An Overview of Sex Addiction

By Dorothy C. Hayden, LCSW

It is well known among people in the 12-step programs that of all the addictions, sex is the most difficult to master. Far from the notion that sex addiction is the “fun” one, the suffering of people dealing with this affliction is enormous. It is common for members of the sex recovering groups to be unable to maintain any continuous time of sexual sobriety, giving way to despair and hopelessness.

Before treatment, sexual enactment is the addict’s only source of safety, pleasure, soothing and acceptance. It vitalizes and connects. It relieves loneliness, emptiness and depression. Sex addiction has been called the athlete’s foot of the mind: It is an itch always waiting to be scratched. The scratching, however, causes wounds and never alleviates the itch.

The percentage of people who go to therapy or a 12-step program is quite small. The majority of sexual compulsives live in isolation, filled with feelings of shame. Almost 100 percent of the people who come to me for an initial consultation — whether it be for compulsive use of prostitutes, phone sex, a fetish, cross dressing, or masochistic encounters with dominatrixes — relay that beneath the shame they feel in telling me their story, they also experience a sense of freedom that comes from finally being able to share with another human being the hidden, shameful, sexually compulsive acts that imprison them.

The life of a sex addict gradually becomes very small. The freedom of self is impaired. Energies are consumed. The rapacious need for a particular kind of sexual experience drives the addict to spend untold hours in the world of his addiction. Inexorably, the compulsion begins to exact higher and higher costs. Friends slip away. Hobbies and activities once enjoyed are dropped. Financial security crumbles as thousands of dollars a year are spent on sex.

Then there is perpetual fear of exposure. Relationships with partners are ruined. The appeal of intimate sex with a partner pales in comparison to the intense “high” of indulging in the dark and devious world of sexual compulsion.

Sex addiction, of course, has nothing to do with sex. Any sexual act or apparent “perversion” has no meaning outside of its psychological, unconscious context. What sets sex addiction apart from other addictions and makes it so persistent is that the subject of sex touches on our innermost unconscious wishes and fears, our sense of self, our very identity.

While the definition of sex addiction is the same as that of other addictions — recurrent failure to control the behavior and continuation of the behavior despite increasingly harmful consequences — sexual compulsion is set apart from other addictions in that sex involves our innermost unconscious wishes, fears and conflicts. Sex addiction is a symbolic enactment of deeply entrenched unconscious dysfunctional relationships with self and others. It involves a derailed developmental process that occurred as a result of inadequate parenting.

Current treatment might include:

  • participating in a 12-step program;
  • going to an outpatient clinic;
  • engaging in aversion therapy; or
  • using medications to stave off hypersexuality.

Cognitive-behavioral therapy is used to help the patient control or repress the instinct for a period of time.

Addicts usually have a dysfunctional mother-child relationship. An unempathic, narcissistic, depressed or alcoholic mother has low tolerance for the child’s stress and frustrations. Nor is she able to supply the empathy, attention, nurturing and support that foster healthy development. The result in later life is separation anxiety, fear of abandonment and a sense of imminent self-fragmentation.

This anxiety sends the sex addict running to his eroticized, fantasy cocoon where he experiences safety, security, and diminished anxiety as well as the quelling of an unconscious wish to establish and maintain the missing, yet essential tie to mother. There is the hope that he can find an idealized “other” who can embody and make concrete the longed-for nurturing parent. This approach is doomed to failure. Inevitably, the other person’s needs start to impinge on the fantasy. The result is frustration, loneliness and disappointment.

On the other hand, a mother can be overly intrusive and attentive. She may be unconsciously seductive, perhaps using the child as a replacement for an emotionally unavailable spouse. The child perceives the mother’s inability to set appropriate boundaries as seductive and as a massive disillusionment. Later in life, the addict is hypersexual and has trouble setting boundaries. Real intimacy is experienced as an engulfing burden. The disillusionment of not experiencing appropriate parental boundaries is acted out later in life by the addict’s unconscious belief that the rules don’t apply to him with regard to sex, although he may be regulated and compliant in other parts of his life.

