1. BEHAVIORAL SYMPTOMS, CAUSES, PSYCHOLOGICAL TRAUMA, TREATMENT
Sex addiction
BEHAVIORAL SYMPTOMS, CAUSES, PSYCHOLOGICAL TRAUMA, TREATMENT

2. AGENDA
BRIEF HISTORY OF SEXUAL ATTITUDES AND BEHAVIORS
DEFINITION OF SEX ADDICTION AND THE CRITERIA
CONTROVERSY ABOUT THE DISORDER
DIFFERENTIAL DIAGNOSIS – DSM 5
DIFFERENCES BETWEEN SEX ADDICTION AND SEX OFFENDING

3. AGENDA ETIOLOGY: FAMILY DYNAMICS
TRAUMA EXPERIENCED – PHYSICAL & EMOTIONAL
ATTACHMENT THEORY
NEUROSCIENCE
SEXUAL LEARNING

4. BRIEF HISTORY OF SEXUAL ATTITUDES AND BEHAVIORS
PREHISTORIC SEX: PAINTINGS ON CAVE WALLS (32,000
YEARS OLD) INDICATE INTENSE INTEREST IN SEX, HUNTING, RITUAL, AND ANIMAL BEHAVIORS; THE PAINTINGS CONNECT SEX AND SPIRITUALITY
CIVILIZATION HAS BEEN SHAPED BY SEXUAL CULTURE
RELIGION HAS HAD A POWERFUL INFLUENCE ON SEXUALITY: HINDUISM, JUDAISM, BUDDHISM, CHRISTIANITY AND ISLAM

5. BRIEF HISTORY OF SEXUAL ATTITUDES AND BEHAVIORS
Species – we are like all others in our species
Sexuality
Individuality – we are like no others
Culture/Religion
we share similar things with some others

7. How is sex addiction defined
Briefly stated:
“A pathological relationship to a mood altering experience (sex) that the individual continues to engage in despite adverse consequences.”
Stephanie Carnes, Ph.D.

8. Sex addiction and sex offending
SEX OFFENDERS ARE USUALLY MORE IMPULSIVE
THEY ARE OFTEN VIOLENT AND USE MORE FORCE
THEY ARE EVEN MORE MANIPULATIVE AND IN DENIAL
THEY ARE NOT OPEN TO TREATMENT
THERE MAY BE A HISTORY OF OTHER OFFENSES
THERE MAY BE A HISTORY OF PHYSICAL ABUSE
THEY DO NOT HAVE REMORSE AND DO NOT FEEL SHAME (MAY HAVE ANTISOCIAL PERSONALITY DISORDER)

10. Sex addicts - 1- ARE FREQUENTLY MULTI-ADDICTED CARRY INTENSE SHAME
HAVE A HIGH POTENTIAL FOR SUICIDE
USUALLY HAVE SUFFERED FROM EMOTIONAL OR SEXUAL ABUSE AND PHYSICAL/EMOTIONAL NEGLECT
ARE PREOCCUPIED WITH SEXUAL THOUGHTS/DESIRES
HABITUAL LYING

11. Sex addicts - 2
Distrust of authority
Intimacy deficit
Post-traumatic stress disorder
Extreme eroticization
Compartmentalization
Compulsive cycles
(Patrick J. Carnes, Ph.D)

12. Losses suffered by sex addicts

13. DIAGNOSES TO BE CONSIDERED – DSM 5
OTHER SPECIFIED SEXUAL DYSFUNCTION
UNSPECIFIED PARAPHILIC DISORDER
MOOD DISORDER*
ANXIETY; DEPRESSION; DYSTHYMIA

14. DYSTHYMIA

15. DIAGNOSES TO BE CONSIDERED – DSM 5
RULE IN OR OUT BIPOLAR AFFECTIVE DISORDER OBSESSIVE COMPULSIVE DISORDER SUBSTANCE INDUCED DISORDER ANTISOCIAL/NARCISSISTIC PERSONALITY DISORDER (OR CHARACTERISTICS) PTSD PARAPHILIA COGNITIVE DISORDER

16. SEX ADDICTION DOES NOT INCLUDE PARAPHILIAS
EXHIBITIONISM
FETISHISM
FROTTEURISM
PEDOPHILIA
SEXUAL MASOCHISM/SADISM
VOYEURISM
TRANSVESTIC FETISHISM

