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Treating Different Categories of Sex/Porn Addicts

In my previous post to this site, I discussed the difference between traditional, trauma-driven sex/porn addicts and a new and rapidly growing subcategory of sex/porn addicts that I refer to as digital-age/conditioned porn addicts. The primary difference between the categories is one group is trauma-based, as we traditionally see with addictions in general, while the other is not. Typically, digital-age/conditioned porn addicts are individuals who start using porn at a young age (often before puberty hits). Over time, they get used to the intensity of pornography, turning to it more and more often until, eventually, it becomes an addiction.

Treatment for traditional, trauma-drive sex/porn addicts and digital-age/conditioned porn addicts is, in some respects, the same, but in a few extremely important ways it is significantly different. That is the subject matter of this post.

Treating Traditional, Trauma-Driven Sex Addicts

Traditional, trauma-driven sex/porn addicts are individuals who are preoccupied to the point of obsession with sexual fantasies and behavior, who’ve tried and failed to either cut back on or quit with sexual fantasies and behavior, and whose lives are in turmoil related to their sexual fantasies and behavior. They also have deep and painful unresolved early-life trauma issues like neglect, physical abuse, sexual abuse, etc. Over time, they’ve learned to use sexual fantasies and behavior as a coping mechanism, as a way to escape from and numb feelings of stress, anxiety, depression, loneliness, boredom, etc.

These men and women are best treated with the same strategies and techniques that work with alcoholism, drug addiction, eating disorders, and other addictions (compulsive gambling, spending, video gaming, etc.) Nearly always, early treatment for trauma-driven addiction focuses on stopping the problematic behavior, in this case the escapist use of sexual fantasies and behavior. After that, therapists work to break through the addict’s denial, to manage the crisis or crises that drove the addict into treatment, and to implement tactics designed to prevent relapse.

Longer-term, relapse prevention can and usually should, if the addict is willing, involve working through the addict’s underlying trauma issues, as those are usually the primary driver of the addict’s desire for emotional/psychological escape and therefore the addictive behavior. That said, trauma-focused work should not begin until the addict has established a modicum of sobriety and developed his or her ego strength and both a social and sobriety-focused support network. If undertaken too soon, trauma work, which is emotionally and psychologically stressful under the best of circumstances, can trigger the addict toward relapse.

Generally, treatment for traditional sex/porn addiction/compulsivity (and other addictions) includes both individual and group therapy—nearly always a behavior-focused modality such as Cognitive Behavioral Therapy (CBT)—paired with social learning, psycho-education, and 12-step or other recovery-focused support groups. Sometimes addicts who are struggling with sexual behavior will start a trial run of an antianxiety or antidepressant medication, typically an SSRI, as these can reduce sexual urges in addition to helping with issues like anxiety and depression.

Treating Digital-Age/Conditioned Porn Addicts

As stated in last month’s post, this new and growing subcategory of porn addicts is not driven by unresolved early-life trauma. Like other sex/porn addicts, this group is obsessed with sexual fantasies and behaviors (online porn), they’ve lost control (they’ve repeatedly tried and failed to quit), and they’re experiencing directly related negative consequences. In other words, they absolutely qualify as sex/porn addicts. But they lack the trauma-driven need/desire to escape from and/or numb their emotions.

Typically, digital-age/conditioned porn addicts start using porn at a young age (often before puberty hits) and they don’t move beyond it. For them, porn and sometimes other forms of non-intimate online sexuality are both sex education and sexual fulfillment. As a result, their ability to form meaningful real-world romantic attachments does not develop (or does not fully develop).

So, how does treatment differ with this group? In the early stages of recovery, the approach is exactly the same as with traditional porn addicts, with a focus on stopping the use of porn, breaking through the addict’s denial about his or her porn use, and developing countermeasures to help prevent relapse.

That’s where the similarities end.

One primary reason for this is that digital-age/conditioned porn addicts typically find it easier than traditional, trauma-driven sex/porn addicts to quit and stay quit. These conditioned users seem more able to walk away from porn use and related behaviors, even extremely heavy porn use, with a relatively modest among of intervention and support. And when they do quit, many of their most obvious porn-related problems (in particular porn-induced erectile dysfunction) tend to abate within a few months. Basically, the pleasure centers of their brains are able to “reboot,” returning to a pre-porn baseline, relatively quickly. With trauma-based addicts, this process tends to take much longer. Thus, treatment of digital-age/conditioned porn addicts can move from initial intervention to secondary issues far more quickly.

