Is Masturbation OK in Recovery From Sexually Addictive Behaviors?

Masturbation  can present a problem for people with sexually addictive behaviors.

I would not encourage anyone to see masturbation as inherently bad or a problem, and yet there are some people who would see any sexual activity outside of marital sex, even masturbation as wrong.  If you hold such a view on religious or other  grounds, then you may see masturbation as wrong no matter what.

But since I do not hold such a view I distinguish between those situations in which masturbation is harmless and those in which it can complicate things for someone attempting to recover from sex addiction.

When is masturbation counter-productive?

In the early months (or maybe years) of recovery I believe it is a good idea for sex addicts to abstain from masturbation, regardless of whether compulsive masturbation is one of their sexually addictive behaviors or not.  Here are some situations where Masturbation can reinforce addictive patterns.

  • Masturbation can itself be a compulsion, meaning that it is being used to excess and as a drug.  For some sex addicts masturbation is their primary sexually addictive behavior.  Often it is done in conjunction with porn use but sometimes it is done using fantasy alone.  Compulsive masturbation often starts early in life and continues into adulthood.  The addict will often develop a pattern of masturbating numerous times per day.  In order to be free of this compulsion and lead a more normal sex and relationship life in recovery, the addict will need to “kick” the habit and allow their brain chemistry to return to normal functioning.  This means total abstinence for a period of time during treatment and recovery.
  • Masturbation can be part of a pattern of other sexually addictive behaviors.  Masturbation often accompanies other sexually addictive behaviors built around fantasy such as compulsive cybersex, sexual chat,  voyeurism, and exhibitionism.  The masturbation may be done at the time of the other behavior or it may be done later using the stimulus of the memory of the event.  In this case the behavior of masturbating is tied to whatever pattern of addictive acting out behavior exists and provides the sexual gratification for which the other behavior is the stimulus.  At least initially, the addict cannot quit one behavior without quitting both.
  • Masturbation in early recovery can prevent the process of withdrawal and lead to relapse.  Since the addict’s “arousal template” as it is called, is one of addictive sexual acting out of one type or another, it is likely that any form of sexual stimulation, at least in the beginning of recovery, can lead back to cravings and urges for the addict’s preferred sexually addictive behaviors.  Even if the addict has never masturbated compulsively, masturbating in recovery can bring on cravings for other behaviors, behaviors like anonymous sex, prostitutes, etc.   I takes a long time in treatment for the unhealthy urges and fantasies to subside or at least be less powerful.  Instead of allowing the addictive pattern to weaken, masturbation may be like taking small amounts of the drug, thus prolonging the process of withdrawal.

When is masturbation a useful part of recovery?

After a sex addict has established a period of abstinence from all sexually addictive behaviors, it is possible that masturbation can be engaged in in a normal way that does not threaten their sexual sobriety.  This is very much a subjective and individual decision to be arrived at by the addict and their sponsor or counselor.

  • Masturbation can become a more healthy activity that is not a compulsion and is not tied to another sexually addictive behavior.   It may be that the addict will find it a useful way to explore and check in with the fantasies that have driven their addiction and the memories or traumatic events that have shaped their sexuality in the past.
  • Sometimes addicts can actively change the content of their masturbation fantasies to experiment with different and healthier mental stimuli.  Some addicts masturbate while thinking about their spouse or partner.
  • Or addicts may simply be able to enjoy occasional masturbation as a positive, private experience that is different from their relational sex but is not part of a compulsion or an addictive pattern.

But many times masturbation loses it’s charm for sex addicts once they have given up their sexually addictive behaviors and no longer crave the hyper-arousal that their addictive fantasies provided.

 

Treatment for Partners of Sex Addicts: The Fallout and the Recovery

When a partner discovers they are in a relationship with a sex addict they are to a greater or lesser degree in a kind of post traumatic state of shock.  This means that they may not be able to sort out what they are feeling very well.

Often the first reflex is to be angry and want to reject the addict.  But I have found that the partner or spouse will usually realize that the addict has a serious problem and begin to do the leg work of finding the right kind of help.

