Denial in Sex Addiction: Delusion, Distortion and Dissociation

Denial in sex addiction is a form of distorted thinking. In fact it is a masterpiece of distorted thinking. Breaking through denial marks the beginning of addiction treatment. This is just as true for sexual addiction and behavioral addictions generally as it is for chemical dependency.

Without treatment, the set of ideas, rationalizations and beliefs that constitute a system of denial become more and more entrenched and tend to spread, becoming a world view which supports a deceptive and disordered way of life.

Even for a practicing sex addict, there are moments of clear-headedness when he or she suspects that they are engaging in a problematic or pathological pattern of behavior. But that awareness does not hold up. Why? Because denial is distorted thinking in the context of a semi-dissociated (i.e. “checked out”) state. Continue reading

4 Spiritual Practices You Don’t Know You’re Doing

Spirituality and spiritual enlightenment are mystified in our culture. By mystified I mean made to seem mysterious and esoteric. I think this is mistaken thinking. In the world of addiction recovery many people balk at joining 12-step groups because the spiritual emphasis is alien or elusive and they cannot relate to the idea of surrender to a higher power.

The 12-step literature is deliberately vague about what is meant by a faith or by a spiritual awakening. But even for people who are very religious there can be something that is not working for them.

A religious client of mine put it well. He said basically that his religion had not been adequate to help him to overcome his sexually problematic behavior. Although he continued in his religious life, he was open to another kind of spirituality as part of his recovery.

I have argued in a previous post that one does not need the concept of a higher power to succeed in recovery and I proposed practicing certain attitudes and behaviors that promote spirituality. These ideas which are now increasingly accessible and a number of excellent writers draw on a variety of spiritual traditions without requiring any kind of religious faith. Their emphasis on mindfulness, meditation and intuition has now become well established in the scientific literature as an evidence-based aspect of treatment.

But in addition to spiritual practices that can be cultivated, I believe there are many things we do in the course of our daily life that draw upon our spirituality. These are things we are not aware of as being spiritual per se, but which serve a necessary purpose in our everyday attempt to regain our equilibrium and cope with inevitable challenges big and small.

I will describe some of these, in no particular order, and give a rationale as to how each is an expression of our spirituality.

Schadenfreude. This refers to the rather base impulse to take some pleasure in someone else’s misfortune. We all do it. Sometimes it’s gloating but very often it’s relief: “At least I haven’t lost my job, or my money or my health, etc.” In other words, “It could be worse.” And hidden in this line of thought is a very important concept; that of gratitude, the idea that life is pretty darn good. Gratitude is a key concept in maintaining contact with reality. In taking our thoughts away from what is lacking and focusing on how lucky we are, we are brought back into the present. We are taken out of the frame of mind of never having enough, of being deprived, or being a victim. We let go of the “if only” mentality and enter into the feeling of the present moment without judgment. It doesn’t get any more spiritual than that. Gratitude is the royal road to acceptance.

“Whatever!” This is what we say when we hit the wall. We are in a situation where we care a lot about the outcome; a test we will pass or not, a meeting that could go well or badly, an operation, even whether or not our partner is telling the truth. At the “whatever” point we are allowing ourselves to let go. Letting go of outcomes is one of the premier spiritual moments and we experience it instinctively when we give up on obsessing about something that is out of our control. Letting go of outcomes does not mean thinking that everything will turn out great, but it implies a kind of faith that we can retain our perspective and our serenity no matter what.

Running away. By this I mean making a conscious choice to hide or isolate one’s self temporarily. This could be getting away from a party or gathering that feels alienating, withdrawing from an unpleasant conversation, carving out quiet time at home, or walking out of a movie. This is a spiritual practice in two ways. It involves listening to an inner voice or intuitive sense that something is not right. In listening to this voice we are practicing getting in touch with or becoming aware of what we are feeling in the moment and being willing to trust that awareness. But isolating, deliberately being alone, also serves to provide the outer stillness that allows us to get centered in inner stillness, to shut out all the noise both inside and outside our heads. This is essential to mindfulness and meditation.

