Archives for Hypersexual Disorders - Page 2
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.
Will I Go Blind? Of all the types of sexual acting out, compulsive masturbation, with or without pornography, is the most secretive and isolating—and also the most common (in both men and women). Because many individuals view sexual self-stimulation as shameful, dirty, or sinful, those who engage in the practice compulsively are unlikely to discuss it with others, even a therapist. If and when a compulsive masturbator does seek help, he or she is unlikely to do so for his/her sexual acting out. Instead, that individual is far more likely to report anxiety, depression, feelings of loneliness and isolation, and the inability (or lack of desire) to form intimate relationships with other people. Some people who masturbate compulsively do so as part of their daily routine. These are “morning, noon and night” people who masturbate on a regular schedule, almost like clockwork—when they wake up, before they go to bed, when they’re in a particular place, when some “thing” happens, or when they experience a certain (usually uncomfortable) feeling. Other individuals are binge masturbators, “losing themselves” for hours or even days at a time, sometimes continuing to masturbate even after physically injuring their genitalia. Binge masturbation is occasionally accompanied by illicit drug use, usually stimulants like cocaine or crystal meth. Binge masturbators can lock themselves in their home or a motel room for days on end, losing all track of time and life in the real world.
In David J. Ley’s recently published book, The Myth of Sex Addiction, Dr. Ley argues that the concept of sexual addiction is based on questionable research and subjective moral judgments. He believes that labeling problematic sexual behavior as addiction undermines the individual’s personal responsibility for that behavior. He also believes that the sexual addiction treatment “industry” is driven by economic greed. Sadly, sexual addiction is not a myth and the treatment “industry” is barely in its infancy. As a licensed sexual addiction specialist with over 20 years experience in the field of sex and intimacy, I have seen thousands of individuals whose sexual behaviors satisfy every criteria of addiction. These individuals—both men and women—act on those sexual behaviors repeatedly and, once headed down that path, without the ability to stop. They also develop a tolerance to their sexual activities, most often causing them to engage in those behaviors for longer periods of time or to seek out more intensely arousing situations, images, etc. To say that these people are not suffering from an addiction is to deny reality.
What is “Hypersexual Disorder”? The American Psychiatric Association (APA), recognizing the increasing public and clinical acceptance of the concept of sexual addiction, has requested and received extensive Tier 1, peer reviewed research data, along with an exhaustive literature review (Shout out to Dr. Marty Kafka of Harvard!) toward its consideration of a potential DSM-5 Hypsersexuality Disorder diagnosis. While “Hypersexual Disorder” may not be the ideal term for a problem that more accurately involves the lengthy search and pursuit of sexual and romantic intensity rather than just the sex act itself, the proposed criteria as written do point to problem patterns of excessive fantasy and urges that mirror most aspects of what we have come to know more commonly as “sexual addiction.”
Is Sex Addiction Real? There will always be controversy – as there should be – when any form of inherently healthy human behavior such as eating, sleeping, or sex is clinically designated as pathological. And while the power to “label” must always be carefully wielded to avoid turning social, religious, or moral judgments into diagnoses (as was homosexuality in the DSM-I and DSM-II), equal care must be taken to not avoid researching and creating diagnostic criteria for healthy behaviors when they go awry due to underlying psychological deficits and trauma. Pre-Internet sexual addiction research in the 1980s suggested that approximately 3 to 5 percent of the adult population struggled with some form of addictive sexual behavior. Those studied were a self-selected treatment group, mostly male, who complained of being “hooked” on magazine and video porn, multiple affairs, prostitution, old-fashioned phone sex, and similar behaviors. More recent studies indicate that sexual addiction is both escalating and simultaneously becoming more evenly distributed among men and women. This escalation in problem sexual behavior appears to be directly related to the increasingly high-speed Internet access to both intensely stimulating graphic pornography and anonymous sexual partnering. Today these connections are furnished not only through the use of home and laptop computers, but also via smart-phones and the related geo-locating mobile devices we now carry in our pockets and briefcases.
In the world of addiction treatment, there are two major areas of concern: addiction to substances, and addiction to patterns of behavior. Substance addictions involve abuse of and dependency upon chemicals such as alcohol, nicotine, prescription drugs, and illegal drugs like heroin and cocaine. Behavioral addictions, often called “process” addictions, involve problematic repetitive behavior patterns involving potentially pleasurable or compulsive activities such as gambling, sex, working, spending, eating, etc. Some individuals struggle with both types of addiction simultaneously. Sadly, the general public often mistakenly views process addictions as “moral flaws” or as “less serious” than substance addictions, yet those of us who treat these concerns directly witness firsthand the countless ways in which out-of-control impulsive, compulsive, and addictive behaviors wreak as much havoc on families, careers, and lives as drug addiction and alcoholism. We also see that process addictions often contribute significantly to substance abuse relapse.
There’s a saying in addiction recovery that “we’re only as sick as our secrets.” Even after completing drug addiction treatment, some people continue to keep long-held secrets and/or act out in unhealthy ways. Much to the dismay of concerned family and friends and despite their best attempts at healing, some men and women may find themselves relapsing repeatedly on drugs and alcohol, even though they’ve tried counseling, 12-Step programs and drug rehab. Is the chronic relapser doomed to a life plagued by addiction? Was drug rehab a waste of time? Chronic relapse has varied causes. For some, ongoing stressors such as family dysfunction and major life transitions can trigger a return to drug or alcohol abuse. Others may stop using drugs only to “transfer” their addiction to other substances or behaviors that stimulate the reward circuitry in the brain, such as gambling, spending, overeating or sex. In some cases, an unrecognized and untreated sex or love addiction may contribute to the relapse cycle.
This is the friend you worry about. You wonder how she doesn’t end up in the hospital or on the late-night news. She doesn’t seem the least bit afraid of hooking up with strangers, even those she just met online. When it comes to sex and intimate relationships she takes a typical male role. Much like the character Samantha in Sex in the City, Dora has all the sex she wants and that’s just how she likes it. No one gets too close; no one can really hurt Dora. Into the high of meeting new men, Dora hooks up online, through social networks on her smart phone, and in local bars. Dora often meets men for the first time at their apartments, never considering this might be dangerous because it’s so exciting.
Lucy the Love Addict - you have likely encountered her: She is dying for love. Always on the hunt for Mr. Right, her eyes scan every crowd looking for him wherever she goes. Unable to tolerate dinner or a movie out alone, and unwilling to go places or attend events unless available men will be there, she stays home alone a lot … but searches online. When out, Lucy’s made up and ready for a date whether at the Laundromat or picking up a few things at the corner store. You never know, he could be there -- the man who will make everything okay. The one who will finally make her feel whole. For a love addict like Lucy, every place has the potential for her to meet her one true love. Obsessed with finding the guy who will make her life complete, Lucy’s needful drama and intensity tend to turn men off. Sadly her relationships rarely go beyond the first few days, yet she doesn’t understand why.
Sex, love and porn addiction aren't just gay issues; rather, they are predominately male issues. These diagnoses are as widespread and problematic among straight men and bi-sexuals as they are among gays. Heterosexual male sex addicts act out in many of the same ways gay men do; they just act out in different settings and choose female rather than male partners. Gay men go to sex clubs, straight men go to strip clubs; gay men use Grindr, straight men use Ashley Madison. In fact, the similarities between gay and straight sex addicts are much more apparent than their differences.