Sometimes the partner will be interested in participating in the addict’s recovery and sometimes not.  Often the partner will be on the fence about whether they will be able to stay in the relationship.  There are many different kinds of responses to this crisis and many different ways of coping.

Some common reactions

Some spouses and partners focus too much on the addict.  They go into an emergency mode in which they concentrate their energy on the addict’s need for help that they neglect their own needs.  The feeling is to get this problem solved as fast as possible and get back to “normal.”  But the treatment for sex addiction will of necessity change the people involved in some profound ways and will therefore mean that the relationship will not go back to exactly the way it was.

Getting help for a sex addict partner is not like helping a partner get through knee surgery.  It involves the addict getting help with problems relating to intimacy.   A relationship that was one of dishonesty and compartmentalization becomes one of openness and trust.  This big picture is usually hard for either partner to discern at the outset.

Some partners feel an urge to explain away the addict’s problem.  They feel very invested in what they may think was a great relationship and don’t quite know how to adjust to the idea that there is a major problem.  One way to attempt to get clarity  is to blame themselves or other circumstances, such as a separation, a pregnancy and so on.  “If such-and-such hadn’t happened then my partner wouldn’t have felt X or Y or Z and he wouldn’t have needed to engage in sexually addictive behavior.”

But the addict does have a problem and the fact that a life stressor caused it to escalate does not mean that it is not there.

Sometimes partners are so angry at their spouse or partner that even though they do not immediately decide to leave the relationship they try to completely shut out the problem.  They say in effect: “I’m fine, you’re messed up and you need to go get fixed.”  Meanwhile, their thinking goes, I will just get on with my life, and if you get better then we’ll be a couple again.

This is also a natural response but the fact is that although the addict’s recovery is not the partner’s responsibility, the partner does have to face up to what has happened to the relationship and to the impact that it has had on them.  Eventually partners of sex addicts need to be able to recognize that the kind of betrayal they have experienced is not a small matter and that it is OK to be vulnerable to being hurt and OK to get support.  We are human and we need to be able to trust those we love.  And because we are human our loved ones can hurt us. This means we deserve help too.

What kind of help do partners and spouses need

The kind of support that partners need and want varies enormously.  I have seen spouses so devastated by sexual betrayal that they wanted and needed a residential treatment program of their own.  Other partners find it useful to get therapy with a sex addiction counselor for themselves.  They need to better understand the nature of sex addiction and the fact that they didn’t cause it and they can’t cure it.  They may need to learn to set boundaries, communicate their feelings more clearly and sort out, bottom line, what they are willing to accept and what they are not.

Most spouses and partners benefit from the support of other spouses and partners of sex addicts who are dealing with the same experiences.  This can take the form of group therapy, 12-step programs for partners of sex addicts or co-dependents generally, on online resources for educational information and websites by and for partners of sex addicts.

It is surprising how many couples survive sex addiction and go on to thrive.  The research has indicated that the participation of the spouse or partner in the process of recovery at an appropriate time is key to this success.  Both the addict and the partner need to get the right kind of help and then they need to work together to rebuild their relationship.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

The One Essential Key to Porn and Sex Addiction Recovery

Some people start recovery for sex addiction at a full gallop and never look back.  But for people who struggle with sex and porn addiction and who have multiple slips or periodic relapses there is one key thing they may be missing.

I’m not talking here about the spiritual enlightenment side of it, the so called “white light moment” or even just the daily spiritual practice.  Those are important elements but there is something much more mundane than that.

A simple idea with big ramifications

It sounds deceptively simple but the thing you need to get your head around in recovery is that your recovery comes first.  Deceptively simple because it is very hard to put this idea into practice.  For one thing although addicts may be selfish and narcissistic, that does not mean that they are any good at getting their priorities straight.

The idea that  recovery literally comes before anything else. 

You might say well what if I am having a heart attack?  Should I go to a Sex Addicts Anonymous meeting or to the emergency room?  Well of course you need to deal with really life threatening situations first.  But in day-to-day life it is important to take the commandment to put recovery first quite literally.

