Defining sexual addiction
Sexual addiction, also referred to as sexual compulsion and sexual dependency can be defined as any sexual activity that feels “out of control”. The sex addict feels compelled to seek out and engage in sexual behavior, in spite of the problems it may cause in their personal, social and work lives. It may encompass any single or multiple type of sexual behavior. In the assessment and defining sexual addiction, its important to start by discussing the sexual behaviors that are out of control.
- Compulsive masturbation
- Compulsive use of pornography
- Having multiple, ongoing affairs
- Dangerous sexual practices
- Anonymous sex
- Telephone sex
- Chat room/online sex
- Partner sex
- Illegal sexual practices
The type of behavior does not define addiction. The essential difference between the addict and the non-addict is that these behaviors feel out of control. An addict may spend an inordinate amount of time planning, engaging in and recovering from their chosen sexual activity. And in spite of the physical, emotional, relational, financial and even judicial cost of these activities, they feel unable to stop their behavior. Or at least, unable to stay stopped.
Another key factor is that the chosen sexual behaviors are used to anesthetize psychological pain. In the same way an alcoholic may get lost in a bottle or a compulsive gambler fixates on the next win to avoid the pain of life, the sex addict chooses sex as their way to cope with the world.
Prevalence and Profile
The true prevalence of sexual addiction is unknown but estimates range from 3 to 6 percent of the population. According to Sex Addicts Anonymous, 6% of the British population are I suspect they got that figure from Carnes and just applied it to the UK sexually addicted . Dr Patrick Carnes, one of the world’s leading researchers and authors on sexual addiction reported that approximately 20% of all patients seeking help for sexual dependency are women and further research went on to observe that there were significant differences in the types of behaviors engaged in by male and female sufferers . Men tended to engage in sexual activities that revolve around a sex object such as voyeurism, prostitution and anonymous sex while women tend to use sex for power for example, pain-exchange sex, fantasy roles, particularly seductive roles and trading sex.
A survey of over 1,000 sex addicts and their partners concluded that many sex addicts had come from severely dysfunctional families. 97% reported emotional abuse, 71% physical abuse and 83% sexual abuse. They also found that 87% had come from families where at least one other family member had an addiction. There was also a pattern of dual addictions. 43% reported chemical dependency, 38% an eating disorder, 28% compulsive working, 26% compulsive spending and 5% compulsive gambling.
The Internet explosion
The advances of the internet have significantly changed the landscape of sexual addiction. The accessibility and anonymity of the web has allowed many people to explore their sexuality in a way that has been hitherto impossible. An estimated 20-33% of internet users engage in online sexual activities. The most common online sexual activity is viewing pornography, sited by 69% of male users and 20% of women. One report estimated hardcore pornography is now accessed in the UK by 33% of all internet users.
Online pornography is big business. In 2002, sex related sites became the number one economic sector of the internet, estimated to be worth a staggering 2.5 billion dollars. There are 4.2 million pornographic websites making up 12% of all websites. 70% of pornography is viewed between the hours of 9 and 5 which may explain why 1 in 6 employees reported having trouble with sexual behavior online.
The significance of all these statistics to clinicians is that both the profile of a sex addict and prevalence is changing. The internet accelerates arousal because anonymity reduces the fear and shame that would normally act as a suppressant. What’s more, evidence suggests that the internet can tap into powerful, suppressed unresolved sexual issues from childhood. This means that behavior is intensified and escalates both in the amount of time spent on the activity but also the variety of activities engaged in.
Narcissism and sexual addiction
Thaddeus Birchard, one of the UK’s leading researchers and therapists in sexual addiction believes the psychological root of sexual compulsive behaviors lies in narcissistic damage. He proposes that this wounding happens in childhood and results both in the self being experienced painfully and also, the self being experienced as unacceptable. This negative self image results in depression, chronic anger, core loneliness and unremitting shame.
Much has been written over the years about narcissism and its impact on adult relationships and self-regulation and many have made connections between this and addictions. Instead of resolving narcissistic damage, the addict either consciously or unconsciously chooses to anesthetize the resulting pain. But why do some choose sexual behaviors as their drug of choice?
