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

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 PsychCentral.com

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.

Continue reading

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.

Continue reading

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

Losing a Partner Complicates Sex Addiction Recovery

A sizable number of couples stay together through the upheaval of sex addiction. According to my educated estimate about half of all sex addicts in sex addiction recovery are working with a partner to try to repair the relationship.

By the same token many sex addicts end up losing their partner following the disclosure of sex addiction and the ensuing crisis. I have found that there are complications for recovery in both situations.

If the sex addict’s partner chooses to stay in the relationship, then the sex addict has certain advantages. The presence of a partner (and possibly children) very often provides a strong motivation for the addict to follow through with treatment and recovery. No matter what the addictive behavior, internet porn, prostitutes, hook-ups, etc. the married sex addict has a lot to lose by failing to get “sober”.  Also the presence of a partner adds a level of accountability. If the addict is truly engaged in recovery, then he or she will be committed to transparency and honesty with a partner and in general. Agreeing to tell all can help to give the addict a reason to be more conscientious about avoiding situations that might lead to relapse.

But what happens when the addict comes clean to a partner, becomes sincerely engaged in recovery and then the partner or spouse leaves? I would like to share my observations as to the impact of divorce on sex addiction recovery; both the negative impact and to whatever extent, the positive impact as well .

Negative impact of break-ups

  • Apart from the loss of motivation and accountability that was connected to the relationship, separation and divorce add serious emotional stresses to the situation. The end of any relationship, even a bad one, is experienced as a loss. This means that even for a person who was not struggling with addiction and recovery, there would be grief and deep feelings of abandonment.
  • As I have discussed elsewhere,  sex addicts tend to be highly co-dependent themselves even though they have lead a secret life outside their relationship. They are insecure and tend to base their self worth on the perceptions of others. The rejection of a break-up only reinforces their feeling of unworthiness which in turn can derail any new found sense of strength in recovery.
  • The turmoil surrounding a separation or divorce can become a serious distraction from the addict’s recovery routine. The mechanics of leaving familiar surroundings, finding a place to live, arranging to see their children if there are any, and dealing with the legal process of impending divorce proceedings can sap the addict’s energy and resources.
  • Addicts in a break-up will be experiencing a great deal of emotional pain and distress. Their typical way of dealing with negative emotions in the past was through escape into their addictive behavior. Thus the added emotional distress of shame and rejection increases the motivation to reach for their “drug”.
  • Most sex addicts have a problem dealing with boredom and loneliness without wanting to act out sexually. Isolation is not helpful to sex addiction recovery and the fact of suddenly being on their own can be a big risk factor, especially if break up has left them feeling less motivated to engage with supportive people.
  • The addict can become obsessed with the partner who has rejected them, thus leading them into destructive fantasies and delusional thinking. They may fantasize that they can win the partner back, or they may ruminate and become angry and resentful. They may also become obsessed with finding a new partner immediately in order to bolster their damaged sense of self and restore parity with the person they have lost. All of this obsessing and emotion pulls the addict away from reality and from the need to address their own recovery and growth.

Is there any upside to break-ups?

Obviously there may be advantages for the spouses and partners who feel that moving on is in their own best interests. But what about the addict? I believe that after the immediate crisis of the break-up and its impact on sex addiction recovery have subsided, the addict will be in a better position to assess the intimacy problems that almost certainly characterized the relationship. I contend that practicing addicts are drawn to partners and styles of relating that do not demand. In that sense, I think the practicing addict promoted a sort of dysfunctional situation both because it was somehow familiar and because it provided a situation that at once allowed and was an excuse for sexual acting out.

In sex addiction recovery, the divorced or separated addict has a chance to recover from the addiction and to learn a new kind of relating built on intimacy and trust.

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

It’s OK to Have Bad Sex: The Sex Addict’s Difficult Adjustment

Sex addicts tend to be perfectionists.  And this is especially true in their attitude toward sex.  They are known for their all-or-nothing thinking, the tendency to view the world in terms of extremes.  In their sex life with a partner, sex addicts in recovery tend to carry with them an extreme and basically intolerant set of expectations. Just as an aside, there have been a slew of blogs and research survey findings that suggest that we are all having our sexual expectations distorted by the increasing pornification of our culture.  Some in the “feminist porn” movement and elsewhere have attempted to fight the idealized images and expectations shown in mainstream porn and in the “ambient porn” of movies, games, magazines and TV.  See also my journal article the findings of the APA task force on the sexualization of girls in our society.