Empathy. Feeling sorry for someone else is powerful spiritual practice. When we pity someone it may or may not do anything for them but it helps us. We are noticing another person not just with our eyes but with our feelings. This involves letting go of any other feelings of resentment or judgment we may have had about the person. It also involves letting go of our separateness; we identify with another being and in so doing we are, at least momentarily, experiencing a oneness with them and letting go of the illusion of our separate ego identity.

There are many resources for spirituality (mindfulness) practices and guided meditations available that do not depend at all on sectarian religion. For more on spiritual practice and guided meditations I recommend the work of Sam Harris  available online at

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

New Treatment Models for Teen Porn Addiction

The enormous global proliferation of online pornography has made a vast array of sexually explicit material available to a large teen audience on laptops, tablets and smart phones. And if smart accessories catch on, you will soon be able to wear your pornography.

Online pornography accounts for such an overwhelming proportion of internet traffic that a new search engine has been created specifically for adult content. It was designed by two former Google employees and searches only for pre-screened adult content that is free of illicit or malevolent intent. It is also designed to protect the user from cookies and other forms of identity tracking. The site was launched on September 15th and according to the founders has “taken off like a rocket.”

Internet porn has long been seen as more readily accessible than riskier and more costly habits like prostitutes, massage parlors or anonymous hook-ups. This in turn makes it more easily available to youth, with the typical first exposure being in the pre-teen years.

Effects of porn on teens and young adults

A study published this summer in the by the UK’s Institute for Public Policy Research surveyed 500 18-year-olds about the impact of porn on their lives. Most of the respondents reported that accessing pornography was common throughout their school years, began in their early teens and had a damaging effect on their sexual and relationship lives.

Dr. Anthony Jack, a researcher and neuroscience professor at Case Western Reserve University stated that recent studies show “…widespread rates of sexual dysfunction… such that approximately 50% of late adolescents of both sexes report sexual dysfunction of clinical severity”.  (See “Your Brain on Porn” by Gary Wilson)

Another study published this month by researchers in the US found that among a sample of over 900 emerging adults in college more frequent porn viewing was correlated with a greater number of sexual hook-ups and one night stands.

Other recent studies of the brain activity of chronic porn users have begun to show detrimental effects such as:

• Less gray matter and reduced reward center activity while viewing sexually explicit imagery, i.e. desensitization.

• A weakening of nerve connections between the reward centers and the higher brain centers thus increasing impulsiveness and impairing decision making.

• Porn induced erectile dysfunction

As one of the researchers put it, “…regular consumption of pornography more or less wears out your reward system.” And clinicians here and abroad are seeing many more young adults and teens who can achieve erection and ejaculation with porn but not with a real person.

Treating the young porn addict: three models

The current crop of very young addicts have some special characteristics. The pre-teen brain is not fully mature and their emerging sexuality programs them to react powerfully to sexual stimuli. Getting hooked on porn at an early age can be damaging in at least three different ways. These in turn require interventions very different from the years of addiction treatment and relapse prevention that are appropriate for most adult addicts.

I. The drug-driven model

Jeff’s addiction appears to have come about through the habit-forming nature of porn itself in the absence of any other obvious psychopathology.

At first I thought Jeff was just like any other sex addict client, only younger. He had been watching porn on his computer since he was 13, and at age 18 he realized he had begun to fixate on child porn. Fortunately this scared him enough that he came clean to his parents who put him in a 6 week residential program for sex addiction.

After the residential program Jeff saw me for therapy for about a year. He also attended weekly Sex Addicts Anonymous meetings. He was an attractive, sophisticated kid with a sunny disposition, but at 20 he was still a virgin who had never dated a girl. While he was seeing me he began dating a very appropriate same-age young woman and eventually began a robust sexual relationship with her. Although that relationship ended he never returned to porn use that I know of. I am as certain as I can be that he had no residual attraction to children.

