Therapy for Sex and/or Porn Addiction

 

Chapters:


 

What is Sex Addiction?

Sexual addiction is defined as any sexually-related, compulsive behavior that interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment.

Sexual addiction has also been called hypersexuality, sexual dependency and sexual compulsivity. By any name, it is a compulsive behavior that completely dominates the addict’s life. Sexual addicts make sex a priority over family, friends, and work. Sex becomes the governing principle of an addict’s life. They are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior.

No single behavior pattern defines sexual addiction. These behaviors can take control of addicts’ lives and become unmanageable.  Common behaviors include, but are not limited to compulsive masturbation, compulsive heterosexual and homosexual relationships, pornography, prostitution, exhibitionism, voyeurism, indecent phone calls, and anonymous sexual encounters. Even the healthiest forms of human sexual expression can turn into self-defeating behaviors.

I personally believe the label’s of “Sex Addiction”, “Love Addiction” are too vague and do not give legitimacy to a field and body of knowledge that is differentiating at light speed. I prefer to use the label, “Chronically Problematic Sexual Behaviors,” as I believe this label leaves room for the evolving fields of “Internet Pornography Addiction,” “Internet Gaming Disorder,” and/or “Internet Addiction,” along with the field of “Sex Offending” and some of what is labelled by the DSM-5 as “Paraphilia” and/or “Pedophilia.”

 

What behavior patterns may indicate Sex Addiction is present?

While an actual diagnosis for sexual addiction should be carried out by a mental health professional, the behavior patterns below can indicate the presence of sexual addiction. Individuals who see any of these patterns in their own life, or in the life of someone they care about, should seek help from a certified professional.

  • Acting out: a pattern of out-of-control sexual behavior
    Examples may include:

    • Compulsive masturbation
    • Indulging in excessive pornography
    • Having chronic affairs
    • Exhibitionism
    • Dangerous sexual practices
    • Prostitution
    • Anonymous sex
    • Compulsive sexual episodes
    • Voyeurism
  • Experiencing severe consequences due to sexual behavior, and an inability to stop despite these adverse consequences.
  • Persistent pursuit of self-destructive sexual behavior.
  • Ongoing desire or effort to limit sexual behavior.
  • Sexual obsession and fantasy as a primary coping strategy.
  • Behaviors increase in intensity or risk
  • Severe mood changes related to sexual activity.
  • Inordinate amounts of time spent obtaining sex, being sexual, and recovering from sexual experiences.
  • Neglect of important social, occupational, or recreational activities due to sexual behavior.

 

Is Sex Addiction like addiction to substances?

Sex, Love and/or Internet Pornography Addiction are not currently considered formal diagnoses by the American Psychiatric Association’s DSM-5, despite having considerable Tier I, peer reviewed literature stating they meet all the same criteria as all Substance Use Disorders, Severe. They are considered “Behavioral Addictions.” The DSM committee changed the wording from “Substance-Related Disorders” in the DSM IV-TR to “Substance-Related and Addictive Disorders” in the DSM-5. Within this new chapter is a subchapter entitled, “Non-Substance Related Disorders,” created for Behavioral Addictions such as Gambling Disorder (previously known as Pathological Gambling,) and Binge Eating Disorder. The DSM-5 sub-committee accepted “Internet Gaming Disorder” into their sub-chapter entitled, “Conditions for Further Study,” stating this Behavioral Addiction needs further research by peer-reviewed journals. Despite a large body of research from Tier I, peer reviewed journals, indicating chronically problematic sexual behaviors exhibit the same signs and symptoms as any Substance Use Disorder, Severe and/or Gambling Disorder, Severe, the DSM-5 sub-committee refused to acknowledge that Sex, Love and/or Pornography Addiction exists. They even refused to place it within the chapter, “Conditions for Further Study.” Fortunately the World Health Organization’s (WHO) International Classification of Diseases (ICD) is working on their 11th edition and has a diagnosis named “Compulsive Sexual Behavior Disorder,” recognizing these issues are legitimate disorders. WHO’s acknowledgement will hopefully bring needed insurance reimbursement for thousands inflicted with this and will decrease the shame and stigma attached to these disorders.

 

How many people are affected by sexual addiction?

