Recovering addicts often resist participating 12-step programs for addiction because they seem to rely so heavily on the notion of “God.”  Even though the programs often use the terms “higher power” or “God of your understanding” some people feel overwhelmed with what they feel as oppressive religiosity.  Other people who are already religious can come to resent the 12-step idea of a higher power or a spiritual awakening because they feel they already have a perfectly good religious framework for their lives and they don’t need to learn a new one.

No matter what the objection the person has to the concept of a higher power, they can often accept the notion of intuition as a way to conceive of the concept of higher power. (See the new Psych Central blog about intuition!)  I support this idea because of the many strands of thinking that have come together around the idea of intuition in recent years.

What is intuition?

Intuition is real.  It appears to have certain defining characteristics.  It is generally written about as a kind of mental processing, a form of understanding or apprehending something

• Without verbal thought

• Without conscious problem solving, and

• Without the time required for normal thinking

In everyday life we experience intuition without realizing what it is.  We have been trying to figure something out and all of a sudden as if out of nowhere the answer pops into our head.

Where is intuition?

Intuition is talked about by Malcolm Gladwell in his book Blink as a scientifically documented kind of mental processing which he calls rapid cognition whereby people can know something instantaneously and even act on it in a tiny fraction of the time that it would take to actually think about it.

Eckhart Tolle has a similar notion of non-verbal awareness when writes about tuning in to yourself as a process that is beyond words, concepts and thinking in the usual sense.  He describes this meditative state as one that is “above” thought, transcending thought rather than “below thought” as when the thinking mind is numbed out with drugs.  The meditative state of being present is very open to intuitive understanding whereas the drugged state is unavailable to intuition or much of anything else.

To the extent that it is localized, intuition can be conceived as a right brain activity. The famous book by Betty Edwards Drawing on the Right Side of the Brain, suggests that drawing involves a kind of joining with the thing we draw that is a non-conceptual process.

Intuition as higher power works well for many people 

Intuition as currently written about connects well with ancient spiritual traditions like Taoism which are alive today.  Taoism says that “those who know don’t say and those who say don’t know.”  In other words the notion of a higher power is one that is beyond words and cannot be talked about using words.  This is unlike the traditions that revolve around a deity.

In recovery we become more connected with ourselves with other people and with the rest of “being.”  Normal thought categorizes things into verbal boxes and separates me from you, us from them etc.  Intuition is where we feel the oneness because we let go of all the trappings of our old egotistical ways of thinking.

Because it is non-conceptual, intuition is a form of thinking that is non-judgmental and therefore fits with our recovery process of becoming more accepting and living a surrendered life.  As they say in recovery circles we “live life on life’s terms” instead to trying to control everything and making ourselves miserable.

How to use your intuition

Best of all, your intuition as  your higher power is not something you need to search for.  It is already there inside you.  You don’t need to read a lot of spiritual writing if you don’t want to and you certainly don’t need to go to someplace to study and sit and meditate for hours.  You just need to begin to listen to your own inner sense of things more closely.

Sometimes listening to your intuition means quieting noise from outside for periods of time and not filling up every spare moment with something to do or listen to or watch.  The important point is that it is not a religious process or a belief in God in the usual sense.  It is not listening to what something outside us tells us but listening to the wisdom that is already inside us .   Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

The harm reduction approach to addiction treatment is conceived as an alternative to total abstinence from the substance or behavior and involves techniques to reduce the risks that go along with addiction.  The early harm reduction techniques originated in 1972 in the Netherlands as an approach to drug addiction.  Early harm reduction, later called “normalization”  involved things like needle exchanges and methadone maintenance for drug addicts.  Recently the term has been used to describe system of care services that are interdisciplinary, empowering, and involving the family and community.

In sex addiction, harm reduction might include charting techniques such as having the addict track the amount of time he or she spends masturbating, risk reducing strategies like getting addicts who visit prostitutes to use condoms and other plans for risk reduction like refraining from using internet porn on work computers.   These would be intended both to raise awareness and to contain the behavior in ways that make it less damaging.

