Diagnostic Criteria of Sex Addicts - Case Study Example

Sex Addicts Sex addicts are people who engage in compulsive sexual encounters with multiple partners with whom they are not emotionally engaged. While they may enjoy the sex as it is taking place, afterwards, they feel terrible about themselves. As with any addiction, they are usually using it to avoid dealing with other psychological problems. Often, they experience sensations of emotional emptiness when they are not indulging in their addiction. Then, to escape the emotional pain, they repeat the cycle. A sexual addict’s life begins to revolve around sex. Although sexual dysfunction (problems that interfere with the ability to have sex) are often seen as a greater psychological problem, sexual addiction is a dangerous disease that can destroy the lives of individuals, their families, and their friends. Fortunately, like all addictions, help is available. Nobody has to live their life suffering the pain and shame of a sexual addiction. Diagnostic criteria Sexual addiction may comprise a wide range of compulsive sexual behaviors. In some cases, it can be filed under paraphilia, if the addiction involves “recurrent, intense sexually arousing fantasies, sexual urges, or behaviors generally involving 1) nonhuman objects, 2) the suffering or humiliation of oneself or one’s partner, or 3) children or other nonconsenting persons” (DSM-IV, 2000, p. 566). Statistically speaking, “paraphilias are considered rare, affecting only a small percentage of the US population. Researchers have a difficult time trying to determine a specific percentage of involved individuals because many of the acts are illegal and reporting methods typically are unreliable” (Bellnir, 2005, p. 328). This is the case for any kind of sexual disorder, because the stigma involved with sexual problems prevents many people from discussing their problems or seeking help. Usually when we talk of sexual addiction, we are referring to behaviors that involve compulsive sexual acts, most likely with a variety of partners, particularly when the sexual behavior has the nature of upsetting the person engaging in it, or otherwise negatively affective his or her life (even if they cannot admit the problem). The DSM-IV categorizes sexual addiction with other miscellany at 302.9 Sexual Disorder Not Otherwise Specified. Squeezed between feelings of sexual inadequacy and unhappiness with ones sexual orientation, it is succinctly described as “Distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used” (DSM-IV, 2000, p. 582). So, for a psychological diagnosis, it seems the patient must admit to having a problem. Some questions that people wondering if their sexual behaviors are a problem are as follows: Do you stay in unsatisfying, humiliating, or unhealthy relationships only so you can continue to have sex with someone? Do you fantasize about sex, masturbate, or use sex in any way in order to escape, deny, or numb your feelings? Do you believe that your sexual thoughts and behaviors cause problems? Does illicit sexual behavior hurt your ability to form an intimate relationship with a loving partner? (Silverman, 2001, 34) The DSM-IV reminds us that “notions of deviance, standards of sexual performance, and concepts of appropriate gender roles can vary from culture to culture” (DSM-IV, 2000, p. 535). Behaviors that might not be problematic for an undergraduate in a fraternity might be considered pathological in a married man. Also, due to the double standard in our culture, women are more likely to experience distress over compulsive sexual behaviors. Men, even if they are unhappy with their behavior, might find they are socially rewarded for their proclivities. The key element in the diagnosis is the patient’s sense of powerlessness. The sexual addict is controlled by the desire to have sex and cannot act in his or her own best self-interest because the compulsion to have sex takes over their lives and becomes more important than anything else. Without treatment, sexual addiction tends to get worse and worse, following the pattern of any addiction. Sexual Addiction in Survivors of Childhood Sexual Abuse Many sex addicts are victims of childhood sexual abuse. As one survivor wrote, “I confuse sex with love, compulsively repeated this destructive pattern with one man after another. I do this because as a girl I learned that sex is love from my father, the first dangerous man who sexually misloved me” (Silverman, 2001, p. 17). Childhood sexual abuse teaches children that sex is equated with love (especially if the abuse was perpetrated by a close and otherwise loving family member), and victims often choose to self-medicate feelings of pain, shame, loneliness, or other forms of unhappiness, with the temporary ecstasy of sex. According to a popular manual for survivors, “it makes sense that survivors who received all their attention and affection sexually as children now sexualize even nonsexual needs” (Bass & Davis, 1994, p. 269). The nonsexual needs which sex addicts are often trying to meet through their behaviors include a desire for “closeness, intimacy, or communication, when you want to feel you are loved and worthwhile and cared for, when you’re unhappy, disappointed, or angry” (Bass & Davis, 1994, p. 269). Of course, loveless sexual encounters, although they may temporarily creates the sensation of satisfying these needs, do not really constitute intimacy. In fact, they may prevent intimacy, particularly if the addict is neglecting a committed partner. The sexual experience for sex addicts is analogous to the high of a drug abuser. For a brief time, during the act, the