Vincent Estellon
For a long time, this behavior has been somehow ignored from psychological and neuroscientific research. In this article — reflecting the collaboration of a clinical psychologist and a neuroscientist — we show that in the current period, sexual affiliation is one of the most promising affiliation context to articulate a debate, a dialog and convergence points between psychoanalysis and neuroscience. Recent data on healthy sexual behavior and its compulsive variant are discussed under the prism of neuroscience and psychoanalysis.
The modern western society in which we live is slowly but surely conditioning women and men — children or adults — to a world where whatever we desire must be available for immediate acquisition. In just a few decades, access to pornography has not only been developed but also became banal. We are far from the censure of the early 20th century when kissing scenes were simply cut from cinematographic reels. Sexuality has become recreational, and even imperative.
In effect, it was as if the slogan of the new societal Super-ego had become: In these dynamics, in which the power of images is constantly growing, where screens television, internet, telephone, etc. One can question the ever-more important role of pornography as a new educational tool of sexuality, its effects on the psychic apparatus in its capacity to imagine or fantasize the sexual. The danger being that external images come little by little to replace fantasies produced from within. The subject, thus, passes from an active role implied in fantasmatic production or in the imagination to passivity, in the act of consuming images magazines, films.
Progressively, sexual excitement is increasingly distanced from the loving feelings associated with a relationship. The fact of loving implies both an encounter and sharing, loving someone else has the particular power of being able to tear a person away from a regressive position of narcissic omnipotence in which he believes himself to be self-sufficient, capable of everything, all alone. Yet, when I am attracted by another, I recognize that I am lacking, and in a certain passive manner, in expectation of and dependent on another.
And that other, come to that, can never fully satisfy these deficiencies … And yet, in the affective splitting of the sex-addict , not being completely satisfied is equal to not being satisfied at all. Here, there are no half-measure. The dependency here is not a dependence on a toxic object but rather a behavioral dependency in which sexual activity, or the seeking of it, is experienced in an obsessive and compulsive fashion.
On the medical level and in the scientific literature, the notion of sexual dependency was developed by Goodman , , a psychiatrist of psychoanalytic orientation. The given definition also remains somewhat vague: In order to better detect subjects suffering from addictive sexuality, Patrick Carnes and Robert Weiss put together a questionnaire — The Sexual Addiction Screening Test — in two versions one for the gay and bisexual population, another for the heterosexual population. If responses to the 25 questions result in 13 positive answers or more, the subject has a problem with addictive sexuality.
The s, marked by the appearance of the AIDS virus, were propitious to new research on addictive and compulsive sexual behavior CSB within which habitual promiscuity with multiple partners appears as an important risk factor in the transmission of the HIV virus. In , the National Council on Sex Addiction was created to inform the public and warn about the risks related to addictive sexuality. In , the North American psychiatrists Reed and Blaine proposed a nosological description of addictive sexuality and described a process in four phases in which both compulsive and impulsive aspects can be found:.
Like other forms of dependency, sexual addiction builds up through a process in which several stages can be distinguished: It is when this use becomes a response to existential difficulties that an addictive problematic, that is to say a dependency, and which has become a source of suffering, begins to settle in. The starting point is a devouring sexual need that can have various manifestations: This dependency on objects or situations presenting a sexual connotation images, places, clubs, online pick-up sites, films, etc.
Coleman proposed an evaluation grid to detect sexual addiction. The subjects who present at least two of the following characteristics can recognize themselves as being sex-addicts:. But these statistics remain empirical in the measure that there have been no epidemiological studies on the question. In France, research in clinical psychopathology took some time to take an interest in the phenomenon.
Since then, work in the field of addictology has progressively developed research, reflections, and observations on these new behaviors of dependency. From the phase of searching up until the actual sexual activity, the subjects concerned may feel some benefits: But as soon as the sexual act has taken place, certain subjects can be gripped by sadness, remorse, as well as by feelings of shame, and guilt.