These techniques involve working with the addict toward agreed upon goals that do not involve entirely giving up the addictive sexual behavior.

Can the harm reduction model  work for sex addicts?

The harm reduction model does not necessarily address why you engage in sexually compulsive behavior, but only how you do it.  It does not attempt to get at the root causes of addiction which we now know involve early attachment problems and neurodevelopmental factors.

Current thinking among sex addiction therapists is that addicts will be very prone to relapse if they have not worked through their early childhood trauma issues.  Without this, the thinking goes, the addict will stay stuck in patterns involving poor coping skills, inadequate emotion regulation, low self-concept and intimacy avoidance.  These “survival skills that no longer serve,” as they are called, will in turn lead inevitably to a return to dependence on addictive substances and behaviors.

Harm reduction by definition does not require the addict to go through withdrawal from an addictive behavior.  This in turn means that the addict is continuing to use the behavior as a drug.  As such the sexually addictive behavior keeps in place all the self delusion, denial and secrecy that characterize the sex addict’s functioning.

When addicts in early recovery abstain from all sex it appears to allow their heads to clear, the so-called “neural reset.”  This in turn opens up the possibility of thinking more realistically, exploring the underlying psychodynamics and becoming committed to a different kind of life.  A life without being stoned all the time.

Given that sex and porn addiction are progressive and the behavior tends to escalate over time, addicts who continue to engage in addictive behavior, even under harm reducing parameters, can be expected to follow the typical course of acting out more frequently and in more extreme ways over time.  The very risks that harm reduction attempts to curtail may be the very thing the addict begins to crave more as time goes on.

The harm reduction model is already part of sex addiction treatment

Many of the basic ideas of harm reduction are already present in treatment and 12-step program work for sex addicts.  Outside of an initial period of abstinence, these programs are never geared toward a life devoid of all sex.

The addict with the help of a sponsor or counselor lays out the behaviors that characterize his compulsive sexual acting out.  These are the ones he agrees he needs to abstain from entirely and for good.  This might include internet pornography or any other addictive sexual behavior but might not include abstinence from sex with a partner or masturbation once recovery is established.

12-step sex addiction recovery involves a great deal of learning and awareness about the harm of the addiction.  Step 1 in the 12- steps involves looking at how the addiction has made the addict’s life unmanageable.  The later steps continue the process of looking at the harmful consequences and repairing the damage.

Even with regard to the forbidden “inner circle” or “bottom line” addictive behaviors there is room in sex addiction recovery for a modification of these definitions.  Recovering sex and porn addicts often move behaviors into or out of the forbidden zone as things change.  If certain behaviors are not problematic in the long run then they can be allowed back in and enjoyed in moderation.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

The common history of childhood trauma or attachment issues leaves most addicts with the core beliefs that they are unworthy, that no one will want to be there for them and that no one will ever like the real them.

And so addicts learn early to reach for a drug to meet their needs.

These negative beliefs lead to psychological problems in the area of self expression, self assertion and being available to connect with other people.  Many addicts develop a narcissistic defense which they present to the world to cover their insecurities.

They feel that the genuine “me” is inadequate or, as Jonathan Young of the Joseph Campbell Archive says, “Shame does not speak up.”

Strategies for being out in the world in an authentic way

• Take a closer look at where your fears come from
  

When I first started doing expert testimony as a forensic psychologist I was always petrified of being cross-examined by an opposing attorney.  I would freeze up.

At some point I realized that as a child my father had always been very verbally challenging and critical about anything I said and that I had become very fearful of being shot down.  I was then able to literally look at the attorney and say to myself: “This guy is not my father!”  I was able to challenge my belief about my own credibility.

• Let go of outcomes.

This is a basic recovery skill, namely that of doing your best and then letting go of the result.  When I first started blogging I thought I always had to please everybody (again a byproduct of my own childhood).  When someone blasted me in a comment I didn’t know what to do.  I thought I had to change somehow.

