Sex Addiction

Sex Addiction Defined

• Compulsive behaviour that completely dominates the addict’s life
• Priority more important than family, friends, and work
• Organizing principle of the addict’s life
• The addict is willing to sacrifice what he cherishes most in order to preserve and continue his/her unhealthy behaviour
• Uses sexuality to regulate emotional life
• Sexuality is used as a pain reliever or a way to relieve anxiety
• Do things that are dangerous, exploitive, and will cause shame afterwards
• Feel lonely and non-intimate

Sex Addiction is Drug Addiction

• Pathological relationship to a mood-altering behaviour
• Sexual arousal – increase in dopamine, serotonin, endorphins, fantasy, etc.
• Induced by preoccupation, fantasy, ritual, behaviours

Diagnosis of Sex Addiction

• Since this is not a widely recognized/ accepted addiction, many psychiatrists, psychologists, and therapists do not diagnose sex addiction
• Missing this behaviour contributes to the continuation of the disease process

Criteria for Sex Addiction

• Recurrent failure to resist sexual impulses in order to engage in specific sexual behaviours
• Frequently engaging in those behaviours to a greater extent or over a longer period of time than intended
• Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviours
• Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experiences
• Preoccupation with sexual behaviour or preparatory activities
• Frequent engaging in the behaviour when expected to fulfill occupational, academic, domestic, or social obligations
• Continuation of the behaviour despite knowledge of having a persistent or recurrent social, financial, psychological, or physical problem that is caused or exacerbated by the behaviour
• The need to increase the intensity, frequency, number, or risk level of behaviours in order to achieve the desired effect; or diminished effect with continued behaviours at the same level of intensity, frequency, number, or risk
• Giving up or limiting social, occupational, or recreational activities because of the behaviour
• Distress, anxiety, restlessness, or irritability if unable to engage in the behaviour

Collateral Indicators of Sexual Addictions

In addition, there are 20 collateral indicators which assist in the assessment of sexual addiction. A minimum of 10 criteria must be met.

1. Has severe consequences because of sexual behaviour
2. Meets the criteria for depression and it appears related to sexually acting out
3. Meets the criteria for depression and it appears related to sexual aversion
4. Reports history of sexual abuse
5. Reports history of physical abuse
6. Reports history of emotional abuse
7. Describes sexual life in self-medicating terms (intoxicating, tension relief, pain reliever, sleep aid)
8. Reports persistent pursuit of high-risk or self-destructive behaviour
9. Reports sexual arousal to high-risk or self-destructive behaviour is extremely high compared to safe sexual behaviour
10. Meets diagnostic criteria for other addictive disorders
11. Simultaneously uses sexual behaviour in concert with other addictions (gambling, eating disorders, substance abuse, alcoholism, compulsive spending) to the extent that the desired effect is not achieved without sexual activity and/or other addiction(s) present
12. Has history of deception around sexual behaviour
13. Reports other members of the family are addicts
14. Expresses extreme self-loathing because of sexual behaviour
15. Has intimate relationships that are not sexual
16. Is in crisis because of sexual matters
17. Has history of crisis around sexual behaviour
18. Experiences diminished pleasure for same sexual experiences
19. Comes form a “rigid” family
20. Comes from a “disengaged” family

Levels of Severity

Level One:

• Masturbation
• Affairs, chronic infidelity, romance addiction
• Sexual relationships with multiple partners
• Pornography use and collection (with or without masturbation)
• Phone sex, cybersex
• Anonymous sex
• Prostitution – strip clubs 

Level Two:

• Illegal prostitution
• Public sex (bathrooms, parks, etc.)
• Voyeurism – online or live
• Exhibitionism
• Obscene phone calls
• Frotteurism
• Stalking behaviours
• Sexual harassment

Level Three:

• Rape
• Child molestation
• Obtaining and viewing child pornography
• Obtaining and viewing rape, snuff pornography
• Sexual abuse of older or dependent persons
• Incest
• Professional boundary violations (clergy, police officers, teachers, physicians, attorneys, etc.) 

