Evaluation and Treatment for Sexual Addiction
Evaluation and Treatment for Sexual Addiction
Trauma is a frequent, primary underlying factor in the development of an addiction. There tends to be a high correlation among the most common addictions, including drug and alcohol dependence, gambling addictions, eating disorders, and sexually compulsive behaviors As a result, many individuals who enter substance abuse treatment programs often suffer from more than one form of addiction. For example, the cycle of compulsive overeating, which includes both bingeing and purging, looks very similar to the cycles of chemical and sexual addiction, particularly when viewed from an emotional perspective.
The concept of "sexual addiction" has developed over the past several years. In a national survey of over 1,000 "recovering sexual addicts," it was found that a history of trauma was prevalent: 81% of the sample had been sexually abused, 72% had been physically abused, and 97% had been emotionally abused (Carnes 1995). This study also found that 42% had been, or currently were, addicted to drugs and/or alcohol, 38% had eating disorders, and 87% had other family members with addictions (Carnes 1995).
Sexual addiction has been described to include ten important signs:
In identifying a pattern of sexual addiction, it is important to evaluate the individual in terms of these above signs. Any indication of rampant, uncontrolled sexual behavior is a sign of serious dysfunction, especially if the behavior involves children or non-consenting adults, prostitution, exhibitionism, and/or voyeurism. Not only are these activities illegal, they also are destructive to self and others, and invariably lead to serious adverse consequences. In addition to these more overt illegal acts, sexual addiction may include more covert behaviors such as excessive masturbation, multiple sexual partners (promiscuity), constant extramarital affairs, constant viewing of pornography, engaging in constant seductive and flirtatious attention-getting behavior, a preoccupation with sexually inappropriate jokes or stories, sexualizing conversations, and touching others inappropriately.
While not all of those sexually addicted are the survivors of traumatic abuse, in those who are, the sexual abuse often has taken place in childhood, before an individual has the ability to understand and integrate the complex concepts and intense experiences associated with sexuality. Experience suggests that the more severe and the more repetitive the sexual abuse, the higher the risk of sexually addictive behaviors developing. As a result of the abuse, survivors may often feel confused about love and sex, thinking that sex is love, that sex is a means for finding love, and/or that sex is the way to feel good about one's self or experience being in power or control. It also is not uncommon for childhood sexual abuse to later affect a person's unfolding sexuality, causing confusion as to one's sexual identity and preferences. These concerns can be sensitively, confidentially, and effectively addressed through individual and group psychotherapy, and through 12-Step support groups such as Sexual Addicts Anonymous (SAA) and Sex and Love Addicts Anonymous (SLA). In other cases, sexual addiction, as with other addictions, may have biological origins, rather than resulting from trauma. For example, it has been found that sexual acting-out is more frequently observed in children and adolescents diagnosed with Attention Deficit Hyperactivity Disorder (See Maryland Institute Research on this WEB site), and in adults with Bipolar Affective Disorder. Although these disorders can, and should, be psychologically treated, they also require pharmaceutical intervention, particularly when uncontrolled sexual behavior is an associated presenting symptom. Regardless of the origin of the disorder, the use of 12-Step and/or cognitive-behavioral principles for dealing with the obsessive and compulsive aspects of the addiction is also recommended (See Protocol for Managing Obsessive/Compulsive Behavior on this WEB site). Also, many addictions specialists believe that "living sober" is not sufficient unto itself, that addicts need something to replace the "magic" that they found in addiction. For many, a good replacement can be exercise: you move the body, pump the blood, activate the brain ... you feel good. There is a growing body of scientific evidence indicating that regular exercise and a high level of fitness can help ward off cardiovascular disease, osteoporosis, and depression, as well as alter brain chemistry in ways that creates a psychological boost and makes a person feel better. Consequently, exercise can offer an excellent counterbalance or prophylaxis for the shame and depression that so frequently occur during the addiction recovery process.
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