A friend helped allay my panic by reminding me that comments are just conversation and that people have a right to their own opinion.  Let other people be them.  Children who have been mistreated will often refuse to play a make believe game without controlling every aspect of it, even when they have reached an age when they should be capable of letting others in.

• Don’t plan ahead so much

Planning everything ahead of time takes you away from the reality of the situation.  This kind of perfectionism makes everything you do seem stilted.  When children receive less than optimal parenting, they can feel that if they do something wrong it’s going to be a disaster.  They experienced love that was conditional on their fulfilling the expectations or needs of their caregivers.  In the real world people won’t be interested in you or love you because you are perfect all the time.

If you go to a lot of 12-step meetings you get to practice this skill when you “share” i.e. talk in meetings.  You can sit there while other people are talking and plan your own perfectly polished share or you can listen to others and then speak from the heart, without a plan.

• Find ways to practice, practice, practice
  

It has been said that to overcome a fear you should do the thing you fear over and over again.  After being in recovery for a while I realized that I needed to learn to be more spontaneous and confident.

So I took an improve class.  It was amazing because in improvisation there is zero time to plan anything you say or do.  It has to come straight out of you, a part of you that you don’t normally access.

Any way that you can practice being “out there” in an unscripted way will help de-condition the fear.  Drawing or painting are great, singing or acting work the same way.  And when you do these things with other people you increase the effectiveness.

Ultimately getting out of your own way is a byproduct of recovery, and an act of faith.  It is accepting that you can be known and appreciated not for any outward attributes or achievements but for what is essential in you.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

If you are a clinician working with sex addicts you may be struck by how often the addict is desperate to save their marriage or relationship.  Sometimes to the point of being so obsessed with holding onto their relationship that it interferes with their focusing on treatment.

It may not be immediately obvious why this is so.  Addicts appear to be focused mainly on themselves. Typically they:

-are sexually compulsive outside of the relationship

-are intimacy avoidant

-use coping skills which create distance

-lead a double life

We typically think of the spouse or partner of the addict on the other hand as the codependent:

-fearful of abandonment

-enmeshed and preoccupied with their partner

-emotionally constricted or volatile

-subject to self-doubt and insecurity.   

And yet most married sex addicts entering treatment (more often they are men but by no means always) exhibit exactly these signs of codependency. They may exhibit them more than their supposedly “co-addict” partners.

Origins of codependence

People who exhibit codependence have typically had some kind of stress or inadequacy in their relationship with their care-givers early in life.  This is sometimes referred to as “relational trauma.”  This early relational trauma causes the child to grow up with mistrust of those close to him and to be insecure and avoidant regarding relationships and sometimes regarding the world in general.

Instead of growing up with a strong internalized sense of self, the codependent survives childhood by using one or another “strategy” by which to adapt to a less than nurturing situation.  These strategies, like numbing out, distracting oneself, suppressing feelings, being over compliant, etc. take different forms depending on the kind of relational stress and the nature of the relationship with the parents. 

But bottom line, the development of the sense of self is impaired in an attempt to get the caregiver’s approval or love.  The codependent’s core belief is “my worth as a person depends on my value to someone else.”

In what way are sex addicts codependent?

Although sex addicts may have a façade, a “narcissistic false self” as it is sometimes called, they have typically grown up with some serious disruptions in their intimate relationships with caregivers.  This can take the form of abuse, but not always.   Often the parents of addicts are distant, repressed, rigid or disengaged. 

Patrick Carnes has pointed out that relational trauma is “a powerful factor in the genesis of addictions and compulsions.”  In Carnes’ theory the addict shares the same fears, mistrust and basic sense of unworthiness as a codependent.  The lack of a strong sense of self and of self worth underlies the intimacy avoidance of addicts and the tendency to medicate their fears with sex and to split their sex life off from their normal life.

The belief that they are unworthy and that they are only lovable to the extent that they can please someone else, can lead to the addict’s extreme fear of abandonment and rejection by the very partner that they have betrayed.