Cybersex

Sexuality that is expressed through the use of technology that is Internet – based 

The Lure of the Net

• Accessibility
• Affordability
• Anonymity
• Interactivity
• Secrecy
• Perceived Safety

Pornography

• Viewing
• Downloading
• Printing
• Exchanging
• Organizing pornography images/video
• Free clips and pay sites
• Self-made porn and picture exchange
• Live viewing of sexual behaviours

Interpersonal Cybersex

• Chatting- chat rooms
• Webcam – exchange of live sexual video, pictures, group sex
• Voyeurism – exhibitionism
• E-mail – text and picture exchange
• Cell phones – picture, videos, text messaging
• Websites – hooking up, anonymous sex
• Dating sites
• Longer term cyber-affairs

 Vulnerability

• Cybersex may lead to development of sexual compulsivity
• May escalate to other sexual acting out behaviours
• May increase risk for boundary violations

Sexual Offending

• Sexual behaviours that violate rights of others
• Lack of consent
• Violation of a trusted relationship
• Exploitive use of power for sex

Ten Types of Sex Addiction:

1. Voyeurism - Usually means objectifying the other person, so it is not a personal relationship.
2. Exhibitionism – From a relationship perspective, it is introducing oneself in an inappropriate way or seeking attention from others with no intent of going further, which is to tease.
3. Seductive Role Sex – Often there is a fear of abandonment so having more than one relationship is away to prevent the hurt they are sure they will receive. They are crippled in their ability to form lasting bonds and enduring relationships.
4. Trading Sex – If a prostitute is a sex addict, meaning that they found sex more pleasurable with clients than in personal relationships and are “hooked on the life”, it represents a significant distortion of normal courtship. The goal is to simulate flirtation, demonstration, and romance. What actually happens in most cases is about replication of childhood sexual abuse in which the child gained power in a risky game of being sexual with the caregiver.
5. Intrusive Sex – People who engage in intrusive sex, such as touching people in crowds or making obscene phone calls, are really perverting the touching and foreplay dimensions of courtship. Their behaviours represent both intimacy failure and individuation difficulties.
6. Fantasy Sex – Many sex addicts find refuge in fantasy sex because other forms of acting out are simply too complicated, too risky, or too much effort. It is about fear of rejection, fear of reality, and reduction of anxiety.
7. Paying for Sex - Here, sex addicts are willing participants in simulated intimacy. They are focused, however, on the touching, foreplay, and intercourse without the hassle of a relationship. Often, the failure is about the sex addict’s inability to communicate feelings to his/her partner or to be willing to work on his/her own attractiveness behaviours.
8. Anonymous Sex – Having to experience fear in order for arousal or sexual initiation. You do not have to attract, seduce, trick, or even pay for sex. It is just sex. Frequently for sex addicts, part of the high is the risk of unknown persons and situations.
9. Pain Exchange Sex – For a sex addict to only be aroused if someone is hurting them is a distortion of what goes into sexual and relationship health. Specifically, touching, foreplay, and intercourse become subordinated to some dramatic story line that is usually a re-enactment of a childhood abuse experience.
10. Exploitive Sex – Addicts in this category will use “grooming” behaviour, which is to carefully build the trust of the unsuspecting victim. Attraction, flirtation, demonstration, romance, and intimacy are all used. Arousal is dependent on the vulnerability of another.

 Sexual Addiction Statistics:

• Approximately 9 million Americans (3-6%) have some form of sexually compulsive behaviour.

 Why do Lawyers Assistance Programs Need to Know?

• Decreased productivity
• Loss of a valuable employee
• Impact on family, clients and colleagues
• Liability
• Treatable disease
• With excellent outcomes

Above material excerpted from the material presented by Ellen A. Ovson, M.D., at the 21^st National Conference for Lawyer Assistance Programs, WORKING TOGETHER Educating the Legal Community – four days of practical sessions on treatment, recovery, and ways to create a healthier profession, sponsored by the ABA Commission on Lawyer Assistance Programs, Little Rock, Arkansas, Oct. 21-24, 2008