Sexual Addiction: Understanding and Treatment: Textbook and Reference Manual - Softcover

Becker, Paul

Softcover

ISBN 10: 1496969871 ISBN 13: 9781496969873

Publisher: AuthorHouse, 2015

Synopsis

The book Sexual Addiction: Understanding and Treatment introduces graduate-level students to the field of sexual addiction. Graduate schools seek a textbook that specifically addresses the dynamics of sex addiction to complete their counseling education curriculum. Some professors have indicated that there is a dearth of targeted instructional content. This book fills that need. As a compendium of Dr. Carnes' research related to the treatment of sexually addicted men and women, the book will serve as clinical manual for therapists. Therapists are invited to use the recovery program presented as an effective treatment regimen for sex addicts. Internet pornography addicts men and women who have a weakness for sexual stimulation. One estimate is that as much as half of the male population and a third of the female population are addicted to pornography. The need for a relevant clinical tool is real. As such, the book contains thirty-six therapeutic exercises to help sexually addicted men and women, in conjunction with sex addiction therapy, to achieve long-term sexual sobriety.

About this title

Excerpt. © Reprinted by permission. All rights reserved.

Sexual Addiction: Understanding and Treatment

Textbook and Reference Manual

By Paul Becker

AuthorHouse

Copyright © 2015 Paul Becker, MAEd, LPC
All rights reserved.

ISBN: 978-1-4969-6987-3

Contents

PREFACE, ix, 
INTRODUCTION, xiii, 
PART ONE: UNDERSTANDING SEXUAL ADDICTION, 1, 
CHAPTER ONE: BEHAVIORS PRACTICED BY SEXUALLY ADDICTED PEOPLE, 3, 
CHAPTER TWO: WHAT IS SEXUAL ADDICTION?, 9, 
PART TWO: CONDITIONS WHICH FOSTER SEXUAL ADDICTION, 35, 
CHAPTER THREE: ROADS TO SEXUAL ADDICTION - FOUR MODELS, 37, 
PART THREE: THE ADDICT'S BOND TO SEXUAL ADDICTION, 49, 
CHAPTER FOUR: CONDITIONS WHICH BOND AN ADDICT TO SEXUAL ADDICTION, 51, 
CHAPTER FIVE: PORNOGRAPHY, 65, 
CHAPTER SIX: MARRIAGE AND ADDICTION, 77, 
PART IV: RECOVERY, 91, 
CHAPTER SEVEN: THERAPY PLATFORM, 93, 
CHAPTER EIGHT: STAGE I - EXPOSING ADDICTIVE BEHAVIOR, DENIAL AND SHAME TO THE LIGHT OF DAY, 105, 
CHAPTER NINE: STAGE II - ADDRESSING BEHAVIORS THAT BOND A MAN OR WOMAN TO SEX ADDICTION, 157, 
CHAPTER TEN: STAGE III - RECOVERY - MODIFYING BEHAVIOR, 215, 
CHAPTER ELEVEN: STAGE IV - LIVING A HEALTHY LIFE STYLE, 243, 
CHAPTER TWELVE: STAGE V - RELAPSE PREVENTION, 285, 
PART V: RESOURCES, 307, 
APPENDIX A: The Sexual Addiction Screening Test (SAST), 309, 
APPENDIX B: Women Self-Test for Sexual/Relationship Addiction, 314, 
APPENDIX C: What is Persistent Depressive Disorder, Dysthymia?, 316, 
APPENDIX D: Thirty Tasks of Sexual Addiction Recovery, 318, 
APPENDIX E: Assessment Instruments, 322, 
APPENDIX F: Suggest Readings, 326, 
APPENDIX G: REFERENCES, 337, 
INDEX, 345, 

CHAPTER 1

BEHAVIORS PRACTICED BY SEXUALLY ADDICTED PEOPLE

This chapter explores the diagnostic criteria (or the lack of specific sex addiction criteria) found in the Diagnostic and Statistical Manual of Mental Disorders (5th ed. DSM-V). It also provides descriptions of aberrant sexual behaviors for which therapy is appropriate (American Psychiatric Association, APA, 2013).

The authority for defining mental disorders is the DSM-V. The manual classifies and establishes common definitions and diagnostic standards for use by the mental health community, insurance industry, and researchers. It is the product of considerable professional study and represents the American Psychiatric Association's guidance to the mental health community at large.

