Women & Sex Addiction Patrick J. Carnes, Ph.D.

Women & Sex Addiction © Carnes, 2006 The Past Sex addiction was regarded as primarily a male problem. The numbers paralleled alcoholism and gambling: for every three men (75%) there was one woman (25%). Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 The Present In treatment, our female patient population has equaled and sometimes exceeded our male patients. Evidence of this shift is also shown in recent large studies of internet sex in which problematic cybersex behavior by women was over forty percent (40%). Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Gender Differences Journal article: Patrick J. Carnes, “Gender Differences in Normal and Sexually Addicted Populations”, Am J Preventive Psychiatry & Neurology, 3:1, Spring 1991, pp.16-27 Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Men in this study tended towards “behaviors that objectify their partners and require little emotional involvement.” Specific examples of these behaviors: anonymous sex, prostitution, pornography, exhibitionism, and fratteurism. Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Women in this study tended towards “behaviors that distort power – either in gaining control over others or being a victim.” Examples here included: sexual conquest, working as prostitutes, and sadomasochism. Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Today Many of these trends persist; however, a new pattern of trends are emerging. We are seeing more “male” types of behavior in women: pornography collections, compulsive use of prostitutes, and aggressiveness in approaching prospective sex partners. Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Why the Shift Much speculation exists as to why. Does cybersex play a role, due to the anonymity and safety of ones own home? Is it a shift in culture and sexual mores? Is exercising greater sexual freedom causing women to accidentally manifest compulsive behaviors? Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 The Story of Angie Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 In Search of Patterns One of the key issues to be aware of is that sexual aversion or “anorexia” (DSM – 302.79) is a frequent companion to sexual addiction. Like eating disorders, the binge/purge phenomenon is common. In treatment we encounter all three – addiction, avoidance, and binge/purge cycles. Women & Sex Addiction © Carnes, 2006

In Search of Patterns % “Yes” Females Males Gay Males Assessment – Sexual Addiction 59 90 94 Assessment – Sexual Anorexia 70 36 48 Table 1. Sexual addiction vs. anorexia. Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 In Search of Patterns % “Yes” Females (N = 588) Males (N = 894) Gay Males (N = 121) Alcoholism 46 49 Bulimia/Anorexia (Food) 27 5 8 Caffeine 37 33 Compulsive Eating 34 18 20 Compulsive Spending/Debting 36 41 Compulsive Violence/Raging 14 12 Compulsive Working 29 High-risk Behaviors/Danger 30 Nicotine 26 Substance Abuse 40 54 Table 2. Other addictions. Women & Sex Addiction © Carnes, 2006

In Search of Patterns % “Yes” Inpatient Females (N = 585) Online Females (N = 4979) Were you sexually abused as a child or adolescent? 57 Have you stayed in romantic relationships after they became emotionally or physically abusive? 75 74 Does your spouse (or significant other) every worry or complain about your sexual behavior? 58 59 Do you ever feel bad about your sexual behavior? 79 89 Has your sexual behavior ever created problems for you and your family? 63 76 Have you ever sought help for sexual behavior you did not like? 28 Has anyone been hurt emotionally by your sexual behavior? 66 Have you ever felt degraded by your sexual behavior? 86 When you have sex, do you feel depressed afterwards? 60 50 Has your sexual activity interfered with your family life? 46 Table 3. Contrast of inpatient and online assessments - Similar.

In Search of Patterns % “Yes” Inpatient Females (N = 585) Online Females (N = 4979) Do you often find yourself preoccupied with sexual thoughts or romantic daydreams? 52 92 Do you feel that your sexual behavior is not normal? 37 53 Do you have trouble stopping your sexual behavior when you know it is inappropriate? 50 88 Have you ever worried about people finding out about your sexual activities? 63 91 Have you made efforts to quit a sexual activity and failed? 38 78 Do you hide some of your sexual behavior from others? 61 93 Do you feel controlled by your sexual desire or fantasies of romance? 36 73 Do you ever think your sexual desire is stronger than you are? 39 79 Table 4. Contrast of inpatient and online assessments - Dissimilar.

Women & Sex Addiction © Carnes, 2006 Gambling (N=103) Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Alcoholism (N=740) Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Substance Abuse (N=664) Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Eating Disorder (N=213) Women & Sex Addiction © Carnes, 2006

Addiction Interaction Gambling Eating Disorder Alcoholism Substance Abuse Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Mothers … “discover in machine gambling a highly addictive relief mechanism – a means of escape from what they experience as an excess of demands and responsibilities to care for others.” Natasha Schull on Female Machine Gamblers Women & Sex Addiction © Carnes, 2006

Common Language of Technological Change Internet sex as the “crack cocaine” of sexual compulsivity – Al Cooper Ph.D. Machine video poker as the “crack cocaine” of compulsive gambling – Robert Hunter, Ph.D. Women & Sex Addiction © Carnes, 2006

Definition of a Black Hole: A celestial phenomenon when a massive star collapses from its own gravity. A black hole has such a strong pull that not even light can escape from it.

