As addicts recover from addiction they gain emotional skills they never had before.

Dimensions of Emotional maturity

1. The ability to modulate emotional responses.  Addicts tend to have an all or nothing emotional response.  When they respond they become overly emotional and take a longer time to return to baseline.  They are easily flooded with emotion to the point of impairing functioning.

1. The ability to tolerate frustration.  Another emotional skill learned as we grow up is the ability to tolerate a frustrating situation with a level of self control.  Addicts tend to respond to frustrating situations as disasters rather than having any perspective.

1. The ability to delay gratification.  Emotionally immature people have trouble planning and working toward goals.  The ability to give up immediate gratification is necessary for anyone to go about life in a successful way.

1. The ability to control impulses.  The mature self has the ability to see that feeling the urge to do something is not the same as doing it.  The recovering addict has a level of control over his or her behavior and can put boundaries around what is inappropriate to say or do.  This is the basis for making logical choices like whether to act on impulses or not to.

1. The ability to be reliable and accountable.  Addicts are often self centered and not good at dealing with the everyday requirements of life like being on time, fulfilling obligations and telling the truth.  As they gain emotional maturity they gain the ability to get out of themselves and think about the impact of their actions on others and on their own lives as well.

Recovery skills promote emotional maturity

The process of recovery from addictions is in many ways a process of completing the process growing up.  The work that goes on in addiction treatment involves changes that allow for that process to occur.

Looking at the addict’s core beliefs.  The addicts assumptions about himself, acquired in childhood are largely negative.  Addicts feel they are basically unworthy and unlovable.  They lack trust and don’t feel that others will be willing or able to help them.  Looking at these negative core beliefs about oneself is a first step toward being able to question them.  Addicts in recovery begin by getting honest about what they are doing and feeling.  It allows the addict to contemplate the idea of change.

Connection.  In recovery addicts are helped to see that they are not so alone or so different and that there are other people to connect with.  This in turn allows for learning the emotional skills of accountability and honesty.  They come to realize that what they do matters and has real life implications for themselves and for the people in their life.

Self reflective ability. The recovery process involves learning to stop and reflect on what is going on inside of oneself in any situation.  This is amazingly absent in most practicing addicts.  Impulse control and emotional regulation are impossible if the person lacks the ability to observe their inner state.  It is only through developing this “observing ego” that the recovering addict can have the means to look at things more realistically, self-regulate emotional responses without resorting to drugs.

Tolerating feelings.  In giving up their drug of choice, addicts begin to feel all the feelings they have been running from.  Abstaining from an addictive behavior means being forced to deal with emotions like insecurity, self-hate, and loneliness.   In this way the addict begins to have the means to see and label their own emotions and connect with painful memories that they may have buried. You can’t deal with a problem if you can’t allow yourself to feel it.

Feelings are only feelings.  When we gain emotional maturity we accept our feelings but we are able to deal with them effectively.  We have choices.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

If you ask someone to describe their most compelling sexual fantasies, especially a sex addict, you will find that there is a central core, a rather specific set pattern as to where their imagination takes them.

Addictive fantasies are laid down early in development

For many people and for most sex addicts a specific thing, activity or imagined scenario becomes connected to sexual arousal.  For sex addicts this can be a rather specific scenario that is played out in the sexual acting out behavior, in pornographic imagery or in masturbatory fantasies.

Intense early experiences  can become “sexualized,” meaning they can come to be associated with sexual excitation.  Often these are experiences of frightening events or scenarios as fear (and other strong emotions) seem to be connected to sexual arousal in most humans.

Early experience can be particularly intense when it is part of how we relate to a caregiver.   Often  it involves the things we needed to do in order get love and/or avoid abandonment.  If allowing ourselves to be threatened or punished in some way was necessary to maintain a bond with a caregiver then being threatened or punished can take on a sexual meaning as we develop sexually.  Whether sexuality is connected to abusing someone or to being ourselves abused, the scenario is the same.  We are just playing different roles in it.

