. Studies also show that

deficiency of dopamine transmission is associated with depression (Eric Dailly, 2004).

Melancholic depression is a depressive disorder that is known to affect cognitive and motor

components. Research shows that the neurotransmission of dopamine is also associated with

cognition and motor. According to the article Does Dopamine Dysfunction Drive Depression?

dopamine is involved with reward and the development of behavior to adapt to these stimuli. In

context, an abnormal dysfunction of the reward system can lead to symptoms related to
depression such as dysphoria, apathy, and anhedonia. Dysfunction in the mesolimbic dopamine

system can also cause a decrease in motivation which can, in turn, be a leading symptom of

depression. An example of dysfunction is the failure of a predicted reward which can then cause

depression. GS Malhi states, that novel and rewarding stimuli release dopamine from the

neurons, in which case the increase if a predicted stimulus causes the release of dopamine to

decrease. This failure of the predicted rewards brings about n decline in dopamine activity which

can be re-emerged by a new rewarding stimulus.

Psychotic depression in other word is also called depressive psychosis. This is mostly caused by

bipolar disorder. Psychotic depression prognosis is not as poor as that for schizoaffective

disorders (Belanoff, Joseph K., (2001). But still, individuals who have had the psychotic disorder

have increased the hazards of relapse and suicide and have sleep abnormalities. Research shows

that individuals who suffer from psychotic depression are between the age of 20 and 40 years. It

can be chronic and in some cases episodic. Kathleen S. Bingham conducted research on which

she found that patients suffering from psychotic depression and undergoing treatment are on

“remission”. The main difference between psychotic depression and non-psychotic depression is

the abnormality in the hypothalamic-pituitary-adrenal axis (HPA). Victims with psychotic

depression suffer high ventricular-brain ratios compared to those with non-psychotic depression.

Research for Transcranial magnetic stimulation (TMS) as a possible treatment to psychotic

depression is ongoing.

Bipolar depression in his article, Daily Rx stated, “Research suggests up to 60 percent of

bipolar sufferers experience a substance abuse problem at some point in their lives.” The main

question is, bipolar hypersexuality or sex addiction? Research shows 57% of people suffering

from bipolar depression have hypersexuality (Sachs, Gary S (2007). Manic hypersexuality
involves high sex drive which results in constantly thinking about sex, addiction to watching

pornographic films, having unprotected sex, having sex with multiple partners, engaging in one

night stands, seeking out prostitution and being unfaithful in relationships. Addictions are known

to have great deals with their neurobiology as well as their origin. Bipolar depression is heritable.

This is likely to be the reason why there are several reported cases of child sexual abuse. Parents

with mania or hypomania are likely to have been sexually inappropriate around children.

According to Patrick Carnes, child sexual abuse incidents are 83% among sexual addicts.

Dopamine initiates pleasure, it makes us happy and motivates us. Sex addicts most say they want

to have sex “to feel normal” this is very correct. Once they are “stimulated”, the production of

dopamine is needed to catalyze pleasure and happiness since the brain can not do it on its own.

Low grade, chronic depression is a result of the condition of dysthymic disorder which is also

referred to as persistent depressive disorder (PDD). Some of its main symptoms include;

concentration problems, sleep difficulties, loss of weight and appetite, fatigue and low energy

levels.

Chronic depression is a result of major depressive disorder and is also a multifactorial

condition. Its main cause is a genetic predisposition, imbalance of biochemical, environmental

conditions and life stress. This could also be caused by sex addiction which is more common in

women. Research shows that 1.5% of people living in the U.S suffer from chronic depression.

(Nemeroff, Charles B (2003). Abnormality in brain circuit or nerve cell functioning is said to be

majorly involved in chronic depression.

People with sexual addiction, in most cases, are addicted to other sexual behaviors. Some of the

activities involved with sexual addiction are, excessive masturbation, having multiple partners

and engaging in one night stands, practicing sex that is unsafe, excessive use of pornography,
practicing cybersex, practicing prostitution or being involved with prostitutes, practicing

exhibitionism, voyeurism. These behaviors can lead to; personal guilt, low self-esteem, anxiety,

breakups and family relationship problem, legal consequences, financial problems, sexually

transmitted diseases, AIDS, and depression.

There are steps for determining the severity of depression. (Kor, Ariel, (2013). Take no shortcuts,

get a wide anthropological view while searching for symptoms of depression and suicidal

thoughts. Carry out psychological tests in case something was missed in interview data and

clinical observation. Review any suicidal attempts history, find out if how the person handled the

exposure of sex addiction in the past or any other humiliating occasion he has faced. Consider

the depth of the person’s shame, which ‘viable’ way the person will choose to avoid the shame.

Inquire how the person has handled shame in the past. Either towards himself or those around

him. Measure if the patient’s medication is having any effective changes on the patient. These

steps and more could help the clinician to understand the victim better and find ways to help

them.

Steve, the youngest in his family had an elder sister who always teased him once he began to

sexually develop. He narrates an incident he had given out his bracelet to a girl and his sister

confronted him of the missing bracelet while having dinner with his family. This incited fear in

him for his mother hysterical reaction since that was a gift from his mother. His mother

overreacted about the bracelet issue which shows how protective she was of her son. She never

wanted him to have a girlfriend at such an early age. His mother was very loving to him and

would tell him “I love you” every 10 seconds. As he continued to grow up and mature, he got

very attached to his mother. When he was 15, his father who used to work in hardware died. But

the loss did not affect Steve since his closeness to his mother filled the gap. Steve became
addicted to watching pornography. He requested his mother to take his dog for a walk so that he

could be left watching pornography and masturbating secretly. Unfortunately, his mother was hit

by a bus and died. The loss was too much for him and as a result, he turned in to an “erotic-

haze”. Like most sexual compulsives, his sexual addiction was initiated by changes in his life.