17. PARAPHILIAS
Voyeurism: watching an unsuspecting/nonconsenting individual who is either nude, disrobing, or engaging in sexual activity
Exhibitionism: exposing one’s own genitals to an unsuspecting person
Frotteurisim: touching or rubbing against a nonconsenting person
Sexual masochism: being humiliated, beaten, bound, or otherwise suffering
Sexual sadism: the physical or emotional suffering of another person
Pedophilia: sexual activity with a child that is prepubescent (usually 13 years old or younger)
Fetishism: sexual fascination with nonliving objects or highly specific body parts: cross-dressing that is sexually arousing and interferes with functioning
Other specified paraphilia: some paraphilias do not meet full diagnostic criteria for a paraphilic disorder but may have uncontrolled sexual impulses that cause enough distress for the sufferer that they are recognized. Examples of such specific paraphilias include necrophilia (corpses), scatologia (obscene phone calls), and zoophilia (animals).

18. PARAPHILIAS
Pedophilia: sexual activity with a child that is prepubescent (usually 13 years old or younger)
Fetishism: sexual fascination with nonliving objects or highly specific body parts
Transvestism: cross-dressing that is sexually arousing and interferes with functioning

19. PARAPHILIAS
Other specified paraphilia: some paraphilias do not meet full diagnostic criteria for a paraphilic disorder but may have uncontrolled sexual impulses that cause enough distress for the sufferer that they are recognized. Examples of such specific paraphilias include necrophilia (corpses), scatologia (obscene phone calls), and zoophilia (animals).
Partualism (exclusive focus on one part of the body; coprophilia (feces); Klismaphilia (enemas); urophilia (urine).

20. OTHER TERMINOLOGY FOR SEX ADDICTION
COMPULSIVE
IMPULSIVE
HYPERSEXUAL
Criteria are similar

21. American Society of Addictive medicine
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuity. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

22. Addictive behavior
Numb feelings
Escape from painful parts of life
Mood altering
Most important need

23. Addictive behavior includes:
Loss of control
Efforts to stop
Loss of time
Preoccupation
Inability to fulfill obligations
Continued use despite negative consequences
Escalation
Losses
Withdrawal
Wthdrawal causes considerable distress, anxiety, restlessness, irritability, physical discomfort

24. ADDICTION- 1
While active in their addiction, sex addicts often nurture fantasies and engage in behaviors that are anathema to their core values and beliefs. Most often, their behaviors start out somewhat in line with their moral center, but as addictive patterns escalate, some progress from “vanilla” interests like soft-core porn and fantasizing about sex with someone met on Facebook to hardcore porn, illegal porn, affairs, voyeurism and/or exhibitionism, buying and/or selling sex, fetish behaviors, coupling illicit drug use with sex, etc.

25. ADDICTION -2
Each time an addict violates his or her core values, he or
she typically experiences an ever-growing sense of guilt,
shame, and remorse. And because they are addicts, these
individuals often respond to these uncomfortable emotions
by “self-medicating” with more of the same addictive
escapist fantasies and behaviors, thereby creating even deeper feelings of guilt, shame, and remorse. This defines the addictive cycle. Over time, as the individual spirals downward into his or her addiction, these negative feelings add to previously internalized beliefs like: “I am a bad and unworthy person,” or, “I am incapable of receiving love,” eventually becoming incorporated as an integral part of the addict’s personality and thinking. This negative self-talk is often bolstered over time by the consequences that addicts routinely experience as a direct result of their problem behaviors. For many such individuals, ruined relationships, lost jobs, financial problems, declining emotional and physical health, and even arrest can feel earned, deserved, and even unavoidable.

26. ADDICTION - 3
Over time, as the individual spirals downward into his or her addiction, these negative feelings add to previously internalized beliefs like: “I am a bad and unworthy person,” or, “I am incapable of receiving love,” eventually becoming incorporated as an integral part of the addict’s personality and thinking. This negative self-talk is often bolstered over time by the consequences that addicts routinely experience as a direct result of their problem behaviors. and physical health, and even arrest can feel earned, deserved, and even unavoidable.

