The Brain in Love: 12 Lessons to Enhance Your Love Life (18 page)

Youth are more troubled and addicted than adults. The pre-frontal cortex (PFC) is not fully developed until age twenty-five, making it much more likely that teens and young adults will have problems controlling their impulses. According to the National Coalition Against Legalized Gambling, the following are the
prevalence rates among youth groups: 16 to 24-year-old males, 4 percent; 11 to 18-year-old males, 4 to 7 percent; national average, all ages, 1.2 percent.

Sexual Addictions

Sexual addiction can encompass a wide variety of activities. Sometimes a sex addict has problems with just one undesirable behavior, sometimes with many. According to Sex Addicts Anonymous, a high percentage of sex addicts think that their unhealthy use of sex has been a progressive process. It may have started with excessive masturbation, the use of pornography, or a sexual relationship, but over the years it progressed to increasingly risky behaviors. The core problem with sexual addictions, like all addictions, is the feeling of powerlessness or helplessness over a compulsive behavior, resulting in a person’s life becoming unmanageable or out of control. Addicts typically experience shame, guilt, and self-loathing. The addict tries to stop, but is unable to do so. The consequences are often severe, including terminated relationships, problems at work, arrests, financial troubles, a loss of sexual interest in anything not associated with the addiction, low self-esteem, and feelings of hopelessness.

The preoccupation with sex takes up tremendous amounts of energy, draining time from other activities and responsibilities; as this intensifies, behaviors or rituals follow, which usually leads to more troubled behavior, such as searching the net for pornography, lying about sex, or secretive flirting. There is usually guilt over the behaviors, followed by shame, despair, and confusion.

Here are six questions to consider if you think you may have a sexual addiction:

1. Do you keep dark secrets about your sexual activities from those who should know? Do you lead a double life?
   

2. Do you frequently feel remorse, shame, or guilt after a sexual encounter?
   

3. Is it taking more variety and frequency of sexual activities than previously to bring the same levels of excitement and relief ?
   

4. Have you ever been arrested or are you in danger of being arrested because of your practices of voyeurism, exhibitionism, prostitution, sex with minors, indecent phone calls, etc.?
   

5. Do your sexual activities include the risk, threat, or reality of disease, pregnancy, coercion, or violence?
   

6. Has your sexual behavior ever left you feeling hopeless, alienated from others, or suicidal?
   

If the answer to any of these questions is yes, professional help may be in order. See an expert in sexual addiction.

In a study performed by my colleagues Mark Laaser and Richard Blankenship on sex addicts, the PFC was clearly involved. The researchers used the Amen Clinic Brain System Checklist, a questionnaire I developed based on our brain-imaging work, with seventy patients who met the diagnostic criteria for a sexual addiction. In addition, I performed brain-SPECT studies on eleven of the patients. The results of the survey were that 67 percent of the participants showed prefrontal cortex problems. Fifty percent of the participants had anterior cingulate gyrus issues (a tendency to get stuck on negative thoughts or behaviors, like addictions). There was also a high association between limbic (mood issues) and basal ganglia problems (anxiety issues). On the SPECT scans, eleven out of eleven patients with sexual addictions showed low activity in the PFC.

Here is an example of a sex addict. Joseph had been married eighteen years when he came to see me. During his marriage he had many affairs and spent excessive money in strip clubs and on Internet pornography sites. Even though he did not want to be divorced, and his wife was threatening to leave him if he didn’t stop, he felt he had little control over his sexual behavior. Joseph had a family history of substance abuse and addiction, common
among sex addicts. When he was arrested for soliciting sex from an undercover vice police officer, he sought treatment for his sexual addiction. Traditional psychotherapy was ineffective. Attention-deficit/hyperactivity disorder (ADHD), a neurological disorder that often affects the PFC and that is highly responsive to certain medical treatments, was suspected and he was sent to my clinic for an evaluation. His scans showed marked decreased prefrontal cortex activity. He was prescribed stimulant medication and placed on a brain healthy program (healthy diet, exercise, fish oil, and vitamins). With his medical treatment in place, he sought the help of an expert in sexual addiction. Joseph is now ten years sober from his sexual addiction. He and his wife have renewed their wedding vows and continue to do well.

