For most people affected by serial sexual or romantic infidelity of a spouse, it’s not so much the extramarital sex or affair itself that causes the deepest pain. What hurts committed partners the most is that their trust and belief in the person closest to them has been shattered. For a healthy, attached, primary partner, the experience of profound and/or unexpected betrayal can be incredibly traumatic. One 2006 study of women who had unexpectedly learned of a loved one’s infidelity reported such women experience acute stress symptoms similar to and characteristic of post-traumatic stress disorder (PTSD). Sadly, it’s only in the past few years that the aftermath of intimate partner and marital betrayal has been considered a legitimate area of study. Today, family counselors and psychotherapists are slowly gaining insight into the traumatic, long-term emotional effects of betrayal of a closely attached partner. As part of this professional growth, those specialists who deal day-in and day-out with marital infidelity and relationship betrayal have become much more open to spotting and treating the oftentimes fragile, rollercoaster emotional state of cheated-on spouses – both male and female.

“Infidelity is the breakdown of trust caused by keeping secrets in an intimate partnership.” – Robert Weiss

The Agony of Betrayal

I’ve employed the above definition to describe cheating ever since the Internet came along in the early 1990’s. When working with clients and their betrayed spouses, I attempt to bring home the concept that it is the betrayal of relationship trust caused by consistent lying, rather than any specific sexual act, that both defines infidelity and causes the deepest pain to the betrayed partner. The emotional violation and trauma experienced by a spouse who is forced to live with ongoing secrets, lies, and the resulting denial of his or her own reality by a cheating partner is indeed deep. The sudden discovery or unraveling awareness that a long-term intimate partner has been living a secret life filled with sexual infidelity—whether that infidelity has been carried out in-vivo (affairs, prostitutes, anonymous sexual partners, etc.) or online (porn, webcams, social media, dating/hookup sites, etc.)—evokes feelings that lead the betrayed partner to question literally everything about his or her relationship.

Hardly a day goes by without the national media trotting out the problem sexual misbehavior of some politician, sports star, actor, or religious leader. Oftentimes, within a few days or weeks we hear that same person is “entering treatment” for sexual addiction. This begs the question: What is sexual addiction treatment?

Generally speaking, well-rounded sexual addiction treatment mirrors in many ways the structure and techniques that have proven highly effective in drug and alcohol addiction treatment—focusing on breaking through denial, managing the crisis or crises that drove the person to seek help, social learning, cognitive behavioral therapy, group therapy, relapse prevention, etc. Depending on the individual being treated, the work may center on the person’s immediate life circumstances in an attempt to determine (and find healthy ways to control) the various triggers to his or her sexual acting out. Other addicts, while still needing to learn how to contain their sexual behavior, may have a greater need and ability to work though various forms of past trauma and emotional reactivity—challenges that oftentimes have been lifelong concerns. For all individuals, once sexual sobriety has been established, all useful clinical methods are on the table: art therapy, traditional cognitive behavioral therapy and relapse prevention work, social learning models, equine and experiential work, EMDR, somatic therapies, the support of 12-step meetings, etc.

When All You Know How to Use Are Hammers, Doesn’t Everything Resemble a Nail?

Over the past several months I have been writing blogs for Psych Central that extensively explain the DSM-5 Hypersexuality Diagnosis and the concept of sexual addiction. I have written about the basics of what it means to be a sex addict, how sex addicts can (like someone with an eating disorder) achieve “sobriety,” and the great effect technology is having on those with impulsive and compulsive sexual problems. These blogs have generated a great deal of discussion among clinicians in the multiple forums and groups where they have been posted around the globe. One of the more emphatic threads of comment I often receive is a judgment of sorts—that those who recognize sexual addiction as a treatable disorder must somehow be “sex negative,” that those who acknowledge and treat sexual addiction somehow believe that anyone who engages in ego-dystonic sexual behavior or enjoys sexual proclivities that do not mirror the larger culture’s values is a sex addict. This is not the case. In fact, nearly all sexual addiction specialists readily acknowledge that most of the vast range of human sexual behavior is neither problematic nor evidence of an addiction.