All addicts experienced profound and chronic need deprivation throughout childhood. Addicts in general sustain emotional injury within the realm of the mother-infant interaction as well as with other relationships. Intense interpersonal anxiety is the result of this early-life emotional need deprivation. In later life, the person experiences anxiety in all intimate relationships.

The sex addict has anxiety about being unable to get what he needs from real people. His desperate search for the fulfillment of unmet childhood needs inevitably ends in disillusionment. So he returns to his reliance on sexual fantasies and enactments to lessen anxiety about connection and intimacy and as a way to achieve a sense of self-affirmation.

Sex, for the addict, begins to be his primary value and a confirmation of his sense of self. Feelings of inferiority, inadequacy, and worthlessness magically disappear while sexually preoccupied, through acting out or through spending untold hours on the Internet. However, the use of sex to meet self-centered needs for approval or validation precludes using it to meet the intimacy needs of a cherished other.

People with this kind of narcissism view other human beings as deliverers of desperately needed satisfaction that shores up a fragile sense of self — not as whole people who have their own feelings, wants and needs. This narcissism prevents addicts from deriving satisfaction from mutual, reciprocal relationships in real life. Sexualizing is used as a magical elixir to meet needs without having to negotiate the ups and downs of intimate relationships.

A client of mine, a 48-year-old attractive single man, is in the process of the breaking up of yet another relationship. After spending years of living a noxious childhood household, he went into his own world of fantasizing and masturbation as a way to soothe and protect himself.

“When I was a kid, I was obsessed with beautiful women in the magazines. When I was able to date, I went through one woman after another. In adulthood, I knew there was sadness and anger I didn’t want to face. To evade them, I had a steady stream of women who worshipped me, soothed me, paid attention to my needs. I went to peep shows and I visited prostitutes. Many a night I would spend hours in my car circling the block looking for just the right street-walker to give me oral sex in my car. One night I had sex with a transvestite. I cried all the way home.”

He met a girl whom he designated as “perfect — my redemption, my salvation.” He became engaged but soon lost interest in the sex, which he described as “boring.” While still engaged, he started picking up hookers for oral sex in the car and began compulsively using phone sex.

His current relationship is breaking up because he picked a woman for her youth and beauty (which reflected well on his narcissistic self). The rest of the story is predictable. They moved in together and the beautiful, young, sexy female started become real and having needs of her own. He admits he never felt warmth or love for her; she was merely a supplier of his narcissistic needs. As the relationship deteriorated, he fought the impulse to return to sex with strangers who don’t make demand on him.

Another client, a 38-year-old married man, has a compulsion to visit prostitutes. Three years into the treatment, he was finally able to talk about his anger toward his mother for depriving him emotionally through neglect and for never touching or caressing him. He can now make a connection between visits to the prostitutes and his hostility against mother for depriving him of sensual pleasure. He got lost in the mire of his parents’ constant feuding.

“When I was very young I would put a blanket on my genitals as a kind of soothing which I wasn’t getting from my parents. The rest of my life was a struggle to find other ways to soothe myself. When I discovered prostitutes, I thought I was in heaven. I can get sex now and be in total control. I can have it immediately, any way I want it, whenever I want it. I don’t have to concern myself with the girl, as long as I pay her. I don’t have to concern myself with vulnerability and rejection. This is my controlled pleasure world. This is the ultimate antithesis of the deprivation of my childhood.”

The use of sexualization as a defense is a common theme in psychoanalytic literature. A defense is a mechanism the young child devises to psychologically survive a noxious family environment. While this way of protecting himself works well for a period of time, the continuous use of it as an adult is destructive to the person’s ongoing functioning and sense of well being.

By losing himself in sexual fantasies and constantly seeing others as potential sex partners, or by erotic Internet enactments, the sex addict is able to significantly reduce and control a wide variety of threatening and uncomfortable emotional states. Diminished depression, anxiety and rage are some of the payoffs.