Like Joseph, people with ADHD are likely to engage in some form of addiction. According to ADHD expert Wendy Richardson, “It is common for people with ADHD to turn to addictive substances such as alcohol, marijuana, heroin, prescription tranquilizers, pain medication, nicotine, caffeine, sugar, sex, cocaine, and street amphetamines in attempts to soothe their restless brains and bodies. Using substances to improve our abilities, help us feel better, or decrease and numb our feelings is called self-medicating.” Treatment of ADHD and other underlying disorders affecting the PFC substantially increase the efficacy of treating addictive disorders.

Unusual Sex

In the movie
There’s Something About Mary
, the main character, Mary, was stalked by Dom when she attended Princeton University. Dom’s obsessive behaviors led to restraining orders. In addition, Mary had to change her name and buy all new shoes. Dom had taken all of her footwear. At the end of the movie Dom finds Mary once again. He is seen passionately clutching several pairs of her shoes as Mary’s friends are pulling him off her. Dom is clearly over-attached to her shoes.

Can neuroscience help us understand these deviations, paraphilias,
and fetishes? Unusual sex can have elements of both obsessive-compulsive disorder (repetitive thoughts or behaviors that feel as though they are out of control), and attention-deficit/hyperactivity disorder (associated with impulse control problems). Obviously, there is more to the story, as most people with OCD or ADHD do not engage in these behaviors. Imaging and brain chemistry findings can help uncover some the reasons behind these behaviors.

Sexual excitement is an individual experience; things that some people find stimulating are not the least bit interesting to others. Within a culture there are sexual norms that most individuals and couples incorporate into their own lives. Outside the range of these norms lies an area of more unusual sexual acts termed
paraphilias
or
perversions:
sneaky thoughts that get played out in actions. The word
paraphilia
, coined by Sigmund Freud, has Greek origins. “Para” meaning along the side and “philia” meaning love. It has been estimated that men outnumber women with a paraphilia 20:1, indicating that brain sex differences and hormonal factors are likely involved. The medical definition of a paraphilia connotes sexual deviance, perversion, or abnormality. It is seen as a medical problem only if the behavior interferes with relationships, health, work, or legal status or causes significant emotional distress. Culturally bound limits distinguish between normal and deviant sexual practices. Here is a list of common paraphilias and fetishes.

COMMON PARAPHILIAS

Exhibitionism: exposure of genitals to a stranger

Fetishism: use of nonliving objects, such as Mary’s shoes

Frotteurism: rubbing against a stranger

Hyphephilia: fabrics

Klismaphilia: enema

Masochism: pain, humiliation, or punishment of self

Narratophilia: erotic talk

Pedophilia: children

Sadism: psychological or physical suffering of another

Stigmatophilia: body piercing or tattooing

Voyeurism: observation of others undressed or in the act of sexual activity

Transvestic fetishism: cross-dressing

OTHER TYPES of PARAPHILIAS

Acrotomophilia: amputee partner

Asphyxiophilia: self-strangulation

Autonepiophilia: diaperism

Coprophilia: feces or defecating

Mysophilia: filth

Urophilia: urine or urinating

Zoophilia: animals

Fetishes

A fetish, defined as “an excessive or irrational devotion to some object or activity,” such as Dom’s attachment to Mary’s shoes, becomes a problem when people become dependent on the object or practice. It can be an inanimate object, such as shoes, or an animate object, such as feet or breasts. People use various things to achieve sexual excitement. A fetish is when that object becomes the preferred or exclusive method of achieving excitement.