This then forms what sex addiction professionals call an “arousal template.”  Arousal templates are surprisingly persistent since they usually represent a kind of conditioned response.  But sex addicts can “escalate” in their addictive behavior not only in terms of greater frequency of acting out and greater risk taking, but also in the extremity of the sexual scenarios themselves.  A sex addict who seeks out people to dominate or be dominated by can over time seek out ways of relating that are more exploitive or harmful.

Sexual fantasies may exist to solve a problem

Some sexual fantasies can be deciphered in terms of how they function to overcome sexual inhibition.  Sometimes fantasies or sexual rituals of being overpowered or dominated my serve the function of overcoming learned prohibitions surrounding sexual arousal.  In this case the person is creating the feeling that they are not responsible for their sexual response and are therefore free of guilt and inhibitions that would otherwise keep them from responding.

Sometimes sexual fantasies are attached to feelings of powerlessness and frustration.  In these cases the sexual scenario can be a way to express anger and resentment.  The boy with a seductive mother may grow up with feelings of shame and rage associated with his sexuality and his sexual arousal template may involve ways to express that rage.

Straight men who act out sexually with other men are often puzzling until you realize that the man may actually be straight but may have had early experiences that established a sexual response to males, and which he keeps feeling the urge to repeat, even though he has no interest in relating to gay men.

The origin of sexual fantasies may be buried

Why is it so hard to decipher the specific fantasy content?  Sometimes it is obvious as when the person’s addictive behavior has to do with voyeurism and their childhood experience was one involving being allowed to covertly observe sexual activity in some way.

Other times the early formative experiences are forgotten or were never seen for what they were.  Sometimes powerful experiences took place prior to the child learning to talk, in which case there is no way they can be remembered in words.  Being violated early in life may not be remembered in words but may be experienced as a specific sexual fantasy in adulthood.  The physical feeling of sexual arousal and other intense feelings may be connected on a level of “body memory” to an experience that cannot be verbalized.

Food for thought

Obviously there are a great many different kinds of addictive sexual fantasies and it would take a whole book to catalogue even the major themes and to describe the possible precursors.  Those who engage in the academic study of pornography are in a positions to look at the larger social context of sexual fantasies, and those of us who work with the individual psyche are positioned to decode their personal, individual meanings.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Self-esteem

Self-esteem is probably my all-time biggest pet peeve.   There is such a thing as low self esteem, or poor self concept.  And so it seems logical that we would strive for “high” self esteem as a solution to the problem.  But the problem is not simply one of changing our assessment of our own worth from “low” to “high.”

First of all the problem of low self worth is tied into the process of judging oneself.  Whether we judge ourselves to be inadequate or marvelous we are engaged in evaluating how we measure up, usually compared to someone else. So instead of being able to feel confident and unselfconscious, we are looking at ourselves (usually from the outside, as someone else would look at us) and making an assessment.

Regardless of what the verdict is, the process is one that is built on insecurity and that takes us away from functioning freely in the moment.  Rather than placing the emphasis on whether we admire or despise ourselves, I like to talk about things like “self-efficacy” and “self-activation.”  These are the strengths that allow us to stick up for ourselves, pursue our goals, and not be hamstrung by worrying about how we are doing or what others think of us.

Anger management

Anger management is another misleading concept.  It sounds good—so good an entire industry was built on it which promises to remedy dangerous and destructive behavior patterns.  I am referring of course to the “traffic school” programs for people with aggressive acting out problems like hockey dads and spouse abusers.

The misleading part is that, as it is commonly used, the idea of anger management suggests that we can learn how to “handle” our anger.  This may be true in some ways but it can lead us to ignore what most people now believe: that anger is never the primary emotion.  Anger is itself a way to manage another emotion, such as pain, fear, shame, etc.

When someone experiences undue anger, we should be working with the whole person including their underlying wounds and insecurities, rather than with just this one type of overt expression or action.  If we try to “manage” it we forfeit a chance to look at it as a symptom of something and use it in a way that will help the person grow.

