Volume 27 Lesson 12

Update on Sexual Addictions

Oriana Vesga-Lopez, MD, Andrew Schmidt, LCSW and Carlos Blanco, MD, PhD

Dr. Vesga is a Research Therapist; Mr. Schmidt is a Project Manager; and Dr. Blanco is Associate Professor of Clinical Psychiatry. All authors are affiliated at the New York State Psychiatric Institute/Columbia University, New York, NY.

Sexual addictions include a group of conditions characterized by intrusive sexual thoughts combined with poorly controlled sexual behaviors. More prevalent and impairing than initially recognized, this syndrome is gaining attention from patients and clinicians, provoking an increase in the identification and treatment of this disorder. Considerable debate exists about the appropriate conceptualization of this clinical syndrome and its place in psychiatric nosology. Some investigators have suggested that this condition constitutes a nonpharmacologic addiction; others have suggested it constitutes an obsessive compulsive spectrum disorder. Finally, an impulse control model has been proposed. Nevertheless, there have been encouraging outcomes with psychotherapeutic and psychopharmacologic treatments. Currently, a number of treatments have been suggested as potentially effective: ÒTwelve StepÓ programs, behavioral therapy, cognitive therapy, and several medications, including antiandrogens and selective serotonin reuptake inhibitors. The latest remain the best studied pharmacologic treatment. This lesson reviews the definition, epidemiology, and etiology of sexual addictions. Particular importance is given to the conceptualization, associated psychopathology, and management of this condition.

Editor's Note

The authors have provided an objective, concise, and comprehensive review of the emotionally difficult subject of sexual addictions. They begin their review with definitions and clinical characteristics of sexual addictions. The lesson continues by reviewing the assessment, epidemiology, and comorbidity of sexual addictions. The authors then present the three dominant models as well as the psychological and neurobiological theories of sexual addictions that provide the basis of their discussion of the various treatment modalities. Of note, there is a paucity of large sample size studies that examine the efficacy of treatment. Nonetheless, the authors have provided a thorough summary of current knowledge related to the sexual addictions, which serves as a valuable reference guide to clinicians.