A passage in the Co-Dependents Anonymous “Big Book” states this point clearly:

“Since the very nature of existence is relationships, and I had a disease that precluded my ability to maintain healthy relationships, I began to see that I was pretty well screwed.

I think of the disease of codependence as a tree. 

The roots of the tree are my childhood abuse and neglect.  The branches are my acting-out behaviors I developed to cope with life.  Both the roots and the branches have to be healed (my italics). 

I cannot stop the acting-out without healing the damage that spawned the behavior, and likewise, I cannot work on the roots if I’m still medicating myself with my addictions.”

Understanding and working through these underlying early childhood issues will dismantle the unconsciously held core beliefs and allow for the emergence of a real self and real intimacy with another.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

A week ago the National Institute of Mental Health (NIMH) published its intention to work towards and devote research funding to a new system for mental health diagnoses as an alternative to the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association.  The various incarnations of the DSM have been dubbed the “gold standard” of diagnostic criteria for mental disorders and have provided a common framework for practitioners, researchers and insurers to relate to. 

The trouble is that the DSM has never been any good as a basis for understanding and treating mental disorders because it is built, as the NIMH announcement says, out of collections of symptoms rather than identifiable or understandable disorders.

The NIMH will be doing what has needed to be done for decades: to create a new set of diagnoses of mental disorders based on something real.  In this way the new approach to diagnosing psychopathology will cut across previous descriptive domains and tie a diagnosis to growing knowledge of neurobiological, genetic and developmental processes.

I have been frustrated for many years by the DSM diagnoses’ evident lack of any connection to any underlying process or known etiologies (origins) of mental disorders.  Much to my embarrassment, I have found myself while working for community mental health, diagnosing a youngster as having an “Oppositional Defiant Disorder” (113.81 in the DSM-4).  Knowing a little about psychology, I was aware that oppositional behavior in kids is often related to the child’s experience of parental rejection.  But in the DSM world (i.e. the world of billing and reimbursement) I could not treat the family system.  I had to attempt to treat an emotionally dysregulated child as though he had some mysterious disease coming from who knows where.

The DSM and Sex Addiction

In the recent effort to find a way to include what we understand to be sex addiction in the DSM 5, the group attempting to satisfy the DSM evaluators proposed the term “hypersexual disorder” and specified basically the practical diagnostic criteria that have emerged over the last three decades of researching and and treating sexual addiction.  The effort involved testing the characteristics of people actually undergoing treatment for sex addiction against the proposed criteria. 

Reading the resulting diagnostic description one is struck by how closely they seem to mimic the terminology of the DSM while attempting to carve out a category not already included in another diagnosis.  This is pretty fruitless.  It suffers from all the deficiencies of the rest of the DSM including the fact that it is not tied to any underlying process or any scientific way of understanding such an addiction.  However, for no logical reason, the DSM folks chose not to include hypersexual disorder in the DSM 5.

Perhaps it is for the best that we are not tethered to the term “hypersexual disorder” because the term is problematic.  Hypersexual behavior is not really a disorder and is a symptom of many, many other existing DSM disorders.  Furthermore, what we think of as “hypersexuality” in common language is not necessarily present in those who have compulsive sexual behaviors.

We need a new way of talking about addictive disorders

Researchers are in the beginning stages of identifying the neuropsychological, genetic and developmental factors that underlie all addictions, sex addiction included.  They are even beginning to address the issue of which type of childhood attachment trauma leads to which kinds of addictions based on the individual’s developmental trajectory. 

It has been clear for a while now that although we treat addictions, we are really treating an underlying problem that has its roots in childhood trauma that has affected brain development and brain chemistry and in which the addictions are only part of the overall picture. 

In a new diagnostic schema that actually makes sense, addictions including addictions like sex, food and gambling, might end up as subtypes of a larger category such as disorders of the self (now called personality disorders) or dissociative disorder, or some new concept which contains the idea of childhood attachment trauma as the root cause, neurodevelopmental abnormalities impairing the formation of  normal self-monitoring functions as the intermediary, and addictions as the end result.