The 2013 version of the DSM does not recognize sexual addiction as a disorder. Discussion continues in the mental health community and by others to ascertain if sexual addiction is better described as hyper-sexuality. Other experts believe that sexual addiction is actually a form of an obsessive-compulsive disorder and refer to it as sexual compulsivity. Still other experts believe that sex addiction is a myth, a by-product of cultural influences (Goodman, 2001, Abstract). Some therapists would classify typical sex addiction behavior under the heading, Other Specified Paraphilic Disorders (APA, 2013, p. 10).

Sexual addiction is diagnosed by adapting the DSM-V criteria for substance dependence. The brain chemistry of a sex addict is nearly the same as that of a drug addict. Sex addicts demonstrate similar abuse characteristics as those who are dependent on alcohol or drugs (APA, 2013, p. 10-11).

The previous version, DSM-IV, provided a not classified elsewhere category entitled Sexual Disorders Not Otherwise Specified. Such behaviors as compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships, and compulsive sexuality in a relationship were included here. This section has not been included in the DSM-V.

The DSM-V does address multiple sexually aberrant behaviors under the title of Paraphilia. However, the DSM-V does not specifically classify paraphilias as sexually addictive behaviors. Nevertheless in the normal course of events, sex addiction therapists would consider these behaviors as sexually addictive disorders (APA, 2013, pp. 685-705).

Paraphilias

The DSM-V includes and classifies a small proportion of aberrant sexual behaviors and labels them as paraphilias. According to the DSM-V, they are characterized by reoccurring, intense sexual urges, which have occurred over at least 6 months. To make a diagnosis, they must also cause significant stress or impair social, occupational, or everyday functioning. The individual also experiences a sense of distress. Typically, addicts recognize the symptoms as negatively affecting their lives but believe they are unable to control them (APA, 2013, pp. 685-705).

Paraphilia included in the DSM-V are:

• Voyeurism. Involves observing an unknowing and non-consenting person, usually a stranger, who is naked or in the process of becoming unclothed and/or engaging in sexual activity. The act of looking (peeping) produces sexual excitement and is usually accompanies masturbation. Fantasies arising from voyeurism fuel future masturbation.

• Exhibitionism. Involves the surprise exposure of genitals to a stranger. Exhibitionism may coincide with masturbation and a fantasy expectation that the stranger will become sexually aroused.

• Frotteurism. Involves touching and rubbing genitals against a non-consenting person. The behavior may also involve fondling. During the act, the perpetrator usually fantasizes an exclusive and caring relationship with the victim. The behavior generally occurs in crowded places.

• Masochism. Involves the acts of humiliation such as beatings, being bound, or otherwise made to suffer physical abuse in order to enhance or achieve sexual excitement. In some cases, the act is limited to a fantasy of rape while bound with no possibility of escape. Sexual masochism may involve a wide range of devices to achieve the desired effect, including some devices that may cause death.

• Sadism. Involves an act in which the individual derives sexual excitement from the psychological or physical suffering, including humiliation, of the victim. The partner may or may not be consenting. Sadism may involve a wide range of behaviors and devices to achieve the desired effect.

• Pedophilia. Characterized by sexual activity against a child by a pedophile. The sexual interest of a pedophile is solely for children age 13 or younger, or in the case of an adolescent, a child five years younger than the pedophile. The sexual interest of a perpetrator may include asking or pressuring a child to engage in sexual activities (regardless of the outcome), indecent exposure of genitals to a child, exposing a child to pornography, actual sexual contact with a child, physical contact with the child's genitals, viewing the child's genitalia without physical contact, or using a child to produce pornography.

• Fetishism. Involves the use of nonliving objects, for example, a man/woman's underwear or other male/female apparel to achieve a state of arousal. The addict may masturbate while holding, rubbing, or smelling the apparel. The spouse may wear the apparel during sexual encounters. The fetish is either preferred or required for sexual excitement. Sexual arousal from a particular body part is classified as partialism.

• Transvestic fetishism. Involves mostly heterosexual males who dress in female clothing (cross-dressing) to achieve or enhance their sexual arousal. The fetish is based in fantasy when the male portrays himself as the female partner. Women's garments are arousing primarily as symbols of the individual's femininity.

• Other Specified Paraphilic Disorders. Classifies recurrent and intense sexual arousal involving telephone scatologia (obscene phone calls), necrophilla (corpses), zoophilla (animals), corprophilia (feces), kilsmaphilia (enemas), or urophilia (urine) (APA, 2013, pp. 685-705).

Aberrant Sexual Behaviors not Found in DSM-V

The following aberrant sexual behaviors are not included in the DSM-V but may result in significant stress or impair social, occupational, or everyday functioning.

