Wednesday October 26th 2016

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The problem of defining sex addiction: What it IS and IS NOT

The struggle to define sex addiction

Sex addiction as a discrete psychological category only became known to the public in 1983 with Dr. Patrick Carne’s book Out of the Shadows – Understanding Sex Addiction. Since then, it’s been struggling to define itself as both a legitimate addiction that contains the underlying elements of all addictions and yet is distinct because it involves one of our most primal needs.

Sex addicts use sex as a way to get unmet emotional needs met that weren’t met in childhood. It is a misfired way to connect.

This article defines sex addiction in terms of what it is NOT and concludes with preliminary treatment goals and objectives. Then, we invite your questions or comments about how to stop compulsive sexual behaviors at the end. In fact, we try to respond to all legitimate inquiries personally and promptly.

What sex addiction IS NOT … (and what it is)

Sex addiction is not defined the intensity of sexual desire. Nor is it define by the type or quantity of sexual acts performed. Sex addiction IS, however determined by the sex addict’s continual use of sexual urges, cravings, fantasies and behaviors to gratify infantile emotional needs that went unmet from his early life. Sex addiction is a misuse of sex. Sex is, after all, only sex.

Sex can’t undo the past; it can’t make your distant mother love you; it can’t shore up a shaky sense of self if it is already shaky; it can’t make you powerful or important; it can’t give you a sense of self-worth; is doesn’t make you desirable to all women; it doesn’t give you control over anybody else; it doesn’t preclude rejection or abandonment; it doesn’t make the nerds in college change their minds about you; it’s not an achievement or an accomplishment; it can’t change your moods except temporarily; it’s not rebellion for the injustices done to you in your childhood by parents or your church; it doesn’t provide meaning and it’s not an answer to the existential dilemma of living.

All it is is a fleeting experience of pleasure, followed by shame, remorse and guilt.

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When sex is compulsive, it can be addictive

Q:What are some of the main symptoms of sex addiction?

A: A compulsive enactment of preoccupied, ritualized  sexual behavior, sex addiction is an obsessive relationship to sexual thoughts, fantasies or activities that an individual continues to engage in despite adverse consequences. These thoughts, fantasies or activities occupy a disproportionate amount of “psychic space” (the inner world of the addict that isn’t conscious, but is emotionally powerful enough to overrule thinking). The result is an imbalance in the addict’s overall functioning in areas such as work, marriage, hobbies, interests and spiritual activities.

Distress, shame and guilt about the behaviors erode the addict’s already fragile sense of self. To be caught in the clutches of addiction, with its loss-of-control, shame and depression, together with its negative consequences on work/relationships/finances/self-esteem, is demoralizing. Yet the benefits to the addict, while in active addiction,  outweigh the costs as the lure of the sexual rush is found to be irresistible, regardless of consuming negative consequences.

At the core of sex addiction

At core a fragile ego, born of a lack of attunement with the early mother-child dyad, seeks bolstering through the illusionary power and control of sex. The addict’s sense of masculinity, which may have been enfeebled through problems in his early psychological development, is experienced to be strengthen by multitudinous sexual affairs.

Sexual addiction is an attachment disorder which hinders the individual in forming and maintaining intimate relationships.

Central to the disorder is the inability of the individual to adequately bond and attach. At it’s core, sex addiction is an enactment of deeply entrenched dysfunctional relationships with self and others, especially childhood parental figures.

While the definition of sex addiction has similar features as that of other  addictions, sexual compulsion is set apart from them in that sex is one of our most primal needs and involves our innermost unconscious wishes, needs, fantasies, fears and conflicts.

Like other addictions, it is relapse-prone.

Sex addicts are seen as an enigma

Sex addiction is a complex syndrome that involves personality issues, bio-chemistry, environment, family-of-origin issues, particular ways of thinking, sense of self-worth, and the quality of relationships.

Psychiatrists see sex addicts somewhat as an enigma; they still don’t know if it’s an obsessive-compulsive disorder, an impulse-control disorder, or an addictive disorder. The fact that it was left out of the DSM-V and so not recognized as a psychological disorder means that more research needs to be done to understand this complex syndrome.

Sex addiction represents same processes of addiction that underlie all compulsive behaviors: an enduring compulsion to engage in a pleasure-producing behavior to eliminate distressing emotional states that are painful and overwhelming. Also common to all addictions, sex addicts  have problems with self-care and self-regulation. Achieving a sense of “self-governance” is part of sexual addiction recovery treatment.

Elements of effective treatment

Sex addiction treatment must address both the compulsive behavior as well as the underlying addictive process. The challenge of the sex addiction therapist is to offer a variety of approaches to treat the addict on multiple levels. The therapist needs to have the concrete skills to do sex addiction counseling as well as the psychological clinical training and sophistication to treat underlying issues.

Sex addiction treatment, then, is most effective when it an integrated, approach that brings together different methods, and is individually tailored to the  personality and evolves as he progress.

What are some of the specific goals of comprehensive sex addiction treatment?

  1. To resolve ambivalence about change;
  2. To prepare you to prevent relapse  by helping you to recognize triggers, urges and cravings, and arm yourself with specific tools for dealing with them;
  3. To recognize and work through painful feelings from childhood that remain alive in the present;
  4. To put issues of shame and a sense of inadequacy to bed;
  5. The discovery of underlying issues of all addiction including lack of self regulation and self care as well as an inability to exercise restraint in the face of destructive impulses;
  6. To recognize and change unconscious belief systems about self, others and the world, including sexuality and intimacy;
  7. To implement sex therapy techniques to overcome obstacles to intimate sexual experience;
  8. To trace the origins of unhealthy relationship patterns that stem from childhood so you can recognize that what worked in the past may be destructive in the present;
  9. To become educated about intimacy skills and attitudes about sex that will help you experience “related sex” as more fulfilling than narcissistic self-centered sex.

Now, it’s your turn

Do you have any questions about sex addiction or its treatment? Please leave your questions in the comments section below. We’ll do our best to respond to you personally!

About the Author: Dorothy Hayden, LCSW, has been in private practice in Manhattan for 20 years, treating sex addicts and their partners. She has published over 40 articles on her website,, and is the author of “Total Sex Addiction Recovery – A Guide to Therapy.”

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About Dorothy Hayden, LCSW

Dorothy Hayden, LCSW, has been treating sex addicts and their partners for 15 years. She has been interviewed by HBO, CNN and "20/20" about cybersex and sex addiction. Author of over 25 articles and one e-book, "Total Sex Addiction Recovery - A Guide to Therapy", she is considered a thought leader in the field. While based in Manhattan, NY, she works with individuals worldwide through SKYPE.

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