This new schema may be a long time coming, but I am greatly relieved that it is now on the table.  I think it offers hope for a rational approach to the treatment of all of what we now think of as addictive disorders.  In the existing DSM the effort to find a logical place for them is doomed.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Many people, both men and women, cheat on the person they are in a relationship with; at least 20-30% admit it depending on which data you are looking at and how the research questions are phrased.  Some people cheat very rarely and others cheat a lot.

Some people cheat repeatedly but do not meet the criteria for sex addiction.  Others who cheat repeatedly use cheating as a sexually addictive behavior and can definitely benefit from being given appropriate treatment. 

So how do you tell the two apart? 

The generally accepted clinical criteria have to do with things like being preoccupied with and unable to resist the urges to do certain behaviors, escalation of the behavior over time, inability to stop despite negative consequences, and distress if prevented from engaging in the behavior.  But many of these criteria would be hard for a spouse or partner of a cheater to see.

General differences

For sex addicts cheating, or having “serial affairs,” is part of a larger pattern of using sex as a drug.  The  majority of sex addicts who cheat usually have some other form of sexual behavior in addition to affairs, such as porn, internet sex, phone sex, flirting, sexual hook-ups, and so on.  And in general they tend to view the world through sex colored glasses, sometimes without realizing it.

Serial cheaters on the other hand may or may not engage in other kinds of sexual behavior and their cheating tends instead to be part of a larger pattern of behavior that is impulsive, self-indulgent, irresponsible or amoral.  Sex is not used as a drug but is one of many forms of manipulation and opportunistic self-gratification. 

Now I can hear some people saying “yes, but sex addicts are self-serving and amoral too.”  It is true that both cheaters and sex addicts can be masters of deception but I believe that there are differences. 

Some signs that your cheater may be a sex addict

• Although sex addicts have a long standing pattern of using sex as a way to cope with feelings and with life generally, they also typically experience their sexually addictive behavior as in some way “ego-dystonic,” meaning that the addict does not really want to see himself as a cheater.  In other words for the sex addict, the behavior doesn’t fit his self-concept.   He rationalizes it and lies about it to himself as much as to others.

• Addicts who cheat very frequently have other addictions besides sex.  Dr. Patrick Carnes found that the overwhelming majority of sex addicts had at least one other addictive behavior such as drugs, alcohol, nicotine, work, etc.  Scientific evidence is beginning to show that there are neurophysiological and even genetic bases to addiction and that all addictions are similar on some level.  So the sex addict cheater will likely show signs of addictiveness to other things.

• Sex addicts typically have a core belief that sex is their most important need.  One way this will be observable is that the sex addict will find it hard to completely hide his or her preoccupation with sex.  He or she will often tell sexual jokes more readily than people normally do, make sexual references in social conversation when it may not be entirely appropriate and talk privately about the sexual attributes of people to an unusual degree. 

• Sex addicts who want to hook up or cheat as one of their sexually addictive behaviors will almost certainly sexually “objectify” the people they meet.  This means that they will be sizing everyone up as a sex object or potential sexual partner.  This will be most visible in the form of staring and fixating visually as well as flirting in a predatory way.  It may be even subtler, taking the form of “intriguing” in which the addict tries to connect in subtle ways like eye contact and innuendo.

Sometimes a cheater is just a cheater

Repetitive cheaters who do not have a sexual addiction may decide that it is a good idea to quit cheating, but their quitting is determined by self interest rather than by treatment or basic change.  Some cheaters may just “mature out” of the behavior.   Cheaters who are not addicts probably cheat in a lot of areas of their lives.  They may be secretive but only because it would be very inconvenient if their partner knew the truth. 

Cheaters are not obsessed with sex and they are certainly not riddled with self doubt and shame.  They are not acting against their value system because they genuinely feel that what they are doing is justified.  They do not wish they could stop; rather their motto is “if you can get away with it, do it.”