What is striking is that although Jeff went along with the usual program of sex addiction recovery, what seems to have worked for him was just getting away from porn! With abstinence, it seems his young brain rebalanced and in a period of months he was able to resume normal sexual development. He became more outgoing and began college with the ambition to become a filmmaker. Jeff needed a structure that would allow him to stay away from porn along with some outside support to get his life back on a normal track.

II. The trauma model

Brad discovered internet porn at 12 and became instantly hooked. He reports that his use escalated very rapidly as did his sexual tastes. He was binging on porn very heavily every day. While still in his teens he says that he quit, primarily out of exhaustion. His sexual interest diminished to zero and as of his mid 20’s he reported that his libido seemed to be permanently gone. He attributes this result to a kind of virtual sexual trauma.

There is some research that would support the idea that very early exposure to sexually explicit material can have effects on the developing psyche similar to actual sexual assault. The young mind is not ready to deal with the shock, adrenaline and stress of the hyper-arousal caused by porn. It thus constitutes a violation which can leave lasting sexual scars. Brad correctly sought out treatment with a specialist in sexual trauma rather than sex addiction.

III. The hybrid model

Ken is a happily married man in his late 20’s. He entered treatment for an addiction to porn and masturbation dating from childhood. He had no other sexually addictive behaviors but he had significant early trauma. His father died of a cocaine overdose when Ken was a toddler. Ken became the “man of the house” at age 3 and soon after had a serious illness requiring months of hospitalization. He had an unhealthy relationship with his narcissistic, demanding mother. Also as a child he witnessed his teenage sisters being molested by an older cousin.

After about 8 months of abstinence from porn and with the support of group therapy Ken has shifted gears. His relationship with his wife whom he adores is going well and he is comfortable with a new-found intimacy with her. In fact Ken no longer presents as an addict; he does however have issues that he knows he needs to work on. In particular he knows he has never fully understood or worked through his early childhood experiences and he is working his way out of his enmeshed relationship with his mother. He is appropriately seeking help for these problems and appears to be at zero risk of relapse into porn addiction.

So the good news is that the youthful porn addict’s brain can recover and resume a more normal developmental trajectory. And given that their only addictive behavior is internet porn and that their total time of usage relatively short, they do not have to overcome addiction as a pervasive and deeply entrenched coping style. They can get cured and stay cured. The bad news is that there is as yet so little awareness of the risks to children and teens on the part of the medical profession, the academic community, schools and the public at large. As with so many public health issues, prevention and education are sorely needed.

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

Online Relationships: Real or Fantasy?

When I “e-meet” someone, that is connect online, I often have strong and immediate feelings that I like them or that I don’t, even though I have never seen them or talked to them in person.  It is not a stretch to see that this feeling of connection can be experienced by many people as an intimate and even sexual attraction.  (I have dealt with the topic of connecting sexually through cybersex vs. real sex in another post.)

The reality basis of online connecting and “she sounded cute on the phone”

Part of the sense of immediately knowing someone from very little actual information has to do with the fact that we as humans may be using our gift for “rapid cognition” as it is described by Malcolm Gladwell in his book  Blink: the Power of Thinking Without Thinking.

Gladwell also uses the term “thin slicing” to describe the phenomenon by which we can sometimes evaluate situations and make decisions almost instantaneously, with a seemingly miniscule amount of information and without actual logical reasoning.

This is a scientific description of what I think of in some situations as “intuition”.  I am reminded of my surprise when first hearing men say things like “she sounded cute on the phone.”  “She sounded cute?”  How does somebody sound cute looking?

Regardless of what we call it, it does seem that we can get a powerful and sometimes fairly accurate idea of what someone is like with limited actual input and without the aid of analytic thought. And this is especially true as people scan for sexual cues.  But surely there is much more that we don’t know that may be crucially important in determining whether they could be a close friend or lover.

However, in connecting online we have come into contact with someone with whom closeness and even intimacy could be a real possibility as opposed to the millions of people we wouldn’t even want to know.  We have used our intuition and our computer tools to give us better odds than we would ever have otherwise.  And of course this is the numbers game that online dating and friendship sites depend on.