I prefer to approach anger by working through the reactivity that comes from early trauma as well as the more behavioral techniques of assertiveness training and learning healthy communication skills.

Child abuse

Child abuse is a serious concept.  It is only misleading because it is popularly used in a narrow way to mean physical, sexual or verbal/emotional harm inflicted on a child.

Many of my clients cannot understand why they have sex addiction or other problems when they can’t identify any kind of abuse in their childhood history.  In other words they can only see childhood trauma and abuse in terms of these very overt and extremely visible kinds of harm.

In fact we now have a much broader understanding of the concepts of child abuse and childhood trauma.  In current thinking, a relationship with a caregiver can be seen as abusive when that caregiver is emotionally unavailable or unresponsive, is not able to be appropriately nurturing, supportive and validating, or induces abandonment fear or other severe stress.  All these things can traumatize a child and lead to serious problems in the child’s learning normative developmental competencies including distress tolerance, behavioral control, self protection, learning, attention and empathy.

Words matter

We all get lazy in our use of words and reach for the word that comes most easily to mind, myself included.  But as our understanding of psychological phenomena changes I think it is important to occasionally go back and look at how we use concepts and whether they are continuing to serve a useful function or are due for an overhaul.

Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Objectification

Objectification means looking at someone as a commodity, an object of either pleasure or utility.

It includes not seeing the person’s inner feelings, fears, needs or basic humanity.  This means not seeing the person as having a subjective self that is separate from your own.

This is not to say that the mere noticing of a person’s looks is objectification.  We see how someone looks first, before we know much else about them.  But objectification concerns a systematic bias.

We usually talk about the objectification of women in terms of their being viewed as bodies; bodies that are either appealing (or “hot” or sexy) or not, with little or no regard for the person in the body.  Objectification is usually self serving and sometimes exploitive; and it implies a failure of empathy.

Men can be physically objectified too and can be viewed as hunks, beefcake, eye candy and babes or the opposite.  And women (and men) do sometimes view men this way.  But men are most often objectified, seen as objects of utility, in terms of their power, success and money.

Dimensions of male objectification

With greater or lesser amounts of success, power and money men are attractive to women or potential partners to a greater or lesser extent.  Sure being accomplished or being good at something are appealing traits.  But men are perceived in different ways based solely on power and money. As my friend Debra Kaplan would say “The richer you are, the more attractive you become.” (See Debra’s soon-to-be published book about money and sexuality.)

I suppose some would argue that women are of necessity looking for “good providers” and men are looking for good child-bearing prospects.  But regardless of the origins there are certain results which may not be so desirable today.

• Women can be drawn to rich men partly because of the way it enhances their own status.  This is an exact parallel of the way that a beautiful woman enhances the perceived status of the man she is with.  This is a self-serving reason to be seen with someone and has nothing necessarily to do with the actual relationship.  In buying into this men and women are essentially agreeing to let themselves be used.

• Men can fall victim to “self-objectification” in the same way that women do.  This happens when people view themselves as though they were looking at themselves from outside.   It means evaluating yourself in terms of how you think others might see you and losing sight of your real sense of self.  For women it is viewing oneself as if through the eyes of a man who is looking at them as an object of sexual pleasure.  To place your self worth in someone else’s hands is always ultimately to devalue yourself.

• Men become even more highly competitive with one another and feel one up or one down based on how they measure up money-wise.  This puts distance between men and makes them feel bad in the same way that women feel threatened by someone who looks better than them.

• Men are at risk to get carried away with the business of power and money in the same way that women can get carried away with being skinny or having plastic surgery.  Men can become workaholics.  They can get wrapped up in risky activities, or low-probability high-payoff situations.  They can allow themselves to behave in immoral or sociopathic ways if this is somehow “normalized” in the effort to get ahead.

• Money can become sexualized for men and for women as well.  One form of sexual addiction involves being aroused by the mere act of exchanging money for sex and less aroused when sex is consensual.  This is the sex addict whose sexual compulsion involves unequal power, exploitation, buying someone and sometimes “rescuing” someone.