Why is this so important?  Because addicts find excuses to avoid getting sober.  The need for the “drug” leads to rationalizations for putting other things ahead of the addict’s own need to recover.  This is faulty logic.  And it is part of the “cunning baffling and insidious” nature of the addiction talked about in the 12-step literature.

Isn’t spending time with your kids more important than your own recovery?  My addict clients are surprised when I challenge this idea.  Off the top it seems selfish and harmful to their children to disappoint them and undermine the closeness.  But dropping the ball on your recovery work is more harmful in the long run to everyone concerned.

There is a saying in 12-step circles that “Anything you put ahead of your recovery you will lose”.

This is profound  The reason recovery comes first is that addiction is so destructive.  Over time, the un-sober addict will forfeit everything that ever mattered to him.  He will destroy relationships, jobs, money, health, and lose any chance to fulfill his potential in life.

Many addicts get stuck in a pattern of continual relapse even though they are quite diligent about going to treatment, going to meetings and so on.  Making recovery the center of your life, at least until you are well on your way (usually at least a year or two and often longer) means more than just going through the motions of getting help.

Recovering addicts may enter treatment for any number of reasons other than wanting to get over their addiction.  In fact few actually want to stop using porn or sexually addictive behaviors in the beginning.  Most likely they have come to get help because their spouse or partner threatened to leave them, because they lost their job, because they got in trouble with the law, or some other crisis situation.

The crisis motivates the addict to get into recovery in order to hold onto something else: the wife, the career, their freedom.  And yet in the long run the motivation needs to shift, the addict needs to put those things after his recovery or he will stay an addict.  He will lose the very things he came into recovery to keep.

Putting recovery first is very hard.  As if the siren song of sex addiction weren’t enough, life throws numerous other challenges our way.  We get temporarily derailed from what we need to do to stay sober.  But eventually the basic principle applies: be ruthless in your pursuit of your own need to recover.  If you think in this way nothing and no one can stop you.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Why Some Sex Addicts Keep Relapsing in Recovery

Let’s assume you are already clear on the fact that you are a sex addict.  You have consulted with experts and ruled out other causes of hypersexual behavior such as medication reactions (as with some Parkinson’s drugs) and other psychological, physical or neurological disorders. Are there any wrong reasons to get help?  Yes and no.  The initial motivation for getting into sex addiction treatment is often as a means to some other end rather than as a way to become healthier. Yet in the process of recovery the motivation moves from outside of you to inside of you; from extrinsic to intrinsic.  This is when you become truly engaged in recovery.  And this process of embracing recovery even in the absence of any outside pressures to do so is what makes it possible to enjoy solid, long term sexual sobriety.

What drives people into recovery vs. what keeps them there

There are a number of  situations that lead people to reach out for help and then stall out. 

  • Getting in trouble

This could be anything from getting arrested for indecent exposure to losing your job after being discovered using pornography at work to getting in trouble for sexual harassment.  You may get into treatment because you are required to as a result of getting in trouble. But if that remains your only reason to change you will not get too far.  You may stay committed to your addictive behavior and simply “white knuckle” your sobriety in order to meet society’s requirements.  Chances are you will correct your legal or employment situation but you will  still lack the recovery skills to stay away from sexual acting out. It is extremely hard to “embrace” recovery while you are feeling forced into it.

  • Pressure from a partner

This is by far the most common reason propelling people to seek help initially.  It’s not a bad reason, but if all you want is to get your wife back or placate your husband you will not only have a poor prognosis in recovery, you will also probably find that your partner continues to be mistrustful.  And with good reason. Partners can regain trust in a sex addict but only if they see the addict as genuinely involved in their own individual growth.  Furthermore, if you only want to get things “back the way they were” (before you were found out) then the chances are you will continue unhealthy patterns in your relationship that provided the excuse for your addictive sexual behavior.

  • Social pressures

You may find that your sexual behavior is inconsistent with the belief system of your church or community.  You want the good opinion of people you need to impress. You seek to appear to yourself and others as though you care about changing. Wanting to behave in accordance with principles is a good things except when it involves placing the locus of control outside of yourself.  You are seeing your worth as determined by what others think and not what actually works for you in your life.  This is a position of low self esteem and if it does not change in the course of treatment you may remain stuck.

