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The nature and prevalence of sexual compulsion has changed due to the influence of the Internet, and widespread media interest -- but counseling still needs to focus on controlling the behavior and addressing the narcissistic damage.
Sexual compulsion is not a joke but a real problem. The term is regularly overused and misused, often being attributed to anyone with a high sex drive or to a media celebrity whose lack of discretion or impulse control has led them to be caught with their trousers down. In common parlance, the term may be met with a snigger or a raised eyebrow, and perhaps even a little salacious curiosity. All of which adds to the shame and confusion of the true sufferer, who is often desperate for understanding, empathy and help.
Defining sexual compulsion
* Compulsive masturbation
The type of behavior does not define compulsion. The essential difference between the addict and the non-addict is that these behaviors feel out of control. An addict may spend an inordinate amount of time planning, engaging in and recovering from their chosen sexual activity. And in spite of the physical, emotional, relational, financial and even judicial cost of these activities, they feel unable to stop their behavior. Or at least, unable to stay stopped.
Another factor is that the chosen sexual behaviors are used to anaesthetize psychological pain. In the same way that an alcoholic may get lost in a bottle or a compulsive gambler fixates on the next win to avoid the pain of life, the sex addict chooses sex as their way to cope with the world.
Prevalence and profile
A survey of over 1,000 sex addicts and their partners concluded that many sex addicts had come from severely dysfunctional families. Ninety-seven per cent reported emotional abuse, 71 per cent physical abuse and 83 per cent sexual abuse. They also found that 87 per cent had come from families where at least one other family member had an compulsion. There was also a pattern of dual compulsions. Forty-three per cent reported chemical dependency, 38 per cent an eating disorder, 28 per cent compulsive working, 26 per cent compulsive spending and five per cent compulsive gambling.
The Internet explosion
Online pornography is big business. In 2002, sex-related sites became the number one economic sector of the Internet, estimated Lo be worth a staggering 2.5 billion dollars. There are 4.2 million pornographic websites making up 12 per cent of all websites. Seventy per cent of pornography is viewed between the hours of nine and five, which may explain why one in six employees reported having trouble with sexual behavior online.
The significance of all these statistics to clinicians is that both the profile of a sex addict and prevalence is changing. The Internet accelerates arousal because anonymity reduces the fear and shame that would normally act as a suppressant. What's more, evidence suggests that the Internet can tap into powerful, suppressed and unresolved sexual issues from childhood. This means that behavior is intensified and escalates, both in the amount of time spent on the activity but also the variety of activities engaged in.
Narcissism and sexual compulsion
Much has been written over the years about narcissism and its impact on adult relationships and self-regulation, and many have made connections between this and compulsions. Instead of resolving narcissistic damage, the addict either consciously or unconsciously chooses to anaesthetize the resulting pain. But why do some choose sexual behaviors as their drug of choice?
Birchard suggests that there are two additional components in the family of origin of the sex addict. Firstly, there has been a history of sexual compulsion over previous generations. In some cases this becomes apparent, with addicts recalling finding a family member's pornography or a parent engaging in multiple sexual relationships outside the marriage. In other cases the sexual pre-occupation may have taken the form of sexual avoidance or abstinence. The second component is overt or covert sexualization in childhood. This can take many guises and some clients may be painfully aware of specific incidents of abuse or inappropriate sexual behavior, while others may have more difficulty accessing or acknowledging any disturbance of this kind.
Shame is both a principal result of narcissistic damage and a principle driver for addictive behavior. Nowhere is this more apparent than in sexual compulsion. With so many societal taboos and boundaries around sexual behavior, the sex addict is quickly trapped by the compulsion cycle.
The compulsion cycle
The four-stage compulsion cycle proposed by Carnes in his book Out of The Shadows begins with preoccupation. The addict thinks about nothing but the next sexual conquest. Each conversation they have, image they see, person they meet or place they go is somehow fitted into a story they create about sex. This total absorption in their favorite subject blocks out the rest of the world. Not only are problems blocked out, but also important relationships and work. The ritualization stage allows the addict to prepare for their next conquest in a systematic and obsessive way. Each will have their preferred routines that intensify the preoccupation and arousal. This then builds to the sexual behavior of choice -- the end goal of the preoccupation and ritualization. But as the addict comes down from the rush of excitement of the sexual experience, they slip into despair. Knowing they have failed to control their behavior again, they feel powerless and filled with self-loathing. They also feel a great sense of shame and often humiliation. For the addict, the easiest route out of these feelings is to lose themselves in the trance-like state of preoccupation. And so the cycle continues.
The following 10-step assessment tool, developed by Patrick Carnes, can be useful for both addicts and clinicians to consider if the sexual behavior is compulsive
There are various reasons why an addict may present for inividual therapy. It may be they are aware of and have accepted their condition. However, sometimes the trigger will be a relationship or work problem. As mentioned before, addicts will often have neglected other areas of their life for many years, and sometimes it is the consequences of their behavior that they first want to address, rather than the behavior itself. But assuming that the behavior is at some stage revealed, the first thing the clinician will need to do is decide if they have sufficient knowledge, training and supervisory resources to best support the client. If not, referral will be the ethical option.