Sexual addiction and compulsion: recognition, treatment, and recovery

The management of patients with compulsive sexual behavior requires an understanding of the profile of the sexually compulsive or addicted patient. This article summarizes patient characteristics and their implications for treatment. Data from a study of the recovery of 957 patients who had problematic, sexually excessive behavior are presented. Spanning 5 years, the study shows six distinct stages patients experienced and the clinical activities that were most useful to them. A trajectory of a typical diagnosis and treatment path is provided, as well as important resources for physicians and patients.     

Compulsive and addictive sexual disorders and the family

In the treatment of sexual addiction and compulsivity, the family unit is often neglected. Yet this disorder has a major impact not only on the identified patient, but also on the spouse or partner (the coaddict) and on the family as a whole. Moreover, the family unit is the context in which the sexual addict continues to live, and the mental health of the partner has a significant impact on the sexual addict's recovery. Increasing evidence points to a family history of addiction or dysfunction as a primary contributor to both sexual addiction and coaddiction in adulthood. When compulsive sexual behaviors are present within a family, treatment of both members of the couple improves the couple's relationship as well as the mental health of each partner. In addition, treatment of children in such a family can help break the cycle of sexual addiction and prevent its perpetuation into the next generation.     

Sexual addiction and clergy

In this article the concept of sexual addiction is defined and briefly illustrated. It is argued that this is a viable concept for understanding the sexual misconduct, including abusive and exploitive activity, of some clergy. The author believes that sexual addiction becomes intertwined with the role of pastor to form the identity of the sexually addicted clergy. A typology of how is offered. It is concluded that pastoral role is used by clergy in an attempt to manage their sexual addiction, deny its presence, and minimize its consequences both to themselves and to victims. It is urged that this understanding will help provide healing to sexually addicted clergy and the Church.Mark R. Laaser, Ph.D., is a faculty member of the Institute for Behavioral Medicine of Golden Valley Health Center in Golden Valley, MN. He specializes in teaching about sexual addiction and clergy. He received a M.Div. from Princeton Theological Seminary and the Ph.D. from the University of Iowa in the field of religion and personality.     

The Sexual Compulsivity Scale: further development and use with HIV-positive persons

We examined the reliability and validity of the Sexual Compulsivity Scale for use in assessing HIV-positive men and women. Measures collected from 287 men and women recruited from the community, the majority of whom were African American and over the age of 30, showed that the Sexual Compulsivity Scale was reliable for men (alpha = .89) and women (alpha = .92). Correlations with measures of sexual behaviors and numbers of sex partners supported the concurrent validity of the Sexual Compulsivity Scale for men and women. Results of discriminant function analyses that included participant age, use of nonalcohol drugs, the Sexual Compulsivity Scale, and scores on measures of trait anxiety, obsessive-compulsiveness, future pessimism, cognitive depression, and borderline personality characteristics showed that sexual compulsivity clearly discriminated between persons with 1 or no sex partners and persons with multiple partners in the past 3 months, for both men and women, suggesting evidence for criterion-related validity. Associations between sexual compulsivity scores and other markers of psychopathology showed different patterns for men and women; sexual compulsivity was associated with indexes of psychopathology in men but not in women. We conclude that the Sexual Compulsivity Scale is reliable and valid in assessing men and women infected with HIV, although sexual compulsivity may present differently between genders in relation to other forms of psychopathology.     

Boredom Proneness,Social Connectedness,and Sexual Addiction Among Men Who Have Sex With Male Internet Users

The authors collected surveys from 517 men who have sex with men (MSM) recruited from Internet chat rooms to examine the relationships among boredom, social connectedness, and sexual addiction. The results provide addictions professionals psychosocial factors to assess when working with sexually addicted MSM.     

Sexual Sensation Seeking and Sexual Compulsivity Scales: Validity,and Predicting HIV Risk Behavior

Two studies are presented that evaluate newly developed scales of sensation seeking and sexual compulsivity. Results showed that the scales were reliable and correlated with convergent and divergent measures in expected directions in samples of both gay men (N = 296) and inner city low-income men and women (N = 158). Consistent with theories of sensation seeking, the scales corresponded to an attraction toward a range of sexual practices, including increased frequencies of unprotected intercourse and a greater number of sexual partners. As expected, sexual compulsivity was not related to variety and novelty in sexual practices, but was associated with lower levels of self-esteem and resistance to adopting sexual risk-reducing strategies. However, important differences were observed between the gay men and heterosexual samples; scales correlated with substance use only among gay men, and sexual compulsivity was related to a range of sexual practices only among heterosexuals. The sensation seeking and Sexual Compulsivity Scales were therefore reliable, appeared valid, and useful in predicting sexual risk behaviors.     