The fact that we can connect in real ways online has become a pervasive and important part of life.

The fantasy element in online relating and the bridal veil

As a sex addiction therapist I deal with many people who have fantasy relationships online including sexual chat, hook-ups, cybersex experiences, and finding prostitutes.

Obviously for sex addicts online relationships can be part of a pattern of intimacy avoidance and usually involve splitting off part of the addict’s life that deals with sex, often at the expense of real intimacy with a partner.

But the fantasy element of online relating can enhance the illusion of intimacy for addict and non addict alike.

I think of the experience of online intimacy as having a “value added” element. What we add is our imagination of reality in order to complete the online picture which is always incomplete.  These value added elements appeal to our all-too-human needs.  Here are a few.

  • Intimacy without accountability.  In online relationships we don’t owe each other anything and we don’t have to do anything we don’t want to do.  We can just enjoy each other and then walk away from the computer.
  • Perpetual romance.  In an online romance we can idealize the other person and since the fantasy is never contaminated by reality we never have to let go of our ideal.  This allows us to avoid real intimacy and puts in its place a “story” we can concoct about the essence of the relationship—one that fits out best fantasies.
  • Idealizing our self image.  In online relating we can curate and embellish our own image. People can and often do deceive others and indulge in a fantasy of being better looking, more successful, smarter, younger or whatever helps alleviate their insecurities.
  • The excitement of the unknown.  The element of mystery, surprise and sometimes danger involved in the online encounter is powerful fuel which can propel us further into the “relationship” and the excitement can be an end in itself.

Why do some brides still wear veils covering their faces until after they are officially married?  This archaic gesture conveys not only the idea that the bride is pure and untouched, but also serves to prolong until the last possible moment, the fantasy of what physical and sexual intimacy will be like.  In this way veils are a precursor of the mystery and fantasy involved in online encounters.

As with so many things the online relationship can be great or it can become a problem, a substitute for off line relating and even an obsession.  We are still learning how to navigate this new world.

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

The Rocky History of Sex Addiction in Public Awareness

It is the height of the AIDS epidemic, around 30 years ago. Dr. Patrick Carnes, the founding father of sex addiction theory, is going to speak to the gay community. He has been invited in by a respected African American sexologist who feels that the gay community really needs to hear his message. On this occasion Dr. Carnes is transported in one of three identical limos so that if he was attacked it would be impossible to know which limo he was in.

The ridicule and harassment began early and didn’t stop. Carnes’ daughter Dr. Stefanie Carnes, now the president of the International Institute for Trauma and Addiction Professionals, remembers that when she was a teenager her father received death threats.

Even some in the AA community were angered when Dr. Carnes started a 12-step recovery program for sex addiction. So what was the idea that evoked such a violent reaction? In his 1983 book Out of the Shadows, [1] Carnes defined sex addiction as “a pathological relationship with a mood-altering experience.” Twenty years later in Facing the Shadow [2] he states:

“Today we understand that addiction is an illness– a very serious disease. Furthermore, problems such as drug, food, gambling and sex addiction are actually related and rely on similar physical processes. Most important, we know that people can get help and that a good prognosis exists. Sex addiction is the last addiction to be understood.”
How sex addiction was thrown under the bus

In an article on the politics of sex addiction Marnia Robinson describes the events inside the American Medical Association in 1992 when they were considering a new specialty: addiction medicine.

“It became clear that the AMA wouldn’t agree to approve the new specialty unless sex was excluded from the list of possible addictions…the reason was strategic. Doctors were bent on snuffing out the tobacco manufacturers’ spin. Big Tobacco was pulling out all the stops to prolong the illusion that “smoking is not addictive.” It claimed that the addiction experts’ evidence should be ignored because, “the experts are saying everything’s addictive. “Excluding sex demonstrated that doctors weren’t saying everything is addictive. Besides, sex addicts were rare, while smokers were everywhere and suffering unnecessarily.”

