The focus of traditional sex addiction-compulsivity treatment models tends to be on diagnosing and stopping specific sexual behaviors, or sexual sobriety (Carnes, P., 2001). From a treatment perspective, it is correct to implement behavioral containment and stop problematic behaviors.
However, this is where most treatment ends, rather then also treating all the other patterns of abuse and violations of human rights, termed “sex addiction-induced perpetrations” (SAIP) (Minwalla, O., 2012).
Sexual acting out disorders are not just sexual behaviors (Minwalla, O., 2012), but are also abusive behaviors, which include deceptive compartmentalized sexual-relational realities and systems of abusive covert management (Jason, S., 2008; Minwalla, O., 2012). These are patterns of methodical planning over time, careful constructions of manipulation of others, and thought systems well maintained in order to keep a compartmentalized reality protected from discovery (Jason, S., 2008). Managing a secret sexual life and reality takes profound energy to maintain, requiring pre-mediation and an ongoing commitment and intent to deceive, hide and violate others. This is not simply impulsive or compulsive sexual behavior or just a “brain disease”.
A disorder of chronic lying in any human relationship is pathology and requires treatment, regardless of sexual acting out or not. Chronic patterns of establishing and maintaining a deceptive, compartmentalized sexual-relational system in a family system, is not just “compulsive pornography use” or “normal male sexual biology”. The process of gaslighting an intimate partner (Jason, S., 2008), a process of intentional psychological manipulation of a victim’s reality (Jason, S., 2008) over time, is a form of psychological abuse and torture, actually eroding and damaging the victim’s survival instincts and intuition (Minwalla, O., 2011). Clearly, there exist many symptoms and problems, beyond the single symptom of “lack of control of specific sexual behaviors”. These patterns constitute domestic abuse, a specific and often severe form of intimate partner abuse and family harm.
Sexual sobriety alone is an inadequate treatment model (Minwalla, O., 2011). Sex addiction-induced perpetrations are also a clinical problem (Minwalla, O., 2012). However, within traditional treatment models there exists no established diagnosis or treatment for sex addiction-induced perpetrations. This is a serious omission in the field and in clinical practice (Minwalla, O., 2012). The reality here is that treating these complex problems as simply “compulsive or impulse control disorders” (Carnes, P., 2001; Coleman, E., 1990), and focusing on treating sexual acts, while avoiding and omitting the proper diagnosis of abuse and covert violence, leaves these problems untreated (Minwalla, O., 2011; Minwalla, O., 2012).
This also means that the people harmed, the victims of these dynamics of abuse, are rendered invisible (Minwalla, O., 2012; Herman, J., 1997). Their trauma and experiences are not being accounted for in clinical treatment models and their suffering is being dishonored by the complete omission, silence and denial that pervade in existing treatment models. They are dishonored by the professional practice of being satisfied with simple behavioral control over specific sexual patterns (sexual sobriety) as the primary objective of treatment.
Victims need recognition of the patterns of harm and abuse they experience and have endured, which goes way beyond the Pollyanna descriptions of “hurt and betrayal” caused by sex acts. Furthermore, female victims are violated further by being labeled “co-sex addicts” (Carnes, P., 1991) routinely by professionals and actually “educated that they have a disease of self-perpetration”, rather than offered help for abuse and assessment and treatment for both acute and complex trauma (C-PTSD) (Steffens, B., and Means, M., 2009; Jason, S., and Minwalla, O., 2008; Minwalla, O., 2011). This is analogous to labeling a rape victim a “co-rapist” and ignoring and not treating her wounds due to violation.
The Sex Addiction-Induced Trauma Model (SAITM) (Minwalla, O., 2011) is a clinical model which articulates the medical mandate of treating all behaviors that are “out of control” and harmful to others, not just sexual acting out behaviors. Abusive behaviors such as chronic patterns of lying to an intimate partner, creating a lack of relational safety in a family, exposing children to severe trauma via the mother-child bond and her victimization, chronic patterns of martial rape of a wife, just as a few examples, all require clinical treatment. According to the SA-Induced Trauma Model, sex addiction-compulsivity disorders are defined as, “a complex system of sexual, personality, and masculinity pathology, which may include the maintenance of a deceptive, compartmentalized sexual-relational reality, sexual-relational acting out behaviors, and other patterns of perpetration, abuse and violation that causes serious PTSD and C-PTSD (SAIT) in victims, all which requires a clinical management and treatment paradigm (SAITM)” (Minwalla, O., 2011).
Perpetration requires treatment and appropriate clinical intervention, not defensive denial, silence and professional avoidance. Serious harm and violation of others and human rights requires an organized clinical method and direct clinical management, not undefined, underdeveloped or squeamish clinical approaches. After all and in fact, it is often these dynamics of sex addiction-induced perpetrations (SAIP) that often “induced trauma” and does more human damage, and accrues more human cost, then sexual acting out behaviors alone ever possibly could.
American Psychological Association (2007). Guidelines for Psychological Practice with Girls and Women. American Psychologist, 26(9), 949-979.
Carnes, P., (1991). Don’t Call It Love: Recovering from Sexual Addiction. New York, NY: Bantum Books.
Carnes, P. (2001). Out of the Shadows: Understanding Sexual Addiction. Center City, MN: Hazelden.
Coleman, E., (1990). The obsessive-compulsive model for describing compulsive sexual behavior. American Journal of Preventive Psychiatry and Neurology, 2, 9-14.
Coleman, E., (2011) Chapter 28. Impulsive/compulsive sexual behavior: Assessment and treatment. In Grant, Jon E., Potenza, Marc N., The Oxford Handbook of Impulse Control disorders. New York: Oxford University Press., p 375.
Herman, J. (1997). Trauma and Recovery: The Aftermath of Violence – from Domestic Abuse to Political Terror (2nd ed.). New York, NY: Basic Books.
Intimate Partner Abuse and Relationship Violence Working Group, Funded by the Committee on Divisions/APA Relations (2001). Intimate Partner Abuse and Relationship Violence. Retrieved from http://www.apa.org/about/division/activities/partner-abuse.pdf
Jason, S. & Minwalla, O. (2008, September). Sexual Trauma Model: Partner’s Reaction, Addict’s Reaction. Presented at the national conference of The Society for the Advancement of Sexual Health (SASH), (APA Accredited Presentation); Boston, Massachusetts.
Minwalla, O. (2011, September). A New Generation of Sex Addiction Treatment: The Sex Addiction-Induced Trauma Model for the Treatment of Sex Addicts, Partners, and the Couple. Presented at the national conference of The Society for the Advancement of Sexual Health (SASH), (APA Accredited Presentation); San Diego, California.
Minwalla, O. (2012, July, 23). Partners of Sex Addicts Need Treatment for Trauma. The National Psychologist. http://nationalpsychologist.com/2012/07/partners-of-sex-addicts-need-treatment-for-trauma
Minwalla, O. (2012, September, 12). The “Co-Sex Addict” Paradigm: A Model of Diagnostic Mislabeling that Perpetuates Gender-Based Violence and the Oppression of Women. Presented at the National Conference for The Society for the Advancement of Sexual Health (SASH) (APA Accredited Presentation); San Antonio, Texas.
Steffens, B. & Means, M. (2009). Your Sexually Addicted Spouse: How Partners Can Cope and Heal. Far Hills, NJ: New Horizon Press.
For more about SAIP and Dr. Minwalla go to http://theinstituteforsexualhealth.com/
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Last reviewed: 3 Mar 2014