health

"I'm a psychologist. Here's what you need to know about sex addiction."

Sex and sexual behaviour tend to be taboo as topics of conversation. But in therapy when clients tell me their relationships, finances, emotional wellbeing or other areas of their lives are in disarray due to their out-of-control sexual behaviour, I listen. The conversation will quickly turn to their sexual habits and how they’re feeling. For most people, it’s confronting.  

It’s important that we, as a society, don’t pathologise healthy sexual behaviour. Some people internalise cultural and gender norms, and judge their healthy sexual behaviour as unacceptable. 

Others may have feelings of shame because they have transgressed their own values.

Although not formally recognised as an addiction (in the DSM-V), compulsive sexual behaviour is commonly referred to as sex addiction by those in 12-step programs. 

Without treatment, it can escalate and these behaviours can significantly impact a person's life and lead to relationship breakdown. 

Understanding the history of the behaviour and what is contributing to the distress, as well as the feelings of shame and unworthiness, are important.

These symptoms need to be addressed, including problematic behaviours, painful emotions, unhelpful thinking styles, as well as the underlying issues.

What is compulsive sexual behaviour?

Compulsive Sexual Behaviour Disorder (CSBD), which is now included in the ICD-11 (The World Health Organisation’s International Classification of Diseases 11th Revision), is an Impulse Control Disorder. 

It’s characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. 

Symptoms may include repetitive sexual activities becoming a central focus; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.

Here’s what you need to know if you suspect that you or someone you know has compulsive sexual behaviour.

It doesn’t just mean that you are compelled to have sex.

There’s a misconception that compulsive sexual behaviour is only about penetrative sex.

However, it can manifest as excessive consumption of porn, compulsive masturbation, preoccupation with sex, intrigue or obsession with sexual related activities, voyeurism and compulsively paying for sex (including phone and cybersex). 

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Some of my clients can spend hours in sexual rituals, such as on hook-up apps or other cruising behaviour resulting in anonymous sex. 

Long hours spent online provides an opportunity for the escalation of particular aspects of compulsive sexual activity such as cybersex and pornography. The problem with online porn is that it is easily accessible and highly conspicuous.

It is similar to any other compulsive behaviour.

Similar to other substance or process addictions, compulsive sexual behaviour creates significant psychological distress and leads to impairment in important areas of life such as work, relationships, social, financial and personal care. 

Clients who present for treatment often do so because their lives are in chaos. They are usually suffering in similar ways to an alcoholic or gambling addict who seeks treatment after a ‘rock bottom’.   

There is treatment for Compulsive Sexual Behaviour.

Some people who have compulsive sexual behaviour think that it is a life sentence. That’s untrue. 

A multi-faceted approach to treatment can help. 

This includes understanding the history of the issue and its origins. 

For many people (not all) who present with compulsive sexual behaviour, there has been a history of childhood trauma, including for example, physical, psychological, religious or sexual abuse. 

These issues need to be addressed, along with co-occurring addictions such as substance abuse, depression and anxiety. They are often highly correlated with compulsive sexual behaviour.

When compulsive sexual behaviour is used in a maladaptive way as a self-soothing technique, an aspect of treatment is to teach healthy emotional regulation skills. For many individuals, masturbation or porn may have been used to help them deal with stressful emotions or experiences. 

In the absence of healthy emotional regulation skills, or in ongoing stressful environments, these behaviours may offer ‘relief’. However, if these behaviours become uncontrollable and continue to be used to replace healthy emotional expression, they can lead to significant psychological distress and other issues in a person’s life. 

Jane O’Keeffe is psychologist and consultant at South Pacific Private. She holds a Bachelor of Science (Psychology) (Hons) from the University of NSW.

Feature Image: Getty.

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