This is a new type of contribution. I will be discussing Compulsive Sexual Behavior (CSB). Some people refer to the pattern of behavior as SEXUAL ADDICTION. I am not in agreement with the use of sex addiction for CSB as I perceive CSB as being in a different category.
In previous posts I focused on couples who have the ability to have an emotionally intimate relationship. Some people however, are NOT CAPABLE to tolerate emotional and psychological intimacy. When they talk about the issues they experience, they often state that they care about the person they live with but that they cannot commit or they state that they are not deeply in love with the person they live with. What they might mean is that they have a fear of vulnerability and as a result they avoid becoming emotionally intimate with another person. It has been found that these people are not often aware of the root causes of their behaviors.
Researchers have written about this and Marcus (2010) in “Men who are Not in Control of their Sexual Behavior” writes that he prefers the term SEXUAL COMPLULSIVITY but that other researchers refer to this phenomenon as SEXUAL ADDICTION or HYPER SEXUALITY or SEXUAL DEPENDENCY. Marcus also refers to the pattern of behaviors as SEXUAL ACTING OUT and as a “relationship disorder”. The problem with the use of all these different titles is that there is no consensus and this means that people either are pathologising all perceived hypersexual behaviour in the form of an addiction. People with CSB have a more complex problem as rather than hyper sexuality, people with CSB are not capable to form long-term satisfying emotional relationships (please refer to Post 29, I do not prefer the term sex addiction).
According to the DSM 5 Hypersexual Behaviour Disorder is not an official psychiatric disorder, as evidence is lacking to include the behaviour in the handbook. This is in my opinion a positive decision as if we would include all behaviours that are excessive and that have a negative impact on daily functioning and relationships we could include about all human behaviours in the DSM-5 as most “normal” behaviours can be exercised in excess and therefore will have a negative impact on oneself and on others.
Hypersexual behaviour may include: excessive masturbating, excessive viewing of pornography and frequently engaging in cybersex, among other behaviors. In general, it are men who come forward with the problems and those who come forward experience shame and guilt. We have to be aware that what has been historically seen as paraphilia (and disordered behavior) might be seen as perfectly acceptable in current times. Of course, cultural differences also play a role in what is seen either as excessive and abnormal or as an accepted preference. Needless to state that some screening tests are no longer valid (Jonnides, 2012).
To add affairs as a common aspect of hypersexual behaviour is not correct, as affairs have an additional component. This is deception, and doing HARM to others. Hypersexual behaviour does not include doing harm to others.
It is interesting that the terminology Sex Addiction is used AFTER an adulterer is caught and facing the consequences. Although I use the term porn addiction when relevant, I do not use the term sex addiction (see Post 29).
Jonnides (2012) in “The Challenging Landscape of Problematic Sexual Behaviors, Including “Hyper-sexuality”, refers to three published research studies. He found that the prevalence of hyper-sexuality varies from 5 to 6%. A large study undertaken by Skegg and colleagues in 2010, found that 14% of men and 7% of women perceived their sexual fantasies and urges “out of control”. More importantly, less than 1% of the total sample of 1,037 men and women reported that their sexual behaviors had interfered with their lives.
This means we are talking about a small group of people who experience negative affects from their sexual behaviors. Many studies focused more on male versus female behaviors. It might be that females experience their “out of control” sexual behaviors in different ways. More studies are needed to find out whether there is a difference and whether this effects how therapists can be helpful to females.
SEX ADDICTION IS NOT EQUAL TO PORN ADDICTION!
The most important information I found is that we have to be very cautious in what we define as sex addiction or excessive sexual behaviors, but in general (as with all addictions), we can safely state that when the behavior (thoughts and actions) start to negatively affect your daily functioning and your relationships, you have a problem and it will need your attention before it gets better.
Men with CSB might state that they have told their partner that they do not want to get married and that they do not want to have children, but as the relationship on the surface seems a committed relationship, many female partners will perceive it as such and have the expectations that “he will change once the baby is born” and that they have a “normal” and healthy relationship. Females with CSB often have stated to their partner at some time that they fear that they might not be able to stop having affairs.