• Extramarital affairs. Involve single or multiple sexual relationships with partners outside the marriage that cause significant stress to the marriage relationship. The addict may justify an affair because of unfulfilled sexual expectations within the marriage. Swinging and partner swapping are forms of extramarital affairs that include the participation of both marriage partners.

• Multiple or anonymous sexual partners and/or one-night stands. The sexual acts often are anonymous, situational, and intended to provide sexual experience. Behavior may be habitual when repeated often with new partners. The sexual activities are dangerous to the parties if practiced without the protection of a condom.

• Prostitution. Involves the solicitation and procurement of various types of sexual behavior from male or female escorts or prostitutes. Sexual massage involves the solicitation and procurement of sex, most often oral sex, or masturbation, from a male or female masseuse. In most cases, those who seek such services have an attraction to other aberrant sexual behaviors.

• Obscene phone calls. (scatologia). The caller receives sexual pleasure by delivering sexual or foul language to an unknown called party. Making obscene telephone calls for sexual pleasure is a form of exhibitionism. The obscene telephone calls are unsolicited.

• Rape. Defined as a sexual assault by a man or woman against another person without that person's consent. Rape by a male involves penetration.

• Sexual anorexia. Involves an obsessive state in which the physical, mental, and emotional tasks of avoiding sex dominate life. Preoccupation with the avoidance of sex masks or avoids relational problems. The obsession can then become a way to cope with all stress and all life difficulties (Carnes, 2001 p. 34-36).

• Sexual harassment. Involves intimidation, bullying, sexually demeaning language, or coercion of a sexual nature, or the unwelcome or insensitive promise of a reward in exchange for sexual favors.

Other Sexual Behaviors

Today's society judges some sexual behaviors as reasonably normal. Little stigma is attached to them. Common excuses are "Everyone does it" or "It doesn't hurt anyone." This kind of thinking justifies the behavior. What changes a behavior from acceptable to unacceptable is compulsivity. The sexual behavior is excessive and time consuming; interferes with a person's daily routine, work, or social functioning; continues despite a lack of pleasure or gratification; places the individual at risk of physical harm; or has legal or personal consequences such as financial debt (Carnes, 2001b, p. 86-87, 143).

Examples of compulsive sexual behaviors include:

• Masturbation. Involves self-stimulation, most commonly, by touching, stroking, or massaging the penis, clitoris, or vagina or other body parts until orgasm is achieved. Masturbation is subject to compulsive repetition and is the most common form of sexually addictive behavior practiced by both men and women.

• Pornography. Any material that depicts or describes sexual functions for fostering sexual arousal upon the part of the consumer. Pornography, found in all types of media, includes pay-for-view channels, magazines, video cassettes, motion pictures, and on the Internet. An addict may be stimulated when watching network or cable programs.

• Cybersex. Use of a computer, Internet access, expected anonymity, and sexually provocative material to generate arousal and is usually followed by masturbation. Multiple cybersex venues exist such as dial-a-porn, email, chat rooms, live video streams, instant messaging, postings to social networks (like Facebook), visual images of real or graphically generated persons, and interactive sex through a web cam.

• Phone sex. Involves the use of a phone to talk or listen to a provocative discourse to generate arousal followed, most often, by masturbation.

• Obsessive dating through personal ads. Preoccupation with making relational contact with another person to engage in some form of sexual behavior (Carnes, 2001, pp. 38-48).

Which term, sexual addiction or hyper sexuality, better describes sexually deviant behavior? (Rettner, 2012). In reality, both terms essentially define the same sexual conditions although hyper sexuality is a more apt description of a male sexual disorder. In contrast, healthy sexual relations consist of a mutual expression of love that ideally results in healthy sexual activity (para. 6).

CHAPTER 2

WHAT IS SEXUAL ADDICTION?

This chapter explores aberrant sexual behaviors that share common characteristics and consequences.

The following are representative examples of the definition of sexual addiction.

The Society for the Advancement of Sexual Health (2014) defined sexual addiction as a "persistent and escalating pattern or patterns of sexual behaviors acted out despite increasingly negative consequences to self or others" (screen 2).

Ferree (2010) defined sexual addiction as an "intimacy disorder." Sex is the most intimate of connections between a man and woman but childhood experiences may serve to sever relational intimacy and substitute a false intimacy based on the primacy of getting their sexual needs met (p.72).

Sex Addicts Anonymous (SSA, 2014) defined sex addition by presenting characteristics.

• Powerlessness over addictive sexual behavior.

• Results in unmanageability of his/her life.

• Feelings of shame, pain, and self-loathing.

• Failed promises and attempts to stop acting out.

• Preoccupied with sex leading to ritual.