According to Dr. Patrick Carnes’s research and the website sexhelp.com, estimates range from three to six percent of the population.(7.4 billion people currently on the planet which equates to between 220 million and 440 million people.)

 

Are more Sex Addicts male or female?

It remains unclear whether one gender has a higher incidence of sexual addiction over the other. Research by Dr. Carnes shows that approximately 20-25% of all patients who seek help for sexual dependency are women. (This same male-female ratio is found among those recovering from alcohol addiction, drug addiction and pathological gambling.) The great irony is that sex addiction in women appears to be increasing. In recent, very large studies of online behavior, 40% of those struggling with sexually compulsive behavior are women.

Anecdotal evidence suggests more males attend the mutual aid, 12-step fellowships Sexaholics Anonymous, (SA), Sex Addicts Anonymous (SAA), and Sexual Compulsives Anonymous (SCA) and more females attend Sex and Love Addicts Anonymous (SLAA.) The scientific research behind this phenomena is lacking, but recent Tier I research, is currently looking at why this is the case. There are various hypotheses as to why more men attend SA, SAA, and/or SCA, and more women attend SLAA and suggests that men tend toward being more visually stimulated due to evolution and women tend to be more relational due to evolution, thus men tend to more addicted to visual, high speed internet pornography, while women tend to be more drawn to the “love” addiction such as romance novels, romance television shows and thus tend to gravitate toward Sex and Love Addicts Anonymous (SLAA.) As stated above, recent Tier I research is validating that high speed internet pornography is so dysregulating the homeostatic balance of the reward-pleasure pathway, that many women are displaying the hallmark symptoms of addiction to internet pornography.

 

How is Sex and/or Love Addiction and/or Internet Porn Addiction diagnosed?

To help professionals determine whether a sexual addiction is present, Dr. Carnes has developed the Sexual Addiction Screening Test (SAST), an assessment tool specially designed for this purpose. The SAST is a free initial assessment test (sexhelp.com) for people with potentially addictive behaviors. It provides a profile of responses that help distinguish between addictive and non-addictive behaviors. It was developed in cooperation with hospitals, treatment programs, private therapists and community groups. The SAST has been developed since 1983 and has gone through several editions and factor analyses, and has been proven to be valid and reliable in detecting problematic sexual behavior. The SAST can be performed by going to sexhelp.com (which is highly encrypted and confidential) and take the SAST in less than 20 minutes. It will give you immediate results with a bar chart with cutoff numbers.

As with any good assessment, it takes several meetings with a trained professional to perform a thorough assessment. Utilizing screening tools such as the SAST, SARA and ISST are part of the overall assessment process. Being a CSAT, I have specialized training to utilize the Sexual Dependency Inventory, 4th Revision (SDI.4.) This is an 800 question measure that measures attachment style, arousal template, and will further assess for the ten characteristics of Sex Addiction. The SDI.4 has been normed to the Minnesota Multiphasic Personality Inventory (MMPI) to be valid and reliable in regard to screening for problematic sexual behaviors.

If The SARA (Sexual Addiction Risk Assessment) consists of 88 questions, which take approximately 25 minutes to finish. Upon completion, you will receive a detailed, personalized 23-page report to help you determine your next course of action. Please note that fees do apply for this assessment test.

The Internet Sex Screening Test (ISST.) The ISST is currently a research project investigating the development of the Internet Sex Screening Test, an instrument designed to assess an individual’s sexual use of the Internet. You are being asked to respond to 34 true / false questions regarding your sexual thoughts and behaviors while using the Internet. In addition you are asked to respond to questions that will help describe and compare individuals who participate in this study. These questions include such things as your age, sex, education level, sexual orientation, sex offense status, etc. Your participation will take approximately 15 – 20 minutes and you will receive and immediate print out explaining to you if you are at risk and what other actions to take.

 

What is the role of the Internet and Internet Pornography Addiction (Cybersex)?

Today, over 70% of sex addicts report having problematic online sexual behavior. Two-thirds of those engaged have such despair over their internet activities that they experience suicidal thoughts. Sexual acting out online has been shown to manifest in similar off-line behavior. People who already were sex addicts find the internet accelerates their problem. Those who develop an addiction in the online space quickly start to act out in new ways off-line. One of the pioneering researchers of this problem, the late Dr. Al Cooper, described online sexual behavior as the “crack-cocaine” of sexual compulsivity.