The number of Hollywood porn films produced have exceeded that of mainstream movies, with the 2006 porn industry revenue of $13.3 billion making porn bigger than the NFL, NBA, and Major League Baseball combined.

The sex and porn industries employ a large number of women and there is a recent explosion in the number of women in the webcam pornography sphere.

How are the women in the online porn industry faring?

I came across some interesting data through an organization operated by former porn and sex industry workers.  They report on the results of “a cross sectional study based on the California Women’s Health Survey” which compared the mental health of female adult performers with that of other young women in California.

As children:

37% women in porn had been child victims of forced sex compared to 13% of women not in porn

21% had been placed in foster care compared to 4% of women not in porn

As adults:

33% of women in porn met the criteria for depression vs. 13% of women not in porn

34% of women in porn experienced domestic violence in the past 12 months vs. 6% of women not in porn

27% of women in porn experienced forced sex as adults compared to 9% of women not in porn

50% of women in porn lived in poverty in the past 12 months vs. 36% of women not in porn.

On the other hand…

An article called “Female Porn Stars Have High Self-Esteem, Study Says” describes a study in which the self-reports of 177 porn actresses suggested high levels of self-esteem, positive feelings, social support, sexual satisfaction and spirituality.  But at the same time the study found that porn actresses had sex at an early age, had more sexual partners and were more concerned about contracting STDs.

Others have claimed that porn can be empowering for female performers and that for some it offers a chance to escape poverty and go on to college.

The sex industry generally

Jennie Ketcham, a blogger for Huffington Post has been quoted as saying that being a porn star is traumatic and that she experienced symptoms similar to those of post-traumatic stress disorder after leaving the industry.

This is not a big revelation.  In studies of women in various aspects of the sex industry, including prostitution, have been found to have a an incidence of PTSD that is about on a par with combat war veterans.

Women in various aspects of the sex industry have been found to have higher rates than the general population of

Drug addictions

Sexually transmitted diseases

Violent assaults, and

Mental health problems

Also 73% of women in prostitution have been raped more than five times (U.N. Office on Drugs and Crime) and 89% of women in the sex industry reported that they wanted to escape but had no other means for survival. (www.protitutionresearch.com).

Webcam porn sites

Forbes.com interview with the author of A Billion Wicked Thoughts: reports that

“The single most popular adult [porn] site in the world is LiveJasmin.com, a webcam site which gets around 32 million visitors a month, or almost 2.5% of all Internet users.”

And

“…what men prefer the most is watching women strip on a webcam and being able to talk to them while they do, telling the women what they want to see. Once this became available (through high-quality broadband streaming of webcam video) it just shot to the top of popularity; it’s even more popular than the tube sites like PornHub and RedTube.”

The Forbes article reports that almost all the performers in webcam porn are from eastern Europe and southeast Asia.

“At $8-$15/hour with no benefits, it doesn’t pay enough for American women… except teenage girls and college students.”

I have not found any studies yet on the mental or physical fallout from performing in webcam porn.   Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

“Really listening is like dying for a minute” Michael L. Alvarez, MFT

You can make the art of listening work for you in your recovery.  Practicing real listening gives us a chance to practice basic recovery skills.

Addicts and people with intimacy issues are not particularly good at listening to other people.  Really listening to someone demands a level of awareness and a kind of attending that every addict needs to acquire.

Why listening is like love

When you really listen to someone it means that the person you are listening to is more important at that moment than any other need, opinion, motivation or preoccupation you might have.  That person is, for that time, the center of your attention and of your universe.

This is true whether you are in a relationship with the person or whether you never saw them before in your life.

When you make someone the center of your attention in this way the other person is likely to sense that you are giving totally of yourself.  In a way you have let go of your own sense of separateness and immersed yourself in them.