It is worthwhile to remind ourselves of the need to fight these trends toward mutual commoditization  in our culture.  We women need to be able to see the inherently worthwhile things in men and resist the tendency to hold men to unrealistic standards.

The harm reduction approach to addiction treatment is conceived as an alternative to total abstinence from the substance or behavior and involves techniques to reduce the risks that go along with addiction.

The early harm reduction techniques originated in 1972 in the Netherlands as an approach to drug addiction.  Early harm reduction, later called “normalization”  involved things like needle exchanges and methadone maintenance for drug addicts.  Recently the term has been used to describe system of care services that are interdisciplinary, empowering, and involving the family and community.

In sex addiction, harm reduction might include charting techniques such as having the addict track the amount of time he or she spends masturbating, risk reducing strategies like getting addicts who visit prostitutes to use condoms and other plans for risk reduction like refraining from using internet porn on work computers.   These would be intended both to raise awareness and to contain the behavior in ways that make it less damaging.

These techniques involve working with the addict toward agreed upon goals that do not involve entirely giving up the addictive sexual behavior.

Can the harm reduction model  work for sex addicts?

The harm reduction model does not necessarily address why you engage in sexually compulsive behavior, but only how you do it.  It does not attempt to get at the root causes of addiction which we now know involve early attachment problems and neurodevelopmental factors.

Current thinking among sex addiction therapists is that addicts will be very prone to relapse if they have not worked through their early childhood trauma issues.  Without this, the thinking goes, the addict will stay stuck in patterns involving poor coping skills, inadequate emotion regulation, low self-concept and intimacy avoidance.  These “survival skills that no longer serve,” as they are called, will in turn lead inevitably to a return to dependence on addictive substances and behaviors.

Harm reduction by definition does not require the addict to go through withdrawal from an addictive behavior.  This in turn means that the addict is continuing to use the behavior as a drug.  As such the sexually addictive behavior keeps in place all the self delusion, denial and secrecy that characterize the sex addict’s functioning.

When addicts in early recovery abstain from all sex it appears to allow their heads to clear, the so-called “neural reset.”  This in turn opens up the possibility of thinking more realistically, exploring the underlying psychodynamics and becoming committed to a different kind of life.  A life without being stoned all the time.

Given that sex and porn addiction are progressive and the behavior tends to escalate over time, addicts who continue to engage in addictive behavior, even under harm reducing parameters, can be expected to follow the typical course of acting out more frequently and in more extreme ways over time.  The very risks that harm reduction attempts to curtail may be the very thing the addict begins to crave more as time goes on.

The harm reduction model is already part of sex addiction treatment

Many of the basic ideas of harm reduction are already present in treatment and 12-step program work for sex addicts.  Outside of an initial period of abstinence, these programs are never geared toward a life devoid of all sex.

The addict with the help of a sponsor or counselor lays out the behaviors that characterize his compulsive sexual acting out.  These are the ones he agrees he needs to abstain from entirely and for good.  This might include internet pornography or any other addictive sexual behavior but might not include abstinence from sex with a partner or masturbation once recovery is established.

12-step sex addiction recovery involves a great deal of learning and awareness about the harm of the addiction.  Step 1 in the 12- steps involves looking at how the addiction has made the addict’s life unmanageable.  The later steps continue the process of looking at the harmful consequences and repairing the damage.

Even with regard to the forbidden “inner circle” or “bottom line” addictive behaviors there is room in sex addiction recovery for a modification of these definitions.  Recovering sex and porn addicts often move behaviors into or out of the forbidden zone as things change.  If certain behaviors are not problematic in the long run then they can be allowed back in and enjoyed in moderation.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

The common history of childhood trauma or attachment issues leaves most addicts with the core beliefs that they are unworthy, that no one will want to be there for them and that no one will ever like the real them.

And so addicts learn early to reach for a drug to meet their needs.

