14 Oct Sex Addiction: Diagnosable and Treatable
In the following article that I wrote for Rehabs.com, I discuss the phenomenon of sexual addiction and sexual compulsivity:
“I don’t know how it got this far out of control,” Matt practically whispered during our first session.
“It all started so innocently. I went on Ashley Madison (a website that connects men and women interested in engaging in infidelities) after reading about it in the Wall Street Journal. The next thing I knew, Marsha and I were deep into this S&M thing. Now, I obsess about her all the time. It’s taken over my life.”
While Matt claimed his wife knew nothing about his infidelity or the sexual pleasure he derived from binding and gagging his mistress, he knew his life was spinning out of control and racing towards a disastrous ending.
“Tell me what to do?” he pleaded. “I can’t sleep and it’s affecting my work. I don’t spend time with my son and my wife’s got to sense something’s going on. We’ve been married for 23 years and I love her…I just can’t break it off with Marsha.”
As a marriage and family therapist who works in the realm of addictions, I’ve successfully treated a host of “Matts” and a few “Marshas” too. These are smart, successful and dedicated family men and women who find themselves trapped in one of the most insidious, gripping and controversial addictive disorders.
A Controversial Diagnosis
While the recovery community has embraced the phrase “sexual addiction” to describe a very real and very destructive phenomenon, it has not been officially acknowledged by the American Psychiatric Association (APA). This failure to grant it diagnostic status has led to increased stigmatization of the people who suffer from it, a misunderstanding as to its root causes and a refusal to move the disorder out of the realm of morality and into science.
Fortunately, this failure of the bureaucratic and academic elites to officially recognize a very treatable condition has not prevented a handful of clinicians and recovery centers from formulating treatment approaches that liberate individuals and families from the degradation, despair and destruction inherent in it.
Sexual addiction first attained the public’s attention in 1983 with the publication of Dr. Patrick Carnes’ Out of the Shadows: Understanding Sexual Addiction. In this groundbreaking book, Dr. Carnes outlined five central features.
Five Central Features of Sexual Addiction
The use of sex to manage uncomfortable emotions (self soothing)
An escalation of sexual behaviors (tolerance)
A loss of control (impulsivity and compulsivity)
Significant negative consequences
Physical and emotional distress when the ability to sexually act out is limited (withdraw)
The National Council on Sexual Addiction and Compulsivity defines sex addiction as “a persistent and escalating pattern of sexual behavior acted out despite increasing negative consequences to self and others.” Put in more accessible terms, a person who suffers from a sexual addiction will continue to act out in sexually destructive ways in spite of escalating risks to their:
Finances and career
Significant relationships with spouses, lovers, friends and family
Four-Pronged Approach to Treatment
In contrast to those seeking treatment for drug and alcohol addictions, people who suffer from sexual addictions face more obstacles to getting effective care. These include the controversy surrounding the disorder’s existence that prevents treatment from being covered by insurance, the shame and guilt that keeps the people who suffer from asking for help and the scarcity of competent clinicians who can treat it.
In my own practice, I utilize a treatment approach that addresses the disorder in its four dimensions. These consist of the following:
The patients’ genetic predisposition and neuropsychology
Existing mood disorders that frequently include anxiety and depression
Personality traits that frequently include narcissistic and borderline features
The interpersonal systems in which the patient operates including their romantic and professional relationships, their religion, and their cultural and economic background
This approach is based on solid empirical research indicating the overwhelming majority of patients who suffer from sexual addictions also suffer from biological disruptions in their brain chemistry that cause them to act impulsively. In addition, research shows that people who suffer from sexual addictions also suffer from anxiety and depressive disorders at much higher rates than those found in the general population and have a history of trauma. Finally, several studies as well as my own clinical impressions support my conclusion that life’s stresses and the social, cultural, religious and influences of the patient’s family profoundly impact the patient’s vulnerability to sexual addictions; and, they evidence personality traits that cause them to objectify people as sex objects.
Treatment in Action
Patients who suffer from sexual addictions enter treatment paralyzed by shame and humiliation. They describe themselves as “evil” and “defective.” They desperately want to be liberated from the crush of their destructive behavior, but can’t get out from under it’s demoralizing weight.
They feel profoundly alone in the world and terrified of the vulnerability that comes from authentic intimate relationships. Most often they come to treatment not through their own volition, but rather through the demands of a betrayed and furious spouse or partner who’s unearthed the details of their salacious behaviors. Their world is chaotic and out of control.
It’s important that their treatment be methodically and holistically addressed in a structured and safe frame. They need to be understood rather than judged, heard rather than preached at. They must be able to lay the overwhelming weight of their world in the clinician’s hands and trust that he or she won’t drop it.
The clinician in turn must have specific and concrete interventions to address the four prongs of the patient’s addiction. These should include psychiatric evaluations to assess the need for appropriate medications, clearly articulated behavioral plans to address the patient’s high-risk behaviors, relational work to give them insight into their personality disorders and when appropriate, family and couples therapy. In addition, patients must be given specific tools to address their traumatic histories and responses. These tools should be designed to change the way their brain reacts in the present to the trauma that occurred in their past. Last but not least, patients must be encouraged to partake in recovery communities where they can learn new ways of managing their uncomfortable emotions and the stresses inherent in leading the full and emotionally rich lives they desperately desire.
If you or a loved one suffers from sexual addiction, know that there is a clearly defined course of treatment. Know too that the hardest part in connecting with it is reaching out for help.
Sex and the cloud of moral, cultural and religious judgments that surround it obscures the hard and real fact that you are vulnerable and in pain. Leave these judgments on the curb where they belong and connect to the healing force of science and established psychotherapeutic interventions.
Walk through the door and sit down with a trained clinician who can help you. The only way out is through. The only way up to the light is by digging deep into the darkness.