Note: I wrote this in 2013. Watch for updates. ~ JoAnn
Although I have not been able to find any serious research papers on frontal lobe volume loss in sex addicts, there are more than enough ‘professional opinions’ out there that claim that sex addicts exhibit the same changes in their brains as other addicts. So, this article will assume that this is true simply for argument sake and because indications, such as their personality behaviors, lead me to believe that it is probably so.
In 2002, a study on cocaine addiction demonstrated measurable volume loss in several areas of the brain, including the frontal lobes, in cocaine addicts. Another study was published in 2004 on methamphetamine, with very similar findings. 
I will try not to be too technical, but a significant segment of the neuro scientific community seem to be in agreement that addictions create, in addition to chemical changes in the brain, anatomical and pathological changes which result in various manifestations of cerebral dysfunction collectively labeled hypofrontal syndromes.
Hypofrontal syndromes cause anatomical and functional changes to the frontal cortex of the brain. These changes are popularly thought to be responsible for certain abnormal behaviors in addicts, as well as in trauma and stroke victims who have suffered brain damage. These behaviors include a lack of empathy, compulsive and impulsive behaviors and an inability to consider the consequences of behaviors.
Similar findings have been seen with the abuse of normal biological behaviors such as eating, leading to addiction and obesity. In 2006, a study was published looking specifically at obesity and the results were very similar to the cocaine and methamphetamine studies.  The obesity study demonstrated multiple areas of volume loss, particularly in the frontal lobes, areas associated with judgment and control. This study is significant in demonstrating visible damage in a natural endogenous addiction, as opposed to an exogenous drug addiction.
These obesity studies have been used to explain frontal lobe volume loss and loss of functionality in sex addicts. Anecdotal brain studies of sex addicts claim to have shown these same changes in the brains of sex addicts that occur in drug addicts and in so called food addicts.
The media tends to hype, over simplify and morph these findings into absolutes when it comes to sex addiction. Most want to put the cart before the horse and claim that exposure to porn or compulsive sexual activities cause the changes in the brain. This is somehow supposed to explain why sex addicts can’t help what they do.
My opinion is that the brains of these so called sex addicts were abnormal to begin with.
Here’s just one example of why I believe that addicts of all types are born not made.
Anyone who knows me could say that I am ‘addicted’ to the pleasures of creative projects. Emotions flood my body whenever I engage in something creative, especially if it is a new skill. I love that feeling of success and I seek ways to feel it over and over. I am truly a right brain creative junkie. My self talk is very positive, I say to myself, ‘Wow JoAnn, that is a great picture you just painted’, or ‘what an exquisite curtain panel you have sewn’, or, ‘what a clever article you just wrote’ or ‘wow, that’s a blazing fast computer you just built’.
So, do you think my frontal cortex is shrinking because I hyper stimulate certain pathways or that I habitually create activities to stimulate a dopamine surge?
I bet not. And the reason I think not is because I do not have any issues with impulsivity or compulsivity. I am empathetic and I have no trouble considering consequences before my actions. My creative activities do not supercede normal functioning.
Everyone responds to pleasures with a flood of chemicals to our brains. Our brains are lighting up and firing away constantly. We all like to feel good and we tend to repeat things that make us feel good.
But, not everyone allows these pleasurable activities to get out of control. Not everyone who watches porn winds up a porn junkie. Not everyone who ran wild sexually in college, smoked pot for months straight, drank gallons of scotch or even binged on cocaine becomes addicted.
So, what is the difference? It has been theorized that there are so called ‘addictive personalities’, and I believe that is true (I just don’t like the word addict). But why? Why do some take the low road to addiction while others simply go on with their lives leaving their wild days behind? Is it really a ‘personality’ thing or is it possible that there is a physical cause?
Recently there have been numerous studies that show that the brains of ADHD children are significantly different from children who do not have ADHD. Because these studies have been done on young children the conclusion is that their brain anomalies are responsible for their behaviors, not the other way around.
