1. Closing the Gap Results from the Women’s Sexuality Survey on Female Sex and Love Addicts David L. Delmonico, PhD Duquesne University www.internetbehavior.com delmonico@duq.edu 412-396-4032 M. Deborah Corley, PhD Sante Center for Healing www.santecenter.com deb@santecenter.com 1-800-258-4250

2. Objectives Review results of Women’s Sexual Survey differences between Non-FSLA & FSLA Frequencies of Interest Research Questions & Resulting Subscales Hypersexual disorder/FSLA Impact of Internet-Cybersex Risk factors/Consequences of ACE Health Issues/In Harm’s Way Shame/Need for Affirmation Clinical implications/red flags Next steps in research – who will step up

3. FSLA / Women’s Sexuality Survey Project in collaboration with Duquesne University, Sante Center for Healing, and Society for the Advancement of Sexual Health (SASH) Women’s Summit Group (14 women considered experts in treatment of FSLA) developed 144 questions related to history, symptoms, acting out behaviors, consequences Survey on surveymonkey.com for 9 months Over 500 valid responses (230 self-identified non-addicts, 261 FSLA (95 SA, 166 Love/Relationship Addicts, 32 no selection)

4. FLSA Women’s Sexuality Survey 1 Non-FSLA Grp (n=230) Average age 35 Range 18-70 33% made >60K 24% had BA or above 93% heterosexual 63% com. Relationship Average 10.8 years 56% had no children Mean – 1.04 children 12% TX for sex problm 9% TX cybersex problm FSLA Group (n=261) Average age 33 Range 18-73 23% made >60K 16% had BA or above 90% heterosexual 55% com. Relationship Average 7.2 years 55% had no children Mean – 1.02 children 40% TX for sex problm 22% TX cybersex problm

5. Research Questions Did the women who identified themselves as female sex and love addicts also meet criteria as outlined in other instruments (HBI, Kalichman SCS, W-SAST)? Were there differences on those scales for those who identified self as sex addict compared to those who ID self as love and relationship addict? What if any was the impact of cybersex activity? Were there factors that might highlight risk for FSLA? (Adverse Childhood Experiences)

6. Research Questions 2 Were there similar consequences for ACE in our groups? What type of health consequences were present for FSLA and were they different than the non- addicts? Did the addict groups put self “In Harm’s Way” more frequently than the non-addict group? Did the addict groups have more guilt/shame or have a greater need for affirmation than non- addicts?

7. FLSA Women’s Sexuality Survey 2 Non-FSLA Group 23% feel bad abt sexual behaviors 32% feel degraded 10% can’t control sex desire 30% withdrawal sympt 21% compromised values 17% made failed effort to stop behavior 11% interferes with family life /responsibilities FSLA Group 67% feel bad abt sexual behaviors 70% feel degraded 49% can’t control sex desire 71% withdrawal sympt 67% compromised values 62% made failed efforts to stop behavior 45% interferes with family life /responsibilities

8. Measures Hypersexual Behavior Inventory (Reid, et al, 2011) 19 item scale using 5-point Likert scale Three factor model measuring control, consequences, and coping associated with sexual thoughts, feelings and behaviors. Reliability using Cronback’s alpha co- efficient (Control  =.94, coping  =.90, consequences  =.87) W-SAST (Carnes, et. al., 2010) 25 item questionnaire, true/false response Three factors measuring pre-occupation/loss of control, relationship disturbance, affect disturbance. Reliability scores  =.84 Sexual Compulsivity Scale (Kalichman, et al., 1994) 10 item scales using 4-point Likert type scale endorsing sexual thoughts, feelings and behaviors. Relability scores from  =.86 -.87.

9. Subscale comparisons Hypersexual Behavior Subscale (mirrored items in HBI associated with control, coping, consequences) Three subscales assessing control (19 items,  =.89), coping (15 items,  =.87), and consequences (19 items,  =.85) associated with sexual thoughts, feelings, and behaviors. W-SAST (Carnes, et. al., 2010) Same 25 item questionnaire, true/false response Three factors measuring pre-occupation/loss of control, relationship disturbance, affect disturbance. Reliability scores  =.84 Sexual Compulsivity Scale (Kalichman, et al., 1994) 8 items mirroring the SCS 10 item scales but with true/false response

10.  =.89 * p<.001

11.  =.85 * p<.001

12.  =.87 * p<.001

14. Cybersex (Corley & Hook, 2011, in press) 13.7% of sample identified self as having cybersex problems Participants spent average of 2.48 hr. per wk in cybersex behavior (SD=5.52); 23.8 hr. per wk in general use of computer (SD=19.59). FSA spent significantly more time in cybersex behavior than did FLRA and both addicted groups more than non- addicts. Only small difference in ratio of cyber to general use found. The cybersex group spent significantly more time in cybersex behavior than all other groups, experienced more depression associated with their sexual behavior, more withdrawal symptoms, & scored higher on hypersexual behavior subscales.