Embracing darkness: clinical work with adolescents and young adults addicted to sexual enactments

This paper described common themes and transitions in the treatment of adolescents and young adults presenting as addicted to sexual enactments. Central to their experience is a highly addictive reliance on a bad object, which both enables and relies upon sexually perverse enactments. The paper follows the therapeutic process with patients seen in either group or individual long-term psychotherapy. Their experience is understood in the context of theories central to the work at the Portman Clinic relating to perversion and addiction, combined with some ideas from the field of criminology. Patients usually start by noticing their relationship with their compulsive behaviour, moving from a passive stance to a perception of themselves as active agents. They discover moments that are described as ‘pressing a button’, at which they move from passivity to taking perverse action. Those insights lead to a slowing down of the addictive cycle and emergence of phantasies, core complex anxieties and even hopes, all desperately avoided by taking sexualised action. The paper follows a pathway of change and transformation, which when successful enables patients to reduce or cease addictive behaviours by coming in contact with a good object, enabling both emotional pain and the experience of potency and hope.     

Social olfaction in male brown lemmings (Lemmus sibiricus = trimucronatus) and collared lemmings (Dicrostonyx groenlandicus): I. Discrimination of species, sex, and estrous condition

When tested in a Y-maze olfactometer, sexually experienced and sexually naive brown and collared lemmings (Lemmus sibiricus = trimucronatus and Dicrostonyx groenlandicus) preferred the odor of conspecific females to the odor of females of another species. Both experienced and naive males also preferred the odor of conspecific females to that of conspecific males. Only sexually experienced males showed a significant preference for estrous over nonestrous conspecific females. Sexually experienced males also discriminated between estrous and nonestrous heterospecific females of a familiar (lemming) and unfamiliar (meadow vole, Microtus pennsylvanicus) species. In conjunction with the results of earlier studies of the development of species-specific olfactory preferences, these findings suggest that two olfactory cues mediate a male's attraction to receptive females: a species-specific odor that is learned during early development and a sexual attractant whose saliency is established as a result of adult experience with a receptive female.     

The Effects of Training on Perceptions of Sexual Harassment Allegations

This study of 176 college juniors examined the effects of respondent gender and sexual harassment training on the perceptions of what constitutes sexual harassment in the workplace. Variation in these perceptions, due to severity of the sexually oriented behavior, was also examined. Regardless of the subject's gender, individuals who 6 weeks earlier had seen a training film about sexual harassment rated severe sexually oriented work behaviors as more harassing than did individuals who had not seen the film. Additionally, males who had not seen the film rated ambiguous sexually oriented behaviors as less harassing than did males and females who had seen the film, and as less harassing than females who had not seen the film. Implications for the importance of training in addressing sexual harassment are discussed.     

GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing–based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.     

Personality characteristics of Hare Krishnas

Personality characteristics of 132 males and 94 females of the Hare Krishna movement were assessed using the Comrey Personality Scales (CPS). Subjects were sampled from eight U.S. sites. Their age averaged about 30 years, and their time in the movement averaged 8.6 years. The most prominent and surprising finding is the hallmark characteristic of the Hare Krishna personality, a strong compulsivity trait common to both genders, which is slightly stronger in males. Reduced trust in society was exhibited by both gender averages, with slightly less trust among females. Both these averages, however, were within the normal range for individuals. With the exception of compulsivity, average male CPS scores were within the normal psychological range but differed significantly from the normative male group indicating idiosyncratic traits. Average female CPS scores did not differ significantly from the normative female group except for compulsivity and trust. Study of CPS score distributions about group means supported these findings.     

Assessment of sexual preference using a choice reaction time task

The purpose of this study was to investigate the use of a choice reaction time task, during which slides of sexually explicit and neutral stimuli were used as an interference task, to differentiate between groups of individuals on the basis of their sexual preference. Twenty subjects, in each of the four groups (heterosexual males, heterosexual females, homosexual males, and homosexual females), participated in this study. Sexual orientation was determined by self-report. Subjects were given a choice reaction time with interference task, followed by a recall incidental learning task. A significant higher-order interaction was found among gender, orientation, and stimulus type for all four groups. This interaction indicated a longer reaction time to slides depicting preferred sexual partners than to nonpreferred sexual partners or neutral scenes. These results indicate that sexual arousal does interfere with cognitive processing. A main effect for gender was found for the incidental learning task, with males having the fewest errors.     

Treating the Sexually Addicted Client: Establishing a Need for Increased Counselor Awareness

Seventeen to 37 million Americans struggle with sexual addictions (P. Carnes, 1994b; A. Cooper, D. L. Delmonico, & R. Burg, 2000; B. Morris, 1999; J. L. Wolf, 2000), yet traditionally trained addictions and offender counselors often find themselves unprepared to assist clients who are sexually addicted. This article provides a general overview of the disorder, explores the ongoing definition debate, and offers clinically proven treatment protocols.     

Personality Characteristics of Hare Krishnas

Personality characteristics of 132 males and 94 females of the Hare Krishna movement were assessed using the Comrey Personality Scales (CPS). Subjects were sampled from eight U.S. sites. Their age averaged about 30 years, and their time in the movement averaged 8.6 years. The most prominent and surprising finding is the hallmark characteristic of the Hare Krishna personality, a strong compulsivity trait common to both genders, which is slightly stronger in males. Reduced trust in society was exhibited by both gender averages, with slightly less trust among females. Both these averages, however, were within the normal range for individuals. With the exception of compulsivity, average male CPS scores were within the normal psychological range but differed significantly from the normative male group indicating idiosyncratic traits. Average female CPS scores did not differ significantly from the normative female group except for compulsivity and trust. Study of CPS score distributions about group means supported these findings.     