These negative beliefs lead to psychological problems in the area of self expression, self assertion and being available to connect with other people.  Many addicts develop a narcissistic defense which they present to the world to cover their insecurities.

They feel that the genuine “me” is inadequate or, as Jonathan Young of the Joseph Campbell Archive says, “Shame does not speak up.”

Strategies for being out in the world in an authentic way

• Take a closer look at where your fears come from
  

When I first started doing expert testimony as a forensic psychologist I was always petrified of being cross-examined by an opposing attorney.  I would freeze up.

At some point I realized that as a child my father had always been very verbally challenging and critical about anything I said and that I had become very fearful of being shot down.  I was then able to literally look at the attorney and say to myself: “This guy is not my father!”  I was able to challenge my belief about my own credibility.

• Let go of outcomes.

This is a basic recovery skill, namely that of doing your best and then letting go of the result.  When I first started blogging I thought I always had to please everybody (again a byproduct of my own childhood).  When someone blasted me in a comment I didn’t know what to do.  I thought I had to change somehow.

A friend helped allay my panic by reminding me that comments are just conversation and that people have a right to their own opinion.  Let other people be them.  Children who have been mistreated will often refuse to play a make believe game without controlling every aspect of it, even when they have reached an age when they should be capable of letting others in.

• Don’t plan ahead so much

Planning everything ahead of time takes you away from the reality of the situation.  This kind of perfectionism makes everything you do seem stilted.  When children receive less than optimal parenting, they can feel that if they do something wrong it’s going to be a disaster.  They experienced love that was conditional on their fulfilling the expectations or needs of their caregivers.  In the real world people won’t be interested in you or love you because you are perfect all the time.

If you go to a lot of 12-step meetings you get to practice this skill when you “share” i.e. talk in meetings.  You can sit there while other people are talking and plan your own perfectly polished share or you can listen to others and then speak from the heart, without a plan.

• Find ways to practice, practice, practice
  

It has been said that to overcome a fear you should do the thing you fear over and over again.  After being in recovery for a while I realized that I needed to learn to be more spontaneous and confident.

So I took an improve class.  It was amazing because in improvisation there is zero time to plan anything you say or do.  It has to come straight out of you, a part of you that you don’t normally access.

Any way that you can practice being “out there” in an unscripted way will help de-condition the fear.  Drawing or painting are great, singing or acting work the same way.  And when you do these things with other people you increase the effectiveness.

Ultimately getting out of your own way is a byproduct of recovery, and an act of faith.  It is accepting that you can be known and appreciated not for any outward attributes or achievements but for what is essential in you.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

If you are a clinician working with sex addicts you may be struck by how often the addict is desperate to save their marriage or relationship.  Sometimes to the point of being so obsessed with holding onto their relationship that it interferes with their focusing on treatment.

It may not be immediately obvious why this is so.  Addicts appear to be focused mainly on themselves. Typically they:

-are sexually compulsive outside of the relationship

-are intimacy avoidant

-use coping skills which create distance

-lead a double life

We typically think of the spouse or partner of the addict on the other hand as the codependent:

-fearful of abandonment

-enmeshed and preoccupied with their partner

-emotionally constricted or volatile

-subject to self-doubt and insecurity.   

And yet most married sex addicts entering treatment (more often they are men but by no means always) exhibit exactly these signs of codependency. They may exhibit them more than their supposedly “co-addict” partners.

Origins of codependence

People who exhibit codependence have typically had some kind of stress or inadequacy in their relationship with their care-givers early in life.  This is sometimes referred to as “relational trauma.”  This early relational trauma causes the child to grow up with mistrust of those close to him and to be insecure and avoidant regarding relationships and sometimes regarding the world in general.

Instead of growing up with a strong internalized sense of self, the codependent survives childhood by using one or another “strategy” by which to adapt to a less than nurturing situation.  These strategies, like numbing out, distracting oneself, suppressing feelings, being over compliant, etc. take different forms depending on the kind of relational stress and the nature of the relationship with the parents. 