  • Self image

You may be  stuck in your addiction even though you are active in treatment and support groups.  Your addiction doesn’t square with how you want to think of yourself, and yet you don’t want to give it up.  In this case you are only partially engaged in the recovery process.  You can say “I’m trying really hard but I just can’t get sexually sober.”  This allows you to let yourself off the hook while you continue to have frequent relapses.  You can go to meetings that offer you fellowship and sympathy but you don’t have to change. The way out of this involves building in serious contingency plans for “upping” your program like going into a residential program and going back into therapy in the event that you are stalled out.

The right reasons

The journey of recovery involves establishing abstinence from the behavior, working through the issues that caused the problems, building a sense of commitment, connectedness and strength, and finding a new way of living based on honesty and integrity. If recovery doesn’t start to become valuable to you for its own sake then you are likely going to stall out half way through.  You have found a way to keep one foot in denial.  Find Dr. Hatch on Facebook at Sex Addictions Counseling or Twitter @SAResource

Sexually Addictive Behaviors Connect to Early Memories

In sex addiction treatment we describe the addicts addictive sexual behaviors as “acting out” behaviors.  What does this mean?  In general when we talk about acting out it means doing something that indirectly expresses a fantasy or feeling. Often this acting out is done without awareness of the real fantasy or feeling underneath.  For example, if I lash out when I feel hurt it means that I am acting out my hurt instead of being able to talk about it.

  • The sex addict’s arousal template

You will hear recovery people talk about the sex addict’s “arousal template.”  This refers to a particular addict’s preferred sexual acting out behavior scenario.  These vary widely from person to person.  Many different sexual behaviors can be addictive for different people.  The preferred behavior may involve other people or not.  It may involve voyeurism, paying for sex, anonymous sex, serial affairs, sexual massage parlors, cybersex, exhibitionism, fetishes, and so on.

Even within these categories the behavior may be done in a particular stereotyped way by a particular addict.  And too, the arousal template may be exhibited in the type of pornography scenarios that the addict prefers.  The behavior may be perfectly legal, like viewing pornography or going to strip clubs or it may be illicit, such as child porn or sexual exploitation of the vulnerable.  Whatever it is, it may be done addictively or not.  If it is done addictively it will be done to excess, with escalating intensity, with negative consequences, and with an inability to quit.

  • The arousal template as an X-ray of early trauma

Where does this arousal template come from?  In sex addiction theory it is believed to be based in stressful experiences in childhood.   Any traumatic childhood experiences including an inadequate bond with caregivers can deprive a child of necessary supports and lead to problems in development that lead to any number of addictions as adults.

In childhood any highly charged experience has the potential to become sexualized in the course of development whether it started out as a sexual experience or not.  Take for example a patient who is raised by deaf parents who later becomes an exhibitionistic sex addict.  He grew up never being sure of getting his parents attention because they could not hear him.  He had to be looked at in order for them to know that he needed something, and in order to connect at all.  This produces intense feelings of anxiety and frustration in the child who in adolescence begins compulsively exposing himself to the young girls on the block.  This escalates into various exhibitionistic behaviors in adulthood.

In the above example, it becomes very clear that the sex addict’s addictive sexual behavior is related to early experience.  In the same way we can look at a given addict’s preferred acting out behavior and use it as an X-ray of early experiences that were intense or stressful, or that were violating or frightening.

Of course many other factors come into play in the creation of an addiction in any given person and their life experience.  There are genetic factors, temperamental factors, and family dysfunction which can all increase or decrease the risk of future addiction.

Some experiences are extremely powerful but occur too early to be remembered in words.  These experiences are stored in the brain and body but are not able to be dredged up into conscious memories.  Sometimes we can reconstruct experiences based on what we know of a person’s history and what we can deduce they may have gone through as a young child.

In any case the more strongly the person’s arousal template is connected to a childhood trauma, the more addictive they are likely to become in their sexual behavior.