One fine clinical psychopathology study for that matter shows that — unlike in the schema proposed by Carnes — these reactions vary largely depending on whether the subject functions according to a neurotic, borderline, psychotic, or perverse structure. Reactions of shame, disgust, and guilt being much less frequent in the borderline, personality organization often present in these subjects. One may rather note reactions of intense depression of a narcissistic type when the object or situation targeted by the idealization has not been found or satisfied.
The subject then feels empty and will have a tendency to identify himself with rubbish or waste matter. The negative effects are then experienced: The inability to be happy in a couple relationship, repetition compulsion, giving the impression of a loss of control, and the centering of an existence that only focuses on a single preoccupation; these elements — associated with a painful sense of failure — are often at the origin of a request for treatment.
It is often the sense of marginalization and loss of meaning that forces recognition of the dependency. From the point of view of temporality, the sex-addict suffers from a repetition compulsion, often giving him an impression of a stagnant temporality that is not open toward the future. Kernberg described the characteristics of a specific type of subjective temporality within the narcissistic pathological personality organization.
He distinguished the subjective temporality of neurotic subjects tending toward the investment of a complete object and that of subjects reduced to a narcissistic libido. It is as if the latter made great efforts to shrink or destroy time to reassure themselves with an illusion of permanence and eternity. In this configuration, it is difficult to integrate new experiences; the repetition compulsion shows that time does not pass and that it is frozen. The experience of shrinkage of time in these cases can lead to an intense and growing fear of death, a sense of injustice at the briefness of life as they experience it.
This fear is also related to the infantile fears of abandonment and solitude. A deep sense of the pointlessness of life predominates when there is an absence of investment in love, work, ideals, children, or values. In a certain way, the non-establishment of a relationship of trust in others does not allow the development of a trusting relationship to time.
Sex-addicts experience great difficulties in believing that they will find a response to their desires in others Estellon, , a , b , , , Believing requires recognition of not only the power of invisible phenomena but also hope. Some of these beliefs are vital: And as Freud reminds us, to love other people, one must first be able to love oneself.
In these practices, the sexual partner cannot exist in his identitary or historical dimension: The temporality of zapping is interesting in that it proceeds from a current present that is open onto an immediate future. In this posture, it is a matter of contenting oneself with fragments as they appear without worrying about the whole, of switching to something else. The notions of duration, accomplishment, of the associative link, are quite simply wiped out. Z apping functions partly through the vision. It fills the mind with images and sensations without leaving any time for actual elaboration.
This temporality is characterized by an impatient present tense that wants nothing to do with waiting.
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Defensive strategies often lead the sex-addict to experience any durable construction — implying stability — as being mediocre or as yet another constraint. Hence, the need for constant change in order to feel free … up until the day when the subject can no longer bear his addiction to change.
Engaging in a therapeutic undertaking can be the occasion for the subject to maintain a relationship in a stable rhythm as a couple, with certain overall constants. If addictive sexuality is a disorder that is easier to live with in big cities than in the countryside, this is in part due to the strong urban implantation of various venues dedicated to sexual encounters: After having spotted objects of interest in the soft zones at the bar or on the dance floor , one can head toward the hard zone to get comfortable and share sex … If they have today spread to the libertine world, backrooms were born in the American gay milieu in the s.
Strangely, they developed just as homosexuality started to come out of the shadows, as if to pay a funereal homage to the dark, hidden, clandestine, and shameful places long frequented — for lack of choice — by homosexuals repressed by the police. Somber, damp, and strong smelling, they replaced the former urinals where sexual activity took place inter faeces et urinas.
Often fitted out with minor conveniences slings , glory holes , cages reminiscent of the prison world, labyrinths … , they can be play areas that are appreciated by sex-addicts. In these spaces, there is no social identity, no faces, but body parts revealed by hands touching, caressing, feeling, entering. If the AIDS years led to the closing down of most of these places in the United States, it is in the major European cities that they flourish today.
According to different authors Carnes, Earle, Estellon, Goodman, and Poudat one finds certain common personality traits in sex-addicts such as:. Certain characteristics — the invasive presence of obsessions and the prevalence of compulsive systems — have led some authors to make a link between these clinical elements and obsessive compulsive disorders.