The recovery skills involved in listening

1. Really listening involves letting go of judging the other person.  Judging puts what they say into categories, like true-false, nice-mean, etc.  In really listening you suspend judging and accept the person where they are.
2. Really listening involves setting aside your own egotistical needs.  You cannot pay attention to someone if you are busy planning the next brilliant thing you are going to say.  If you do the latter you will be hearing just enough of what they say to prompt your answer and you will be mostly preoccupied with being right, smart, one up etc.
3. Really listening to someone is impossible if you have an agenda.  If you go into a situation with a desired outcome in mind (like wanting them to like you) you will filter and slant what you are hearing in terms of its value as a means to an end.  This takes you way away from them.  The listening has to become an end in itself.
4. Really listening requires mindfulness in the sense of being present.  This is a state of being that takes place inside of you, one of giving your entire consciousness over to what you are hearing.  Physical presence helps but it is not really necessary.  You can be in a state of alert presence even in a phone call or exchange of texts.  You are aware of what is going on right at this moment.
5. Really listening is never just about the words.  Listening does not depend on what the other person is saying.  In this sense it is unconditional.  If the other person is babbling nervously you may not hear what they are saying in terms of the words but you will be able to listen to them, to their state of mind.

Listening as spiritual practice

The result of practicing the art of listening helps the listener.  When we listen we are able to be mindful, to be accepting, to let go of outcomes, to be authentic and to be empathic.  Paying attention to someone or something in this way connects us to our fellow beings.

What do you do after you have listened?  Listening may be all that you do if no response is required.  But if you have really listened then what you say or don’t say will be likely to make the other person feel more connected and present as well.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

I said that such laws were a long way off in the US.  I received a correction from my acquaintance Dawn Hawkins at Morality in Media’s Pornharms.com.

Ms. Hawkins informed me that there are in fact federal obscenity laws currently on the books which were enacted during the Reagan and 1st Bush presidencies and which cover hardcore adult internet porn.

She said that such laws are not being enforced by the current administration but that there was one old case that was recently prosecuted resulting in a prison term.

Ms. Hawkins stated:

“Our (Morality in Media’s) current President and CEO was the Chief at the US Department of Justice’s Child Exploitation and Obscenity Section under Reagan and Bush I. The (sic) prosecuted 120+ distributors of hardcore porn and never lost a single case. When they were vigorously enforcing these laws, the amount and deviant nature of the pornography available decreased. We know these laws are strong and work to help decrease many of the harms. Clinton and Bush II enforced these laws as well, although less vigorously. However, just a couple of months ago, a case left over from the Bush Administration successfully prosecuted pornographer Ira Isaacs (http://www.huffingtonpost.com/2013/01/17/ira-isaacs-defecation-por_n_2495505.html) and he got 4 years in prison. Another sign that these laws are strong. The U.S. Supreme Court upheld these laws – many argue that is since harder to prosecute on the Supreme Courts defined standards – BUT the courts have still consistently won regardless and pornographers are almost always found guilty. The problem now is that the Justice Department refuses to enforce these laws.”

The new laws proposed in Iceland and the UK and the law that is more aggressively to be enforced in Egypt seem to be approaching porn not from the production angle but from the idea of interdicting porn before it reaches anybody’s home computer, as I described in the previous post.  This makes a certain amount of sense as content can come from anywhere in the world.

The idea of the government telling people what they can and cannot watch is a controversial one in the U.S.  I see much polarization in this country about the issue of enforcing legal restrictions on the production of adult pornography with opposition based on freedom of speech as well as some people’s claims of allegedly positive uses for adult porn.  And of course the porn industry itself has its activist arm.  Many articles point to the difficulties of enforcing the adult obscenity laws due to confusion about the definitions of the words involved.

I would be interested to hear comments and data regarding public opinion on the prohibition of adult hard core pornography.  The data I have looked at show the public to be very much divided with the anti porn view coming from both the religious and feminist camps.

