Sex. It’s a word that can light up part of some peoples’ brains the same way mentioning cocaine or heroin might. Indeed, a compulsive sexual behaviour can be just as alluring for the addict trying to numb feelings as any other form of using – be that alcohol, chemical, shopping, gambling, etc.
“Knowing you are a sex addict doesn’t mean you are bad or perverted or hopeless. It means you may have a disease, an obsession from which many have healed,” Dr. Patrick Carnes, a pioneer in the field, once said.
While the form of using may be different from other addictive behaviours, the symptoms are essentially the same. “It’s a compulsive behaviour expressed in sexual activity, although the activity can be considered obsession, fantasy,, or other things people might do that may not be a behaviour you can see outwardly,” explains Nelson Sacristan, Counsellor at the Edgewood Healthcare Network Vancouver Clinic. “At its root would be trauma, an inability to have intimacy and express emotions,” Sacristan said. “The root of sex addiction is similar to chemical addiction.”
More recently, people seeking treatment treatment may have grown up with the Internet and haven’t socially matured or learned how to court or date and acquire a partner. Now, readily available online pornography may fill that void. “They’re not truly addicted to sex or compulsively with sex outside of pornography,” Sacristan says.
A person struggling with compulsive sexual behaviour might also use chemicals to enhance the stimulation of porn or to disinhibit them for other behaviours. “It allows them to go forward and do something sexually they might not otherwise do,” explains Sacristan. “They might say it was because I was drinking or using cocaine that I picked up an escort.” For others, the alcohol or chemical usage might enhance stimulation, including that from porn. And, some might use substances or food afterwards to deal with the guilt or shame of what they have done.
There are a number of ways that addiction neuropaths in the brain are activated through sexually compulsive behaviour. One way is activation through stimulation or numbing. Alternatively, there are those who might fantasize, or obsess, over a person. It’s not so much about sex. Such people don’t have a good check on reality and need to be shown how to test that. It’s more about having the thoughts, or wishing for the relationship. Another way is through deprivation, or people who are “sexual anorexic.” They don’t seek relationships or may be turned off by sex. Such people might have other deprivations, and treatment can help them identify what other needs aren’t being met.
The concept of sexual compulsion, or sex addiction, first came to light in the early 1980s with the publication of Out of the Shadows by Dr. Patrick Carnes. Carnes started a fellowship in Minnesota, and created a task-centred approach for recovery that is based on the 12 steps.
Through his work, Dr. Carnes identified four phases and ten symptoms of sex addiction.
The four phases are:
- Compulsive sexual behaviour
The symptoms are as follows:
- A pattern of out of control behaviour
- Severe consequences due to sexual behaviour
- Inability to stop despite adverse consequences
- Persistent pursuit of self-destructive or high-risk behaviour
- Ongoing desire or effort to limit sexual behaviour
- Sexual obsession and fantasy as a primary coping strategy
- Increasing amounts of sexual experience (because the current level of activity is no longer sufficient)
- Severe mood changes around sexual activity
- Inordinate amounts of time spent in obtaining sex, being sexual, or recovering from sexual experience
- Neglect of important social, occupational, or recreational activities due to sexual behaviour
Out of the Shadows cemented Carnes’ reputation as a thought leader in the field, and others in the addiction field soon began to follow his lead. The six-point PATHOS questionnaire screening tool for sexual addiction was developed to help individuals and therapists identify if someone should seek help based on their behaviours. The PATHOS questions are as follows:
- Do you often find yourself preoccupied with sexual thoughts?
- Do you hide some of your sexual behaviour from others?
- Have you ever-sought help for sexual behaviour you did not like?
- Has anyone been hurt emotionally because of your sexual behaviour?
- Do you feel controlled by your sexual desire?
- When you have sex, do you feel depressed afterwards?
If an individual answers ‘yes’ to one or more of the questions, seeking help might be a wise idea.
Another available tool is the Sexual Addiction Screening Test, which is designed to assess sexually compulsive behaviour that can indicate the presence of sex addiction.
The goal of sex addiction therapy is to help people move past damaging behaviours and onto happy, productive lives. As Nelson Sacristan stressed, treatment does not ask people to stop having sex. “Abstinence is not the goal,” he said. “We want to get people to the point where they can function again and enjoy life.”