But bottom line, the development of the sense of self is impaired in an attempt to get the caregiver’s approval or love.  The codependent’s core belief is “my worth as a person depends on my value to someone else.”

In what way are sex addicts codependent?

Although sex addicts may have a façade, a “narcissistic false self” as it is sometimes called, they have typically grown up with some serious disruptions in their intimate relationships with caregivers.  This can take the form of abuse, but not always.   Often the parents of addicts are distant, repressed, rigid or disengaged. 

Patrick Carnes has pointed out that relational trauma is “a powerful factor in the genesis of addictions and compulsions.”  In Carnes’ theory the addict shares the same fears, mistrust and basic sense of unworthiness as a codependent.  The lack of a strong sense of self and of self worth underlies the intimacy avoidance of addicts and the tendency to medicate their fears with sex and to split their sex life off from their normal life.

The belief that they are unworthy and that they are only lovable to the extent that they can please someone else, can lead to the addict’s extreme fear of abandonment and rejection by the very partner that they have betrayed.

A passage in the Co-Dependents Anonymous “Big Book” states this point clearly:

“Since the very nature of existence is relationships, and I had a disease that precluded my ability to maintain healthy relationships, I began to see that I was pretty well screwed.

I think of the disease of codependence as a tree. 

The roots of the tree are my childhood abuse and neglect.  The branches are my acting-out behaviors I developed to cope with life.  Both the roots and the branches have to be healed (my italics). 

I cannot stop the acting-out without healing the damage that spawned the behavior, and likewise, I cannot work on the roots if I’m still medicating myself with my addictions.”

Understanding and working through these underlying early childhood issues will dismantle the unconsciously held core beliefs and allow for the emergence of a real self and real intimacy with another.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

A week ago the National Institute of Mental Health (NIMH) published its intention to work towards and devote research funding to a new system for mental health diagnoses as an alternative to the Diagnostic and Statistical Manual (DSM) published by the American Psychiatric Association.  The various incarnations of the DSM have been dubbed the “gold standard” of diagnostic criteria for mental disorders and have provided a common framework for practitioners, researchers and insurers to relate to. 

The trouble is that the DSM has never been any good as a basis for understanding and treating mental disorders because it is built, as the NIMH announcement says, out of collections of symptoms rather than identifiable or understandable disorders.

The NIMH will be doing what has needed to be done for decades: to create a new set of diagnoses of mental disorders based on something real.  In this way the new approach to diagnosing psychopathology will cut across previous descriptive domains and tie a diagnosis to growing knowledge of neurobiological, genetic and developmental processes.

I have been frustrated for many years by the DSM diagnoses’ evident lack of any connection to any underlying process or known etiologies (origins) of mental disorders.  Much to my embarrassment, I have found myself while working for community mental health, diagnosing a youngster as having an “Oppositional Defiant Disorder” (113.81 in the DSM-4).  Knowing a little about psychology, I was aware that oppositional behavior in kids is often related to the child’s experience of parental rejection.  But in the DSM world (i.e. the world of billing and reimbursement) I could not treat the family system.  I had to attempt to treat an emotionally dysregulated child as though he had some mysterious disease coming from who knows where.

The DSM and Sex Addiction

In the recent effort to find a way to include what we understand to be sex addiction in the DSM 5, the group attempting to satisfy the DSM evaluators proposed the term “hypersexual disorder” and specified basically the practical diagnostic criteria that have emerged over the last three decades of researching and and treating sexual addiction.  The effort involved testing the characteristics of people actually undergoing treatment for sex addiction against the proposed criteria. 

Reading the resulting diagnostic description one is struck by how closely they seem to mimic the terminology of the DSM while attempting to carve out a category not already included in another diagnosis.  This is pretty fruitless.  It suffers from all the deficiencies of the rest of the DSM including the fact that it is not tied to any underlying process or any scientific way of understanding such an addiction.  However, for no logical reason, the DSM folks chose not to include hypersexual disorder in the DSM 5.

