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Recognizing and Treating Sexual Addiction

By Leslie Davis & Susan O'Day

Many believe that sex addicts are predators who hide in the bushes, peek through windows, or have sex with children. In fact, most sex addicts are not sex offenders and do not engage in felonious acts. The truth is that sexual addiction is a brain disorder, it often starts as a reaction to childhood trauma, and it is treatable.

"There is often a history of trauma or abuse in the sex addict's childhood, and he or she learns that sex helps to cope with uncomfortable feelings," said Susan O'Day, a therapist in Sierra Tucson's Program for Sexual and Trauma Recovery (PSTR). "Eventually, troubling feelings of anger, fear, or shame become sexualized by the addict and are the initiating mechanism of acting out behavior."

Trauma's Role

Not everyone who experiences childhood trauma becomes a sex addict. However, with few exceptions, addicts' behaviors have roots in traumatic experience. "When addicts understand that sexual addiction can be an adaptation to their childhood trauma, it helps them begin to reduce the toxic shame, let go of their secrets, emerge from their double life, and address their problem," O'Day said.

Frequently, people traumatized in childhood seek out relationships that resonate with their early traumatic experience. For example, a girl ignored or rejected by her pornography-addicted father may seek attention through exhibitionism, using provocative clothing or behaviors.

"Sex addicts often replicate traumatic or abusive childhood experiences in their adult relationships. For example, a man molested as a child by a stranger may engage in anonymous sex as an adult. A woman verbally abused by her parents may choose abusive relationships, taking the role of abuser or victim, or shifting between the two," O'Day said. "Such scenarios serve to recreate the emotional states to which the addict became accustomed in early life."

Sex addicts often report living with profound loneliness and usually avoid emotional intimacy out of the belief that anyone who truly knew them would reject them. With this belief leading the way, these former victims seek power over others through sexual acting out, with tragic consequences. Eventually, the impact on family relationships, friendships, career, physical health, and mental health become seemingly insurmountable.

Signs of Sexual Addiction

Behaviors and experiences that may indicate a sexual addiction include:

• A preoccupation with some aspect of sexual behavior, such as pornography and sexual fantasizing.
• Time spent away from family, friends, and work to engage in such behaviors.
• Spending significant amounts of time engaging in sexual behaviors despite the negative consequences.
• Complaints from others about your sexual behaviors.
• Inability to keep promises to self and others about stopping.
• Feeling shame, guilt, or fear about sexual behaviors but being unable to stop.
• Loss of relationships with family or friends, loss of employment or career, and compromised physical health, often leading to severe bouts of depression.

Types of Sexual Addiction

According to Patrick Carnes and the International Institute for Trauma and Addiction Professionals, sexual addiction manifests through acting-out behavioral patterns. Most sex addicts engage in more than one of the following behaviors:

1. Fantasy: This is engaging in sexually charged fantasies, relationships, and situations. Arousal depends on sexual possibility. Sexual contact may destroy obsession; it is best when on the "verge" of being sexual.
2. Seductive role: Using sex as a means to gain power over others.
3. Voyeurism: Using visual arousal as a means to enter an obsessive trance. Boundary violations, risk, and masturbation may all play a part. Typical behaviors include use of pornography, going to adult bookstores, and frequenting strip bars.
4. Exhibitionism: Using sexual parts and sexual behaviors to gain attention. Sometimes this takes the form of the cliché "park flasher," and sometimes the addict exposes without ownership (for example, dressing provocatively or undressing in front of windows).
5. Paying for sex: Gaining sexual service by paying money or providing sexual service for money. Eventually arousal may become connected with money. Addicts report that getting their paycheck triggers their acting out ritual.
6. Trading: The addict's arousal is based on controlling others through sexual activities. Behavioral examples include trading partners, using sex clubs, producing pornography, and "rescuing" others as a means to be sexual with them.
7. Intrusive sex: This means violating boundaries in a sneaky way. Examples include frotteurism and "losing" explicit material for others to find.
8. Anonymous sex: Engaging in high-risk sex with strangers. The addict acts out in places like public restrooms, bath houses, and adult bookstores. Risk of discovery or violence is usually an important element.
9. Pain exchange: Humiliation and domination contribute to sexual arousal. Addicts often develop specific roles and scenarios, and arousal becomes fused to pain and fear.
10. Exploitive: Arousal based upon exploiting the vulnerable. The addict often develops a preferred "target." Typical targets are a physician's patients, a teacher's students, or a priest's parishioners. The addict is often aroused by the target's distress.

Before treatment, an addict might admit that he or she is engaging in one of these behaviors, but deny that these behavioral patterns may indicate sexual addiction.

Treatment of Sexual Addiction and Trauma

Most sex addicts enter treatment under duress, usually when a person important to them - a spouse, an employer, or a business partner - threatens termination of the relationship. Often, after entering treatment in a program like Sierra Tucson's, the addict does recognize the problem and develops motivation to break the cycle.

"People who come already knowing they have a problem and having a desire to get better often do very well in treatment," O'Day said. "If the addict fails to recognize or accept their problem, or seeks treatment only to placate others, the prognosis will be poor."

Treatment supports and guides the patient's start in recovery from sexual addiction. "We work to help addicts gain an intrinsic motivation for change, through helping them recognize the scope of their problem, learn about their addiction, and address shame-inducing trauma at the core," O'Day said. "Eventually, patients begin to recognize how they have sexualized uncomfortable feelings and have been acting them out rather than processing them appropriately."

"Addiction itself can be traumatic and humiliating," she continued. "In the cycle of acting out, addicts often confirm to themselves that their negative, trauma-induced poor self-worth is true. Thus, addicts become ensnared in their own confirmatory bias, producing a steady supply of the shame that fuels the addiction."

Treatment at Sierra Tucson

At Sierra Tucson, treatment of sex addiction includes daily process groups, weekly therapeutic recreation activities, psychodrama, 12-step "S" meetings, grief therapy, and family treatment. Patients receive Eye Movement Desensitization and Reprocessing (EMDR) sessions and Somatic Experiencing® sessions, while ancillary services support progress. Patients use a workbook provided for their therapy and are educated about the nature of their addiction. Group members participate in group therapy with other sex addicts with synergistic effect. Participants often inspire each other to deeper levels of personal honesty and self-acceptance.

"We make a thorough assessment of the person's sexual history and current behaviors. Each addict needs to know his or her personal arousal template in order to form a comprehensive relapse prevention plan," O'Day remarked. Through developing a comprehensive relapse prevention plan with staff support and guidance, the newly recovering addict anticipates future urges, cravings, or triggers, and forms workable strategies to cope with them.

Sierra Tucson recommends at least four weeks of inpatient treatment for sexual addiction. Many, if not most, patients decide to stay for five weeks or more. "This is a complex problem with deep roots," O'Day said. "According to the International Institute for Trauma and Addiction Professionals, about 40 percent of patients who have sexual addiction have co-occurring additions, mood disorders, and anxiety disorders."

Patients need enough time to adequately address the shame, secrets, relationship damage, and co-occurring disorders that usually accompany sexual addiction. Research indicates that the longer an addict is involved in treatment services, the better the prognosis becomes. With this in mind, a specialized treatment team at Sierra Tucson develops continuing care recommendations for each patient, and a continuing care coordinator completes the process by assisting the patient with arrangements for these prior to discharge.

Any person struggling with sexual addiction would choose well by seeking treatment at Sierra Tucson. Here they will receive the multi-faceted and sensitive care necessary to heal old wounds, initiate recovery with new hope, and begin a life of freedom, understanding, and dignity.