The Challenging Landscape of Problematic Sexual Behaviors, Including “Sexual Addiction” and “Hypersexuality” Paul Joannides, Psy. D.

What is Sexual Addiction? A clinical syndrome characterized by sexual urges, fantasies, and behaviors that are recurrent, intense, and create a distressing interference in daily functioning. Sexual behaviors that are perceived as problematic or out of control.

What is Sexual Addiction A lot of attention and dissension. Growing consensus states there is no specific disorder that generates all the sexual thoughts, feeling, and behaviors that can cause some people to experience their sexuality, or others, as being out of control. Leave it to the client to determine when his/her sexual behavior is out of control.

Other Labels Sexual Impulsivity Compulsive Sexual Behaviors Hypersexuality Impulsive/Compulsive Sexual Behavior Dysregulated Sexuality

Different Perceptions Theoretical Orientation Religious Beliefs Training and Specialty “It is important for clinicians to be comfortable with a wide range of normal sexual behavior, both in types of behaviors and frequency.”

Problems with Defining Problematic Sexual Behaviors What does “create a distressing interference in daily functioning” really mean? Sexual Addiction Screening Test Sex Drive Relationships OVERALL RISKY BUSINESS

How is it defined between groups? Married vs. Single Men vs. Women

Prevalence in General Population Varying statistics 5-6% although these percentages have no published studies to support them. Methodological Nightmare Little consistency in way studies are done and instruments used. Definition of sexual terms EX. Masturbation

Historical Perspective Concept of sexual addiction first put forth in the mid-1970s by member of Alcohol Anonymous, “sex and love addiction” Benjamin Rush Small amounts of masturbation result in a list of problems, including death! Paying for sex Nymphomania Internet Pornography

Cultural Backdrop The idea that mental health professionals created the disorder in an attempt to transform a social problem into a medical one. 12-step program to cure people who watch pornography at the expense of loved ones. But no program for people who watch sports hours on end at the expense of being with a loved one. Sex used to regulate mood and emotions Hobbies and work Focus on career at expense of relationship

Cultural Backdrop Sign of addiction when results in harm to oneself or to others. Riding motorcycles, jumping out of airplanes, volunteer for military during wartime Strong Religious Background Dirty

Approach and Withdrawl Human sexual response is controlled by two independent systems: Sexual Excitation (Approach) Inhibition (Withdrawl) Becomes an issue when individuals have trouble with inhibiting their sexual excitement in risky situations. They don’t recognize it as risky Become more aroused by inhibition (paradoxical effect)

Mood and Sexual Dysregulation Most people are less inclined to want sex when they are anxious or depressed. Small group that is the opposite. Bancroft and colleagues did study that showed 10% respondents showed increase in sexual interest when depressed 20% increase when anxious or stressed Preferred sexual outlet is masturbation When given to self-identified sex addicts huge increase More than 50% for each category

Mood and Sexual Dysregulation Using anti-depressants to treat depression and anxiety have shown to decrease frequency of problematic behavior. WHY?

Sexual Desire Discrepancies Higher Sex Drive Masturbation and Pornography used to help alleviate needs. Individual may be “normal”, but may have partner with lower sex drive and then are considered sex addicts by their partner and/or themselves. Orgasms fail to provide relief Persistent Genital Arousal Disorder

Childhood Sexual Abuse Many assume that childhood sexual abuse is a cause of sexual addiction. There would be as many women sex addicts as men At least five times as many men as women reporting problematic sexual behaviors

Therapy Considerations If client reports being a sex addict we must consider How does the client regard normophilic sexual behaviors? Can the problem be solved with basic sex education? Are guilt and shame involved? Possible deeper psychological factors may be involved. Incompatibility with partner Religious and Personal values

Therapy Considerations Inability to have sex when emotional intimacy is involved. Different sexual drives between partners. Severity of stressors in person’s life. Problems with drug and alcohol use. Possible underlying pathology. Depression, anxiety, mood disorder, personality disorder, etc.

Therapeutic Challenges Lack of clinically validated instruments to measure sexual addiction. No checklist to say whether sexual behavior is normative or a possible symptom of underlying pathology.

My Thoughts Don’t just assume the issue is pathological. Make sure not to put your thoughts about what is normal onto client. Does sexual addiction really exist?