15. Cybersex 2 (Corley & Hook, 2011, in press) 53% of sample exposed to pornography as a child Participants who experienced childhood sexual abuse or who were exposed to pornography were more likely to report cybersex behavior. Exposure to pornography as a child was stronger predictor of hypersexual behavior than sexual abuse as a child. 79% of cybersex group reported frequently visiting porn website and chat rooms compared with 20% of the addict/non-cybersex group and 6% of the non- addicts. 58% of cyber group reported relying on abusive pornography or fantasies to feel aroused, compared with 16% of addict/no cyber, & 10% of non-addicts

16. Hypersexuality in Women (other studies) N=2450 / 18-60 yrs of age /Sweden IC M=5.1, SD=5.4 (men M=5.5, SD=6.2) Mast. M=1.6, SD=3.3) (men M=4.9, SD=6.9) Hypersexual women similar to men Early on set of intercourse; impersonal sex Relationship instability Diverse sexual experiences/same sex partners Paraphilic interests STD infections Smoking; Alcohol & other drug abuse General dissatisfaction with psychological health and life in general Women – sexually abused as children Langstrom & Hansom (2006), Archives of Sexual Behavior, 35(1), 37-52

17. Risks identified other places Carnes et al, 2010 Relationship disturbances – relationship problems as result of sexual behavior; associated with seeking help Affect disturbances included periods of depression, anxiety, feeling degraded or shame Associated features factor, childhood abuse, engaging in S&M, sexual problems of parents, sex with minors CDC – Adverse Childhood Experiences ACE = psychological, physical, sexual abuse; household dysfunction (i.e. living with addicted or substance abusing member of household, mental illness, mother treated violently, criminal behavior Consequences – the more ACEs have, the more risk for smoking, substance abuse, depression, suicide attempts, depression, > 50 lifetime sexual partners, STD, IBS, cancer, stroke, other health risks

18. Risks identified other places 2 CDC – Adverse Childhood Experiences ACE = psychological, physical, sexual abuse; household dysfunction (i.e. living with addicted or substance abusing member of household, mental illness, mother treated violently, criminal behavior

19. FLSA Women’s Sexuality Survey 3 Non-FSLA Group 43% child sex abuse 25% adult sex abuse 41% exposed to porn as child FSLA Group 54% child sex abuse 36% adult sex abuse 63% exposed to porn as child

20. Risks identified other places 2 CDC – Adverse Childhood Experiences Consequences – the more ACEs have, the more risk for smoking, substance abuse, depression, suicide attempts, depression, > 50 lifetime sexual partners, STD, IBS, cancer, stroke, other health risks, living with violent partner

21. FLSA Women’s Sexuality Survey 4 FSLA Group 25% got pg from SA 18% terminated SA pg 7% fertility problems 33% got STD 10.3% attempted suicide 42% used alcohol/drugs during sexual behavior 71% stayed in relationship after became abusive Non-FSLA Group 13% got pg from SA 10% terminated SA pg 2% fertility problems 14% got STD 3.1% attempted suicide 23% used alcohol/drugs during sexual behavior 43 % stayed in relationship after abuse

22. Medical Subscale Sex & Love Addicts = no difference SLRA = different from normals Medical Subscale (  =.54) (4 items)

23. In Harm’s Way Sex & Love Addicts = no difference SLRA = different from normals In Harm’s Way (  =.92) (29 items)

24. Guilt / Shame All groups p<.001 Guilt/Shame (  =.90) (37 items)

25. Affirmation Need for Affirmation (  =.84) (16 items) Sex & Love Addicts = no difference SLRA = different from normals

26. Boundary Violations among Women

27. Sex with a minor? *Pearson Chi-Square p<.01

28. Sex with a subordinate? *Pearson Chi-Square p<.001

29. Clinical Implications Women Sex, Love & Relationship Addicts Exist Some aspects seem differentiated between women identifying as sex addicts versus love addict Some aspects seem the same Sex Addicts More Difficulties Cybersex is worthy of a second look in women and its contribution to sexual problems Placing oneself in the way of harmy is worthy of clinical evaluation – relationship to trauma? Suicide assessment for women SLRA is a must Women can and do violate others’ boundaries

30. Where to now with research Utilizing Women’s Sexuality Survey ACE lens Prevention - In Harm’s Way

31. What women seek in therapy A more negotiated therapeutic relationship When asking about abuse think about ACE questionnaires Think more globally and ask more questions about what the process means for all aspects of their lives (family, work, self) – Level of Burden Need to be encouraged to “find their voice” in therapy. Careful attending and listening to their decisions, choices, and experiences is essential Tend to focus on the relationship and not the treatment tasks; find ways to use the relationship to increase motivation to change through secure attachment with you as therapist Help them identify authentic self, good enough mother, reliable friend

32. Assessment Tools Hypersexual Behavior Inventory (RReid@mednet.ucla.edu)RReid@mednet.ucla.edu Women’s Sex Addiction Screening Test (w-SAST) (Carnes – http://www.sexhelp.com) Internet Sex Screening Test (delmonico@duq.edu)delmonico@duq.edu Kalichman Sexual Compulsivity Scale (Kalichman & Rompe, 1995) Washton/Sealy Questions for Multiple Addiction (JOHN SEALY@aol.com) CDC ACE (www.cdc.gov/ace)

33. Defining Hypersexual Behavior Disorder Over a period of 6 months, recurrent & intense sexual fantasies, urges, or sexual behaviors (SFUBs) in association with 3 or more of the following 5 criteria: Time consumed by SFUBs interferes with other important non-sexual goals, activities and obligations Repetitively engaging in SFUBs in response to dysphoric mood states Or in response to stressful life events Unsuccessful efforts to control or reduce these SFUBs Disregarding the risk for physical or emotional harm to self or others

34. Defining Hypersexual Behavior Disorder 2 Significant personal distress or impairment in social, occupational or other important areas of functioning associated with these SFUBs These SFUBs are not due to physiological effect of an exogenous substance (drug of choice or medication) Specific if: Masturbation Pornography Sexual Behavior with Consenting Adults Cybersex Telephone sex Strip Clubs Other