The over importance of sex and orgasm

Sex addicts have as a core belief that sex is their most important need.  Thus sex addicts place an undue emphasis on sexual arousal and gratification.    Even before the advent of internet porn, sex addicts have always tended to be in a hurry to get to the sex act and to achieve the perfect orgasm.  If this didn’t happen all was lost. Having permission to have “bad sex”, i.e. sex that doesn’t match some perfect ideal, is a way to counteract the desperate need that sex addicts feel.  It can help relieve the pressure and can allow for times when the partners feel less energetic, more sensual etc.  It takes the focus off of “getting my needs met” and places it more on just having a sexual, physical experience with someone you are close to.

Fantasy standards of desirability

Because sex addicts are used to engaging in sex that is excessively loaded with fantasy content, (sex with strangers, cybersex, escorts, strip clubs, and of course pornography) they usually have perfectionistic (fantasy ridden) ideas about how women’s and men’s bodies should look.  This then results in the feeling that any sex with someone who doesn’t measure up to a fantasy standard of beauty or prowess is no good.  Hence the saying that to an addict “sex with a real woman is just bad porn.”

Unrealistic expectations about sexual behavior

Sex in the context of a relationship may seem boring to a sex addict.  In a real situation the addict has to deal with all kinds of awkward, messy and most importantly unpredictable elements.  These will almost certainly burst the addict’s fantasy bubble. In addition, sex addicts are used to fantasy scenarios that may involve all kinds of erotic behavior that their partner may not wish to engage in. We are asking the recovering sex or porn addict to adjust to what they may see as “plain vanilla” sex.

Paradoxically, sex in real life may also be more unpredictable and less boring.  Sex addicts are used to controlling the sexual experience from beginning to end.  In sex addiction, the addict has a preferred scenario or arousal template. This can evolve and escalate into more extreme behaviors, but the addict knows what he or she is going to get.  Real, relational sex is not so predictable.  This means things may end up unusually exciting and passionate or they may end up less so.

Expectations of hyper-arousal and porn induced ED

In addictive sexual acting out, the addict seeks a very extreme form of arousal and often seeks to prolong it.  This level of extreme or hyper-arousal is unlikely to exist in any everyday situation.  Furthermore there is beginning to be evidence that porn addiction in particular can lead men to experience erectile dysfunction when they attempt to have sex with a real person.  This porn induced ED, as it is called, is reversible when the addict abstains from porn use for a period of time.

The use of ED drugs like Viagra is becoming increasingly prevalent, even among younger men and men who don’t need it.  Addicts in particular may have exaggerated ideas about what they need to be able to do to “perform” sexually and may be very anxious in trying to have healthy sex with a partner.  It is normal for men to have a physical response to what is going on around them and sexual “performance” can vary for any number of reasons.  It is unfair, inaccurate and inhumane to see these fluctuations as a sign of something wrong or bad.  In recovery there is often a period of insecurity about sex but this is not a signal to panic and reach for ED drugs.

Sex can be a good thing no matter how it turns out

Sex addicts are so zeroed in on sex as central to life that they don’t realize that it is only one aspect, not the be-all and end-all.  Sex addicts find it hard to fathom the idea that, for many people, sex is great but has its proper place among many other great things in life.  In relationships sex is no doubt very important but it is a source of bonding as well as excitement and gratification.  The behavior of the partners and the level of arousal will exist in a broader spectrum or array of experience.

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

Sex Addicts are Codependents Too

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

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

-are sexually compulsive outside of the relationship

-are intimacy avoidant

-use coping skills which create distance

-lead a double life

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

-fearful of abandonment

-enmeshed and preoccupied with their partner

-emotionally constricted or volatile

-subject to self-doubt and insecurity.   

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

Origins of codependence

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

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

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

In what way are sex addicts codependent?

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

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

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

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

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

I think of the disease of codependence as a tree. 

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

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

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