The inability to develop a deep emotional connection is hurtful to partners of men (and women) with CSB and many partners might not understand the behavior. They might perceive their partner as a adulterer but those who read my other posts will see that there is a difference. The people with the behaviors discussed in this post need treatment when they are ready and it might require long-term therapy. Even if therapy is helpful, a relapse is not unlikely. This can be understood from a therapeutic point of view, but the partner will feel very hurt. It might not be possible for a man with CSB to remain in a relationship or the partner of a man with these behaviors might not be capable to accept the reality of the problem and work with him. This is fully understandable as she too needs a loving and respectful relationship and she might not find that with her current partner.
CSB is not only related to a strong sex drive. If this was the case, medication, an understanding partner and self-help groups should be helpful, but it is hardly ever enough. This does not mean that ALL need lengthy therapy. Some people benefit from brief counseling. Although attending meetings based on the principles a 12-step program can be helpful, for some it is not enough as it does not deal with the root causes. Sexaholics Anonymous (SA) requires of attendees to have a desire to stop lusting and become “sexually sober”. This is a problem as physical intimacy is a basic human need. What attendees want to achieve is a sense of being in control of their behavior. This is no different for people who identify themselves as overeaters. We need food, what we do not want is that food becomes an obsession and controls us. Unfortunately, to many in our society food is an obsession.
Therapists who are working with clients with CSB need to assess the client for mood disorders, ADD/ADHD and a history of trauma based in childhood which has affected parental attachment. If the client is in a relationship, couple therapy can be helpful as well. Further, it is important to ask many questions and to ask for clarifications when issues are not clear. A psychodynamic approach might be helpful in combination with a 12-step program or Cognitive Behavioral Therapy. I mentioned a psychodynamic approach, but other approaches can be equally helpful as long as the therapist spends time on family of origin, attachment and family relationships.
Jonnides (2012) states that therapists have to ask direct questions as often the client and the therapist have a different understanding about certain sexual behaviors. This might be uncomfortable at first, but it is important for successful therapy to at least understand each other.
Some men state that they feel empty and when they are asked about their sexual encounters they rate them as not satisfying. This becomes clear when looking at the core issue: “…in inability to internally soothe themselves [leading to] seeking external means, such as sex to modulate their emotions” (Marcus, 2010, p. 385).
I have noticed that men with CSB only come to therapy when they feel deeply stuck. This happens when they are in a relationship and their partner demands a deeper commitment. It often involves pregnancy or the birth of a baby. Although many men feel deeply ashamed and even express disgust when talking about their multiple short-term sexual encounters, they seem to lack the notion that they hurt many people. In the first place, their partner and the mother of their children, but they also hurt those they have sex with as these people might have expected some sort of relationship or at least some emotional connection.
Although not to confuse with CSB, unfortunately, in my practice only a few female clients disclosed a problem with what they refer to “hyper-arousal”. I am learning to ask my clients more questions as many feel ashamed to open-up about the “real” reason why they sought therapy. I hope that some of these potential clients read this post and feel more confident to reach out and seek help if needed. It is extremely likely that women with an above average libido -in our current Western society- and who are not in a committed relationship, enjoy their life and sexual encounters. The Internet has made it easy to hook-up and to find interested and consenting partners. As long as people are honest about the nature of the interaction and practice as-safe-as possible-sex, it is entirely their business as it is personal and with clear boundaries and honesty and openness others are not hurt by in the process.
…and here again…..affairs are not part of an honest and enjoyable sexual encounter….as affairs are hurting, dishonest and harmful.
In summary, CSB is not the same as having a large sexual appetite. The latter is not a disorder. Using the term sexual addiction as a justification or an explanation for the many affairs mostly men have is a cop-out and the only ones benefiting from the “diagnoses” are the owners and therapists of the many programs set-up for the so called “sex-addicts” (For more information on porn addiction and how this differs from what people perceive as “sex addiction”, please read post 29).