[Sexual addiction in alcohol abuse and dependence. Clinical, nosologic and psychoanalytic aspects]

DSM-III-R names sexual addiction for the first time as a sexual disorder. In this study a group of alcoholics was examined who described their own sexual behavior as being addictive and self-destructive. In this nearly all male patient group sexual addiction manifested itself mostly in excessive masturbation and obsessional sexual fantasies often in combination with use of pornography. Promiscuity, prostitute contacts and excessive sexual demands on a steady partner and sexually deviant behavior, were less often reported in this population. The addictive sexual behavior was said to be usually provoked by emotional distress and unresolved conflicts. More than 80% of these patients were dependent upon at least one other substance beside alcohol. Two-thirds considered their sexual addictive behavior to be their primary and earliest dependency. The nosology of this disorder seems to be unspecific, since a number of forms of neurosis and personality disorder are diagnosed. A psychodynamic interpretation of sexual addiction points to defence mechanisms against inner psychic conflicts, as seen both in addiction and sexual perversion. Aspects of differential diagnosis and classification are also discussed.