Recognizing-the-Consequences-of-Sexual-Addictio-2Assessment Questions

It’s not exactly a clinical secret that most of the sex addicts who enter therapy do so in response to their addiction’s related symptoms—disintegrating relationships, depression, severe anxiety, inability to focus at work or in school, social isolation, and the like. Rarely do these individuals walk in the door say, “You know, I think maybe I’m a sex addict, and that’s probably the first thing I need to deal with.” Instead, sex addicts will tell you that they’re unhappy, and that they’re having a variety of life and relationship problems. In my previous blog I discussed the fact that therapists should always ask at least a few specific but non-graphic questions about sexual activity during assessment in an effort to unearth sex-related issues. These questions may include the following:

  • Do you keep secrets about your sexual or romantic life?
  • Is there anything about your sexual or romantic life that others would find disturbing if they knew?
  • Do you feel ashamed or uncomfortable about any aspect of your sexual or romantic life?
  • Has anyone in your life ever expressed concern about your sexual or romantic activity?
  • What do you do to temporarily escape unpleasant feelings? Some people eat, some people masturbate, some people exercise. What do you do?

If a client is sexually addicted, these and similar assessment questions will typically elicit responses that raise red flags, meriting further investigation.

Looking for Consequences

For a variety of reasons, sex addicts are only rarely forthcoming about their problem. They may be too embarrassed or ashamed to talk about it, and/or they may want to protect their addiction, which has become, either consciously or subconsciously, the driving force in their lives. As such, therapists must often guide sexual addicts toward the truth about their problematic sexual behavior patterns via somewhat circuitous routes. One of the most effective tactics is to question clients about life issues (negative consequences) that have arisen related to their sexual behavior. Usually these consequences manifest in one or more (usually more) of the following arenas.

  • Emotional Problems: Keeping secrets, minimizing, justifying, and blatantly lying are constants in the lives of active sex addicts. For obvious reasons, this can be quite stressful. Many sex addicts say that it feels as if they are living two lives—a hidden one taking place in a shadow world of images and sexual hookups, and another that takes place in the real world of work, family, and friends. Because of this, sex addicts can become increasingly irritable, controlling, and withdrawn. By the time they seek help, they typically show signs of profound anxiety, depression, and emotional exhaustion—driven by the stress of maintaining their ongoing lies coupled with shame, despair, and self-hatred about what they are doing. Plus, there is the constant and nagging fear of being found out.
  • Relationship Problems: Sexual addiction can easily destroy an existing romantic relationship. Obsession with external sexual activity leaves emotional and physical intimacy with a primary partner flat and drained of meaning. Sexuality, affection, honesty, and bonding all suffer as the addict becomes increasingly fixated on carrying out and hiding addictive sexual experiences. Oftentimes sex addicts, after their cheating is uncovered, face breakups, threats of divorce, and other similar issues.
  • Disruption of Family Life: When sexual addiction takes over, family life inevitably suffers. Basic responsibilities of childcare and home management lose precedence, becoming secondary to the emotional distractions of sexuality. So in addition to creating problems within a primary relationship, tech-driven sexual addiction negatively affects all other aspects of family life. Even if children don’t know exactly what’s going on, they are harmed by the addict’s emotional unavailability and sometimes even outright neglect. Sex addiction also creates parental tension and arguments, which can significantly and negatively impact children.
  • Poor Self-Care: To avoid confrontations from a concerned spouse or friend, sex addicts will often give up precious hours of rest to seek out sexual activity. They stay awake long after others have gone to bed or get up in the middle of the night to go online or check their phone apps for hits. Even those who don’t stay up late to sexually acting out can find their formerly healthy sleep patterns increasingly disrupted by the anxiety and fear created by their addiction. Additionally, doctor visits, dentist appointments, exercise, preparing and eating healthy meals, and many other aspects of self-care take a backseat to sexual addiction. Addicts who act out in-person (rather than just online) also risk STDs, unwanted pregnancies, and encounters with dangerous people.
  • Sexual Dysfunction: Sexual addiction, porn addiction in particular, can lead to various forms of sexual dysfunction, especially in men. Many male porn addicts report issues with erectile dysfunction, delayed ejaculation, and/or an inability to reach orgasm. In all likelihood this problem is not simply due to the frequency of masturbation; it is also (and perhaps more) related to the fact that men in general are turned on by new stimuli—which online porn provides in abundance. Thus, the man who spends 90 percent of his sexual life masturbating to a constantly changing stream of porn images is, over time, likely to find a real-world partner less sexually stimulating.
  • Trouble at Work or in School: When a sexual addict is almost completely focused on sexual fantasies and activities, his or her performance at work or in school inevitably suffers. Many sex addicts face reprimands or dismissal as a result. They may also face consequences for acting out sexually while at work or in school, or while using company-issued or school-issued digital devices.
  • Financial Issues: With the digital technology explosion, porn and casual sexual encounters are more affordable than ever. In fact, porn is now almost infinitely available for free, and dating and hookup apps are either free or very inexpensive. Nevertheless, sex addiction can still get expensive if the addict is not careful. In-person meetings can be costly, with money spent on travel, hotel rooms, dinners, and gifts. Prostitutes and erotic massage have always been expensive, as have strip clubs and other sexual venues. Even people who only act out online can spend lots of money, paying membership fees and by-the-minute charges for live video feeds. Plus, it is not unusual for sex addicts, in a moment of shameful determination, to cancel their memberships and delete all of their downloaded porn and sexual contacts. Then, within a few days, they suddenly “find themselves” coughing up still more money to sign back on.
  • Legal Issues: Because of sex addiction’s natural tendency to escalate, some men and women “find themselves” engaged in illegal sexual activities—everything from hiring prostitutes to engaging in exhibitionism or voyeurism to looking at illegal forms of pornography. Oftentimes, when these individuals are caught, they are shocked to finally realize where their addiction has led them.

The above list is by no means complete. However, if your assessment questions about sexual issues raised red flags and further questioning reveals that your client is experiencing one or more of the above issues related to his or her sexual fantasies and behaviors, sexual addiction is almost certainly in play. In such cases, referral to a sexual addiction treatment specialist is probably the best course of action. The websites of the International Institute for Trauma and Addiction Professionals and the Society for the Advancement of Sexual Health are both excellent sources for referrals.

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