 

What is the difference among Sex Addiction, Sex Offending, and Sex Therapy?

Sex Addiction is a conceptual model that describes compulsive participation or engagement in sexual activity, despite negative consequences. It is considered by its proponents to be the same thing as hypersexual disorder. In clinical diagnostics, the term sexual dependence may also refer to a conceptual model that is used to assess people who report being unable to control their sexual urges, behaviors, or thoughts. Related models of pathological sexual behavior include hypersexuality, hypersexual disorder, compulsive sexual disorder, intimacy disorder, romance junkie, erotomania, nymphomania, satyriasis, Don Juanism (or Don Juanitaism), and paraphilia-related disorders.

Dr. Partick Carnes, Ph.D, whose seminal work throughout the 80’s and 90’s helped advance the specialized field of Addiction Medicine a sub-branch in the fields of psychology and psychiatry. Dr. Carnes hypothesized, through performing rigorous research by following over 1,000 recovering sex addicts for over a period of 10 years, and noticed these 10 symptoms for many sex addicts. In 2005 he came up with these 10 diagnostic criteria in 2005:

  1. Recurrent failure (pattern) to resist sexual impulses to engage in specific sexual behavior.
  2. Frequent engaging in those behaviors to a greater extent or over a longer period of time than intended.
  3. Persistent desire or unsuccessful efforts to stop, to reduce, or to control behaviors.
  4. Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experiences.
  5. Preoccupation with the behavior or preparatory activities.
  6. Frequent engaging in the behavior when expected to fulfill occupational, academic, domestic, or social obligations.
  7. Continuation of the behavior despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behavior.
  8. Need to increase the intensity, frequency, number or risk of the behaviors to achieve the desired effect or diminished effect with continued behaviors at the same level of intensity, frequency, number, or risk.
  9. Giving up or limiting social, occupational, or recreational activities because of the behavior.
  10. Distress, anxiety, restlessness, or irritability if unable to engage in the behavior. (Carnes 2011)

Now many studies (see Novelty, conditioning and attentional bias to sexual rewards, by Voon et. al.; Cambridge University, 2015; Journal of Psychiatric Research Article) are proving through fMRI scans, that those who are compulsively using internet pornography are showing the same activation in the exact same regions of the brain as those suffering with Substance Use Disorders, Gambling Disorder, and/or Binge Eating Disorder.

Sexology is the scientific study of human sexuality, including human sexual interests, behaviors and function.

Sexologists apply tools from several academic fields, such as the scientific study of human sexuality, including human sexual interests, behaviors and functions.

Sexologists apply tools from several academic fields, such as biology, medicine, psychology, epidemiology, sociology and criminology. Topics of study include sexual development (puberty), sexual orientation and gender identity, sexual relationships and sexual activity, paraphilias and atypical sexual interests, as well as the sexualities of special groups, such as child sexuality, adolescent sexuality, sexuality among the elderly and the disabled. The sexological study of sexual dysfunctions and disorders, including erectile dysfunction, anorgasmia, and pedophilia, are also mainstays. (Wikipedia, 2016)

Sex Offending– Other names of this are (sexual offender, sex abuser, or sexual abuser) is a person who has committed a sex crime. What constitutes a sex crime differs by culture and legal jurisdiction. Most jurisdictions compile their laws into sections, such as traffic, assault, and sexual. The majority of convicted sex offenders have convictions for crimes of a sexual nature; however, some sex offenders have simply violated a law contained in a sexual category. Some of the crimes which usually result in a mandatory sex-offender classification are: a second prostitution conviction, sending or receiving obscene content in the form of SMS text messages (sexting), and relationship between young adults and teenagers resulting in corruption of a minor (if the age between them is greater than 1,060 days). If any sexual contact was made by the adult to the minor, then child molestation has occurred. Other serious offenses are sexual assault, statutory rape, bestiality, child sexual abuse, female genital mutilation, incest, rape, and sexual imposition. However, particularly sex offender registration laws in the United States, may also classify less serious offenses as sexual offenses requiring sex offender registration. In some states public urination, having sex on a beach, or unlawful imprisonment of a minor also constitute sexual offenses requiring registration.

