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Addicts can squander an astonishing sum of money and time on their inclinations, completely deficient in the capability to control it. They habitually undergo a nearly ‘trance-like’ state during which their actions can go on for many hours.

Similar to other addictions, some addicts go through ‘episodic binges’ (between these binges they may well believe they are completely normal), some others may endure more of a continuous level of the crisis. There are some sexual addicts who move back and forth in opposite end of the continuum, engaging in sexual anorexia, where they repress their tendencies in a manner so that they have absolutely no sexual experiences.

This is in no way a cure for the basic compulsion nor is it an effective manner of control, but, like food addictions is plainly one more symptom of the addiction. Some sexual addicts operate in more intrusive ways or advance to them as they go through diminishing "highs" for their unusual activities. Patrick Carnes PhD. maintains that explicit activities do not identify addiction, “it is the compulsive nature of the behaviors that demonstrates addiction”. Addicts often attempt to stop, but fail. Their behavior generally conforms to a cycle:

1. Preoccupation

2. Ritualization

3. Compulsive sexual behavior

4. Despair

In order to get rid of negative feelings the addict almost immediately happens to become engrossed with sexual thoughts again, resuming the ‘addictive cycle’. Patrick Carnes theorizes that the cycle begins with the "Core Beliefs" which addicts ‘knows’ to be true. Such as; "I am basically a bad, unworthy person. " "No one would love me as I am. " "My needs are never going to be met if I have to depend on others. " "Sex is my most important need. " These attitudes impel the obsession in its advancement and eventual destructive course.

First a “pain agent” activates emotional discomfort (e. g. shame, unresolved conflict) the sex addict is incapable of dealing with the pain agent in an emotionally healthy manner. Before resorting to sexually behavior, the sex addict goes through a phase of mental obsession/preoccupation. They disassociate (moving away from his/her feelings). Thus a division starts between the mind and the emotional self. Once this ‘disconnect’ takes hold, the addict becomes pre-occupied with acting out behaviors. The reality of the situation becomes blocked out and distorted.

Preoccupation, or in other words "sexual pressure" means that the addict is consumed about being sexual or romantic. Consequently ‘fantasy’ turns into a fixation that serves to avoid life. ‘Thinking about sex and planning out’ how to reach orgasm can continue for minutes or hours before moving into the next stage of the cycle. These fixations are strengthen and reinforced through ‘ritualization’ or acting out. A sex addict may for example, go to a strip show to heighten arousal until he/she is ‘beyond the point of saying no’. This helps detach reality from sexual obsession. Once the addict is in the midst of the ritual, there is very little hope of stopping that cycle.

The subsequent stage of the cycle is sexual compulsivity or "sex act". Tensions felt by addict diminished and for the short term they feel better, due to the release that occurs. Compulsivity merely signifies that addict regularly gets a pint where sex becomes unavoidable, no matter what the consequence.

After the compulsive act there may be realization and acknowledgement that the addict has become nothing more than ‘a slave to the addiction’. And the addict launches into feelings of shame and despair. ‘The last time the Addict was at this low point, they probably promised to never do it again’.

Etiology of the condition

Although there is no singular causation of sexual addiction, studies have shown that a high percentage of sexual addicts were abused by someone during their childhood. According to Sex & Love Addiction, Treatment & Recovery 60% of sexual addicts were the victims of child abuse. Additionally, neurochemistry of an individual may predetermine the condition.

There is also a relationship between depression, anxiety, OCD, and Attention Disorders to Sexual Addiction. The progression of a SA theoretically begins early in life through adolescent experimentation and self-stimulation, or premature introduction to pornography and other sexual stimulants. Social conditioning, imprinting and developmental impairments may also be factors.

Sex becomes a dominant, exhilarating fascination very early on and the addiction increases. Others may start later in life—during graduate school, divorce, or when anxiety and nervous tension become so acute that an escape is needed. It turns into an effective form of self-medication, and another way to cope with the demands of life.