He then chose to go for counseling since he was falling into depression. He was counseled and

advised on ways to change his behaviors. He still undergoes therapy. (Volunteer story: Steve”

2018).

Mark had just received a demotion at work and his wife had filed for a divorce. He explained

that he had indulged in drugs before but stopped due to the accidents they caused him at work.

Over the past few months, he realized his urge to masturbate had increased and would do nothing

about them. He remained “horny” the whole time and only had sexual fantasies. Mark felt that

his life was empty, and found nothing enjoying it. He began to watch pornography which he later

found not exciting. He became more involved in sexual fantasies, sexting, and more sexual

behaviors. Every new person or video would release more dopamine helping him to maintain

long periods of excitement. Cybersex became his “drug of choice”. He later realized how much

that had affected his life. He had emotionally neglected children, he had neglected himself due to

lack of sleep and exercise, he had erectile dysfunction, loss of income due to loss of his job,

isolation from friends and living in stress and with guilt. Mark underwent the 12-step program

which helped him begin a change in his behavior.(volunteer story: Mark”2015)

Morgan was the only child that her parents had was more of a spoilt kid. She always got what

she requested from her parents. At an early age, she had a very expensive phone and laptop

which made her get exposed to social media and the internet at such an early age. She was very

close to her parents and had few friends at school. Her mother had been suffering from cancer for
years since Morgan was born. When Morgan was 10years, unfortunately, her mother passed

away when she was 10years. After her mother’s death, they became very close to her dad since

they only had each other. As she continued to sexually grow, she started watching pornography.

Years later, her dad remarried a pretty young girl. Due to her obsession with watching

pornography, she turned into a voyeurist.

She would sneak and listen to her father and stepmother having sex. As she was watching

pornography and masturbating, her stepmother caught her in the act and introduced her to

lesbianism. It became a habit of Morgan and her stepmother having sex when her father was not

around. Due to the exposure of sex at such an early age, Megan developed uncommon behaviors.

Morgan dropped out of school and instead began having sex with other girls. She later started

therapy which helped her change her behaviors and has since then begun going to school.

(volunteer story: Morgan”2013).

Rosetta had just been hired at a new company. The guys she was working with began making

remarks about her body and asking her about her relationship status. Not only did the guys make

dirty jokes, but also the manager contributed to the jokes, which made Rossetta very

uncomfortable. “These guys had pictures of nude women on their machines and would always

make jokes about them” Rossetta. She had enough of them and requested them to stop asking her

dirty questions which they did not take seriously. Rosetta needed the job thus he couldn’t quit.

After working for some time, the manager promised to promote her, but under the condition,

they both get intimate. Rosetta ended up agreeing to the terms and was promoted. It became a

habit for the manager and Rossetta being intimate. They both became addicted to this that they

would get intimate even at the workplace. Rosetta would even get intimate with the other guys

who she worked with. The working environment change into something else and the workers
would barely get any work done. The company sales decreased, it suffered losses but no one was

paying attention to this. Finally, the company was closed down. Rosetta was left with no job and

the mess had already been done. She later realized that she had been infected with sexually

transmitted diseases. She was bitter and since she had already become a sex addict, it was hard to

change her ways. She continued to have sex with different people and spreading the STDS. She

felt lifeless and decide to seek assistance from a clinician. She is currently undergoing therapy

and treatment as well. (volunteer story: Rosetta” 2019)

Kim found herself roaming in the streets of Chicago since she was young. She had no family and

relatives that she knew of. She and other street children spent their day monitoring in town and

would sleep on the corridors late at night when the business is closed. It was not guaranteed that

each day they would find food. Each day for them was different. They would spend the day

begging from strangers in town and if any got lucky, they would share among themselves. They

never attended school. As Kim began to grow and develop, she began to gain sex interest. She

began to offer men sex in exchange for food or money, and to my amusement, most men agreed

to that. Kim began having meals daily and at times a penny in her pocket. She continued with the

same behavior until she met her friend Naomi. Naomi had been a prostitute for more than 5

years. She invited Kim to her house and did a makeover to Kim. She lends her some fancy

clothes. At night, she took Kim with her to where they seek clients and advised her on how to

handle herself. After seeing the money she generated, Kim took that as her job. They would do

that every day. She even started abusing drugs. After years of prostitution, Kim realized some

changes in her body. She lost weight and change in her complexion.

After some time, she realized she had been infected with HIV. She fell into depression and felt

that her life had come to an end. Her life changed a lot and she decides to seek help. She walked
into a health facility and shared her story with one of the doctors. She was helped and guided and

she was able to overcome her depression. She is currently on medication for HIV and she has a

decent job. (volunteer story: Kim”2016).

The above case study examples are my practice in finding what triggers sex addiction. My main

concern was to investigate the possible courses of sex addiction. Clearly shows that, in most

cases, sex addiction comes as a result of a certain change in life or is initiated by different

circumstances, situations. (Bostwick, J. Michael, (2008). According to research by (San Jose

Marital and Sexuality Clinic & MSNBC.com), it shows that 80% of the 10,000 surveyed users

use their computers at home for sexual purposes.

Sex addicts are hurting. Clinicians should be able to access the depth of depression in the addict

and offer treatment. "I choose my behavior; the world chooses my consequences" is a phrase that

is mostly used by those recovering from sex addiction. Sex addicts should engage in therapy and

programs which they can find help. In my opinion, some sites like the cybersex, which are

exposing everyone, including the young ones into sexual staff should be closed. And the therapy

centers should be added because so many people are falling into depression as a result of

addiction. I believe every addiction is stoppable if the addict decides to seek help.
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