Except that to the opposite of the sex-addict , the obsessional does not take action: The psychoanalytic clinical data of sex-addict subjects Estellon, ; Mac Dougall, gives a glimpse of a characteristic psychic functioning — quite close to a borderline functioning with recourse to certain common defensive strategies. Splitting is the essential defensive operation used by sex-addicts. Its main aim is to avoid the confrontation of the subject, in the face of his affective ambivalence, with depressive suffering. Here, splitting radically separates affectionate impulses from sexual impulses.
Sexual partners will be little invested affectively, whereas other people in the entourage friends, family, inaccessible partner are highly invested. Complementary to splitting and shored up by it, denial permits the exclusion of the field of consciousness and facilitates the isolation of those representations or affects that are not in keeping with the ideal self-image. Everything that might fragilize the psychic life by its contradictory or ambiguous character is evacuated.
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A loss, a grieving process, a separation, for example, might in such subjects provoke reactions in which there is no apparent suffering. Denial shoring up the splitting, the sex-addict can, with complete indifference, leave any partner who has been imprudent enough to become tenderly attached to them. In the same way, when the sex-addict feels strangely affectionate toward a partner, reactions of distress or violence can appear. The mechanism of idealization functions in a way that is complementary to splitting. A new person can be strongly idealized: Splitting allows, when the deceptions or frustrations have spoiled the perfection of this object, to denigrate them, to disdain them, and deinvest them as easily as the touch of a finger is able with a remote control to zap a boring TV program instantaneously.
I am thinking of a certain patient who regularly changed sexual partners: This is the phenomenon of devalorization. A corollary of omnipotence, it allows one, without suffering, to get rid of an object when it does not bring the expected or desired satisfaction. Splitting thus ensures that a part of the Ego remains idealized the grandiose self in such a way that the feelings of suffering, frustration, deception, desire, or hatred, when they are experienced, can always be imputed to the action of an ill behaving other.
These charicatural reactions permit the Ego — whose frontiers are unsure — not to collapse. This defense mechanism constitutes a veritable motor for the zapping mode of functioning described above.
From a relationship point of view, addictive sexuality can be understood as a phobic strategy that allows one to avoid any real encounter with others. One often finds at the basis of these compulsive practices two types of relationship anxiety: Haunted by these anxieties, the problematic of attachment becomes unbearable. In such a configuration, the certainty of a breakup is preferable to the torments of its uncertainty. The fact of systematically leaving the other, anonymous person allows one not to suffer the anxiety of being invaded and even less the worries of abandonment.
Thus, one avoids the depressive suffering linked to deceptions caused by the other in whom one might have believed and to whom one might have become attached. Curiously, what takes place is a reversal of the latent desires and the pragmatic and compulsive behavior: This sexual frenzy often covers up a strong and denied affective deficiency. During sexual activity, drugs may be used by the more dependent subjects: Currently, the most common are poppers, cocaine, and GHB, we will here describe poppers and GHB as they are more specifically used during sexual activity.
Poppers are vasodilators originally used in medicine to cure certain cardiac illnesses, containing butyl and pentyl nitrates; sniffed in a non-medical use, their effects are almost immediate: The user feels a strong sensation of inner heat and sensuality is exacerbated. The effect of the sniff lasts about 2 min. GHB is a very powerful anesthetic. In a liquid form, it can be drunk pure or mixed with non-alcoholic drinks. The effects depend largely on the dosage but vary from euphoria, relaxation, somnolence, deep comatose sleep, and unconsciousness to the loss of inhibitions, an intensification of perception, a need to talk, or slight vertigo.
In the organism, GBL turns into GHB; more dangerous; being more difficult to dose, it can provoke potentially fatal comas. Insolent and seductive, risk taking allows one to leave behind the securized world in which one is immersed. Barebacking unprotected sex despite the risk of transmission of the HIV virus is more and more frequent among sex-addicts in the gay world. On top of the risks of HIV, this practice increases the risks of contamination of various other sexually transmitted diseases that can prove dangerous if they are not detected in time Syphilis, Hepatitis B.