intensity of sexual contact overwhelms the pain. Afterwards, the addict crashes, feels terrible about him or herself, disgusted about his or her actions, and then repeats the cycle, having loveless and psychologically damaging sexual encounters to forget, temporarily, the pain. “Only when my body is desired do I feel beautiful, powerful, loved. Except I don’t feel powerful, loved, or whole now. I feel shy, embarrassed, exhausted. Less. Yes, as if I am less than a body” (Silverman, 2001, p. 17). However, during the sex act, addicts can avoid facing these feelings, just as drug abusers forget their problems while they are high. Cybersex Anyone with access to the Internet has access to a wide range of sexual materials. Web sites catering to every fantasy imaginable, and some that many people would never imagine, exist in profusion. In one sense, this can be a positive thing. Information is readily available. People learn that they are not alone in their feelings. It is possible to express unpopular or illegal sexual urges in ways that does not victimize anybody. However, the ready access has a down side. When computer porn and cybersex take the place of physical interaction or take over ones life, we see evidence of a destructive sexual addiction. Of course, the Internet offers every kind of pornography imaginable, in audio, video, or text format. But it doesn’t end there. Addicts can carry on on-line affairs via texting or video conferencing, with a consensual partner somewhere in cyberspace, paid or otherwise. And multi-media software brings games and movies to the home computer. All this can be viewed in the privacy of ones own home, or at work, and often no one else is the wiser. Screen names allow the addict’s behavior to become completely anonymous, so there are no repercussions as long as the behaviors are hidden in real life. Sexually compulsive users find “the power of isolation, fantasy, anonymity, and affordability interacts with certain underlying personality factors to increase their use of the Internet for sexual activities to the point where it becomes difficult, if not impossible, for them to control it” (Carnes, Delmonico & Griffin, 2001, p. 15). Some clues that may be used to determine whether Internet sex is a dangerous addiction include agreeing with any of the following statements: I have spent more money for online sexual material than I planned. Internet sex has sometimes interfered with certain aspects of my life. No one knows I use my computer for sexual purposes. I have tried to hide what is on my computer or monitor so others cannot see it. When I am unable to access sexual information online, I feel anxious, angry, or disappointed. (Carnes, et al., 2001, p. 27) One study found that “nearly 17 percent of Internet users have problem with sex on the Net….severe problems with sex on the Net exists for 1 percent of Internet users—and 40 percent of these extreme cases are women” (Carnes, et al., 2001, p. 6). In 1999, it was estimated that “8.9 million people in the United States…need intervention for the sexually compulsive use of cybersex” (Carnes, et al., 2001, p. 16). As with any sexual addiction, the individual needs help when the addiction takes over their life. If thoughts of cybersex are invasive, if the addict cannot limit or cut off his or her exposure to Internet sex, if use affects real life relationships, then it is a problem that needs to be treated. Outpatient Treatment There are three steps necessary to end the cycle of any kind of addiction. First, the addict must cease participating in their addiction. For sex addicts, this means stopping all sexual behavior for a period of time, as well as avoiding any addictive or destructive behaviors. For instance, in one treatment program, addicts are told “no overeating, no starving, no vomiting, no masturbating…no smoking, no caffeine, no sugar” (Silverman, 2001, p. 31). The second step is to address the underlying causes by receiving therapy for the past issues, including abuse and depression, which the addiction was used to escape. Finally, recovering addicts must learn new, healthy behaviors, to replace the old destructive ones. Twelve-step programs similar to those sponsored by Alcoholics Anonymous are often helpful for sexual addicts. Sex Addicts Anonymous is one of the most popular, with over 750 chapters around the world as well as on-line meetings. Programs such as this have many benefits, the first of which is that they are completely free. Also, participants have a sponsor, someone who has been in the program longer, who they can contact at any time for support. Meetings take place on a regular basis, and there is a good history of success. As in any twelve-step program, the addict must admit that he or she has a problem that they cannot control on ones own. In admitting that he or she is powerless to control the addiction, the addict is asked to place their faith in a higher power, because “finding the spiritual part of yourself can be an important aspect of your healing process” (Bass & Davis, 1994, p. 166). Some people, however, find themselves uncomfortable with this aspect of the program. Further, the addict must be sufficiently motivated to continue attending meetings in place of engaging in dangerous sexual behaviors. Twelve-step programs require a degree of commitment that addicts may not be willing to agree to unless they have already hit rock bottom and realized their life is completely miserable because of their addiction. Other forms of outpatient treatment include psychotherapy, singly, or with a spouse. Particularly for those whose sexual addiction stems from deeper underlying