• Progressive worsening of adverse consequences. (para.4)

Carnes (1994), the foremost researcher and writer in the field of sexual addiction in the United States, defined sexual addiction as a "pathological relationship with a mood-altering substance or behavior" (p. 4). Pathological means a very unhealthy or diseased relationship during which an addict alters mood by sexual stimulation as an intended outcome.

If recovery from sexual addiction just entailed transforming behavior to preclude a pathological relationship with a mood-altering entity, recovery would be incomplete. Behavior modification is only one aspect of recovery. Sexual addiction has underlying psychological attributes that need to be addressed if a wounded man or woman is to be made whole. For example, sexual addiction is a shame-based disease. In recovery, the specific source of the addict's shame is identified and resolved.

Shame has a corollary. Feelings underlie the addict's perception of his or her adequacy as a human being. As a defense mechanism against exposure and shame, the addict often shuns normal feelings. Addicts also engage in other behaviors to obscure feelings. For example, a sex addict who is also a workaholic focuses on work objectives to the extent that feelings, relational or otherwise, are only distractions. Restoring the addict's ability to enjoy normal feelings is a requisite recovery task.

A sex addict often presents with co-existing mental illnesses or personality deficiencies. For example, it is very common for an addict to live life in low-grade depressed mood. Other potential co-existing deficiencies include life controlling anxiety, unreasonable anger, alcohol and drug abuse, personality and bi-polar disorders, and the inability to give and feel loving intimacy. Co-existing deficiencies must to be recognized and remedied.

This book addresses the recovery triad: behavior modification, restoration of normal feelings, and attending to co-existing deficiencies. Supplemental therapy, such as an eating disorder, may be required to address fully all of the addict's issues. For some, it is a life-long endeavor.

Addiction - Multiple Characteristics

Sexual addiction has defining characteristics, of which the following are the most definitive.

• The addict compulsively repeats sexual behavior.

• The addict is obsessed with sex.

• Behavior continues despite adverse consequences

• Sex addiction is subject to tolerance, that is, the flow of neurochemicals must increase in order to maintain the addict's same level of interest.

Compulsion. Compulsivity is an irresistible and persistent impulse to perform an act repeatedly. It characterizes all addictions. Addiction forms such a choke hold that the addict no longer has the ability to refrain from addictive behavior. An addict acts out without regard to consequences. Over time, acting out becomes a habitual repetition of a means to escape reality. Ultimately, an addict forfeits his or her ability to choose, that is, to exercise free will. Normal control mechanisms become impaired or disabled. The addict develops a psychological dependency based on the flow of the brain chemical, dopamine. The hyper chemical flow creates neuropathways, which take prominence in determining the addict's behavior. In other words, the brain forms highways to facilitate the onset of sexual fantasy, thinking, and activities, which lead to emotional euphoria or orgasm (Carnes, 1997b, pp. 11-13, 28).

According to Hastings (1998):

While (aberrant sexual) behaviors distract from healthy sexuality, they are only addictive if they are also obsessive or compulsive; in other words, if the person has difficulty interrupting thoughts about sex, searching for sex, or acting sexually. While sexual addiction recovery tends to focus on behaviors, the trance state can begin many hours or days before the sexual activity. This is the obsessive part of the addiction. The sexual act can be brief and is often unsatisfying. Alternatively, it can go on for hours, to the point of damaging tissues of the penis or vagina. This is the compulsion. (p. 71)

A common misconception is that acting-out sexually is always a frequent event—daily or at least weekly. Not necessarily so, every addict has his or her own repetition cycle. For some it is opportunity based. For most, the frequency of sexual thinking and fantasy determine sexual urges. Although timing varies for each addict, compulsivity underlies the craving to repeat the sexual event.

Ted's story. Ted came to counseling after he visited a house of ill repute. Although he expressed considerable remorse for having fallen, he was particularly concerned that he may have been exposed to a venereal disease. He spent most of the session talking about how sorry he was. Because of finances, Ted scheduled his next counseling appointment for a month later.

Ted did not return for his second session. In a follow-up telephone conversation, Ted declared he was not sexually addicted. He said his behavior was under control and he would not fall again. About six months later Ted revisited the same house of ill repute. Ted's acting-out cycle was lengthy.

(Continues...)

Excerpted from Sexual Addiction: Understanding and Treatment by Paul Becker. Copyright © 2015 Paul Becker, MAEd, LPC. Excerpted by permission of AuthorHouse.
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Edition details

• Publisher: AuthorHouse
• Publication date: 2015
• Language: English
• ISBN 10: 1496969871
• ISBN 13: 9781496969873
• Binding: Paperback
• Number of pages: 366