  • Treatment and the arousal template

Early experiences can shape sexual behavior in ways that are an obvious reenactment of traumatic experiences.   The addict may repeat his or her victimization or may reverse the situation and take the role of the perpetrator.  It is said that repeating trauma in this way “deepens the trauma wound”.

Sex addicts do not know why they are compelled to do a particular thing.  They only know that doing that thing is their most exciting “high”.  In treatment addicts are forced to abstain from their sexually addictive behavior which allows them to begin to see what their emotional landscape looks like without their sexual drug.  This in turn opens the way to connecting with the feelings and experiences that played such a formative role in their early life.  Understanding these feelings and experiencing them instead of acting them out allows the addict to escape from the endless cycle of re-enactment of sexually addictive behavior and to learn healthy coping mechanisms for dealing with emotional stress.

Do You Need God to Live a Sober and Surrendered Life?

Here are some of my own meandering thoughts and observations.  Most anonymous programsfor treating addictions such as sex addiction and drug addiction seem to begin and end with turning something over to a “higher power.”  They begin with admitting powerlessness over an addiction and end with living an enlightened life in which we accept what we cannot control.

Do you need God to get sober in the first place?

In the beginning you are urged to admit that you cannot kick your addiction on your own, that you are powerless when it comes to your addictive behavior, that you must let go of “self will” and so on.

It is pretty clear to a lot of addicts who get sober that they were not able to kick on their own.  These are the cases where the addiction was so compelling that they finally had to reach out for help.  Does this help have to involve calling on a higher power such as God?

In the beginning every journey involves a leap of faith

So the addict who decides to go to an AA meeting or a Sex Addicts Anonymous meeting and ends up believing that he or she should give the program a try is actually making a leap of faith.  They may not see it that way but in fact they have decided to try to follow a set of instructions, like a 12-step program, even though they may have zero ability to imagine how it will work in their own case.

The same is true for an addict who enters a treatment center or who works with an addiction therapist.  In effect they are putting their faith either in a 12-step fellowship or in a program or clinician that is saying “trust us, we can help you.”

Is a leap of faith the same as belief in God?

All of us take leaps of faith at many points in our lives.  When we embark on a new endeavor or career path, or when we get married.  We do not know what is in store for us and we do what we do because we have some reason to believe that the path will take us where we want to go.  But we don’t really know.

So what kind of faith is involved?  Some people believe that there is a deity, someone watching over them and that whatever happens to them will be for the best.  But other people simply accept that they do not know where the road will lead and that they can live with the results whatever they are.

The willingness to take a leap of faith is often just the intuition that something is a good idea.  Sometimes this takes the form of believing in a mentor or guide such as a therapist or sponsor.  On some gut level we believe that we can trust someone or something and we go along with the program.

Is this a belief in God? Are we then making that person into a “higher power?”  Not necessarily.  I think often what we are doing is trusting our gut level sense of things.  We have no proof, but something gives us a sense of hope and we put our faith in our own judgment.

Is “intuition” the same as God?

One of my favorite quotes pulls these ideas together:

“If you can’t trust that the universe will, in its own way look after you and protect you, like the lilies of the field, it means that you have no trust in yourself…”

Learning to trust your own instincts, learning to believe that you have the gut level ability to make good choices and look after yourself is, I think, a belief in a higher power of sorts.  Sometimes this is experienced by people as being “guided” by a higher power in that it is not a product of conscious thought.

When a new way of looking at something or a creative idea “comes to you” it seems to come out of nowhere.   It often seems like you are listening to something on a whole other level.

My 20-something step-son has a T-shirt that says: “I used to be an atheist until I realized that I was God.”  What has been your experience?

Sex Addiction Deniers: What Makes Them So Mad?

The mere idea of “sex addiction” gets a lot of people angry.  I’m talking here about the writers who rail about the “myth” of sexual addiction and who argue that the whole idea of sex addiction is just a cop-out for the addict and a money making scam for the professionals.

The anatomy of a sex addiction denier

I prefer to see these “deniers,” as I call them, as a part of a larger societal pattern and one that is worthy of study in its own right.

Currently the opposition to the concept of sex addiction comes in two main flavors.

