What Sexual Scientists
Know About Compulsive Sexual Behaviour
This article was
referenced by the guest pychologist who spoke at the January 2000 meeting
Note: In her speech
she was articulating that BDSM is not a deviant lifestyle and was
using the following article to help make her case.
http://www.ssc.wisc.edu/ssss/wssk_csb.htm
The Society for
the Scientific Study of Sexuality
PO Box 208
Mount Vernon
IA 52314-0208
Ph 319-895-8407
Fx 319-895-6203
TheSociety@worldnet.att.net
What Sexual Scientists Know About...
Compulsive Sexual Behavior
Compulsive
Sexual Behavior
Can sex become
compulsive? Like most behaviors, sex can be taken to its obsessive
and compulsive extremes. Sexual obsessions and compulsions are recurrent,
distressing and interfere with daily functioning. Many people suffer
with these problems but finding consensus about them among sexual
scientists or treatment
professionals is not easy. This makes it more difficult for those
suffering from compulsive sexual behavior (CSB) to get the appropriate
help they need. For those who want to know more about this problem,
it is helpful to know about the types of CSB, the various theoretical viewpoints
and treatment approaches. While there are many types of compulsive
sexual behavior, they can be divided into two main types: paraphilic and
non-paraphilic CSB. Sexual scientists have used various terms to describe
this phenomenon: hypersexuality, erotomania, nymphomania, satyriasis, and
most recently sexual addiction and compulsive sexual behavior. The
terminology has often implied different values, attitudes, and theoretical
orientations.
Paraphilic
CSB
Paraphilic behaviors
are unconventional sexual behaviors which are obsessive and compulsive.
They interfere with love relationships and intimacy. While John Money(1)
has defined nearly 50 paraphilias, the Diagnostic and Statistical
Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association
has currently classifed eight paraphilias and these are generally considered
the most common:
*
pedophilia (sexual attraction to pre-pubescent children)
*
exhibitionism (sexual excitement associated with exposing one's genitals
in public)
*
voyeurism (sexual excitement by watching an unsuspecting person)
*
sexual masochism (sexual excitement from being the recipient of the threat
or
administration of pain)
*
sexual sadism (sexual excitement from threatening or administration of pain)
*
transvestic fetishism (sexual excitement from wearing the clothing of the
opposite sex)
*
frotteurism (sexual excitement from touching or fondling an unsuspecting
person) (2)
In the recent
DSM-IV, the paraphilias are defined as "recurrent, intense sexually
arousing fantasies, sexual urges, or behaviors involving 1) nonhuman objects,
2) the suffering or humiliation of oneself or one's partner, or 3) children
or other nonconsenting persons ... The behavior, sexual urges, or
fantasies cause clinically significant distress in social, occupational,
or other important areas of functioning (p. 522-523)." Some
behaviors, such
as sado-masochism when they are consensual and do not impair life functioning
are not considered a paraphilia because they do not eet all the diagnostic
criteria.
Nonparaphilic
CSB
Nonparaphilic CSB
involves conventional sexual behaviors which when taken to an extreme are
recurrent, distressing and interfere in daily functioning. One example
is given in the DSM under the category of Sexual Disorders Not Otherwise Specified.
The authors of the DSM describe an
example of "distress about a pattern
of repeated sexual relationships involving a succession of lovers who are
experienced by the individual only as things to be used" (p.538). Other
forms of nonparaphilic CSB include: compulsive fixation on an unattainable
partner, compulsive masturbation, ompulsive love relationships, and compulsive
sexuality in a relationship.(3)
The Danger of
Overpathologizing this Disorder
The possibility
of overpathologizing this disorder is the main criticism given by those who
do not believe in the idea of compulsive sexual behavior as a disorder.
The pathologizing of sexual behavior may be driven by anti-sexual attitudes
and a failure to recognize the wide-range of normal human sexual expression.