Consequences of Sexual Addiction

There are many consequences which result from sexual addiction. This includes the ‘social cost’; sexual preoccupation can lead to loss of friendship and family relationships. Anxiety and stress are a general theme in the lives of sex addicts, as they live with the ‘constant fear of discovery’.

Guilt and shame are also commonplace, as the addict’s lifestyle is mostly at odds with personal values and beliefs. Compulsive sexual thoughts and/or behavior leads to ‘severe depression, often with suicidal ideation, low self-esteem, shame, self-hatred, hopelessness, despair, helplessness, intense anxiety, loneliness, resentment, self pity, self blame ,moral conflict, fear of abandonment, spiritual bankruptcy, distorted thinking, remorse, and self-deceit’.

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The sexual addict who is in a marriage or committed relationship will find that his/her behavior and activities outside the primary relationship can result in loss of self-esteem to himself/herself as well as their partner. Besides severe stress to the relationship, parenting and bonds with children may also be detrimentally affected.

With increased high risk activities, Sex addicts may place themselves in situations of potential harm, which may even result in death. Many diseases may occur due to sexual addiction; these include but are not limited to genital injury, cervical cancer, HIV/AIDS, herpes, genital warts and other sexually transmitted diseases.

Sexual addiction can result in violation of the law, in cases such as sexual harassment, obscene phone calls, voyeurism, prostitution, rape, obscene phone calls, exhibitionism, incest and child molestation. There is also a related chance of loss of professional status and professional licensure, they may go to jail, get sued, or incur other financial and legal consequences because of their behavior.

There are also financial consequences, as debts may arise from the cost of prostitutes, cyber/phone sex and multiple affairs. Moreover, there are indirect costs associated with legal fees, the cost of divorce or separation, and decreased productivity or job loss.

Assessment and treatment

An assortment of surveys and examinations have been created in an effort to assess sexual addiction, but a small number of, if any have been officially evaluated, or verified to be correct. Advocators of the concept of the sexual addiction consider the cycle and the associated beliefs clearly exemplify the sexual addict.

Patrick Carnes PhD puts forward a fundamental test in order to deduce if a specific sexual behavior has become addictive:

1. It is a secret.
2. It is abusive or degrading to self or others.
3. It is used to avoid (or is a source of) painful feelings.
4. It is empty of a caring, committed relationship.

A copy of an actual test designed by Patrick Carnes is included towards the end of this report (figure 1)

In contrast with the aims in treatment of other forms of dependency (such as drug or alcohol), the therapeutic objective in sexual addiction is abstinence only from compulsive behavior with the goal and adaptation of a healthy sexuality. Most SA treatment programs recommend that patients refrain from all sexual activities (including masturbation) for 30 to 90 days to make it clear that life without sex is possible. It has been noted that when some sexual addicts stop all sexual activity, they report withdrawal symptoms akin to those encountered by cocaine addicts.

It is crucial that the Addict’s partner (if he/she has a significant other) be involved with the treatment program. In fact, the Mental Health Report by the Mayo Clinic categorically states that the most important predictor of relapse after treatment of sexual addiction is failure of the spouse to be involved in the treatment program.

The conduct of sex addicts has intense effects on partners, children and other family. The addict is typically ‘partially or totally unaware’ that they have affected those close to them. Families in turn cultivate detrimental coping skills as they make every effort to acclimatize to the addict’s irregular moods behavior. Hence, friends and families will often need to be involved in the recovery process.

Recovery is a course that works when there is:

1. Acceptance of the disease and its consequences.
2. Commitment to change.
3. Surrender of the need to control the compulsion.
4. Willingness to learn from others in recovery in sexual addiction Twelve Step support groups, and from trained therapists.

Due to the fact that most sex addicts were often sexually abused as children, they may have distorted ideas about sex and they usually require information about healthy sexuality. Therapists may need to work with early trauma and provide reassurance during treatment. Shame, a chief concern for sex addicts, is best addressed in group therapy; moreover, other recovering addicts can provide both support and confrontation. Group support can be an influential tool for overcoming the shame that most sex addicts feel.

