Toates: A motivation model of sex addiction - relevance to controversy over the concept

Question 1

sex addiction should be seen as an addictive process:

Answer 1

incentive motivation theory + dual control theory = Toates’ model

toates model: suggests that addiction to sex is driven by an imbalance between stimulus-based (automatic, cue-driven) and goal-based (conscious, controlled) behaviours. sex addiction involves an overpowering craving that becomes increasingly resistant to conscious control over time.

Question 2

welke pathways horen bij dit addiction model

Answer 2

dopamine pathways, associated with wanting rather than liking. dopamine enhances the urge for repetitive sexual behaviour. incentive sensitization happens, where cues related to sexual behaviours (like pornography or sexual fantasies) gain magnet-like power, intensifying cravings without necessarily increasing pleasure. over time, these stimuli become increasingly compelling, leading to tolerance and escalation, hallmark features of addiction.

Question 3

2 processes underlying motivation

Answer 3

• stimulus based: fast, automatic, causation of behaviour can occur outside conscious control.
• goal based: slow, intentional, goal-directed. goals represented in the brain, involves full consciousness and insights.

Question 4

how is sexual addiction different from hypersexuality

Answer 4

hypersexuality individuals pursue frequent sexual activity without distress or loss of control, whilst sex addiction involves the distress and the desire to cease this behaviour.

Question 5

difference sex addiction and OCD

Answer 5

in OCD, compulsive behaviours are often anxiety-driven and lack the intense craving seen in sex addiction. this model suggest that sexual adddiction is marked by a deeper imbalance in reward processing rather than simple impulsivity

Question 6

similarities to drug addiction

Answer 6

• tolerance: the need for more extreme behaviours or stimuli over time to achieve the same satisfaction
• withdrawal: symptoms like tension, irritability, and depression when sexual behaviours are stopped
• escalation: moving towards more risky or intense sexual activities

Question 7

comorbid conditions

Answer 7

sex addiction often cooccurs with:
- ADHD, BPD, BP and parkinsons disease (door medicatie)
- underlying attachment issues, childhood trauma, or stress (may predispose to addiction)

Question 8

hoe staat het in relatie tot attachment insecurities

Answer 8

these people may use sex as a way to regulate emotional pain, pointing to a deeper root in interpersonal struggles and self-soothing.

Question 9

evolutionary perspectives

Answer 9

we have a hypersexualized culture. whereas early humans faced scarcity, modern world offers an overwhelming abundance of stimuli, including porno and other sexual outclets, which easily trigger dopamine responses beyond what is biologically typical. the model suggests that this availability of sexual stimuli can overwhelm the brains ability to self-regulate

Question 10

criticism on sex as an addiction

Answer 10

some critics argue that sex addiction lacks essential features of addiction, such as the physiological withdrawal or the drug-like escalation.

however, toates argues that similarities between sex and drug addiction are not physical but in behavior patterns and neural mechanisms, where dopamine-driven wanting outpaces rational control. sex addiction should be viewed along a continuum of behavioural addiction, where a persons ability to control behaviour gradually diminishes.

Question 11

therapeutic interventions

Answer 11

• behavioural: goal-setting, increased awareness of triggers, reinforcing alternative, non-addictive behaviours
• cognitive therapies: ACT and future-oriented thinking
• medication: SSRIs, opioid antagonists, testosterone-blocking meds
• electrical brain stimulation

Question 12

dual control of behaviour:

Answer 12

1. stimulus based compulsive system 1,
2. goal based/system 2

excitation vs inhibition

Question 13

types of inhibition in sex addiction

Answer 13

fear of performance failure (stimulus-driven inhibition), fear of performance consequences (goal-driven inhibition)

Question 14

incentive motivation model

Answer 14

motivation is triggered by certain incentives in the world, cues associated with such incentives and internal representations of the incentives in memory

Question 15

cue reactivity=

Answer 15

refers to the activation of certain brain regions in response to cues related to the addictive behaviour/substance

Question 16

In addiction, there is typically a lot of wanting (dopamine), but not much liking (opioids)

Answer 16

oke

Question 17

Supernormal stimuli =

Answer 17

refer to the abundance of vastly more potent stimuli than the ones we evolved to interact with (e.g. the infinite variety and availability of porn)

Question 18

difference sex addiction and impulse control disorder

Answer 18

sex addicted people only show domain-specific impulsivity