Some recent progress

The idea of addiction to a behavior has been around for years and gambling has been included in the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association as an impulse disorder, but the diagnostic criteria parallel those of most addictions.

In 2011 the American Society of Addiction Medicine announced a new definition of addiction which included behavioral addictions like sex, food and gambling.

“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Addiction affects neurotransmission and interactions within reward structures of the brain… such that the memory of previous exposures to rewards (such as food, sex, alcohol and other drugs) leads to a biological and behavioral response to external cues, in turn triggering craving and/or engagement in addictive behaviors.”

The research on the brain and behavioral addictions including sex/porn addiction is beginning to show that sex addiction is similar to other behavioral addictions.

So have people gotten over their indignation at the whole idea? Not hardly.

The furor continues

People seeking help for out-of-control sexual behavior are amazed that anyone would claim to have proved that sex addiction doesn’t “exist.” The addict knows it exists.

The overall historical trend will no doubt follow the same progression as that of alcoholism and mental illness. As I have argued elsewhere,  this trend is from demonization to criminalization to medicalization to reintegration as the problem becomes better understood.

On the one hand there are still arguments that sex addiction is not an affliction it’s just bad behavior. On the other hand there are arguments that sex addiction is just a normal variation on the sexual continuum.

The former view is based on the fear that a diagnosis of sex addiction will be too permissive, allowing all manner of sexual behavior with no moral sanctions or personal responsibility. Ironically, the second fear is the opposite: that medicalizing sex addiction will lead to a curtailing of sexual freedom with some sex police deciding what sexual behavior is healthy and what is pathological.

Who are the current sex addiction deniers?

• Pro-pornography people

People who have a vested interest in the pornography industry. Producers and/or viewers of porn are sometimes fearful of any regulation that may grow out of the awareness of internet porn as potentially addictive. One cheating website recently solicited writers from the sexology community to promote affairs as healthy and debunk any unflattering research.

• Anti-feminists

Some who wish to normalize sex addiction, the “boys will be boys” contingent, see medicalization as a feminist plot to control men.

• People with grossly mistaken beliefs

A handful of professionals who are not well acquainted with the field tend to loudly misrepresent it. One such personal communication stated:

“I’ve written extensively on the heavy moral agendas embedded in much sex addiction publications. Further, there is a strong anti-male, and anti-gay/bi male stance implicit in most sex addiction writings, labeling things as unhealthy, due to social stigma, not based on actual research or ill health.”

• Misleading Crusaders 

The occasional zealot in the professional community intent on rescuing patients from the clutches of money grubbing therapists. One of these recently tweeted the suggestion that patients file complaints:

“Remind patients: can file vs. therapist (free, any state) for “false advertising”, including “sex addiction”

What’s next?

Sex addiction treatment does not condemn any specific sexual behavior, does not support any legislation, and has no bias about gender or sexual orientation.

I am happy to report that Dr. Carnes has an article on the diagnosis of sex addiction soon to appear in The Journal of the American Medical Association. Hopefully one more step on the rocky road to understanding.


1. Carnes, P. (1983b). Out of the Shadows: Understanding Sexual Addiction. Minneapolis, MN:
Compcare Publications.

2. Carnes, P.J. (2010) Facing the Shadow. Carefree, AZ: Gentle Path Press.

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

What is a Certified Sex Addiction Therapist (CSAT)? Frequently Asked Questions

Mature students studying in libraryWhat is involved in becoming a certified sex addiction therapist or counselor?

First, an important point to remember is that only those therapists who are already licensed or otherwise credentialed in their particular counseling field (e.g. psychologists, clinical social workers, marriage counselors, pastoral counselors) are eligible to enroll in the CSAT training.

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Intimacy Disability and the Loneliness of Sex Addicts

Addicts are profoundly lonely. They may be active and sociable; they may have friends. But in terms of the deeper emotional connection to a partner, they tend to keep themselves on a starvation diet. The loneliness of course is self-imposed. Addicts are not addicts because they are making up for the fact that they don’t happen to have a lover. Their addiction and their emotional isolation are both related to a deep fear of intimacy. It has always been striking to me that they should suffer so much in their alienation.