This caution is important when assessing whether a person is engaging in compulsive
sexual behavior. It is important for professionals to be comfortable
with a wide range of normal sexual behavior - both in types of behaviors
and frequency. Sometimes individuals with their own restrictive values
will diagnose themselves with this disorder, creating their own distress.
Therefore it is very important to distinguish between individuals who have
a values conflict with their sexual behavior and those who engage in obsessive
sexual behaviors.
A Conflict
Over Values
There is an inherent
danger in diagnosing CSB simply because someone's behavior does not fit the
values of the individual, group or society. There has been a long tradition
of pathologizing behavior which is not mainstream and which some might find
distasteful. For example, masturbation, oral sex, homosexual behavior,
sado-masochistic behavior (S-M) or a love affair could be viewed as compulsive
because someone might disapprove of these behaviors. However, there
is no scientific merit to viewing these behaviors as disorders, compulsive
or "deviant." When someone is distressed about these behaviors, they
are most likely in conflict with their own or someone else's value system
rather than this being a function of compulsion.
Problematic Vs.
Compulsive Sexual Behavior
Behaviors which
are in conflict with someone's value system may be problematic but not obsessive-compulsive.
Having sexual problems is common. Problems are often caused by a number
of non-pathological factors. People can make mistakes. They can
at times act impulsively. Their behavior can cause problems in a relationship.
Some people will use sex as a coping mechanism similar to the use of alcohol,
drugs, or eating. This pattern of sexual behavior can be problematic.
Problematic sexual behavior is often remedies by time, experience, education
or brief counseling. Obsessive and compulsive behavior, by its nature,
is much more resistant to change.
Developmental
Process vs. Compulsive Sexual Behavior
Some sexual behaviors
might be viewed as obsessive or compulsive if they are not viewed within their
developmental context. Adolescents, for example, can become "obsessed"
with sex for long periods of time. In adulthood, it is common for
individuals to go through periods when sexual behavior may take on obsessive
and compulsive characteristics. In early stages of romance, there is
a natural development period where an individual might be obsessed with their
partner and compelled to seek out their company and express affection.. These
are normal and healthy developmental processes of sexual development and
must be distinguished from CSB.
What Causes
CSB?
Disagreement exists
as to whether CSB is an addiction, a psychosexual development disorder, an
impulse control disorder, a mood disorder, or an obsessive-compulsive disorder.
Patrick Carnes (4) popularized the concept of CSB as and addiction.
He believes that people become addicted to sex in the same way they become
addicted to substances or behaviors. However, many dispute the idea
that you can become addicted to sex in the same way that someone becomes
addicted to alcohol or sex. Despite this criticism, sexual addiction
has become a poplar metaphor similar to "workaholism." Twelve-step programs
of spiritual recovery (similar to Alcoholics Anonymous) have become popular
solutions to those who view CSB as an
addiction. However, the "abstinence
model" useful for alcoholics, cannot be applied to sexuality since sexual
expression is a basic need of life. Critics view the abstinence solution
as an oversimplification of CSB and potentially dangerous when proper medical
and psychological treatment is not provided.
Different explanations
have been given as causes of CSB. Robert Stoller (5) was a strong advocate
of psychodynamic factors. His theories have been helpful to our understanding
of inner conflicts which fuel obsessive and compulsive drives. Others
have suggested factors of anxiety, mood and
personality disorders. In some
cases, CSB can result from a bipolar mood disorder. In other cases,
CSB can be caused by a neurological disorder such as epilepsy or Alzheimer's.
John Money has assisted us to understand the complex interplay of biological,
psychological and environmental factors in CSB. CSB in some cases may
be caused by irregular chemical functions in the brain which produce repetitious
nature of the self-defeating behavior. In this model, CSB is driven
by anxiety where certain sexual behaviors provide temporary relief of the
anxiety but is followed by further anxiety and distress - creating a self-perpetuating
cycle.(6)
Since CSB is such
a complex disorder involving biological, psychological and social factors,
a careful assessment by a well trained professional is necessary. Because
of disagreements in theoretical approaches, the lay person should ask the
professional about his/her own theories on CSB and consider other professional
opinions.
