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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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 – ) 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

11. 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

12. 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

13. 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.

14. 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.

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

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

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

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

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

20. 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

21. 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

22. 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.

23. 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.

24. Women & Sex Addiction © Carnes, 2006

25. Women & Sex Addiction © Carnes, 2006

26. Women & Sex Addiction © Carnes, 2006

27. 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

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

29. Women & Sex Addiction © Carnes, 2006

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

31. Women & Sex Addiction © Carnes, 2006

32. 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

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

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

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

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

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

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

39. 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.

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

41. Women & Sex Addiction © Carnes, 2006

42. Women & Sex Addiction © Carnes, 2006

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

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

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

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

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

48. 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

49. 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

50. 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

51. 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

52. Additional Information:
Women & Sex Addiction © Carnes, 2006

53. 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: Or
Or call
Women & Sex Addiction © Carnes, 2006

54. Women & Sex Addiction © Carnes, 2006
Gentle Path Press
For books, workbooks, CDs & DVDs on the subject of sex addiction and recovery, go to:
Or call
Women & Sex Addiction © Carnes, 2006

55. 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:
Women & Sex Addiction © Carnes, 2006