T
YPES OF
F
ETISHES

Shoes: boots, high heels

Clothes: leather, jackets or pants, suspenders, underwear, bras, raincoats, lace, silk, and nylon

Body parts: Buttocks, breasts, legs, elbows, ears, feet

Profiles in Fetishes

I Like to Watch

Watching unsuspecting people engaged in sexual activity or getting undressed holds an air of appeal to voyeurs because they are
aroused by the chance of getting caught watching. They seek excitement, often as a way to stimulate an underactive brain. Exhibitionists find excitement in revealing their genitals to strangers, also considered an impulse-control disorder. A sixty-five-year-old man with dementia displayed this kind of behavior and was arrested five times, within one year, because of complaints regarding indecent exposure. Dementia often results in a disinhibition due to frontal-lobe deficits.

Vacuuming to Death

The tools of masturbation are as varied as people’s imaginations. I have heard and read stories about vibrators, ice cream scoopers, butter knives, an old-fashion whisk, serving spoon, hairbrush, toothbrush, pillows, stuffed animals, pens, candles, dildos, tampons, towels, bedding, bottles, cell phones, curling irons, hot dogs, salami, Popsicles, and fruit. The list goes on and on. One case, however, stands above the rest in weirdness. A seventy-seven-year-old man was found dead in his bathroom due to a heart attack. Next to his body was found a vacuum cleaner and hair dryer. Both these electrical devices were still on and the man’s underpants were actually found lodged in the hose of the vacuum! More than likely, these appliances were used autoerotically during masturbation.

Don’t Try This at Home

People will go to almost any means to get sexual pleasure, even strangling or asphyxiating themselves to near death, or in some cases, death itself. For some, inducing a lack of oxygen to the brain while masturbating enhances sexual experience. The ways to choke off one’s air supply are innumerable. For this purpose people have used hanging or choking devices, such as ropes, electrical cords, ties, belts; constricting devices around the chest or abdomen; plastic bags covering the face; toxic gases or chemicals that are inhaled; or partial or total submersion in water, known as aquaerotic asphyxiation. The problem with this sort of excitement
is that hundreds of deaths each year result from this behavior. Sometimes the release mechanisms fail, sometimes people do not know when to quit. This paraphilia can affect people of all ages. In one study of 132 people, 6 were in their fifties, 2 in their sixties, and 1 in his seventies. This practice may continue throughout life; frequency may lessen with age, but the motivation behind the behavior may never be completely gone.

Stop Being a Baby

Paraphilic infantilism or autonepiophilia, also called diaperism, is the desire to be a baby and to talk and act the way an infant does. One thirty-five-year-old man employed in law enforcement was affected with this disorder his whole life. While at his job he did not feel like a baby and none of his colleagues knew about his desires, he dressed like a child when going out into public. His desire to become a baby began around the age of twelve. It can be postulated that the threat of sexual maturity caused regression. His infantlike behavior involved wearing diapers, eating baby food, sleeping in a custom-sized crib, and sucking on a pacifier. While wearing diapers he would urinate and defecate in them as a child would and, at other times, he would masturbate while wearing them. This case is an extreme side of a disorder that can be looked at as a spectrum ranging from infantile obsession to sadomasochistic behaviors involving domination and discipline.

Unusual Places

Like other orifices in the body, many objects have been used to stimulate the anus and rectum. The oldest reported case dates to the sixteenth century when a foreign object that was inserted into the rectum became lodged, and at that time removal of the object was not possible. To this day, physicians find themselves extracting objects from the rectum, sometimes requiring surgery. Such was the case of a sixty-three-year-old man who inserted a
salami into his rectum. Twenty-six percent of those admitted to the hospital for foreign bodies in their rectums required surgery. Reports of patients seen in an emergency room for this problem vary and do not occur only in young people. In a large study of these patients seen at USC and UCLA Medical Centers between 1993 and 2002, the mean age was 40.5 years old. Other reports include an elderly woman at a nursing home who reportedly inserted utensils into her rectum. She said she was “digging herself out” and had been doing so for years, which caused her long-term constipation and stool incontinence. A sixty-five-year-old man who described abdominal pain had an inverted glass jar lodged in his rectum, which eventually required surgical removal.