Compulsive buying behavior: Re‐evaluating its dimensions and screening

Despite the significant research in the consumer behavior literature on compulsive buying behavior (CBB), there is still no general agreement about the dimensionality or diagnostic screening of the disorder. Previous studies have identified two principal dimensions: compulsivity and impulsivity, although more recent strands of theory characterize CBB with reference to loss of self‐control and behavioral addiction. This study challenges the impulsive–compulsive paradigm by validating a new model with compulsive and self‐control impaired spending dimensions. The model more closely reflects the disorder's ego‐dystonic character, routed in an anxiety‐based reactive mechanism with uncontrollable buying and an inability to rationalize the behavior and its consequences. The study also develops and cross‐validates a new seven‐item CBB screening tool, using a comparative analysis with three existing screeners and an independent sample. The findings indicate that compulsive buying results from both compulsive and self‐control impaired impulsive elements, which are characteristic of behavioral addiction.     

The internet and its role in the escalation of sexually compulsive behaviour

As increasing numbers of patients present with problems of compulsive use of internet sex and internet pornography, psychotherapists are challenged to develop models that address the powerful, and potentially disturbing effect of this stimulus. Internet sex does not just facilitate access to sexual materials but can act as a catalyst, affecting established defences and ego and superego functioning. Escalation in sexually compulsive behaviour, which affects a small proportion of those accessing online sex, may be thought of as a series of transitions: from casual to compulsive use, from compulsive use to illegal use, and from use of illegal pornography to contact offending. Drawing on clinical experience and the available research evidence, psychodynamic processes associated with movement through these transitions are considered. Internet sex has the potential to fuel manic defences, invites narcissistic and part-object relating, provides a vehicle for the expression and disowning of sadistic impulses and can potentially undermine superego functioning. The combined effect of these processes may lead to a breakdown of ego controls in vulnerable individuals.     

Sexual Addiction and the Internet: Implications for Gay Men

The authors present an overview of sexual addiction and explore the relationship between Internet use and sexual compulsivity. The role of Internet use in gay men's sexual behavior is described. Implications for the counseling profession are discussed, and a clinical case study is presented.     

Family Functioning Moderating the Effects of Childhood Sexual Abuse on Memory Specificity

The main goal of this study was to investigate if adults sexually abused as children who were raised in a functional family are more able to generate specific autobiographical memories and suffer fewer depressive symptoms than sexually abused adults who were raised in a dysfunctional family. We found that abused males retrieved fewer specific memories than nonabused males, abused females, and nonabused females. The three latter groups did not differ from each other. Further, childhood sexual abuse did not predict depression among males and females. After accounting for family functioning, there were no group differences regarding memory specificity. Functional families appear to have beneficial effects on the adjustment of male victims of childhood sexual abuse.     

Effects of sexual attitudes and physical attractiveness on person perception of men and women

A sample of 180 males and 180 females completed person perception measures for stimulus women who varied in physical attractiveness and permissiveness of sexual attitudes. The results indicated that both physical attractiveness and sexual attitudes had strong effects on peson perception. Physically attractive stimulus women were rated higher than the unattractive stimulus women on a physical appeal factor and an item measuring interpersonal attraction. The sexually conservative women were rated higher on an evaluative factor, lower on a personability factor, and higher on the interpersonal attraction item than the sexually permissive stimulus women. It was also found that the effects of physical attractiveness were greater for males than for females and that women rated the sexually permissive stimulus women less favorably than did men.     

From “I Want To Hold Your Hand” to “Promiscuous”: Sexual Stereotypes in Popular Music Lyrics, 1960–2008

Media content analyses indicate that gender-based differences in sexuality are common and consistent with gender stereotypes. Specifically, women are expected to focus on love and romantic relationships and have sexually objectified bodies, while men are expected to focus on sexual behavior. Although decades of research have documented the presence of these stereotypes in a broad variety of visual media, much less is known about the content of popular music lyrics. Relying on a database of 1250 songs across five decades (the top 50 songs from even-numbered years from 1960 through 2008), we documented the presence or absence of a dating relationship, the word “love” (and its uses), sexual activity, and sexual objectification of females and males (separately). Analyses revealed that the vast majority of songs addressed at least one of these themes, primarily dating relationships. Although female performers were proportionally more likely to address romantic relationships than male performers, raw counts reversed this pattern because male performers substantially outnumbered female performers. Males were proportionally more likely to sing about sexual behavior and to objectify both females and males. References to romantic relationships became less common over time, while references to sexual behavior and objectified bodies became more common. Content varied across genres, with rap being the least likely to reference dating and most likely to reference sexual behavior. Implications for sexual development are discussed.