Birchard suggests that there are 2 additional components in the family of origin of the sex addict. Firstly that there has been a history of sexual addiction over previous generations. In some cases this is very apparent with addicts recalling finding a family member’s pornography or a parent engaging in multiple sexual relationships outside of the marriage. In other cases the sexual preoccupation may have taken the form of sexual avoidance or abstinence. The second component is overt or covert sexualisation in childhood. This can take many guises and some clients may be painfully aware of specific incidents of abuse or inappropriate sexual behavior, while others may have more difficulty accessing or acknowledging any disturbance of this kind.
Shame is both a principal result of narcissistic damage and a principle driver for addictive behavior. No where is this more apparent than in sexual addiction. With so many societal taboos and boundaries around sexual behavior, the sex addict is quickly trapped by the addiction cycle.
The Addiction Cycle
In between the highs of sexual fulfillment are the lows. The feelings of shame, regret, remorse and anxiety. Most sufferers will have tried and failed to curb their behavior on many occasions and consequently they feel powerless to change. They are alone and isolated and soon they find themselves seeking out sex as a way to escape from difficult feelings. Sex becomes a pain reliever, an escape from the very problem that it has created itself.
The four stage addiction cycle proposed by Carnes in his book Out of The Shadows begins with preoccupation. The addict thinks about nothing but their next sexual conquest. Each conversation they have, image they see, person they meet or place they go is somehow fitted into a story they create about sex. This total absorption in their favorite subject blocks out the rest of the world. Not only are problems blocked out, but also important relationships and work. The ritualisation stage allows the addict to prepare for their next conquest in a systematic and obsessive way. Each will have their preferred routines which intensify the preoccupation and arousal. This then builds to the sexual behavior of choice – the end goal of the preoccupation and rituatlisation. But as the addict comes down from the rush of excitement of the sexual experience, they slip into despair. Knowing they have failed to control their behavior again, they feel powerless and filled with self loathing. They also feel a great sense of shame and often humiliation. For the addict, the easiest route out of these feelings is to lose yourself in the trance-like state of preoccupation. And so the cycle continues.
The first step of treating any addiction is acceptance. Until the addict accepts the reality of their condition nothing will change. Sex addiction is no different. But unlike other addictions, abstinence is rarely the solution. Sex, like alcohol is not a problem in itself, it is the relationship the addict has with their substance of choice that is the problem. Until the addict realizes that the way they use sex needs to change, they are unlikely to ask for help.
The following 10 step assessment tool, developed by Patrick Carnes, can be useful for both addicts and clinicians alike to consider if the sexual behavior is compulsive.
- Do you feel that the behaviour is out of control?
- Could there be severe consequences if you continue, for example for your relationship, your work, your health, your finances or legal consequences?
- Do you feel unable to stop your behavior, in spite of knowing these consequences?
- Do you persistently pursue destructive and/or high risk activities?
- Do you want to stop or control what you’re doing and have you previously taken active steps to limit your activities?
- Do you use sexual fantasies as a way of coping with difficult feelings or situations?
- Do you find you need more and more of the sexual activity in order to experience the same level of high?
- Do you suffer from intense mood swings around sexual activity?
- Are you spending more and more time either planning, engaging in or regretting and recovering from sexual activities?
- Are you neglecting important social, occupational or recreational activities in favor of sexual behavior?
There are various reasons why an addict may present for individual therapy. It may be that they are aware of and have accepted their condition. However, sometimes the trigger will be a relationship or work problem. As mentioned before, addicts will often have neglected other areas of their life for many years and sometimes it is the consequences of their behavior that they first want to address, rather than the behaviour itself. But assuming that the behavior is at some stage revealed, the first thing the clinician will need to do is decide if they have sufficient knowledge, training and supervisory resources to best support the client. If not, referral will be the ethical option.
Therapy needs to be focused on two areas. Firstly on stopping and controlling the behavior. This will often involve education on sexual addiction and CBT techniques to punctuate the addiction cycle. All the literature suggests that people relapse unless there is an involvement in group work and a culture of recovery. Unfortunately there are still only a handful of groups in the UK though this is rapidly changing. However, there are also online groups available through sex addicts anonymous.
The second area of therapy needs to address the initial narcissistic damage. Within the context of a safe and reparative therapeutic relationship, the client can share and explore their woundedness and begin to develop further understanding and insight into it’s consequences. Clients then need to create new stories of themselves and new ways of relating to others in their life. The goal being to fill the void that stopping their addiction will have created and find new ways of feeling and being in the world.
Excerpt taken from “Understanding Sex Addiction” by Paula Hall