Treatment of
CSB
While disagreement
exists about the nature of CSB, treatment professionals have generally found
a combination of psychotherapy and prescription drugs to be effective in
treating CSB. While medications which suppress the production of male
hormones (anti-androgens) are used to treat a variety of
paraphilic disorders,
newer anti-depressants such as Prozac (R), Zoloft(R) or Paxil(R) which selectively
act on serotonin levels in the brain are also effective in reducing sexual
obsessions and compulsions and their associated levels of anxiety and depression.
These newer medications interrupt the obsessive-compulsive cycle of CSB
and help patients use therapy more effectively. The advantages of these
anti-depressants over older anti-depressants or anti-androgens are their
broad efficacy and relatively few known side effects.
How Does One Know
if He/She Needs Help Regarding CSB?
The following questions
are examples of those used in assessing and treating CSB.
1. Do you,
or others who know you, find that you are overly preoccupied
or obsessed with sexual activity?
2. Do you
find yourself compelled to engage in sexual activity in
response to stress, anxiety, or depression?
3. Have
serious problems developed as a result of your sexual behavior
(e.g., loss of a job or relationship, sexually transmitted diseases,
injuries or illnesses, or sexual offenses)?
How Does Someone
Find a Professional Who Has the Expertise in Assessment nd Treatment of CSB?
There are several
ways to find qualified professionals.
*
Call your state licensing boards for psychologists, psychiatrists,
social workers, or marriage and family therapists who have a
specialized competence in treating compulsive sexual behavior.
*
Inquire through college or university psychology, psychiatric or counseling
departments.
*
Ask professionals for their credentials in treating compulsive sexual
behavior (e.g., certified sex therapist).
Summary
Compulsive sexual
behavior is a serious psychosexual disorder which can be identified and treated
successfully. CSB does not always involve strange and unusual sexual
practices. Many conventional behaviors can become the focus of an
individual's obsessions and compulsions. The exact mechanism of CSB
is still under debate and various treatment approaches have been developed.
Research is needed to further clarify the nature of the disorder, the mechanisms
involved, and to test the most effective treatment
approach.
In the meantime, individuals suffering from CSB should not hesitate to seek
professional guidance to properly assess their problem and to find help through
counseling and treatment.
References
1. Money,
J. (1996). Lovemaps: Clinical Concepts of Sexual/Erotic Health
and Pathology, Paraphilia, and Gender Transpositions in Childhood,
Adolescence, and Maturity. New York, NY: Irvington Publishers.
2. American
Psychiatric Association. (1994). Diagnostic and Statistical
Manual of Mental Disorders. 4th ed. Washington, D.C.: American
Psychiatric Association.
3. Coleman,
E. (1992). Is you patient suffering from compulsive sexual
behavior? Psychiatric Annals, 22(6), 320-425.
4. Carnes,
P. (1983). Out of the Shadows: Understanding Sexual Addiction.
Minneapolis, MN: CompCare Publishers.
5. Stoller,
R. (1975). Perversion: The Erotic Form of Hatred. New York:
Pantheon.
6. Coleman,
E. (1991). Compulsive sexual behavior: New concepts and
treatments. Journal of Psychology and Human Sexuality. 4(2), 37-52.
Written by Eli
Coleman, Ph.D. Professor and Director of the Program in
Human Sexuality,
Department of Family Practice and Community Health,
University of Minnesota
Medical School, University of Minnesota.
Series Edward S. Herold, Ph.D.
Editor: Patricia Aletky, Ph.D.
Reviewers:
Linda Perlin Alperstein,
M.S.W.
Volume 2(1), 1996
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(c)1999 The Society for the Scientific Study of Sexuality
P.O. Box 208
Mount Vernon, IA 52314 U.S.A
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