Another client illustrates a case of narcissistic personality together with the use of sexualization as a defense. He is a 52-year old attractive, successful single man.

“I went on a date the other night. She wanted sex. I didn’t. It’s predictable. I don’t think I can even maintain an erection anymore. While I spend untold hours compulsively websurfing to live in my erotic fantasies, when it becomes real, when you find someone who seems to be the embodiment of your sexual preoccupation, interest soon wanes as her wants and needs come into the picture. Sometimes, I don’t even bother with the pursuit of real women, because I know the inevitable result is disillusionment. I’m simply not prepared to meet somebody else’s needs.

“Oddly enough, my life is still dominated by sex. It becomes the lens through which I view everything. I go to a family gathering and get lost in sexual fantasies about my teenage nieces. I live in constant fear of being found out to be a ‘pervert.’ I see a woman on the train dressed in a way that triggers me, and I’m ruined for the day. Regular sex just doesn’t do it for me anymore. It’s got to be bizarre or forbidden or ‘out of the box.’ I arrive at work in an erotic haze. Women around me are all objects of sexual fantasy. I’m distracted; not focused. If something requires my attention, when real life intrudes and yanks me out of my sexual preoccupation, I get angry. Real life is so boring. Ordinary sex with a girlfriend holds no interest for me.”

This man uses sexualization as a defense. His sexual preoccupation is a way to ward off chronic feelings of loneliness, inadequacy and emptiness born of a childhood trying to get nurturing from a withdrawn, depressed mother. When stress or anxiety begins to overwhelm him, he is beset by intense urges to indulge in his fantasies and enactments. Sexualization thus becomes his standard way of managing feelings that he perceives to be intolerable as well as a way of stabilizing a crumbling sense of self-worth.

Some contemporary psychoanalysts use the concept of a vertical split in treating the addict. The split exists from inadequate parenting which results in structural deficits in the personality. Patients often report that they feel fraudulent, living two separate lives with two different sets of values and goals. They feel they’re acting out a version of “The Strange Case of Dr. Jekell and Mr. Hyde.”

One sector of the personality, the one anchored in reality, is the responsible husband and father. This part of the person is conscious, adaptive, and often successful in business. This is also the sector that experiences guilt and shame about his sexual behaviors and ultimately drives him to seek therapy to ameliorate his misery.

The “Mr. Hyde” side of the vertical split has a completely different set of values and seems to be impervious to his own moral injunctions. “Mr. Hyde” represents the unconscious, split-off part of the personality. It is impulse-ridden, lives in erotic fantasy, and is sexualized, unstructured and unregulated. This side of the vertical split seems to be incapable of thinking impulses through, and thus is oblivious to the consequences of his behavior. This is the part of the self that is hidden, dark, driven and enslaved.

Treatment bridges the gap of the split. Its aim is the establishment of a therapeutic relationship that regulates emotional states. It is used as a “laboratory” to bring to consciousness maladaptive relationship patterns. The therapist provides empathy and understanding and reconstructs the childhood origin of the addiction. The goal is an integrated self that is able merely to experience a sexual fantasy without being preoccupied with it and without acting out a damaging sexual scenario. The patient achieves some ability to self-regulate moods, and to seek out adequate and sustaining available supportive relationships both in and out of treatment. He is then free to put sexuality in its proper place and free up energies to gain satisfaction from real relationships, pursue creative or intellectual goals, obtain pleasure from hobbies and activities, and have a heightened sense of self-esteem, thus enabling him to end his isolation. He is then free to love, to have deeply satisfying, self-affirming sex, work to his potential, and experience being a valued member of the human community.

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APA Reference
Hayden, D. (2006). An Overview of Sex Addiction. Psych Central. Retrieved on October 25, 2014, from http://psychcentral.com/lib/an-overview-of-sex-addiction/000521
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    Last reviewed: By John M. Grohol, Psy.D. on 30 Jan 2013
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