1.  Sex addiction is really just normal behavior.

These men and women have a defensive reaction to the whole field of sex addiction treatment as an attempt to restrain normal sexual freedoms.  Sometimes their blogs and online commentary seem to be jokingly, (nervously?) defending behavior around which they have some unacknowledged shame.  The message is “we all do it and you just think it is ‘sick’ because you are so uptight!”  This is an uninformed bias that seems to resist logic.

2.  Sex addiction is really just irresponsible behavior.

This argument comes from all quarters including some in the scientific community.  It minimizes the seriousness of the problem and the suffering it can cause, and the message is often “you so-called addicts are just behaving badly and you need to take responsibility and shape up!”

This second argument sometimes takes the form that “if sex can be an addiction then anything can,” or “if we let people off by calling it a disease then there’s a slippery slope which will lead to nobody ever taking any responsibility for anything.” (OMG!)

Both of these arguments have the net effect of saying that we shouldn’t medicalize the issue of sexually compulsive behavior and therefore that we shouldn’t actually do anything about it.  See the New York Times Op-Ed for an excellent discussion.

We need to understand the deniers, not condemn them

“Deniers” have always existed in relation to almost every unwelcome phenomenon that has emerged throughout history.  Sometimes they have taken a socially acceptable position which conforms to religious or other dogma and have acted accordingly, as in burning heretics or imprisoning the mentally ill.  In other cases they have simply veered off into crazy-sounding conspiracy theories such as that the 9/11 terrorist attacks were really a government plot or that the holocaust never happened.

These are elaborate attempts to explain or deal with something that is experienced as incomprehensible or intolerable.  In this regard they are all defense mechanisms and nowhere more obviously so than in the area of sexual addiction.

Sex addiction deniers are trudging a road well traveled in earlier eras by those who wished to defend themselves against a trend or theory that they found very threatening.  This is especially true in recent history in the evolution of the disease model of mental health. It has been very gradually that the “deadly sins” have been recast as very human psychological afflictions.

Fear and loathing as a developmental phase

Because I believe sex addiction deniers are genuinely reacting to some unconscious fear, I think professionals cannot dismiss them but rather need to understand them.  If we don’t they won’t go away and will keep confusing the public and getting in the way in much the same way that global warming deniers get in the way of protecting the biosphere.

As the superstitions and fears surrounding a social ill begin to dissipate, the issue moves through a predictable sequence in public awareness from demonization to criminalization to medicalization to reintegration.  First the problem, say alcoholism, is a moral failing, then it’s a legal problem, then a medical disease, and finally a larger societal or public health issue.

Leaving aside the issue of illegal sexual behavior, this mans that society’s current approach to sexual addiction is moving beyond demonization and criminalization but has not yet reached medicalization.  This transition to full medicalization will mean the evolution of awareness. This involves dispelling fears, confronting judgmental attitudes, and persuading people to suspend those judgments.  It is up to us to patiently explain.

Six Things That Help Marriages Survive Sex Addiction

Couples can get through the crisis of sex addiction and recovery and they very often do so, more often in fact than you would think given how traumatic the disclosure of sex addiction is to a relationship.

Part of the reason that couples can get through the upheaval of sex addiction and recovery I think is that the addiction is really not a problem that is a product of the relationship or marriage.  Sex addiction has roots that go way back into childhood attachment issues and involve patterns of coping behavior that existed well before the marriage.

The following are six basic things that couples need to know and do in order to have the best chance of having a good relationship in the future.

