photo for levels of severityThe standard set of categories currently in use to describe sexually addictive behavior according to three levels of severity is not wrong, but it has limitations. And I would argue that it can be misleading to sex addicts in treatment in a number of ways.

Here is the level system as described by Patrick Carnes in Out of the Shadows:

Level One:

  • Masturbation
  • Affairs, chronic infidelity, romance addiction
  • Sexual relationships with multiple partners
  • Pornography use and collection (with or without masturbation)
  • Phone sex, cybersex
  • Anonymous sex
  • Prostitution – strip clubs

Level Two:

  • Illegal prostitution
  • Public sex (bathrooms, par
    ks, etc.)
  • Voyeurism – online or live
  • Exhibitionism
  • Obscene phone calls
  • Frotteurism
  • Stalking behaviors
  • Sexual harassment

Level Three:

  • Rape
  • Child molestation
  • Obtaining and viewing child pornography
  • Obtaining and viewing rape, snuff pornography
  • Sexual abuse of older or dependent persons
  • Incest
  • Professional boundary violations (clergy, police officers, teachers, physicians, attorneys, etc.)

Levels relate to social norms and legal consequences

According to Carnes, level one behavior creates few real social consequences.  The behaviors are seen as “victimless”. Level two behaviors are described by Carnes as relatively minor, and seen by society as pathetic.  But they nevertheless have a “victim.”  They are all intrusive in some way and violate social norms.  They can be legally prosecuted.  Level three behaviors violate significant boundaries and usually involve serious law violations.

This system has the advantage of illustrating that it’s not the specific behavior that makes something a sexual addiction or not.  The continuum being described is merely one of how the specific addictive behaviors are viewed by society and the legal system.

Problems with the relative severity of the behaviors 

  • This system doesn’t take into account aspects of how the behavior is done.  A behavior may be part of a pattern of sexual addiction and yet be carried out intermittently, as when an addict feels compelled to prostitutes while on out of town trips or when he is be unable to stop having extramarital affairs.  The behavior may be just as addictive even though it is not continuous.
  • The reverse can also be true.  A person can commit what would be categorized as a level three behavior such as exposing himself, but not be an exhibitionist.  I have a client who has had two incidences of “indecent exposure” when drunk and in the company of prostitutes.  These two incidents were separated by 10 years.   His major behaviors were all “level one” behaviors and he does not seem to qualify as an exhibitionist.  In many cases the more serious behaviors do not indicate that the person has moved into level three but rather that they are in a period of heavy addictive acting out in which there is an uncharacteristic transgression.
  • Many sexually addictive behaviors exist in combination with other addictions in various kinds of “addiction interaction.”  I have seen addicts whose sexually compulsive behavior such as anonymous sex or sex with prostitutes, was always paired with illegal drug use and some where it was combined with drug use, alcohol use, gambling and other risky behaviors.  But these addicts may still be level one in terms of strictly their sexual behavior.
  • The system encourages sex addicts to evaluate their behavior largely in terms of these legal/social factors.  Thus addicts can tend to give themselves a pass when they compare themselves to other addicts whose behavior is of a higher level.  They may feel “at least I’m not as bad as __” even thought they may be acting out their addiction to a more extreme degree in other ways.

Problems with “social consequences” as a basis of the categories

The levels of severity can also be misleading in that they are constructed according to how damaging they are to society or to a particular victim, with the most violent and intrusive acts being the most “severe”.

But this does not necessarily describe what acts are most destructive for the addict or those around him.

  • The obsession with internet pornography and masturbation may not be damaging to society or to other people but it can be devastating to the addict.  Even addicts who commit intrusive acts like sexual harassment, may suffer less personally than a more severely affected porn addict or an addict who spends his entire paycheck in strip clubs.
  • Likewise the severity levels don’t take into account the impairment in functioning caused by the addictive behavior.  Someone may go to prostitutes but suffer way fewer damaging consequences than someone who gets caught with online pornography at work.
  • Severity can also relate to the damaging affects on those close to the addict.  A lifelong history of extramarital affairs is not categorized as very severe, but post-disclosure the damage to the spouse can be extreme.  This may also include sexually transmitted diseases, divorce and trauma to the children of the addict in the process.

Ultimately perhaps we need another yardstick or set of yardsticks to depict the severity of the sexually addictive behavior.  As therapists we need to talk about the affects on the addict, their partner and family and on future generations.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

 


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    Last reviewed: 15 Sep 2013

APA Reference
Hatch, L. (2013). Sexually Addictive Behavior “Severity Levels”: Limitations of the System. Psych Central. Retrieved on December 22, 2014, from http://blogs.psychcentral.com/sex-addiction/2013/09/sexually-addictive-behavior-severity-levels-limitations-of-the-system/

 




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