Childhood issues

I find that most often sex addicts are not aware of how fearful they are about intimate relationships.  They have most likely come from families in which they received inadequate or inappropriate forms of connection with adults. Without realizing it, they have adopted a way of behaving based on fear and the avoidance of intimate connection.

I have heard many addicts tell me that as a child they felt ignored discounted, abandoned or invisible. This is their model of close relating; it is one of intense pain and stress. And this can be true despite the fact that their family life and childhood appeared outwardly “normal“.

Intimacy avoidance and sexual acting out

Many sex addicts are using their addictive acting out behavior as a substitute for an intimate connection. Their addictive behavior provides an illusion of some kind of connection, reinforced by sexual gratification in a situation that is safe. Sexual acting out is emotionally safe because it requires nothing from the addict on an emotional level.

For the typical sex addict, this way of finding gratification without intimacy is not a matter of wanting to be selfish and controlling, although that is how it ends up looking. But rather it is a way of finding an escape from negative emotions and achieving some gratification without having to experience intense discomfort and fear. Sometimes it is due to sexual inhibition and shame. Other times it is the fear of letting their guard down and feeling that they will inevitably be hurt. Or it involves feeling so unworthy and unlovable that they cannot feel free to be who they are. Usually it is a combination of the above.

Intimacy avoidance in relationships

The intimacy avoidance that goes along with sex addiction shows up in relationships in a number of ways.

  • Avoiding sex

Sexual connecting in the context of an intimate relationship can be too difficult for an addict to do comfortably. Even if they are very attracted to their partner or would-be partner, they may try to create emotional distance. For example, they may be emotionally absent during sex or lost in fantasy, they may want to drink alcohol as a way to be less present during sex, or they may avoid sex altogether.

  • Avoiding physical intimacy

Sex addicts often come from families in which there was an absence of physical touching and affection. Thus they may feel that hugging, cuddling, etc. are awkward and uncomfortable. Some addicts were smothered by physical touching in an inappropriate way and they too may avoid physical affection due to feeling vulnerable.

  • Not being able to express their needs

Many sex addicts isolate themselves emotionally by avoiding letting the other person in on what they feel, need or want. This is a fear of being unworthy or of being rejected or hurt.

  • Being self conscious around people or in social situations

Often addicts substitute a role or facade for actually showing up emotionally. They may play a role, eg teacher, guru, performer, etc. with people instead of just being able to be who they are and take their chances.

  • Withdrawing into work or another addiction

Some addicts escape the demands of intimacy by becoming swallowed up in work or exercise or other hobbies that take them away from their partner and other potentially intimate contacts.

  • Fleeing intimate connection

Many addicts can enter a relationship but leave before it becomes too intimate. They may think this is a fear of commitment, or not the “right person”, when in reality they feel inadequate to the demands of a relationship and/or fear being abandoned by anyone they are close to.

Intimacy avoidance and loneliness

The same addict who is doing everything to avoid intimacy will often feel desperately needy and lonely. Sometimes the addict is aware of a longing for connection; other times the addict lives without intimate relating but doesn’t quite know what is missing or why they push people away. Isolation and loneliness can then become the excuse and the occasion for sexual acting out such as online sex, sexual massage parlors, prostitutes, etc. It is only in recovery that the addict can recognize his or her own lack of intimacy ability and begin to practice new behaviors to overcome their fears of being known and connected.

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

5 Signs you are Involved with a Narcissist

Basically you can’t get close to a narcissist.  A relationship with a narcissist will be a problem, and the more narcissistic they are the more it becomes impossible.

Sex addicts and addicts generally are often described as narcissistic, but many non-addicts are narcissists as well.  Trying to have a relationship with a true narcissist can be an extremely tortuous and confusing experience.