Can this be true of people who cannot seem to control their sexual behaviors? Brain scans of sex addicts, in fact, of all addicts, do show significant differences from normal brains. Popular opinion wants to blame the changes on the addiction. It seems strange to me that no one has hypothesized that the brain abnormalities may have always been there and the behaviors are because of the abnormalities.
Another curious finding is that there seems to be a link between sex addiction and adult ADHD. I did a survey on my website http://marriedtoasexaddict.com asking the partners of sex addicts if the sex addicts had been diagnosed with ADHD. Of the current 2,000+ respondents, 54% said the sex addicts were diagnosed with ADHD, 27% said they thought they were but did not have an official diagnosis and only 19% said no.
This is quite a significant finding and the assumption (and it is only an assumption until proven) would be that every single sex addict who has ADHD also has physical and functional brain abnormalities.
Now, it is true that exposure to what does not occur in nature can become a repeatedly sought after behavior. Millions of potential sex partners (as in porn) and excessive amounts of fat, sugar and salt that are abundant in fast foods do not occur anywhere in nature. It has been proven that these excesses produce certain neurological changes in the brain, causing those who are exposed to these excesses to crave them. Some would call it an addiction. I call it a habit.
But, as far as I know, habitually partaking in porn or big macs or funnel cakes has not been shown to cause the brain abnormalities that have been found in adult addicts. Again, this leads me to believe that addiction does not cause the brain abnormalities, but the abnormal brain can cause the addictive behaviors.
We do not have the luxury of any brain scan research on sex addicts when they were children. Research is conducted after the fact and then the assumption is made that the addiction caused the changes in the brain. But, is it possible that these people we call sex addicts were born with these brain abnormalities? And, could these brain abnormalities be the cause of their behaviors?
I have found studies done with children who are diagnosed with ADHD quite interesting. Brain scans of these children show very similar brain abnormalities that are shown in scans of adult drug addicts. And, people with ADHD do have a much higher incidence of addictive and anti social behaviors as well as co morbid personality disorders
So, my question to the medical community that is researching addictions, and specifically sex addiction is, ‘Which came first’? Do sex addicts show changes in brain anatomy and function because of their sexual activities, or, are their brain abnormalities responsible for their behaviors? Has anyone ever seen a normal brain lose volume in the frontal lobe after a patient has started compulsive sexual or drug use behaviors?
Which really did come first?
Either way the sad part of the story is that these so called sex addicts are not getting the proper treatment for their problems. 12 step programs, soft, non accountable type counseling to improve their self esteem, marriage counseling that assumes complicity, outrageously expensive intensives with no validated outcomes and other treatment modalities that focus on changing a behavior that may be caused by brain abnormalities can never work.
The personality disorders that we see in these individuals (sex addicts) I believe are also a result of these brain abnormalities.
I would love to see researchers conduct brain scans of anyone who is diagnosed with a Personality Disorder or sex addiction. I believe that just that simple, non invasive test just might reveal a clue as to why these men (and women) cannot control their impulses and continue to engage in behaviors that ruin their personal and professional lives.
Unfortunately, even if that were the case, and we discovered that sex addicts are born not made, what do we do with that knowledge? There is no cure, but possibly the problem could be managed in some way in order to allow at least a few of those afflicted to lead a somewhat normal life.
- Franklin TR, Acton PD, Maldjian JA, Gray JD, Croft JR, Dackis CA, et al. Decreased gray matter concentration in the insular, orbitofrontal, cingulate, and temporal cortices of cocaine patients. Biol Psychiatry. 2002;51:134–42.[PubMed]
- Thompson PM, Hayashi KM, Simon SL, Geaga JA, Hong MS, Sui Y, et al. Structural abnormalities in the brains of human subjects who use methamphetamines. J Neurosci. 2004;24:6028–36. [PubMed]
- Pannacciulli N, Del Parigi A, Chen K, Le DS, Reiman EM, Tataranni PA. Brain abnormalities in human obesity: A voxel-based morphometrystudy.Neuroimage. 2006;311:1419–25. [PubMed]