Sexual Addiction & Compulsivity

“Like an alcoholic unable to stop drinking, sexual addicts are unable to stop their self-destructive sexual behavior. Family breakups, financial disaster, loss of jobs, and risk to life are the painful themes of their stories.

Sex addicts come from all walks of life – they may be ministers, physicians, homemakers, factory workers, salespersons, secretaries, clerks, accountants, therapists, dentists, politicians, or executives, to name just a few examples. Most were abused as children – sexually, physically, and/or emotionally. The majority grew up in families in which addiction already flourished, including alcoholism, compulsive eating, and compulsive gambling. Most grapple with other addictions as well, but they find sex addiction the most difficult to stop.

Much hope nevertheless exists for these addicts and their families. Sex addicts have shown an ability to transform a life of self-destruction into a life of self-care, a life in chaos and despair into one of confidence and peace.”

– Patrick J. Carnes, Ph.D.
Author of Out of the Shadows

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

Sexual addiction has been called 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 more important than family, friends, and work. Sex becomes the organizing principle of addict’s lives. They are willing to sacrifice what they cherish most in order to preserve and continue their unhealthy behavior.

Dr. Patrick Carnes estimates three to six percent of the population are facing sexual addiction. It remains unclear whether one gender has a higher incidence of sexual addiction than the other. Research by Dr. Carnes has shown 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.)

What Defines a Sex Addict?

No single behavior pattern defines sexual addiction. These behaviors, when they have taken control of addicts’ lives and become unmanageable, may include:

  • Compulsive masturbation
  • Compulsive heterosexual and homosexual relationships
  • Compulsive use of pornography
  • Prostitution
  • Exhibitionism
  • Voyeurism
  • Indecent phone calls
  • Exploitive sex
  • Boundary violations
  • Fetish behavior to the exclusion of other behaviors
  • And more

Even the healthiest forms of human sexual expression can turn into self-defeating behaviors.

While an actual diagnosis for sexual addiction should be carried out by a mental health professional, the following behavior patterns 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 professional help.

1) Acting out: a pattern of out-of-control sexual behavior.

Examples may include:

  • Compulsive masturbation
  • Indulging in pornography
  • Having chronic affairs
  • Exhibitionism
  • Dangerous sexual practices
  • Prostitution
  • Anonymous sex
  • Compulsive sexual episodes
  • Voyeurism

2) Experiencing severe consequences due to sexual behavior and an inability to stop despite these adverse consequences.

In Patrick Carnes’ book, Don’t Call It Love, 1991, some of the losses reported by sex addicts include:

  • Loss of partner or spouse (40%)
  • Severe marital or relationship problems (70%)
  • Loss of career opportunities (27%)
  • Unwanted pregnancies (40%)
  • Abortions (36%)
  • Suicide obsession (72%)
  • Suicide attempts (17%)
  • Exposure to AIDS and venereal disease (68%)
  • Legal risks from nuisance offenses to rape (58%)

3) Persistent pursuit of self-destructive behavior.

Even understanding that the consequences of their actions will be painful or have dire consequences does not stop addicts from acting out. They often seem to have willfulness about their actions, and an attitude that says, “I’ll deal with the consequences when they come.”

4) Ongoing desire or effort to limit sexual behavior.

Addicts often try to control their behavior by creating external barriers to it. For example, some move to a new neighborhood or city, hoping that a new environment removed from old affairs will help. Some think marriage will keep them from acting out. An exhibitionist may buy a car in which it’s difficult to act out while driving. Others seeking control over their behavior try to immerse themselves in religion, only to find out that, while religious compulsion may soothe their shame, it does not end their acting out. Many go through periods of sexual anorexia during which they allow themselves no sexual expression at all. Such efforts, however, only fuel the addiction.

5) Sexual obsession and fantasy as a primary coping strategy.

Through acting out sexually can temporarily relieve addicts’ anxieties, they still find themselves spending inordinate amounts of time in obsession and fantasy. By fantasizing, the addict can maintain an almost constant level of arousal. Together with obsessing, the two behaviors can create a kind of analgesic “fix.” Just as our bodies generate endorphins, natural anti-depressants, during vigorous exercise, our bodies naturally release peptides when sexually aroused. The molecular construction of these peptides parallels that of opiates like heroin or morphine, but is many times more powerful.

6) Regularly increasing the amount of sexual experience because the current level of activity is no longer sufficiently satisfying.

Sexual addiction is often progressive. While addicts may be able to control themselves for a time, inevitably their addictive behaviors will return and quickly escalate to previous levels and beyond. Some addicts begin adding additional acting out behaviors. Usually addicts will have three or more behaviors which play a key role in their addiction—masturbation, affairs, and anonymous sex, for instance. In addition, 89% of addicts reported regularly “binging” to the point of emotional exhaustion. The emotional pain of withdrawal for sexual addicts can parallel the physical pain experienced by those withdrawing from opiate addiction.

7) Severe mood changes related to sexual activity.

Addicts experience intense mood shifts, often due to the despair and shame of having unwanted sex. Sexual addicts are caught in a crushing cycle of shame-driven and shame creating behavior. While shame drives the sexual addicts’ actions, it also becomes the unwanted consequence of a few moments of euphoric escape into sex.

8) Inordinate amounts of time spent obtaining sex, being sexual, and recovering from sexual experiences.

Two sets of activities organize sexual addicts’ days. One involves obsessing about sex, time devoted to initiating sex, and actually being sexual. The second involves time spent dealing with the consequences of their acting out: lying, covering up, shortages of money, problems with their spouse, trouble at work, neglected children, and so on.

9) Neglect of important social, occupational, or recreational activities because of sexual behavior.

As more and more of addicts’ energy becomes focused on relationships which have sexual potential, other relationships and activities— family, friends, work, talents and values— suffer and atrophy from neglect. Long-term relationships are stormy and often unsuccessful. Because of sexual over-extension and intimacy avoidance, short-term relationships become the norm. Sometimes, however, the desire to preserve an important long-term relationship with spouse or children, for instance, can act as the catalyst for addicts to admit their problem and seek help.

Sexual Dependency vs. Other Addictions

Sexual addiction can be understood by comparing it to other types of addictions. Individuals addicted to alcohol or other drugs, for example, develop a relationship with their “chemical(s) of choice” – a relationship that takes precedence over any and all other aspects of their lives. Addicts find they need drugs merely to feel normal.

In sexual addiction, a parallel situation exists. Sex – like food or drugs in other addictions— provides the “high” and addicts become dependent on this sexual high to feel normal. They substitute unhealthy relationships for healthy ones. They opt for temporary pleasure rather than the deeper qualities of “normal” intimate relationships.

Sexual addiction follows the same progressive nature of other addictions. Sexual addicts struggle to control their behaviors, and experience despair over their constant failure to do so. Their loss of self-esteem grows, fueling the need to escape even further into their addictive behaviors. A sense of powerlessness pervades the lives of addicts.

Why Don’t Sex Addicts Just Stop Their Destructive Behavior?

Sexual addicts feel tremendous guilt and shame about their out-of-control behavior, and they live in constant fear of discovery. Yet addicts will often act out sexually in an attempt to block out the very pain of their addiction. This is part of what drives the addictive cycle. Like other forms of addiction, sex addicts are out of control and unable to stop their behaviors despite their self-destructive nature and potentially devastating consequences.

Key to understanding loss of control in addicts is the concept of the “hijacked brain.” Addicts essentially have rewired their brains so that they do behaviors drinking, drug use, eating, gambling, and sex) even when they are intending to do something quite different. The triggers to these maladaptive responses are usually stress, emotional pain, or specific childhood scenarios of sexual abuse or sexual trauma. Breakthrough science in examining brain function is helping us to understand the biology of this disease.

What is the Role of 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 have had 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 start in the on-line behavior quickly start to act out in new ways off-line. One of the pioneering researchers of this problem, the late Dr. Al Cooper, described on-line sexual behavior as the “crack-cocaine” of sexual compulsivity.

What Help is Available for Sex Addiction?

At the Center for Healthy Sexuality, Dr. Levinson can diagnose your problem through a comprehensive assessment process. A thorough psychosexual evaluation is done along with personality testing, and an in-depth clinical interview and testing using the sexual dependency inventory developed by Pat Carnes. After the evaluation is complete you will get a copy of your SDI which will be explained to you along with the results of your testing and the clinical interview. Very often Dr. Levinson gives you the information you need in the first session, and she will develop a completely comprehensive treatment plan. Your treatment may include the task centered approach developed by Dr. Carnes and the modalities of individual, group, and psycho educational sessions. Your partner is encouraged to come in with you and is an integral part of the treatment. They will probably be suffering from the effects of your addiction, and their recovery from the trauma is focused on in this integrated approach. Not only is this a task centered approach, but your family of origin history is studied in depth and any traumas are uncovered that may have been precursors to your behaviors. A lot of trauma work is done once the compulsive behaviors are managed. The use of 12-step support groups is encouraged and is part of the recommended treatment.

The first step in seeking help is to admit to the problem. Though marital, professional, and societal consequences may follow, admission of the problems must come, no matter the cost. Fear of these consequences unfortunately keeps many sexual addicts from seeking help.

There are many self help groups available.

1) What treatment is available for sex addiction?

Dr. Levinson’s Treatment programs for sexual addiction also offer family counseling programs, support groups, and educational workshops for addicts and their families to help them understand and work through the trauma and betrayal. Unlike recovering alcoholics who must abstain from drinking for life, sexual addicts are led back into a normal, healthy sex life much in the way those suffering from eating disorders must relearn healthy eating patterns.

2) Are sex addicts ever cured?

Like other types of addicts, some sexual addicts may never be “cured.” Sexual addicts achieve a state of recovery, but maintaining that recovery can be a lifelong, day-by-day process. The Twelve Step treatment approach teaches addicts to take their recovery “one day at a time” – concentrating on the present, not the future.

3) Is there any help available for the partners of sex addicts?

Partners of sexual addicts, like partners of alcoholics, will also benefit from counseling and support groups. Normally these partners, suffer from Post traumatic Stress from the trauma of the betrayal. (please see Partners, in the menu)