The continuum of narcissism

Many psychological disorders are now being talked about as existing on a “spectrum”, that is they are not like other diseases where either you have them or you don’t.  With spectrum disorders the set of symptoms can range from very mild to very severe.

As I have discussed previously, narcissists at the mild end may be labeled as having narcissistic personality traits such as self centeredness and vanity; those labeled as having narcissistic personality disorder will be mostly oblivious of the needs of others and will focus on maintaining a false and grandiose sense of a self.  At the outer most extreme the narcissist becomes akin to a sociopath, feeling so over-entitled and so lacking in conscience or empathy that they are opportunists and even criminals.

Many sex addicts and other kinds of addicts have what is called a narcissistic defense system, that is they have a façade of self importance which merely covers a deep seated lack of self worth.

What to expect with a narcissist

Narcissists are cut off from others by their underlying insecurity but they nevertheless can become expert at manipulating people in order to draw them in.  They can be habitually seductive as a way of finding validation and power in relating to people generally.  They are fundamentally impossible to connect with in the following ways.

  • The narcissist needs you to be focused on him.

He or she may initially show  great interest and appreciation for you.  This is gratifying but is skin deep.  It is done to get you to focus on them.  They may give lavish praise and compare you favorably to others; in this way they manipulate you into trying to keep their good opinion thus becoming more and more focused on what they think about you (and everything else.)  And you become unconsciously afraid to displease the narcissist or incur his disapproval.

  • The narcissist needs to see anyone they are close to as special.

The idea here is that the narcissist needs to feel he is wonderful and that he wouldn’t be seen associating with anyone who wasn’t wonderful too.  He sees you as a reflection of his own specialness.  This does not really say anything about how he really feels about you, what is important to the narcissist is how you make him look to others and to himself.

  • The narcissist will be controlling and demanding.

You may feel constantly thrown off from what you were doing or thinking about because the narcissist will come at you with their needs and wants.  Narcissists will have their own agenda most of the time.  They will use their judgmental attitude, their scrutiny of you and their strong opinions to enforce that agenda.

If you have already become involved you may be sacrificing yourself in a million little ways and even feeling that your life has been taken over.  This is a far cry from a real relationship in which the partners’ lives together involve mutual decision making and genuine listening.

  • Narcissists will be volatile when they are challenged.

Since their façade of superiority is just a façade, the narcissist will be cut to the quick if they feel criticized in any way.  Their first line of defense will be to discount and devalue whatever or whoever has pricked their bubble.  But they will be deeply affected and may harbor rage or resentments.  This makes it impossible to express your true feelings or needs and to have them be heard.

  • Narcissists will bail out when you stop feeding their narcissism.

You may be unable to shake the feeling that the relationship is tenuous because it is.  It is possible to puncture a narcissist’s false self very easily.  And since your worth to him or her lies in your ability to reinforce their self image, you can become a hindrance if and when you stop mirroring their perfection.

Someone who has milder narcissistic traits is probably using their grandiosity as a defense, as is the case with most sex addicts in treatment.  In recovery they can gain a stronger sense of self worth and let go of the narcissistic defense system.  With treatment, these people may be more able to connect to their insecurities and you may find that they both want and have a genuine capacity for a healthy relationship.

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

Attention Deficit Disorder and Sex Addiction: What’s the Connection?

A large number of sex addicts have attention deficit hyperactivity disorder (ADHD)

Dr. Rory Reid of UCLA did research in 2007 and 2011 in which groups of men in treatment for sex addiction were assessed for ADHD and in which 23%-26% were found to meet the criteria for adult ADHD.  Almost all of these (97%) were of the “predominantly inattentive type” rather than being predominantly hyperactive. (The prevalence of ADHD in the general population is 3-5% according to Reid.)

Can impulsivity or low self-concept explain the correlation?

Dr. Reid also gathered evidence about whether ADHD might be “driving” sex addiction due to the impulsivity of people with attention deficit as children.