When he becomes interested in searching for stronger sensations, the sex-addict can direct his sexuality toward more hard-core practices fist-fucking, bondage, SM, urophilia, scatophilia, etc. It is in these aspects that addictive sexuality can become a source of suffering, of isolation, and marginalization. The results of the studies by Peretti-Watel et al. Depression often constitutes the backdrop on which sexually addictive behavior is constituted and chronicized. The loss of belief in the positive effects of a relationship, the loss of hope in others, progressively makes one lose sight of the meaning of a life that has — despite the erogenous sensations that exhaust themselves in compulsive repetition — become sad and empty.
In this chapter, it is interesting to summarize some recent studies issued from cognitive neuroscience that investigated human male sexual behavior in general and, for some of them, its compulsive practice. Although using very different theoretical and experimental settings, sexual affiliation is for us one of the most promising context to articulate a dialog between neuroscience and psychoanalysis.
Today, what do we know on the neural circuits involved in human male sexual arousal?
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Is that possible to identify variations within these neural processes when sexual practice is becoming compulsive? Here are the two main questions of this section. From now several decades, the growing development of neuroimaging techniques shed light on brain processes with a new angle. It is now possible to record brain activity in a wide variety of perceptual, cognitive, or motor paradigms.
In addition to a considerable increased knowledge of the brain circuits involved in general cognitive processes, two fields meet an exponential development: These two approaches converge on questions such as the investigation of brain processing of emotional informations emitted by conspecifics. In this regard, recent studies have helped to highlight the connections between cognitive and neural systems involved in the production of the action and the perception of the action by a third party.
The above-developed perspective is now extending to the topic of emotions. For example, to be exposed to a disgusting flavor activates the same neural structures than to observe a disgust facial expression in another person see the example of the insula in Phillips et al. Insular lesions prevent both the experience of disgust and the recognition of social cues conveying disgust Calder et al.
Comparably, the neural circuits of nociception are activated both by real pain and the representation of the affective state of someone in pain Morrison et al. These results suggest that neural structures involved in emotional information processing also participate in the intersubjectivity of interacting people. However, the recovery between activated structures is not total.
This suggests a certain amount of dissociation between regions involved in self-perception and those involved in other perception. Although a functional context such as empathy encompasses an intrinsic social component, relationships between individuals first obey to an intrinsic interattraction motivational component that can be either positive or negative. However, this interattraction component can be studied within different functional contexts.
Among these contexts, sexual behavior and its associated neural circuits has been more and more studied during last years, shedding light on interesting new results for socioaffective neuroscience. Until the end of the 90s, the investigation of mental and neural representations associated to sexual behavior was poorly studied but is now exponentially emerging. However, it has to be noted that this is mostly investigated in human males. At the moment, an exponential number of scientific studies investigates the neural correlates of human male sexual arousal.
Here, we would like to underline some recent results issued from socioaffective neuroscience studies that used sexual affiliation to study motivated social interactions and provided more general results. Here, we will first focus on results obtained in healthy human males and secondly on very preliminary data from patients that could be involved in CSB occurrence. To understand the present assumptions of neuroscience on the neural networks that could be involved in sexual addiction, it is necessary to present some interesting recent results on the role of the brain on healthy human male sexual motivation.
First, it has to be noted that functional magnetic resonance imaging fMRI , that is, the possibility to use MR imaging to identify brain activations thanks to local blood flow variations recording, was discovered in In this article, we present the main results from studies with two objectives: Mainly, to explore the neural correlates of healthy human male sexual motivation, these studies used fMRI.
Among other neuroimaging techniques, fMRI has a relatively good spatial resolution, but a quite poor temporal resolution around 1 second instead of milliseconds regarding the classical temporal unit of the cell functions. Currently, an attempt that can be offered to try to overcome this pitfall is to try to unify the corresponding psychological and neural components in a neurobehavioral model.