Apart from the demographic and religious differences on the issue, it seems to me that many people may have two sets of feelings about the issue, namely they may be vehemently against exposure of children to pornography, as I am, and may even feel that pornography in general is offensive, while still being a bit queasy about the ”big brother” aspect of regulating this content at the government level.

Personally I find the gender justice point of view to be as interesting as it is challenging to argue.  See for example the arguments for the Icelandic porn law in my earlier post and the work of the new feminists in the U.S. such as Professor Robert Jensen.

The one thing I know I can count on is that no matter what I post about this issue I will get people taking issue with me from one side or the other.

According to a handful of studies reported in the National Alliance for Mental Illness (NAMI) article “Opening the Door on Hypersexuality,” the prevalence of hypersexuality among people with bipolar disorder is anywhere from 25 to 80% with an average estimate of 57%.  NAMI states:

“Hypersexuality may be the last frontier in bipolar disorder. Even now, despite everything that has been learned about the illness, it’s hard to put a finger on how big a problem it really is.”

Manic hypersexuality is generally described as involving a significantly heightened sex drive resulting in things like constantly thinking about sex, a preoccupation with pornography, an abundance of one-night stands, engaging in sex with multiple partners, having random and often unprotected sex,  seeking out prostitutes or having multiple affairs even when in a committed relationship.

A Healthline article on sexuality during mania gives a laundry list of out-of-control sexual behaviors that sound like those of sex addicts.

And the heightened sexuality in mania is sometimes described as driven by other characteristics of mania like the heightened physical and sensory state, the disregard of consequences, feelings of being indestructible, impulsivity and amorality.

Bipolar disorder and addiction generally

An article in Daily Rx refers to “the nearly inextricable link between bipolar disorder and the use of alcohol and drugs.”  According to that article “Research suggests up to 60 percent of bipolar sufferers experience a substance abuse problem at some point in their lives.” 

Since all addictions are now thought to have a great deal in common in terms of their origins and their neurobiology, it stands to reason that there would be a high incidence of sex addiction as well among those diagnosed with bipolar disorder.   So that although drug and alcohol use has been seen as being largely an attempt to self medicate bipolar disorder, it may be that the addictions and the bipolar diagnosis have some common roots.

Is there an overlap with sex addiction?

The incidence of child sexual abuse is reportedly high among those with bipolar disorder.  This is seen as likely due to the fact that bipolar disorder is heritable and therefore that a parent with mania or hypomania may have been sexually inappropriate with or around a child.

And the possibility of disruptions or dysfunction in parenting with a parent with bipolar disorder would also be a risk factor for sex addiction and other addictions as well.

The incidence of child sexual abuse among sex addicts is as high as 83% according to the work of Patrick Carnes.  Thus a high proportion of those diagnosed with bipolar disorder might also have sex addiction due to the prevalence of child sexual abuse in both populations.

This all suggest to me that there may be a drift over time toward an increasing overlap of sex addiction and bipolar spectrum disorders due to the way nature and nurture support the same processes.

Diagnosis and treatment

First let it be said that bipolar disorder is not the only DSM diagnosis with hypersexual behavior as a symptom.  Others include PTSD, Dissociative disorder, dementia, impulse disorders and paraphilias, to name a few.  But bipolar disorder is a distinct diagnosis and is treated very differently from these other disorders and very differently from the addictions.

There  are distinct diagnostic criteria for bipolar disorder.   And  bipolar hypersexuality responds to treatment and will diminish when the symptoms of mania are brought under control.  This would not be the case with a person diagnosed with only sexual addiction.

Many sex addicts initially have reason to want to deny their addiction; they would prefer to think that their sexual behavior is only due to a mood disorder.  This is because they think the latter is more understandable, more socially acceptable, less stigmatized, and easier to treat.  On the other hand people with  manic sexual behaviors  may not see themselves as having a “mental disorder” but rather feel that they simply have a “high sex drive.”

In my experience, the two diagnoses are often fellow travelers and both can be difficult to treat because they share one more common feature.  Both are very difficult to see and to accept in oneself.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource