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Section 12
Understanding Sexual Compulsion

Question 12 | Test | Table of Contents

The nature and prevalence of sexual compulsion has changed due to the influence of the Internet, and widespread media interest -- but counseling still needs to focus on controlling the behavior and addressing the narcissistic damage.

Sexual compulsion is not a joke but a real problem. The term is regularly overused and misused, often being attributed to anyone with a high sex drive or to a media celebrity whose lack of discretion or impulse control has led them to be caught with their trousers down. In common parlance, the term may be met with a snigger or a raised eyebrow, and perhaps even a little salacious curiosity. All of which adds to the shame and confusion of the true sufferer, who is often desperate for understanding, empathy and help.

Defining sexual compulsion
Sexual compulsion, also referred to as sexual dependency, can be defined as any sexual activity that feels 'out of control'. The sex addict feels compelled to seek out and engage in sexual behavior, in spite of the problems it may cause in their personal, social and work lives. It may encompass any single or multiple type of sexual behavior. For example:

* Compulsive masturbation
* Compulsive rise of Pornography
* Having multiple, ongoing Affairs
* Exhibitionism
* Fetishes
* Dangerous sexual practices
* Prostitution
* Anonymous sex
* Voyeurism
* Telephone sex
* Partner sex
* Illegal sexual practices.

The type of behavior does not define compulsion. The essential difference between the addict and the non-addict is that these behaviors feel out of control. An addict may spend an inordinate amount of time planning, engaging in and recovering from their chosen sexual activity. And in spite of the physical, emotional, relational, financial and even judicial cost of these activities, they feel unable to stop their behavior. Or at least, unable to stay stopped.

Another factor is that the chosen sexual behaviors are used to anaesthetize psychological pain. In the same way that an alcoholic may get lost in a bottle or a compulsive gambler fixates on the next win to avoid the pain of life, the sex addict chooses sex as their way to cope with the world.

Prevalence and profile
The true prevalence of sexual compulsion is unknown, but estimates range from three to six per cent of the population. According to Sex Addicts Anonymous, six per cent of the British population is sexually addicted. Dr Patrick Carnes, one of the world's leading researchers and authors on sexual compulsion, reported that approximately 20 per cent of all patients seeking help for sexual dependency are women, and further research went on to observe that there were significant differences in the types of behaviors engaged in by male and female sufferers. Men tend to engage in sexual activities that revolve around a sex object, such as voyeurism, prostitution and anonymous sex, while women tend to use sex for power, for example pain-exchange sex, fantasy roles, particularly seductive roles and trading sex.

A survey of over 1,000 sex addicts and their partners concluded that many sex addicts had come from severely dysfunctional families. Ninety-seven per cent reported emotional abuse, 71 per cent physical abuse and 83 per cent sexual abuse. They also found that 87 per cent had come from families where at least one other family member had an compulsion. There was also a pattern of dual compulsions. Forty-three per cent reported chemical dependency, 38 per cent an eating disorder, 28 per cent compulsive working, 26 per cent compulsive spending and five per cent compulsive gambling.

The Internet explosion
The advances of the Internet have significantly changed the landscape of sexual compulsion. The accessibility and anonymity of the Web has allowed many people to explore their sexuality in a way that has been hitherto impossible. An estimated 20-33 per cent of Internet users engage in online sexual activities. The most common online sexual activity is viewing pornography, cited by 69 per cent of male users and 20 per cent of women. One report estimated that hardcore pornography is now accessed in the UK by 33 per cent of all Internet users.

Online pornography is big business. In 2002, sex-related sites became the number one economic sector of the Internet, estimated Lo be worth a staggering 2.5 billion dollars. There are 4.2 million pornographic websites making up 12 per cent of all websites. Seventy per cent of pornography is viewed between the hours of nine and five, which may explain why one in six employees reported having trouble with sexual behavior online.

The significance of all these statistics to clinicians is that both the profile of a sex addict and prevalence is changing. The Internet accelerates arousal because anonymity reduces the fear and shame that would normally act as a suppressant. What's more, evidence suggests that the Internet can tap into powerful, suppressed and unresolved sexual issues from childhood. This means that behavior is intensified and escalates, both in the amount of time spent on the activity but also the variety of activities engaged in.

Narcissism and sexual compulsion
Thaddeus Birchard, one of the UK's leading researchers and therapists in sexual compulsion, believes the psychological root of sexual compulsive behaviors lies in narcissistic damage. He proposes that this wounding happens in childhood and results both in the self being experienced painfully and, also, the self being experienced as unacceptable. This negative self-image results in depression, chronic anger, core loneliness and unremitting shame.

Much has been written over the years about narcissism and its impact on adult relationships and self-regulation, and many have made connections between this and compulsions. Instead of resolving narcissistic damage, the addict either consciously or unconsciously chooses to anaesthetize the resulting pain. But why do some choose sexual behaviors as their drug of choice?