And those secondary issues are different. Rather than focusing on resolution of early-life trauma, as eventually occurs with traditional sex/porn addicts, treatment moves into the who, what, when, where, why, and how of real-world relationships—because digital-age/conditioned porn addicts tend to struggle with developing and/or maintaining healthy real-world connections. They just plain don’t know how to successfully navigate the often-confusing waters of dating and sexual exploration. My belief is that this shortcoming occurs because they did not learn these skills during childhood and adolescence (for any number of reasons, including their disproportionate focus on pornography). Then, suddenly, they “wake up” in their 20s or 30s feeling alone and desirous of a real-world relationship with absolutely no idea how to make that happen.

Note: Not all digital-age/conditioned porn addicts are completely bereft when it comes to forming healthy real-world relationships. Some are quite adept socially. But in my experience the majority need to be walked through social development to some degree.

So, rather than developmental trauma driving the addiction, as we see with traditional sex/porn addicts, digital-age porn addiction appears to be driven by conditioning and developmental delay. Sure, digital-era/conditioned addicts probably also have some unresolved early life trauma (doesn’t everyone), but it might not be clinically significant. For these individuals, the driving factor appears to be the supernormal stimulus provided by porn, which the user turns to during key developmental stages because it’s just plain easier than learning how to get one’s needs met with real people. As a result, relational development is delayed.

These digital-age/conditioned porn addicts tend to respond well to much of the early-stage treatment used with traditional sex/porn addiction. In particular, they respond to sexual boundary plans that delineate which behaviors are problematic (for each individual), plus suggestions on how to become more accountable and avoid relapsing. Other aspects of traditional treatment for sex/porn addiction, most notably trauma work, can be overkill with this group. These individuals are far better served with developmental work, including socialization exercises, accountability with peers, and age-appropriate socialization.

When the porn goes away and digital-age/conditioned porn addicts are walked through healthy development, their issues seem to clear up. There is relatively little fight to stay sexually sober. They just put the porn down and move on. Traditional sex/porn addicts do not experience this. For them, walking away from sexual fantasies and behavior is an agonizing process—two steps forward, one and a half steps back. Often, there are multiple slips and relapses before they develop even a small amount of real sobriety. And nearly always, a considerable amount of outside support (individual therapy, group therapy, recovery groups, and, eventually, trauma work) is needed.

Treating Different Categories of Sex/Porn Addicts

Robert Weiss PhD, MSW

Robert Weiss PhD, MSW is an expert in the treatment of adult intimacy disorders and related addictions, most notably sex/porn/relationship addictions along with co-occurring drug/sex addiction. A clinical sexologist and practicing psychotherapist, Dr. Rob frequently serves as a subject matter expert for major media outlets including CNN, HLN, MSNBC, OWN, The New York Times, The Los Angeles Times, and NPR, among others. Dr. Rob is the author of Prodependence: Moving Beyond Codependency, Out of the Doghouse, Sex Addiction 101, and Cruise Control, among other books. He blogs regularly for Psychology Today and Psych Central. His podcast, Sex, Love, & Addiction, is rated as a Top 10 Addiction Podcast for 2019. He also hosts a weekly live no cost Webinar with Q&A on SexandRelationshipHealing.com. A skilled clinical educator, Dr. Rob routinely provides training to therapists, hospitals, psychiatric organizations, and even the US military. Over the years, he has created and overseen nearly a dozen high-end addiction and mental health treatment facilities across the globe. For more information or to reach Dr. Rob, visit SeekingIntegrity.com. You can also follow him on Twitter (@RobWeissMSW), LinkedIn (Robert Weiss LCSW), and Facebook (Rob Weiss MSW).


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APA Reference
Weiss PhD, R. (2019). Treating Different Categories of Sex/Porn Addicts. Psych Central. Retrieved on May 22, 2019, from https://blogs.psychcentral.com/sex/2019/01/treating-different-categories-of-sex-porn-addicts/

 

Last updated: 7 Jan 2019
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