  1. Do the work.  Most sex addicts find it impossible to quit on their own.  I have seen couples go for years without confronting the problem and their relationship just continues to deteriorate.  Partners are often the ones who have to provide the motivation for the addict to seek treatment.  Many addicts will only get help after their partner lowers the boom.  Partners must also be in therapy.  Partners are not the cause of the problem but they need a great deal of help and support if the couple is going to make it.
  1. Get some separation from each other in the beginning of treatment.  Many couples make the mistake of trying to confront sex addiction as a couple.  Sex addiction is not that kind of problem.  Couples may have many problems as a couple in terms of openness, communication, and so on, but they can only deal with those after the sex addiction has been treated for a while.  It is actually a good idea to live separately for a while without making a decision about divorce.
  1. Abstain from sex for 6 months.  Abstaining from all sex will likely be a part of the sex addict’s program in the beginning of treatment.  (The reasons for this are described in my Pushing the Pause Button blog.)  This period of abstaining includes abstaining from sex with spouses and partners of the addict.  This may be difficult or easy, or it may seem counter-intuitive but it is part of the process.
  1. Get “pre-marital” counseling later on.  Each person gets help with their own therapist and their own 12-step support group prior to coming together to work on “the relationship.”  In other words, both people are going to undergo a lot of changes in the course of getting healthier through treatment.  In some ways each partner will not be the same person they were before.  It remains to be seen whether these two “new” people want to be together or not.
  1. Be more honest than you ever thought of being.  A healthy intimate relationship demands a level of honesty, commitment and a willingness to share all parts of yourself with your partner.  It also involves letting go of competitiveness and truly being there for your spouse or partner, not only in terms of what they ask of you but in your ability to respond to and support who they are.
  1. Be prepared to continue to work on your relationship.  It is easy to backslide and become complacent.  Old patterns and ways of behaving can creep back in (also see my blog on how sex addiction can resurface in subtle ways.)  Some couples go to couple retreats periodically or go to couple intensive workshops to give themselves a booster shot.  And be supportive of each other’s continued work in individual recovery.

Sex addiction recovery takes a long time; three to five years for substantial recovery to be achieved.  Couples who decide to stick it out together need to take a very long view.  Both addicts and partners tend to panic in the early phase of discovery and often overreact one way or the other.  But keeping a level head and reminding yourselves that it is a long process and that you can get through it will be an invaluable tool.

Why Sex Addicts Seem Sociopathic

To their partners and spouses, many sex addicts will, at some point in their addiction, seem to lack a conscience.  They may lie, cheat, exploit others, think only of themselves and disregard the harm to others.  And they will often be able to do all this while keeping up a façade of social acceptability.

When you’re around a sex addict, it’s easy to see them as a Dr. Jekyll and Mr. Hyde kind of person; liable to slip into a primitive and depraved state when your back is turned.  Sometimes even the addicts themselves feel that they are two people, one of whom is decidedly anti-social.

The majority of sex addicts (at least those we know about) are not “sociopaths.”  They do not qualify under the diagnostic term of “antisocial personality disorder.”  Their behavior takes on this appearance for some very understandable reasons.

What causes the addict to behave without conscience?

  1. Creeping Denial

Sex addicts try to avoid feeling shame.  They also know on some level that others would disapprove of their addictive behaviors.  In order to keep the feelings of guilt and shame at bay, sex addicts find ways to minimize, rationalize, or justify their behavior.  In so doing they build up a layer of denial.

Over time, this habit of denial can then spread to other areas of the addicts life leading to dishonesty and disregard for risks and consequences in general.

  1. Going it Alone

Along side of their public “normal” life, most sex addicts conduct their sexually addictive life such as anonymous hook-ups, online sex, prostitutes, strip clubs and so on, in secret.  In other words they lead a “double life.”  They are intimacy avoidant and can’t integrate their sex life into their normal life.  This leads to withdrawing from people generally and becoming a closed system, often seeming to lack empathy.

  1. Narcissistic Over-Entitlement

One of the defense mechanisms sex addicts use to justify their behavior is narcissistic over-entitlement.  They come to feel that they are special and that they deserve to act out sexually for one reason or another.  They are important, over-worked, stressed out, and just plain different from everyone else.

This is what sex addiction therapists call being “terminally unique.”  They come to feel that the rules for others don’t apply to them.

With treatment the sex addict can re-connect

The reason we know that most sex addicts we treat are not truly sociopathic is that most of them have the capacity to change the way they live.  With treatment and support they can learn not only to overcome their sexually compulsive behavior, but they can learn to live in honesty and integrity.  They can gain self esteem and drop the narcissistic mask of self importance.  And they can gain intimacy skills and connect with others.  They can experience true empathy.