Birchard suggests that there are two additional components in the family of origin of the sex addict. Firstly, there has been a history of sexual compulsion over previous generations. In some cases this becomes apparent, with addicts recalling finding a family member's pornography or a parent engaging in multiple sexual relationships outside the marriage. In other cases the sexual pre-occupation may have taken the form of sexual avoidance or abstinence. The second component is overt or covert sexualization in childhood. This can take many guises and some clients may be painfully aware of specific incidents of abuse or inappropriate sexual behavior, while others may have more difficulty accessing or acknowledging any disturbance of this kind.

Shame is both a principal result of narcissistic damage and a principle driver for addictive behavior. Nowhere is this more apparent than in sexual compulsion. With so many societal taboos and boundaries around sexual behavior, the sex addict is quickly trapped by the compulsion cycle.

The compulsion cycle
In between the highs of sexual fulfillment are the lows: the of shame, regret, remorse and anxiety. Most sufferers will have tried and failed to curb their behavior on many occasions, and consequently feel powerless to change. They are alone and isolated and soon find themselves seeking out sex as a way to escape from difficult feelings. Sex becomes a pain reliever, an escape from the very problem that it has created.

The four-stage compulsion cycle proposed by Carnes in his book Out of The Shadows begins with preoccupation. The addict thinks about nothing but the next sexual conquest. Each conversation they have, image they see, person they meet or place they go is somehow fitted into a story they create about sex. This total absorption in their favorite subject blocks out the rest of the world. Not only are problems blocked out, but also important relationships and work. The ritualization stage allows the addict to prepare for their next conquest in a systematic and obsessive way. Each will have their preferred routines that intensify the preoccupation and arousal. This then builds to the sexual behavior of choice -- the end goal of the preoccupation and ritualization. But as the addict comes down from the rush of excitement of the sexual experience, they slip into despair. Knowing they have failed to control their behavior again, they feel powerless and filled with self-loathing. They also feel a great sense of shame and often humiliation. For the addict, the easiest route out of these feelings is to lose themselves in the trance-like state of preoccupation. And so the cycle continues.

Treatment options
The first step of treating any compulsion is acceptance. Until the addict accepts the reality of their condition nothing will change. Sex compulsion is no different. But unlike other compulsions, abstinence is rarely the solution. Sex, like alcohol, is not a problem in itself; it is the relationship the addict has with their substance of choice that is the problem. Until the addict realizes that the way they use sex needs to change, they are unlikely to ask for help.

The following 10-step assessment tool, developed by Patrick Carnes, can be useful for both addicts and clinicians to consider if the sexual behavior is compulsive

  1. Do you feel that the behavior is out of control?
  2. Could there be severe consequences if you continue, for example for your relationship, your work, your health, your finances or legal consequences?
  3. Do you feel unable to stop your behavior in spite of knowing these consequences?
  4. Do you persistently pursue destructive and/or high-risk activities?
  5. Do you want to stop or control what you're doing and have you previously taken active steps to limit your activities?
  6. Do you use sexual fantasies as a way of coping with difficult feelings or situations?
  7. Do you find you need more and more of the sexual activity in order to experience the same level of high?
  8. Do you suffer from intense mood swings around sexual activity?
  9. Are you spending more and more time either planning, engaging in or regretting and recovering from sexual activities?
  10. Are you neglecting important social, occupational or recreational activities in favor of sexual behavior?

There are various reasons why an addict may present for inividual therapy. It may be they are aware of and have accepted their condition. However, sometimes the trigger will be a relationship or work problem. As mentioned before, addicts will often have neglected other areas of their life for many years, and sometimes it is the consequences of their behavior that they first want to address, rather than the behavior itself. But assuming that the behavior is at some stage revealed, the first thing the clinician will need to do is decide if they have sufficient knowledge, training and supervisory resources to best support the client. If not, referral will be the ethical option.
- Hall, Paula; Understanding sexual compulsion; Therapy Today; Mar 2006; Vol. 17; Issue 2.

Personal Reflection Exercise #5
The preceding section contained information about understanding sexual compulsion.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Predictors of Compulsive Sexual Behavior
Among Treatment-Seeking Women

- Kowalewska, E., Gola, M., Lew-Starowicz, M., & Kraus, S. W. (2022). Predictors of Compulsive Sexual Behavior Among Treatment-Seeking Women. Sexual medicine, 10(4), 100525. https://doi.org/10.1016/j.esxm.2022.100525

Peer-Reviewed Journal Article References:
Grubbs, J. B., Kraus, S. W., Perry, S. L., Lewczuk, K., & Gola, M. (2020). Moral incongruence and compulsive sexual behavior: Results from cross-sectional interactions and parallel growth curve analyses. Journal of Abnormal Psychology, 129(3), 266–278.

Klein, V., Briken, P., Schröder, J., & Fuss, J. (2019). Mental health professionals’ pathologization of compulsive sexual behavior: Does clients’ gender and sexual orientation matter? Journal of Abnormal Psychology, 128(5), 465–472.

Mendelsohn, D. M., Omoto, A. M., Tannenbaum, K., & Lamb, C. S. (2021). When sexual identity and sexual behaviors do not align: The prevalence of discordance and its physical and psychological health correlates. Stigma and Health.

QUESTION 12
What are two components in the family origin of a sex addict? To select and enter your answer go to Test.

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