27. ADDICTION - 4
For many such individuals, ruined relationships, lost jobs, financial problems, declining emotional and physical health, and even arrest can feel earned, deserved, and even unavoidable.
Weiss LCSW, R. (2015). Addiction and Narcissistic Shame. Psych Central. Retrieved from

28. Trauma AND SEX ADDICTION
Sexual addiction is strongly affixed in shame and trauma. There is a prevalence of emotional, physical, and sexual abuse with” highly restricted environments regarding sexuality, dysfunctional attitudes about sex and intimacy, low self- esteem, anxiety, and depression.”
Coleman E. Is Your Patient Suffering from Compulsive Sexual Behavior?. Psychiatr Ann. 1992; 22: doi: /

29. TRAUMA AND SEX ADDICTION
When a child suffers sexual abuse, sexual arousal becomes activated prematurely and can largely impact the survivor’s sense of autonomy over their body and sexual sense of self (Roller, Martsolf, Draucker & Ross, 2009).

31. neuroplasci

32. Neuroscience issues
Sex addicts experience powerful sexual conditioning and learning
Structural changes in the brain
Cognitive deficits in certain areas of functioning, such as memory, decision making

34. Hypofrontality –decreased executive control functioning
ADDICTION INVOLVES:
Sensitization – repeated administrations of a stimulus results in amplification of a response – cues create cravings
Desensitization – the more exposure, the less activity in the reward circuit – less sensitive to pleasure; tolerance develops after desensitization
Hypofrontality –decreased executive control functioning
Stepanie Carnes, Ph.D

35. Reward deficiency syndrome
Provides a platform for understanding the commonality of brain function in substance and non-substance addictive behaviors.
The goal has been to find a specific genetic variant that could be contributing to this RDS. Early research regarding Reward Deficiency Syndrome discovered a link between carrying a certain allele (the “A1”) and alcoholism.  Upon further investigation, this same allele was also associated with the development of other addictive, compulsive, and impulsive behaviors and disorders (Journal of Reward Deficiency Syndome and Addiction Science)

36. Brain functions
Researchers completed brain scans of individuals with sex addiction and without. Compared to their counterparts unaffected by sex addiction, the participants dealing with the condition experienced an unusual elevation of activity in three separate parts of the pleasure center. These brain structures are responsible for things such as the ability to recognize a rewarding sensation and the ability to control emotional responses to pleasure

37. BRAIN FUNCTIONS
The observed brain function changes in the study participants with sex addiction made these participants desire sex more but did not make them like sex more than their unaffected counterparts. The study’s authors believe that this unusual juxtaposition between sexual desire and sexual liking largely helps explain the presence of sex addiction.
Addiction Research,

38. Alcohol is the most frequently co-occurring addiction in
Multiple addictions
Alcohol is the most frequently co-occurring addiction in
males and females
Drug abuse is most frequent among gay males
Women scored higher on compulsive spending, compulsive eating, and compulsive cleaning

39. ATTACHMENT ISSUES
Attachment patterns have to do with how the infant is tended to by his/her primary caretaker, usually the mother. This means that when an infant is upset, the “good enough” mother soothes the infant which regulates his/her nervous system. If the baby is soothed while under the duress, that baby will grow into an adult who can soothe himself while under stress. This ability helps to create a securely attached adult Alexandra Katehakis

40. ATTACHMENT ISSUES
If the mother or caregiver does not provide nurturance and soothing to the infant because of her/his own dysregulation, the child gtows into an adult who cannot self-soothe when under stress. The ability to self-soothe creates a securely attached adult.

41. INSECURE ATTACHMENT STYLES
The Anxious-Avoidant type of person is both anxious and avoidant of intimate relationships. He can appear to be commitment phobic in his way of relating.
The Disorganized type is simultaneously terrified of engulfment and abandonment. If you get too close, too fast, they bolt. If you get close and have arguments or struggles in the relationship, they

42. INSECURE ATTACHMENT STYLES
The Preoccupied personality is ambivalent in her attachment style. You get mixed messages from her where she seems to be saying, "come here, go away" at the same time. She, too, has difficulty with long-term commitment.

43. INSECURE ATTACHMENT STYLES
The Disorganized type is simultaneously terrified of engulfment and abandonment. If you get too close, too fast, they bolt. If you get close and have arguments or struggles in the relationship, they fear that you will leave them. It can be exhausting to be in a relationship with this attachment style. These patterns are changeable.
Alexandra Katehakis

44. TREATMENT
Education
Group Therapy
12 Step Support
Recommended:
Celibacy agreement
Sexual health plan
Recovering task completion
Mindfulness/CBT
Trauma treatment
Partner trauma treatment
Couple treatment

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