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Sex Addiction is Real: Just Ask a Sex Addict

The concept of sex addiction came from sex addicts. It was never imposed on them by clinicians– far from it. If you read the first of the personal stories in the Sex Addicts Anonymous “Big Book,” which includes an account of how SAA was founded 36 years ago this is clear. At that time people with compulsive forms of sexual behavior were receiving other forms of psychiatric treatment that were mostly doomed to failure; treatments like aversive conditioning or psychoanalysis. The groundbreaking work of Dr. Patrick Carnes and others created SAA as a way to treat sexual addiction in order to help themselves and ultimately to help others.

Listening to addicts, lots of them

And people have been steadily joining the ranks of self-identified sex addicts. Today SAA has 1,176 groups (regular weekly meetings) in the U.S., that are registered with the International Service Organization (ISO) of SAA. In addition there are 62 in Canada, 51 in the U.K., 31 in Central and South America and 48 in other locations including South Africa. There are 101 different registered telephone meetings and other electronic meetings.

These statistics are as of last October and the ISO informs me that the number of meetings has grown steadily by 10% per year in recent years. That’s a lot of people in SAA alone. And there are currently four additional 12-step self-help programs for sex addicts all modeled on Alcoholics Anonymous:

Sexaholics Anonymous (SA)
Sex and Love Addicts Anonymous (SLAA)
Sexual Compulsives Anonymous (SCA) and
Sexual Recovery Anonymous

Even this does not represent the whole picture. Nowadays many sex addicts can get appropriate treatment with therapists who specialize  in working with sex addiction. And of course there are many people struggling with sex addiction who are not getting any help at all, often because they don’t understand the nature of their problem, or because the psychiatric establishment has yet to educate the mass of clinicians as to the diagnostic issues.

The current wave of sex addiction denial

Today there is a rash of sex addiction denialism or misinformation fueled by some flimsy studies that have been easily discredited and gaining followers among those who feel judged or pushed around by the idea that someone might call them (or anyone) a sex addict. But in fact clinicians don’t go around looking for sex addicts or labeling people just because they exhibit certain behavior. People need to be evaluated on a case by case basis. This is partly because compulsive sexual behaviors can be a symptom of at least half a dozen other psychiatric disorders that don’t have anything to do with addiction.

But the “evidence” that porn and sex addicts are not exactly like drug addicts in this one experimental response in this or that isolated experiment is really largely irrelevant to the experience of thousands of sex addicts over decades. In the attempt to save patients from being mislabeled by clinicians, the deniers have ended up undercutting the recovery efforts of bona fide sex addicts. “Sorry, what you have may not be a “real” addiction; so maybe you don’t really need any help!”

The plural of “anecdote” is “data”

Most people and clinicians generally agree that sex is a good thing. People tend to show up for treatment when they, or someone who knows them, notice that their sexual behavior is way out of control and is causing a lot of problems. Some people have had their lives taken over by pornography, some have lost a job due to sexual behavior, others have been arrested more than once for indecent exposure, and some simply spend hundreds of thousands of dollars they can’t afford on prostitutes.

But whatever brings them into the office or the 12-step meeting, they still need to be helped to figure out if in fact they are a sex addict. This can be done by pointing them in the direction of the literature on the subject, by talking to other people with the same problems, and by well validated tests.

I have listened to numerous patients of mine, read hundreds of emails and blog comments and listening to sex addicts talk at hundreds of SAA meetings over the years. Many addicts are unsure to begin with about whether they really have an addiction. But for many there comes a point when the addict realizes that they simply have no control over this or that behavior. I have heard over and over again: “This is an addiction!” ” I can’t stop even though I desperately want to!” and ” I’m ashamed of what I do because it’s not who I am, yet I do it anyway!”

Other addicts will occasionally waver in their grasp on the addictive nature of the problem. This is not at all unusual. “So am I really an addict?” “So-and-so is so much worse than I am!” But of their own accord or because of many unsuccessful attempts to quit, they come back around to the need to approach the behavior as though it were on a par with alcoholism or drug abuse. Many will tell you that it is more addictive even than these.

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