For healthy human male, a neurobehavioral model has been proposed Redoute et al. Therefore, this is important to bring together a psychological process and a cerebral activation and to explain how these processes articulate with the other components of the model. Here, we sum up some data related to cognitive and physiological components of the neurobehavioral model.
With several decades of studies of the neural correlates of healthy human male sexual arousal, the feasibility of this scientific approach has been widely demonstrated. In other words, the presentation of decontextualized visual sexual stimuli within a scanner was valid. Although the experimental setting and procedures were not ecological to study sexual arousal, behavioral results indicate a possible induction of sexual attitudes. Regarding brain processes involved in visual sexual material processing, a good example is illustrated in Fig.
In accordance with the hypotheses of the study, the recorded brain activations were interpreted as involved in the cognitive processes linked to motivational information processing Mouras et al. For example, activations were identified in the inferior parietal lobules IPLs; Fig. Interestingly, these areas were known to be activated in monkeys during visual fixation episodes occurring during environmental exploration Lynch et al.
For this region, an early activation was thought, for example, as being involved in enhancing attentional mechanisms toward motivationally relevant targets.
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Through a more precise study of temporal activations for this part of the brain, we were able to demonstrate activations within the superior parietal lobules. In this study one of the first fMRI studies , these activations were nonetheless sustained not only during all visual sexual stimuli presentation period but also in the early as for IPLs. These results were in accordance with a very short categorization time for sexual stimuli Pizzagalli et al.
Therefore, these activations were interpreted as the anatomical support of an early amplification of attentional processes directed toward visual sexual stimuli. Brain areas activated in response to visual sexual stimuli as compared to neutral stimuli. Figure from Mouras et al. Adapted with permission from Mouras et al. Through published studies, a recurrent question is to know if the identified psychological and cerebral processes are specific to the functional context of sexual behavior. Importantly, the male sexual function is characterized by a highly specific physiological response, that is, the genital response.
For this purpose, a specific MR-compatible device able to record volumetric penile plethysmography concurrently to cerebral BOLD responses was manufactured. This was applied in two recent studies Mouras et al. It allowed to precise the involvement of a specific neuronal system in the brain — the mirror neuron system — for visual sexual stimuli processing, which means visual stimuli with a high motivational relevance.
Importantly, the mirror neuron system was first discovered in monkey as a specific category of motor neurons with an increasing firing rate either during the observation of an action or the mere realization of this action. Today, the question of the involvement of this system within socioaffective information cerebral processing is one of the major debates for contemporary cognitive neurosciences.
A recent study Carr et al. Consequently, it was important here to assess the degree of implication of these mirror neurons in the observation of sexual exchange. Therefore, our hypotheses were that 1 in response to the presentation of sexual visual stimuli, the magnitude of activation of the brain networks involved in movement observation and motor imagery would predict the intensity of genital response and 2 the level of the erectile response would predict the amplitude of the BOLD response in primary and secondary somatosensory areas corresponding to the projection of the penis.
Three results are developed here see Fig. Parasagittal sections showing brain areas where the fMRI signal was correlated with the concurrent penile volumetric response. X refers to the distance in millimeters from the sagittal plane. Correlation profiles between BOLD and plethysmographic signals as a function of the lag between the two signals. The vertical axis represents the Z statistic associated with the correlation coefficient between the two signals, and the horizontal axis the lag, which is the time interval seconds by which the correlated values are separated.
Positive lags are those where the plethysmographic response was correlated with subsequent values of the BOLD signal from Mouras et al. The first region in which the variations in BOLD signal were correlated to those of genital response was the left frontal operculum.
In the functional context of sexual affiliation, two interpretations are possible regarding the role of this neural system: On the other hand, the behavioral response was also recorded by physiological the erectile response and some of the efferences of the frontal operculum to the insula could be the corresponding anatomical support.
Therefore, these results place the physiological response at the center of the processes involved in social relations with a strong motivational component. Write a customer review. Amazon Giveaway allows you to run promotional giveaways in order to create buzz, reward your audience, and attract new followers and customers. Learn more about Amazon Giveaway. Set up a giveaway. There's a problem loading this menu right now.
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