Are some sex addicts real sociopaths? 

Some sex addicts actually do have a diagnosis of anti-social personality disorder. But because they lack the ability to genuinely connect with other human beings:

(1) They will not feel motivated to seek help, and will not respond to treatment, perhaps even ending up in prison, and

(2) They may not actually be addicts but may simply be as opportunistic and self-serving in their sex life as in life in general.

People with antisocial personality disorder have a poor prognosis in any case.  As you can imagine, it is important for the treating professional to understand what it is they are dealing with, but it may take some assessment to separate out the truly anti-social personality from the addict who has just built up an elaborate wall of defense and denial.

What about other diagnoses?

But you might ask “what about sex addicts having other diagnoses such as depression, bipolar disorder, or ADHD?”  There is reason to believe that sex addicts can have many different kinds of other psychological problems along side their addiction, although these other diagnoses don’t predictably cause sexually addictive behavior.

Addicts who have a co-occurring psychological disorder, such as a mood disorder, can and should get help with their psychological disorder and their sexual addiction for optimal treatment of both.

Are We Responsible For Our Sexuality?

The two recent articles, “Head case puzzle” (7/15/2012) by Robert M.  Sapolsky (a professor of neuroscience at Stanford University) and “Do pedophiles deserve sympathy?” (6/21/2012) by James Cantor ( of the Department of Psychiatry at the University of Toronto) point the way toward what will undoubtedly become an increasingly well understood science of the way in which brain wiring, injuries to the nervous system both before and after birth, childhood factors affecting brain development and genetics are all interwoven in such a way as to produce a human being who is predisposed to particular sexual acts.

But for those who want to see sex addicts and/or sex offenders as responsible for making the right choices no matter how they are wired, Sapolsky’s Op-Ed piece in the L.A. Times is a shot across the bow.

As Sapolsky points out, “Self-discipline, impulse control, gratification postponement and emotional regulation are all just as much products of biology as anything else that emanates from the brain.  The same types of evidence that allowed us to understand the role for biology in such things as abnormal sexual urges have also demonstrated a role for biology in giving in to those urges.”

Where are we with understanding sexual compulsion?

Some sex offenders and sex addicts seem to have wiring that is so messed up that they are incapable of ever gaining any connection with or empathy for another human being.  And yet we used to claim that people with “character disorders” such as borderline personality disorder were incurable too. But we now know that these “disorders of the self” as they are sometimes called are most often related to neurophysiological  issues that may be a result of early trauma and attachment issues and that they can be treated with a great deal of success.

So is sexual compulsion a disability permanently etched in the brain?

At present I believe we operate on the basis of a kind of implicitly understood continuum of biological permanence, which goes something like this:

sexual orientation  –  paraphilia  –  arousal template  – trauma reaction

In this continuum sexual orientation (gay, straight etc.) is accepted by most if not all people as hard wired in the brain if not the genome.   At the most fluid end of the scale, a trauma reaction or behavior that is in reaction to (or a repetition of) specific traumatic experiences which are often quite amenable to change through treatment.

The middle two categories are where the sex offenders and sex addicts are usually located.  Pedophilia, attraction to children, is a paraphilia like other types of sexual fixations.   It is the object of sexual attraction that is the most or only really sexually arousing person or thing.  These are seen as learned rather than innate for the most part but have been viewed as resistant to treatment.

“Arousal template” is the word used in most sex addiction therapy to refer to the sexual preferences such as dominance and submission, voyeurism and so on, which are the result of childhood experiences, early trauma and conditioning.  They are closer to trauma reactions in that with proper treatment they can be worked through and in many cases the person’s sexual behavior can come to be more “normal.”

If there is a neurophysiologically identifiable cause of the problem, we tend to see the person as less responsible for their behavior regardless of how effectively it can be treated.  Actually, the question should be not how much or little people have control over a given behavior, but how far we have come in being able to treat it.  The question of responsibility is one that the legal and philosophical systems rely on but ultimately it has little to do with the scientific reality of the prospects for treatment and recovery.