problems (such as unaddressed issues of childhood sexual abuse), sessions with a qualified therapist are really important for addressing the betrayals of the past. However, even individuals attending one-on-one therapy will be encouraged to also attend group therapy as well. As those who developed the idea of twelve-stepping believe, “Through listening to others with a similar problem, one feels not alone and discovers solutions. Through sharing about ones own experience in the addiction and in the recovery process, one makes connections with others and gains self confidence” (Counseling Affiliates). Addicts learn that they are not alone in their troubles, and that others before them have learned to overcome this addiction and live their lives without its baneful influence determining their every behavior. Inpatient Treatment Finally, the most severely disabled addicts will need inpatient treatment to ensure that they do not continue engaging in their addiction even as they seek help. With a therapist’s referral, they can enter a hospital ward setting where all the patients receive daily treatment and supervision. Every day, they will attend group therapy and educational sessions. This is an intensive experience, often lasting twenty-eight days, wherein the patient is given a great deal of help and information in a comparatively small space of time. The greatest advantage of inpatient treatment is that is “permits patients to leave their daily routine and concerns in order to focus fully on their treatment” (Counseling Affiliates). In addition, “for the patient who is in a more serious emotional or psychological state, the in-patient facility provides more safety and medical support” (Counseling Affiliates). In the hospital setting, with more supervision, it is more difficult to engage in sexual behaviors. Doctors are available to deal with immediate crises. Patients are constantly surrounded with people who know the intimate details of their problems, and they cannot retreat into denial by stepping through a door. Even after inpatient treatment, addicts will need to continue in their therapy to prevent relapse. Twelve-step programs can be helpful after an initial intensive treatment. These programs remind addicts that recovery is a life-long process, a day-to-day decision to embrace positive behaviors and leave behind destructive ones. Addicts must remind themselves, “I can’t change all my behaviors in a month. All I can do is keep working on myself, keep moving forward, keep trying” (Silverman, 2001, p. 301). Inpatient treatment is an extreme measure to help an addict take control in the present, particularly for those who will not otherwise be able to engage in the first step to recovery, to stop the addictive behavior. However, a month-long program will not equal a complete cure. Only a lifetime commitment to health on a day-to-day basis will effect that. Conclusion Sexual Addiction is not a new problem, but it is a problem that is becoming more visible in our society. However, it’s almost impossible to determine the extent to which it exists. Due to the vagaries of self-reporting and the fact that most addicts are not receiving help, we cannot guess how many people in the world are sex addicts. It is possible to monitor the Internet, to determine how many pages of pornographic content are available, how many unique visitors they have on a given day, how many people are meeting in certain sexually-oriented chatrooms. These numbers seem to rise every year, but they do not give us an accurate picture of the number of people suffering from sexual addiction. Not every person who views pornography or engages in consensual sexual discussion is a sex addict. Reading the DSM-IV, one might be struck by the small place Sexual Addiction occupies, in comparison to the many diagnoses given to sexual dysfunction. We live in a society where having sex or wanting sex, and lots of it, is considered more or less normal. It is the inability to have sex that seem clinical, in need of treatment. But sex addiction is a disease like any other addiction, to drugs, alcohol, food, self-mutilation. If the behavior is destructive, if it prevents the addict from enjoying a high quality of life or confronting deeper psychological issues, or if it simply makes him or her unhappy, it needs to be addressed and treated. References Bass, E. & Davis, L. (1994). The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse. New York: Harper. Bellenir, K. (ed). (2005). Mental Health Disorders Sourcebook. Detroit: Omnigraphics. Carnes, P., Delmonico, D.L., & Griffin, E. (2001). In the Shadows of the Net. Minnesota: Hazelden. Counseling Affiliates Sexual Addiction Treatment Program. “Sexual Addiction.” Retrieved 11 December 2006 from http://www.sexaddictionhelp.com/general.html. Diagnostic and Statistical Manual of Mental Disorders 4th Edition Text Revision. (2000). Washington, DC: American Psychological Association. Silverman, S.W. (2001). Love Sick: One Woman’s Journey through Sexual Addiction. New York: Norton. Outline Introduction/Thesis: Sexual Addiction is a dangerous condition in which individuals use sex to self-medicate for other psychological problems, but with treatment they can overcome addiction and be happy. I Diagnosis A Paraphilia B Sexual Disorder not specified C. Diagnostic questions D. cultural value II Sexual addiction in survivors A Sex vs. Love B. Self-medication C. Addiction III Cyber sex A. Types of cybersex B. Diagnosis c. Statistsc IV Outpatient Treatment A. 3 steps to overcome additions B. 12 step programs C. therapy V Inpatient treatment A. Setting B. Advantage C followup Conlusions Read More