The biggest differentiating factor between “sex addiction” and “sex offending” is in sex offending there is always a violation in regard to whether the sexual contact was consensual or not.

There is much cross over between “sex offending” and “sex addiction,” (i.e. you can have a sex offender who is a sex addict and you can have a sex offender who is not a sex addict and visa verse.) However, the treatments for these two conditions are different, with sex addiction treatment utilizing the “disease concept” in addiction medicine and psychodynamic theory and mutual aid groups aiding in the rehabilitation. The “sex offender treatment” requires a forensic psychological exam by a trained professional in “sex offending” and the treatment has been traditionally very cognitive behaviorally based with stringent protocols.

 

What role has the invention of the internet played in these issues?

According to the web-site (sexhelp.com,) today, over 70% of sex addicts report having problematic online sexual behavior. Two-thirds of those engaged have such despair over their internet activities that they experience suicidal thoughts. Sexual acting out online has been shown to manifest in similar off-line behavior. People who already were sex addicts find the internet accelerates their problem. Those who develop an addiction in the online space quickly start to act out in new ways off-line. One of the pioneering researchers of this problem, the late Dr. Al Cooper, of Stanford University, described online sexual behavior as the “crack-cocaine” of sexual compulsivity.

What is the comorbidity of Sex, Love and/or High Speed Internet Porn Addiction with other addictions?

According to Dr. Patrick Carnes’s web site (sexhelp.com,) it is not uncommon for people to be addicted to one or more processes or substances. In fact, research has shown that the more trauma an individual has experienced in the past, the higher the probability of multiple addictions. When someone has more than one addiction, the addictive behaviors can interact in different ways. Figuring out these dimensions of addiction interaction and which one(s) apply to you can help your therapist determine the appropriate treatment.

Common addictions that interact with sexual addiction include:

Chemical dependency 42%
Eating disorder 38%
Compulsive working 28%
Compulsive spending 26%
Compulsive gambling 5%

 
International Institute For Trauma & Addiction Professionals, 2017
 

 

Where do I go to get help?

The first step in seeking help is to admit that a problem exists. Though marital, professional, and societal consequences may followadmission of the problems must come, no matter the cost. Unfortunately, fear of these consequences keeps many sexual addicts from seeking help, and the consequences can be dire.

Many resources are available to provide information, support, and assistance for sexual addicts trying to regain control of their lives. These include inpatient and outpatient treatment, professional associations, self-help groups, and aftercare support groups. You can go to sexhlep.com, and find a list of professionals who are specialized in the field of Sex Addiction treatment.

 

Can Sexual Addiction ever be cured?

Like other types of addicts, some sexual addicts may never be “cured” but with adequate therapy, people can and do learn to cultivate a healthy relationship with their sexuality, whatever that looks like for them. Sexual addicts achieve a state of recovery, but maintaining that recovery can be a lifelong, day-by-day process. The recovery process from Sex, Love, and/or Internet Pornography Addiction, is analogous to recovery from Eating Disorders; the goal is not to stop the behavior, but to develop a healthy relationship with the behavior. Competent therapy that looks at the underlying issues (i.e. multi-generational trauma, complex trauma, and/or attachment wounding,) along with involvement of various mutual aid support groups is essential. Many mutual aid groups, but especially the Twelve Step treatment approach teaches recovering addicts to take their recovery “one day at a time,” concentrating on the present, not the future.

 

Is there help for partners of Sex Addicts?

Yes! Partners of sexual addicts, like partners of alcoholics, can also benefit from counseling and support groups. Discovering your loved one is a sex addict can be a very traumatic experience for family members.  Inpatient and outpatient programs, counseling, and support groups are all available to help them regain control of their lives and support the recovery of their partner.  You can go to sexhelp.com, go to the “education” tab, and then go to FAQ. In the FAQ, go to “Is there help available for partners of sex addicts. Under this tab, there is a link to Books and Resources for partners of sex addicts. Like Alcoholics Anonymous, there has been mutual aid, 12-step groups set up for spouses and/or family members of sex addicts. For a complete list of these programs follow the same directions listed above (sexhelp.com.)

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