Perhaps it is for the best that we are not tethered to the term “hypersexual disorder” because the term is problematic.  Hypersexual behavior is not really a disorder and is a symptom of many, many other existing DSM disorders.  Furthermore, what we think of as “hypersexuality” in common language is not necessarily present in those who have compulsive sexual behaviors.

We need a new way of talking about addictive disorders

Researchers are in the beginning stages of identifying the neuropsychological, genetic and developmental factors that underlie all addictions, sex addiction included.  They are even beginning to address the issue of which type of childhood attachment trauma leads to which kinds of addictions based on the individual’s developmental trajectory. 

It has been clear for a while now that although we treat addictions, we are really treating an underlying problem that has its roots in childhood trauma that has affected brain development and brain chemistry and in which the addictions are only part of the overall picture. 

In a new diagnostic schema that actually makes sense, addictions including addictions like sex, food and gambling, might end up as subtypes of a larger category such as disorders of the self (now called personality disorders) or dissociative disorder, or some new concept which contains the idea of childhood attachment trauma as the root cause, neurodevelopmental abnormalities impairing the formation of  normal self-monitoring functions as the intermediary, and addictions as the end result.

This new schema may be a long time coming, but I am greatly relieved that it is now on the table.  I think it offers hope for a rational approach to the treatment of all of what we now think of as addictive disorders.  In the existing DSM the effort to find a logical place for them is doomed.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Many people, both men and women, cheat on the person they are in a relationship with; at least 20-30% admit it depending on which data you are looking at and how the research questions are phrased.  Some people cheat very rarely and others cheat a lot.

Some people cheat repeatedly but do not meet the criteria for sex addiction. 

Others who cheat repeatedly use cheating as a sexually addictive behavior and can definitely benefit from being given appropriate treatment. 

So how do you tell the two apart? 

The generally accepted clinical criteria have to do with things like being preoccupied with and unable to resist the urges to do certain behaviors, escalation of the behavior over time, inability to stop despite negative consequences, and distress if prevented from engaging in the behavior.  But many of these criteria would be hard for a spouse or partner of a cheater to see.

General differences

For sex addicts cheating, or having “serial affairs,” is part of a larger pattern of using sex as a drug.  The  majority of sex addicts who cheat usually have some other form of sexual behavior in addition to affairs, such as porn, internet sex, phone sex, flirting, sexual hook-ups, and so on.  And in general they tend to view the world through sex colored glasses, sometimes without realizing it.

Serial cheaters on the other hand may or may not engage in other kinds of sexual behavior and their cheating tends instead to be part of a larger pattern of behavior that is impulsive, self-indulgent, irresponsible or amoral.  Sex is not used as a drug but is one of many forms of manipulation and opportunistic self-gratification. 

Now I can hear some people saying “yes, but sex addicts are self-serving and amoral too.”  It is true that both cheaters and sex addicts can be masters of deception but I believe that there are differences. 

Some signs that your cheater may be a sex addict

• Although sex addicts have a long standing pattern of using sex as a way to cope with feelings and with life generally, they also typically experience their sexually addictive behavior as in some way “ego-dystonic,” meaning that the addict does not really want to see himself as a cheater.  In other words for the sex addict, the behavior doesn’t fit his self-concept.   He rationalizes it and lies about it to himself as much as to others.

• Addicts who cheat very frequently have other addictions besides sex.  Dr. Patrick Carnes found that the overwhelming majority of sex addicts had at least one other addictive behavior such as drugs, alcohol, nicotine, work, etc.  Scientific evidence is beginning to show that there are neurophysiological and even genetic bases to addiction and that all addictions are similar on some level.  So the sex addict cheater will likely show signs of addictiveness to other things.

• Sex addicts typically have a core belief that sex is their most important need.  One way this will be observable is that the sex addict will find it hard to completely hide his or her preoccupation with sex.  He or she will often tell sexual jokes more readily than people normally do, make sexual references in social conversation when it may not be entirely appropriate and talk privately about the sexual attributes of people to an unusual degree. 