Addiction Interaction An addiction phenomenon where multiple addictions combine to overwhelm a person by their complexity and power. Phenomenon is so strong, no specific focus is strong enough to escape from it.

Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006

Compulsive Attachment: Key Characteristics Troubled people Hero and pathological giving High Intensity and Drama Boundary Collapse Impression Management Conflict Avoidance Women & Sex Addiction © Carnes, 2006

“The addictive dependence on feelings of pain…” Alice Miller, The Drama of the Gifted Child

Women & Sex Addiction © Carnes, 2006

Addiction Interaction Disorder Addictions more than coexist, they interact, reinforce, become part of one another. They become packages.

Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Cross Tolerance A. Simultaneous increase in addictive behavior in two or more addictions. B. Transfer of a high level of addictive activity with little or no developmental sequence. Women & Sex Addiction © Carnes, 2006

Withdrawal Mediation One addiction serves to moderate, relieve, or avoid withdrawal from another.

Replacement One addiction replaces another with majority of emotional and behavioral features.

Alternating Addiction Cycles Addictions cycle back and forth in a patterned systemic way.

Masking Addict uses one addiction to cover up for another, perhaps more substantive addiction.

Ritualizing Addictive behavior of one addiction serves as a ritual pattern to engage another.

Intensification Fusion dependence: neither addiction separately is sufficient; only simultaneous use is sufficient.

Intensification Partial Fusion: Addict combines addictions in such a fashion to be more potent than each addiction separately; addictions are used independently part of the time.

Intensification Binge Features: episodic multiple use, yet functionally independent of one another.

Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006

Numbing Addiction is used to medicate shame or pain caused by other addiction or addictive bingeing.

Disinhibiting One addiction is used to lower inhibitions for other addictive acting out.

Combining Mixing addictive experiences to moderate responses due to neuropathway interaction.

Addiction Interaction: Patient Recognition (N=650) Cross Tolerance – 59% Withdrawal Mediation – 59% Numbing – 59% Fusion –57% Masking – 56% Women & Sex Addiction © Carnes, 2006

Addiction Interaction: Patient Recognition (N=650) Replacement – 47% Disinhibiting – 46% Ritualizing – 44% Combining – 38% Alternating Addiction Cycles –36% Women & Sex Addiction © Carnes, 2006

Addiction Interaction Paradigm Changes: Diagnostic Framework: revision of DSM Treatment Process: depth and scope Treatment Focus: the underlying issues Relapse Prevention: addictions as packages Altered Strategies: first step, screen, neuropathways Mirror Patient Realities: professional allegiances Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 TRAP DOORS Have you ever sought Treatment for problematic sexual behaviors? (Prior efforts to seek help are a key variable.) Have any of your Relationships been damaged or disturbed as a result of your sexual behavior? (Almost always there is a concern about relationship damage.) Were you sexually Abused as a child or adolescent? (Sexual abuse is a key antecedent for compulsive sex.) Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 TRAP DOORS, cont’d Are you Preoccupied with thoughts about sex? (Preoccupation is one of the defining issues in diagnosis.) Do you experience any symptoms of Depression because of your sexual behavior? (Despair, remorse, and feelings of hopelessness result from failure to manage sexual behavior.) Do you feel like your sexual behaviors are Out of Your Control? (Loss of control is another key defining variable for determining the presence of an addiction) Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 TRAP DOORS, cont’d Have you ever felt the need to keep your sexual behavior Out of Sight? (Hiding behavior and living a double life characterize the sex addict’s experience and deep distrust.) Have you engaged in dangerous, illegal, or otherwise Risky Sexual Behaviors? (Sexual risk is one of the hallmarks of sex addiction.) Have you experienced Shame because of your sexual behavior? (Feeling defective is core to the sexual addict’s inner world.) Women & Sex Addiction © Carnes, 2006

Additional Information: Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 IITAP International Institute for Trauma & Addiction Professionals (IITAP) For more on the Certified Sex Addiction Therapist (CSAT) trainings, go to: www.iitap.com Or email Info@iitap.com Or call 480-575-6853 Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Gentle Path Press For books, workbooks, CDs & DVDs on the subject of sex addiction and recovery, go to: www.gentlepath.com Or call 1-800-708-1796 Women & Sex Addiction © Carnes, 2006

Women & Sex Addiction © Carnes, 2006 Sexhelp For more information about Dr. Patrick Carnes, links to other resources, current topics in research and popular literature, go to: www.sexhelp.com Women & Sex Addiction © Carnes, 2006