We all have known a villain or two. Even the sex addiction treatment community has villains. Why are these people villains?
Because they question the validity of sex addiction.
Two, in particular, come to mind, though upon reflection they are not the same.
The first villain, Dr. David Ley, is a rather publicly outspoken opponent of the idea of sex addiction. He is a clinician, writer, and sometimes public debater of Dr. Rob Weiss.
The second villain is Dr. Prause. She is an academic and researcher from the University of California with a prolific CV. Her publications appear in peer reviewed scientific journals. Her argument against sex addiction as a concept is more theoretical and based on the scientific concept of validity.
Listening, Not Just Hearing
Imagine my surprise, after spending three hours in an Association for the Treatment and Prevention of Sexual Abuse (ATSA) training on Compulsive Sexual Behavior Disorder (CSBD), that the first plenary speaker of the ATSA conference was Dr. Prause making her case against sexual addiction.
To be completely honest, I have not read much of her scientific work.
My knowledge of her is second hand from a community that does not consider her a friend.
I had two choices:
- Sit and listen to the talk from a position of defensiveness based on my belief in CSBD.
- Sit and listen from a place of openness and process her information with an open and clear mind.
Do you believe your sexual behaviors are compulsive or harmful to you or others? Then you should take the CSBD-19 free, validated self-assessment tool.
Giving the Villain a Chance
I put on my open-minded researcher hat and listened to her talk entitled Psychophysiology and the Failure to Discriminate Sexual Compulsion as a New Disorder. Her talk focused on two key components of proving the construct validity of a theory.
Particularly, she focused on convergent and discriminant validity.
As a recap for those who did not endure lots of research methods in school:
- Convergent validity is a type of construct validity that tests whether things that should be related are related.
- Discriminant validity, on the other hand, tests whether constructs that should not have a relationship do not have a relationship.
In looking at these two types of construct validity, Dr. Prause is addressing whether our measures of assessing sexual addiction are related and whether sexual addiction is different than other things such as depression.
As professionals, our time is valuable. Dr. Weeks created the Mitigation Aide Research Archive because there isn’t enough focused, data-backed research available in easily digestible formats.
Determination of a New Disorder
We often point to Voon et. al (2014) as a neuroscientific study that lends support to sexual addiction because the results of the self-determined sex addicts in the study had similar results to those of substance abusers.
Prause argues that when you look at the brain imaging studies of sexual desire you see the same reactivity, suggesting that Voon et. al very possibly just studied sexual desire as opposed to sexual addiction.
In terms of discriminant validity, Dr. Prause looks to the many studies that look at sexual addiction and its comorbidity with other mental health issues like major depressive disorder, obsessive compulsive disorder, alcohol use disorder, etc. The point she made is that if a diagnosis has so much overlap with other diagnoses, it is likely not its own separate diagnosis but symptoms of some other construct.
The Villain May Not Be a Villain After all
What I found most interesting: despite not believing that sexual addiction is its own separate diagnosis, she treats people who come in with problematic sexual behavior similarly to a clinician who does believes sexual addiction is valid. For example:
- Assess for other mental health conditions
- Engage in behavioral analysis of the sexual behavior they are concerned about
- Then treat them with shame reduction work and ACT
She agrees that people struggle with sexual behavior sometimes.
Dr. Prause thinks we should help them get a handle on the things they find to be a problem.
She does not believe in using a 12-step model or forced abstinence.
My personal take is that she believes that what some of us would call compulsive sexual behavior disorder is not its own thing but that the same behaviors are likely a symptom of some other mental health issue.
My other take away… I don’t think she is a villain at all. She is just someone who wants us to really think critically about our work.
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