The wife of a client of mine came to therapy for a session after she recently found out that her husband was a Sex Addict. She didn't believe it!
She asked me to explain how I knew that he wasn't just a narcissist and this was a way to excuse his bad behavior. She asked a very important question: What exactly is Sex Addiction?
The images that come to mind when Sex Addiction is mentioned can vary; a smooth-talking famous person, a person addicted to pornography, a person who goes to bars and has a lot of one night stands, a Peeping Tom, prostitution, sex offenders like pedophiles, the list can go on.
Sex Addiction, Love Addiction, Sexual Dependency, or Sexual Compulsivity can encompass many behaviors. The mental health community itself is not in complete agreement about what is considered problematic and none of these terms are included in the new DSM V.
Although the mental health community is not in agreement, there is such a thing as Sexual Compulsivity and Addiction. As I explained to the wife of my client, this label was not meant to "excuse" my client's behavior but to help her understand what was happening to him. He is responsible for his behavior and needs help to stop it.
Origins in Childhood Trauma
The seeds of sex addiction are usually planted in childhood. The person had unmet emotional needs from having a parent that was consistently unreliable in some way, like an alcoholic parent or a parent with a chronic illness. This same person, as a child also experienced some sexual injury.
Examples of sexual injuries can be experiencing sexual innuendo which felt confusing or seeing pornography during early childhood, or to the extreme experiencing childhood sexual abuse.
However, not everyone that has childhood sexual trauma and has an emotionally unavailable parent turns into a sex addict.
A child who grows up with a lot of invalidation or parents and adults who are not emotionally available can learn that having needs is not okay. Since all people have emotional needs, the child has to learn to suppress these needs by numbing out and not feeling them or by pushing them away, thus learning how not to depend on others for support.
The person learns to do this controlling themselves, and their emotions. The confluence of these events causes an addiction to be born.
How Can Sexual Behavior be addictive?
Sexual behavior becomes problematic when it is used to numb inner pain and avoid feelings.
This is not unlike any other addiction in which the person uses a substance or behavior to avoid uncomfortable situations or to change or alter his or her mood. Or a person uses sexual behavior as the only way the individual can relate to or connect with others.
The sex addiction cycle
Preoccupation with Sex
Fantasy and preoccupation with the next sexual encounter be it porn, or cyber-chatting or going to the bar, induce the addict to avoid feelings and produce a numbed-out state. This becomes the beginning of the addiction cycle. The person is thinking about the next encounter constantly.
All thoughts are consumed with sex. Everything becomes sexualized and is twisted into a sexual context; one client told me that when a woman would even smile at him or show any interest he thought she wanted to be sexual. This is the beginning of the high.
Sex then becomes a ritual
The addict then develops special routines that intensify the experience. This adds to the excitement. Examples of rituals can be: cruising, drinking, flirting, or catching a glimpse of an eye. The rituals are more distractions from bad feelings. The high continues.
"Acting out" is the terminology for the addictive behavior itself: affairs, compulsive masturbation while fantasizing or using porn, peeping, exhibitionism, strip clubs, prostitution, non-consensual touch, or anonymous sex.
Once the sexual acting out is over sex addicts report intense shame, hopelessness, fear, and sadness. One client told me that every January 1st he told himself that he would stop his acting out and by mid-afternoon the same day he was back on the computer using porn again.
These bad feelings start the cycle again and the addict starts thinking about it to escape. The cycle becomes self-perpetuating.
These behaviors become compulsive and self-destructive because the need to alter the mood is more powerful than the consequences of the behaviors. Sex addicts have tremendous guilt and shame and are unable to stop their behaviors despite negative consequences.
There is some tolerance created. Sex addicts report needing more and more stimulation to get off, and they report more risky behaviors.
Once the client exclusively used free Internet porn, then started to pay for porn and shocked himself by hiring an escort which eventually got him arrested and led him to recovery.
Although sex addiction includes a high, out of control behavior and tolerance, sexual addiction is not considered a true addiction, because it does not induce a physical "withdrawal" per se. Most addicts report early in their recovery that they continue to have recurring compulsive sexual thoughts.
Treating Compulsive Sexual Behavior
Since compulsive sexual behavior is viewed as a psychological problem and not a will power problem, it is treated like other behavioral addictions.
As mentioned above, people with sexual compulsivity tend to have a past with sexual trauma and abuse, partners and family members need to know that shaming and humiliating their loved one makes the problem worse.
A supportive non-judgmental approach is recommended. This is very difficult for partners of sex addicts because the acting out behaviors can feel personally violating the non-addicted partner since sexuality is shared.
• Individual psychotherapy is recommended to provide insight into the causes and to help with any childhood trauma. Individual therapy can help with triggers and alternative coping strategies. It also helps people explore healthy sexual behaviors that are consistent with their values.
• Couples psychotherapy: To help the partner understand the nature of compulsive sexual behavior, to reduce shame, to improve communication, and to cope with any other related issues that emerge.
• Psycho-education: Since sexual compulsivity and sex addiction not well-understood reading about it can help people learn about their dynamics and the recovery process.
• Group psychotherapy: Used for shame reduction, group support, and to practice new interpersonal skills. Participation in: Sex Addicts Anonymous (SAA) or Sexaholics Anonymous (SA) or Sex and Love Addicts Anonymous (SLAA) and Co-dependents of Sex Addicts Anonymous (CoSa) are important to create new healthy friendships, establish support, enhance spirituality and reduce loneliness.