The 12 steps of Alcoholics Anonymous have been adapted for use in many programs which deal with addictions. A program designed for sexual addiction can be particularly helpful in the recovery process. It is also noted that by the time sex addicts seek help, ‘their marriage or relationship is often in great distress’. The lack of communication, growing distrust, resentment and anger are common in such situations. A therapist can be of great help during recovery. Nevertheless SA, as with other addictions, cannot be "cured" and there might be the risk of a relapse. To overcome this, sex addicts must be trained to stay away from certain people and situations that can ‘trigger old urges and behaviors’.

Though, not empirically proven, some mental health providers say that some patients benefit from specific drugs, such as fluoxetine hydrochloride (Prozac) and domipramine hydrochloride (Anafranil).

Controversy over Diagnosis and Diagnostic Criteria

Those in the mental health field specializing in sexual behavior normally have the same opinion on what represents ‘out-of-control sexual behavior’, but they disagree over whether it is correctly identify as an ‘addiction’ or as an indicator of an essential obsessive-compulsive disorder, which can result in sexual obsessions.

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Many people and professional associations do not recognize SA as a legitimate form of addiction. One argument is based on whether the expression has any accurate connotation for describing human sexual behavior.

Some others see sexual addiction as an excuse for wanton behavior. Other characteristics or symptoms of this supposed condition are not easy to diagnose in a scientific manner, for example the primary difference between promiscuity and sexual addiction is essentially the motivation behind the act.

Other scientists interpret of sexual addiction ‘as a compulsion, an impulse control disorder, a sexual desire disorder, a lack of morals and willpower, or a form of obsessive compulsive disorder. ’ Proponents of the sexual addiction concept frequently liken it to food or gambling addiction, “where an outside substance isn’t used to create the high. ”

The American Psychiatric Association (APA) has not yet identified SA as a mental illness, but, the APA has classifications that are useful for grasping sexual behavior disorders. These disorders are called paraphilias. And include: “pedophilia, exhibitionism, voyeurism, sexual etc. ” All of these are typified by “recurrent, intense, sexually arousing fantasies, sexual urges or behaviors” which involve:- non-human objects; the suffering or humiliation of oneself or one’s partner, children or other nonconsenting persons; and clinically significant distress in social, occupational or other important areas of functioning caused by the behavior, sexual urges or fantasies.

It is vital to keep in mind that just because a person takes part in certain sexual behaviors, it does not mean they need to be labeled a sexual addict. The main feature in figuring out if a person is an addict is if that person’s behavior is compulsive. Case in point, a person sporadically looking at pornography is not automatically a sexual addict. However, a person who spends 13 hours a day, and gets fired because of extreme pornography use is most likely a sex addict. Another issue in determining sexual addiction is if the behaviors are used to ‘self-medicate’ and ‘escape reality’.

Even without the consensus within the field of the mental health community, Sexual addiction manifests in addicts as they attempt to ‘medicate their feelings’ and/or ‘cope with their stresses’ so that their sexual behavior becomes the most important coping mechanism in their life.

References

Carnes PJ. Don’t call it love: recovery from sexual addiction. New York: Bantam Books, 1991 42-4

Carnes P. Out of the shadows: understanding sexual addiction. Minneapolis: CompCare Publishers, 1983

Mayo Clinic staff (September 29, 2005). Compulsive sexual behavior. Mental Health Center. Mayo Clinic. Retrieved on 2007-03-11.

Book, Praeger. (1997). Sex & Love Addiction, Treatment & Recovery. New York: Lucerne Publishing.

Bird. M Sexual Addiction And Marriage And Family Therapy: Facilitating Individual And Relationship Healing Through Couple Therapy,. Journal of Marital and Family Therapy. Upland: Jul 2006. Vol. 32, Iss. 3; pg. 297, 13 pgs

Coleman E. The obsessive-compulsive model for describing compulsive sexual behavior. Am J Prev Psychiatr Neurol 1990;2(3):9-14

Vukadinovic Z. Sexual Addiction, Sexual Compulsivity, Sexual Impulsivity, or What? Toward a Theoretical Model The Journal of Sex Research. New York: Aug 2004. Vol. 41, Iss. 3; pg. 225, 10 pgs

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