• Sex addicts who want to hook up or cheat as one of their sexually addictive behaviors will almost certainly sexually “objectify” the people they meet.  This means that they will be sizing everyone up as a sex object or potential sexual partner.  This will be most visible in the form of staring and fixating visually as well as flirting in a predatory way.  It may be even subtler, taking the form of “intriguing” in which the addict tries to connect in subtle ways like eye contact and innuendo.

Sometimes a cheater is just a cheater

Repetitive cheaters who do not have a sexual addiction may decide that it is a good idea to quit cheating, but their quitting is determined by self interest rather than by treatment or basic change.  Some cheaters may just “mature out” of the behavior.   Cheaters who are not addicts probably cheat in a lot of areas of their lives.  They may be secretive but only because it would be very inconvenient if their partner knew the truth. 

Cheaters are not obsessed with sex and they are certainly not riddled with self doubt and shame.  They are not acting against their value system because they genuinely feel that what they are doing is justified.  They do not wish they could stop; rather their motto is “if you can get away with it, do it.”

The number of Hollywood porn films produced have exceeded that of mainstream movies, with the 2006 porn industry revenue of $13.3 billion making porn bigger than the NFL, NBA, and Major League Baseball combined.

The sex and porn industries employ a large number of women and there is a recent explosion in the number of women in the webcam pornography sphere.

How are the women in the online porn industry faring?

I came across some interesting data through an organization operated by former porn and sex industry workers.  They report on the results of “a cross sectional study based on the California Women’s Health Survey” which compared the mental health of female adult performers with that of other young women in California.

As children:

37% women in porn had been child victims of forced sex compared to 13% of women not in porn

21% had been placed in foster care compared to 4% of women not in porn

As adults:

33% of women in porn met the criteria for depression vs. 13% of women not in porn

34% of women in porn experienced domestic violence in the past 12 months vs. 6% of women not in porn

27% of women in porn experienced forced sex as adults compared to 9% of women not in porn

50% of women in porn lived in poverty in the past 12 months vs. 36% of women not in porn.

On the other hand…

An article called “Female Porn Stars Have High Self-Esteem, Study Says” describes a study in which the self-reports of 177 porn actresses suggested high levels of self-esteem, positive feelings, social support, sexual satisfaction and spirituality.  But at the same time the study found that porn actresses had sex at an early age, had more sexual partners and were more concerned about contracting STDs.

Others have claimed that porn can be empowering for female performers and that for some it offers a chance to escape poverty and go on to college.

The sex industry generally

Jennie Ketcham, a blogger for Huffington Post has been quoted as saying that being a porn star is traumatic and that she experienced symptoms similar to those of post-traumatic stress disorder after leaving the industry.

This is not a big revelation.  In studies of women in various aspects of the sex industry, including prostitution, have been found to have a an incidence of PTSD that is about on a par with combat war veterans.

Women in various aspects of the sex industry have been found to have higher rates than the general population of

Drug addictions

Sexually transmitted diseases

Violent assaults, and

Mental health problems

Also 73% of women in prostitution have been raped more than five times (U.N. Office on Drugs and Crime) and 89% of women in the sex industry reported that they wanted to escape but had no other means for survival. (www.protitutionresearch.com).

Webcam porn sites

Forbes.com interview with the author of A Billion Wicked Thoughts: reports that

“The single most popular adult [porn] site in the world is LiveJasmin.com, a webcam site which gets around 32 million visitors a month, or almost 2.5% of all Internet users.”

And

“…what men prefer the most is watching women strip on a webcam and being able to talk to them while they do, telling the women what they want to see. Once this became available (through high-quality broadband streaming of webcam video) it just shot to the top of popularity; it’s even more popular than the tube sites like PornHub and RedTube.”

The Forbes article reports that almost all the performers in webcam porn are from eastern Europe and southeast Asia.

“At $8-$15/hour with no benefits, it doesn’t pay enough for American women… except teenage girls and college students.”

I have not found any studies yet on the mental or physical fallout from performing in webcam porn.   Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource