compulsive sexual behavior - Dr. Jen's Recovery Readings

Did Compulsive Sexual Behavior get Worse During COVID?

Dr. Jennifer Weeks — Mon, 13 May 2024 12:00:00 +0000

The phones rang off the hook during lock downs and our caseloads for Compulsive Sexual Behavior increased. Was it real or did it just feel super busy? Was everyone looking at pornography then?

Those of us who work in the field treating Problematic Sexual Behavior (PSB) will anecdotally tell you that during COVID and its associated lock down, PSB was on the rise.

Science is now, four years after the lock downs began, backing up our anecdotal claims.

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.

The Study on Compulsive Sexual Behavior During COVID Lock Downs

In a study published last year, Gleason and colleagues surveyed over 1000 people. They asked if the respondents pornography use and masturbation changed due to COVID.

Additionally, they also assessed for Compulsive Sexual Behavior Disorder (CSBD) to see if that had any affect on masturbation and pornography use.

Takeaways From the Study on Compulsive Sexual Behavior

First, myself and my fellow therapists, were not making things up!

Among this sample, masturbation frequency and pornography use increased during the COVID 19 lockdown. Those who screened positive for CSBD had a larger increase in masturbation frequency.

Similarly, those who screened positive for CSBD had a larger increase in pornography use than those who did not screen positive for CSBD.

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But, why?

As this was not an experimental study, no assertions regarding the cause of the increase can be made. However, we can hypothesize.

For example, many people with CSBD use some sort of sexual behavior as a coping mechanism for negative affect (boredom, loneliness, depression, anxiety, etc.) or stress. As this time in life was incredibly stressful for most people, this increase in pornography use and masturbation could have been a means for people to manage those feelings.

While masturbation and pornography use increased for most people in this survey, it seems as though those with CSBD were most influenced by COVID.

Reference: Gleason, N., Conro, K., Banik, S., & Coleman, E. (2023). Compulsive Sexual Behavior and Changes in Solitary Sexual Behaviors During the COVID-19 Pandemic. Archives of Sexual Behavior, 52, 2287-2293.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Do you feel your sexual behavior, or that of someone you love, is out of control? Then you should consult with a professional.

Are you looking for more reputable data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post Did Compulsive Sexual Behavior get Worse During COVID? first appeared on Dr. Jen's Recovery Readings.

Book Review: Sex Under the Influence

Dr. Jennifer Weeks — Mon, 29 Apr 2024 12:00:00 +0000

I had the pleasure of hearing Dr. Fawcett give a presentation on Sex Under the Influence at the 2023 IITAP conference.

This post contains affiliate links. The author or blog owner may earn a commission if you make a purchase using these links.

It was one of the more enjoyable discussions I caught while at the conference. He has a vast amount of experience working with dual chemical and sexual addictions. He is very clearly passionate about helping people work through these issues.

So, when he published a book on the subject, I was eager to read it.

Sex Under the Influence is aimed at Individuals

While this book’s target audience is individuals who are struggling with sexualized drug use, it will also be useful to clinicians who are not as familiar with the pairing of sex and drugs in a compulsive manner.

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.

The first chapter does a nice job with the following points:

What sexualized drug use is
How people use sex and drugs together and why
The biology of the addictive process and the consequences when pairing sex and drugs gets out of hand

Chapter 2 is either a nice primer or recap about what addiction is and how it can be experienced by people.

Chapter 3 looks at addictive behaviors in a variety of demographic groups.

I really enjoyed this chapter. It did something few books on addiction do: it discussed what addiction can look like for men, women, and transgender individuals.

We know from the scientific literature that men and women experience addiction differently both socially and biologically. Dr. Fawcett also discussed how addiction may differ based on one’s sexual orientation.

An entire chapter looking at the diversity of the addictive process was appreciated.

Recovery Tools from Sex Under the Influence

Starting in Chapter 5, the book provides tools and information for recovery. For clinician’s reading this book, particularly those who are trained in treating problematic sexual behavior, a lot of this work will be familiar.

For people struggling with addiction who are thinking about or entering into recovery, the second half of the book provides valuable tools such as:

The three-circle exercise
Emotion regulations tools
Relapse prevention planning

Subsequent chapters delve into the long-term process of recovery. It implicitly and explicitly acknowledges this is a long-term or lifelong process.

Recovery, particularly from issues with sexuality, require us to deepen connections. It requires us to delve into intimacy and our own sexuality.

Stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

My Favorite Part

One of the things I particularly like about Sex Under the Influence is the author’s discussion of harm reduction.

So often, recovery is seen as an abstinence-only model and harm reduction is not discussed.

Abstinence-only models can drive away those thinking about recovery but feel full abstinence is impossible.

Additionally, abstinence-only models often are not realistic for problematic sexual behavior. Sexuality is part of who we are as humans.

The author spends a chapter discussing harm reduction and how it can be applied to sexualized drug use.

This post contains affiliate links. The author or blog owner may earn a commission if you make a purchase using these links.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

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Pornographic Video Games and Sexuality

Dr. Jennifer Weeks — Tue, 16 Jan 2024 13:00:00 +0000

Last Monday, I received screenshots of a game my client was playing, but it wasn’t a traditional game. He indulged in the ever-expanding genre of pornographic video games.

Some of you who read my blog regularly may know, a person on federal supervised release for an internet crime of a sexual nature must have monitoring software on their devices.

The software blocks you from sites based on probation regulations and takes screenshots of what they’re doing. When one of my clients looks at questionable things, their probation officer will contact me and send me screenshots of the content.

I’m Not Going to Moralize About Pornographic Video Games

Nor will I discuss whether or not this is an appropriate expression of sexuality for people whom partnered sex is not an option. This is just a, “Hey it’s out there if you didn’t know about it,” post.

Adult video gaming is legal and the people playing them are making a conscious choice to do so.

So why does it matter? In my work, it matters for a few reasons.

Do you believe you have an online pornography addiction? Take the free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

Pornographic Video Games and

Adolescents

We all know that most kids today game. It is super common and can be as much of a lifestyle as a hobby to kill some time. Games have come a long way from the Frogger of my youth.

Adult video games can be problematic for youth the same as pornography.

Physical and emotional development of teens does not happen along the same trajectory. Bodies might find these games exciting, but minds don’t always know how to process what goes on.

In most pornographic video games, as in pornography, there is not a discussion of consent, boundaries, or anything else. And the themes or topics are similar to pornography.

I braved a google search and adult video games are promoting themes like anal sex with your stepsister and sex with your stepmom the same as live pornography is.

Not the best themes for a growing mind to be masturbating to.

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.

Individuals with Problematic Sexual Behavior (PSB)

Pornographic video games can fall into a grey area for those with pornography addictions or PSB.

They are not pornography, as many will define it in terms of live humans, but it still falls into the category of sex acts or simulated sex acts.

Using adult video games may be a gray area that a person struggling with pornography addiction can use as a means to act out while thinking they are not violating their bottom-line behaviors.

Individuals on Supervised Release

Playing these games could be a violation of the stipulations of supervision for individuals on probation, parole, or federal supervised release for crimes of a sexual nature.

Many of these probation stipulations prohibit viewing pornography. I’ve found most probation/parole officers consider adult video games to be pornography.

Playing pornographic video games and not disclosing it could cause problems with supervision and result in a freedom-losing violation.

See the latest research on criminality related to social media:

Social Anxiety and Loneliness in Online Solicitation Offenders

See more articles related to social media

What’s the Lesson About Pornographic Video Games?

For me, it was to be more specific. My client had permission to play video games. We had worked on that, and it was approved by treatment and probation. Clearly, I needed to be more specific about what types of video games were okay to play.

I needed to have more conversations about exactly what was okay to do and what was not.

Again, not here to have a philosophical discussion about adult sex games. I want to help our guys stay compliant with their conditions.

What’s the Lesson for Non-Supervised Folks?

Particularly if you are a parent of a gaming adolescent, you need to know what games your child is playing.

Be involved in their lives. Ask about their gaming. Ask if they have seen or played these games. Talk about it.

If your child is a gamer and young, learn how to block those sites or games from their gaming device.

Ultimately, the lesson is to be aware.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Are you looking for more reputable data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post Pornographic Video Games and Sexuality first appeared on Dr. Jen's Recovery Readings.

What Happens When You Stop Watching Pornography for a Week?

Dr. Jennifer Weeks — Fri, 03 Nov 2023 12:00:00 +0000

One of the go to suggestions for pornography addiction treatment is an abstinence period. A period of time free from all sexual behavior or to stop watching pornography.

The average duration is 30 days free of any type of sexual behavior, including:

Pornography
Masturbation
Sexual intercourse

This is to allegedly “reset” the brain and dopamine pathways from a biological perspective.

It can also be a great way for couples to reconnect. It allows them to work on emotional intimacy and non-sexual physical intimacy.

Finally: A Study on Those Who Stop Watching Pornography

Despite this being a rather commonly “’prescribed” treatment plan, there is actually very little research on whether this is a scientifically sound practice.

Additionally, one of the markers of addiction is the experience of withdrawal. Many who argue against sexual addiction being a real phenomenon will say that there is no such thing as withdrawal from pornography use despite anecdotal evidence from those who abstain.

Some previous studies have noted that people who attempt abstinence from pornography experience withdrawal symptoms such as erotic dreams, irritability, attention disturbances, depression, mood swings and brain fog.

While these could be attributed to withdrawal from pornography, the authors of the study we are currently discussing state that these negative emotional effects could be the result of simply abstinence from sexual behavior and not necessarily withdrawal.

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.

The Study: Background

This study, published this year in the Archives of Sexual Behavior, was a randomized controlled study that looked at the effects of abstaining from pornography for a period of 7 days.

The authors hypothesized that there would be differences between the abstaining group and the control group on the following measures: craving, positive affect, negative affect, and withdrawal symptoms. They also hypothesized that there would be an interaction between the group (control or abstaining) and Problematic Pornography Use.

Subjects

Psychology Undergraduate students at a university in Malaysia.

The authors do note that Malaysia is a conservative country when it comes to sex and pornography that does have laws that restrict pornography use.

The participants had to meet several criteria:

They had to be at least 18 year old.
They had to be regular pornography users.

176 students made the cut with 86 in the abstinence group and 90 in the control group.

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

The Task

The control group was asked to continue engaging in their sexual behavior as normal.

The abstinence group was asked to stop watching pornography. But they weren’t required to abstain from masturbation or partnered sexual activity.

The Measures

All subjects were asked to note, on a daily basis, the following things:

Frequency and/or duration of any sexual behavior, measured daily
Pornography use, daily frequency
Duration of daily pornography use
Masturbation without pornography, daily frequency
Alternative sexual activity, daily frequency
Efforts at abstaining from pornography, daily
Pornography craving, measured daily
Daily positive and negative affects
Withdrawal symptoms, experienced daily

Creating a Baseline to Stop Watching Pornography

Prior to the start of the study, the authors assessed the following baseline measures:

Previous 4-week frequency of pornography use
Past 4-week average duration of pornography use per session
4-week frequency of masturbation without pornography prior to the study
Prior 4-week percentage of pornography use that was accompanied by masturbation
Previous 7-day frequency of pornography use
Past 7-day duration of pornography use
Baseline abstinence effort
Craving for pornography
Baseline positive and negative affect
Problematic Pornography Use
Intrinsic desire to quit or reduce pornography use
Moral disapproval of pornography

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The Results of the Study to Stop Watching Pornography

There were no significant differences between the abstinence and control group on measures of craving, positive affect, or withdrawal symptoms. There was also no significant interaction between the group and Problematic Pornography Use.

Problematic Pornography Use and Gender

There were significant differences in the results based on gender.

Male subjects had significantly higher problematic pornography use and 4-week frequency of pornography use than female subjects.

The study also looked at the data based on Problematic Pornography Use (PPU) Scores.

When the PPU scores were low, there were no differences between the groups but when the PPU scores were high, there were significant differences on the experience of craving.

Study Conclusions

The hypotheses of the study were not confirmed. There were no significant main effects of the group on all measures.

This is in contrast to previous studies that used self-report measures where subjects reported experiencing withdrawal symptoms. The authors do note that their study used nonclinical samples and the previous studies had subjects who identified with PPU.

The study found no evidence of negative abstinence effects among pornography users who viewed pornography at least three times per week. The authors then suggest that for the average pornography user there is no withdrawal when engaging in a 7-day abstinence period.

Are you a Licensed Professional Counselor in need of continuing education? Learn more about Sex Addiction, Erotic Conflict, and Moral Incongruence from Dr. Weeks and Sexual Addiction Treatment Services, an NBCC ACEP™ approved provider!

Sexual Addiction Treatment Services has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7250. Programs that do not qualify for NBCC credit are clearly identified. Sexual Addiction Treatment Services is solely responsible for all aspects of the programs.

Limitations

The fact that the study used a non-clinical sample means that the results might not be generalizable to people with Compulsive Sexual Behavior who try to achieve abstinence.

This study also contained more female subjects that other studies that have looked at this phenomenon.

From a clinical perspective, as someone who treats Problematic Sexual Behavior, these types of studies are helpful.

In this field there are some therapeutic interventions that seem like gospel despite not having a large amount of scientific evidence to back them up as a best practice.

It is exciting to see abstinence and withdrawal being studied so we can determine, in the future, if a 90-day abstinence period is actually an evidence based best practice.

Reference: Fernandez, D.P., Kuss, D.J., Justice, L.V., Fernandez, E.F. & Griffiths, M.D. (2023). Archives of Sexual Behavior. Doi.org/10.1007/s10508-022-02519-w

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Are you looking for more reputable data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post What Happens When You Stop Watching Pornography for a Week? first appeared on Dr. Jen's Recovery Readings.

How to Un Villain: Listening with an Open Mind

Dr. Jennifer Weeks — Fri, 06 Oct 2023 12:00:00 +0000

Sketch of Dr. David J. Ley from his X (Twitter) profile.

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.

Villain Introduction

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

Dr. Nicole Prause

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.

Research Methods

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

Final Thoughts

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.

Are you a professional looking to stay up-to-date with the latest information on, sex addiction, trauma, and mental health news and research? Or maybe you’re looking for continuing education courses? Then you should stay up-to-date with all of Dr. Jen’s work through her practice’s newsletter!

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

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Let’s Talk About Sex Dolls

Dr. Jennifer Weeks — Mon, 18 Jul 2022 17:51:03 +0000

For me, the concept of sex dolls is fascinating and when my web guy told me that some people were searching for more information about it, I jumped at the chance to write about them again.

The first thing to do when talking about sex dolls is to forget that image of the plastic blow up doll with a permanently gaping mouth. Today’s sex dolls are high tech, sometimes robotic, really life like and nothing like what most people imagine.

Let’s talk about some of the controversies.

Child Sex Dolls and Sex Offenders

This one is a hot button issue with some people falling in either camp. Child sex dolls are manufactured outside of the United States and they are extremely realistic looking. This is pretty uncomfortable for a lot of people.

The two sides of the argument are as follows.

For individuals who have an exclusive attraction to prepubescent children, child sex dolls might be a way for them to have some sense of sexuality without harming children.

The other side of this camp thinks that allowing people who are attracted to children to have child sex dolls will actually increase their risk of harming a live child.

The trouble is, there is hardly any research on the topic to help people make an informed opinion.

For more thoughts on the topic, check out Prostasia Foundation’s blog on the topic.

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.

Sex Dolls and Adults

If we are talking about adult sex dolls, we can avoid the controversy that comes with child sex dolls, but you still get the stigma.

There are many reasons why someone might want a sex doll.

Perhaps they have difficulty meeting people, forming relationships, or hooking up with others for sex.

Perhaps they have a trauma history that makes sex with another person something they can’t engage in.

Or maybe, they just want to.

Interested in more information about sex dolls and their owners? Here’s all of our posts about them:

There is even a sex doll rental company in Houston, Texas that has lawmakers up in arms. They have tried to block it but, to the best of my knowledge, it is still up and running.

In the sex therapy community, the use of sex dolls does not carry the same stigma that it might in other circles. Fundamentally, an adult who wants to have an adult sex doll should be able to do so without worry about what other people think.

However, some people worry that using a sex doll or a sex robot as a replacement for human interaction could be harmful.

Check out some other’s thoughts on the topic here:

Using Love Dolls As a Substitute for Human Intimacy (Psychology Today)
Sex Bot use ‘unrelated to healthcare’ (Medical News Today)

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Answering Your Questions

Some of the google searches related to sex dolls that have landed people on my website have questioned whether or not sex doll use is addictive.

I will take this moment to remind people that when it comes to sex addiction or problematic sexual behavior issues, it is often not the behavior that is problematic but the person’s relationship to the behavior.

A sex doll is a sex doll. If you are questioning whether your use of the sex doll is an addiction, the better questions relate to your relationship with the doll.

Is it something that you cannot stop doing?

Is engaging with the sex doll interfering with your life, work or other relationships?

If your interactions with the doll do not meet the ICD-11 diagnostic criteria for Compulsive Sexual Behavior Disorder, the problem may be an issue of moral incongruence instead of addiction or problematic sexual behavior.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

The post Let’s Talk About Sex Dolls first appeared on Dr. Jen's Recovery Readings.

What is Compulsive Sexual Behavior Disorder?

Dr. Jennifer Weeks — Thu, 12 May 2022 12:00:00 +0000

After years in this field, those of us who treat problematic or compulsive sexual behavior still hear from colleagues that they do not believe that sex addiction is real.

Worse yet, those of us who treat it have been accused of simply being in it for the money. I have a good laugh at that one.

However, one of the arguments that some opposed to the concept of sexual addiction make is that a loose diagnosis of the problem can be confounded by religious or personal beliefs.

Moral Incongruence

This has spurred some great research by Perry, Grubbs and others about moral incongruence, whose basic premise is that some people’s distress over their sexual behavior, which they often label pornography addiction, is caused by them sexually acting in a manner that is against either their religious or personal values. Many of these individuals seek treatment for their self-diagnosed addiction.

Enter, the World Health Organization

Compulsive Sexual Behavior Disorder (CSBD) is not a name or diagnosis that has made its way into the internet lexicon like sex addiction or pornography addiction. It is, however, the World Health Organization’s recently (2019) approved diagnosis in the International Classification of Diseases-11 (ICD-11) relating to what is commonly referred to as sexual addiction. Reporting on the new system went into effect January 1 of this year.

As a side note, the DSM-V does not recognize sexual addiction or pornography addiction as a valid mental health disorder.

From Reed et al, 2022

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Removing Ambiguity about Compulsive Sexual Behavior

One of the most exciting things about the diagnostic criteria for CSBD is that it removes the confound of moral incongruence from the diagnostic picture. The diagnostic criteria specifically states that any distress that is: “entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet the requirement of marked distress. If one looks closely, the diagnostic criteria are strictly behavioral, removing the feelings of the actor or any family member of the actor from the picture.”

Why does this make a difference?

Well, for several reasons:

This is global recognition that CSBD is a real and valid issue that many people struggle with.
It allows for a more nuanced diagnosis that can help clinicians provide treatment best suited for their clients.

The treatment paradigm for someone dealing with sexual behavior with moral incongruence is not necessarily the same treatment plan for someone with CSBD.

Concerned that you may be dealing with CSBD? The CSBD-19 is a validated self-report assessment you can take to help you understand your behavior.

Want to take the CSBD-19 right here in your browser with results you can share with your therapist? We’ve made that available for you for free!

Are you looking for more reputable data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

The post What is Compulsive Sexual Behavior Disorder? first appeared on Dr. Jen's Recovery Readings.

The Law, Autism and Sexuality

Dr. Jennifer Weeks — Mon, 05 Jul 2021 12:06:44 +0000

I came across this book about Autism and Sexuality while searching for information on Autism Spectrum Disorder (ASD) and sex crimes. Unfortunately, we are seeing more and more individuals with ASD being arrested for sex crimes. I’ve been on a quest to make myself much more knowledgeable about the subject.

This post contains affiliate links. The author or blog owner may earn a commission if you make a purchase using these links.

The book, The Autism Spectrum, Sexuality and the Law: What every parent and professional needs to know, is part personal narrative and part educational. It is co-authored by an individual who was arrested for possession of child pornography, a psychologist specialized in ASD and a therapist specialized in sexuality and ASD.

The Story

The book starts with the story of the investigation of Nick by the Federal government.

This part of the story is very familiar to me. I hear it often from my clients. The manner in which the feds enter a home and talk to the suspect is routine and unchanging.

What was new to me was this story from the perspective of someone with ASD and how he was affected by the traditional police policies.

The book then goes on to share Nick’s history and how he finally was diagnosed with ASD as an adult.

There are two chapters, one each, from Nick’s parents. Again, this perspective is common in my work with family members. But to hear it under the frame of ASD adds to the story. The pain of his parents is palpable. A pain, I imagine, many parents go through when their child is facing very serious consequences for very serious actions.

As Nick’s father is a law professor, his chapter provides excellent resources from a legal perspective as well.

Beyond Autism and Sexuality: The Law

The subsequent chapters are written by professionals with the purpose to educate the reader about ASD. The symptoms and how those symptoms can predispose someone with ASD to troubles with the law.

The final chapters discuss the fact that nearly everyone, parents, teachers, etc, discounts the fact that individuals with ASD are sexual beings. This means they are frequently not taught sexual education as non ASD children are. There is an assumption that they will not have the same desires.

Obviously, this assumption is inaccurate.

Frequently, when the education is not provided, they will turn to the same place we all turn to, the internet.

Using the internet for sexual education is fraught with challenges for everyone. Even more so for individuals with ASD due to some of their challenges with social interaction and theory of mind.

The Takeaway

While I did not learn as much from this book as I was hoping, I still believe it is an extremely useful resource. I can envision suggesting this book to the families of the individuals we work with who have family members with ASD whose behavior crosses legal boundaries and gets them involved with the criminal justice system.

Update April 2022: For a related review from another therapist’s perspective, see Eli Irving’s review of this book.

Update May 2022: Related research articles for sentencing reports and forensic psychological investigations.

This post contains affiliate links. The author or blog owner may earn a commission if you make a purchase using these links.

Do you feel your sexual behavior, or that of someone you love, is out of control? Consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

For an in-depth guide on talking to your adolescents about cybersex and pornography, check out Dr. Jen’s book. Amazon | BookBaby

Are you looking for more reputable, data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

The post The Law, Autism and Sexuality first appeared on Dr. Jen's Recovery Readings.

The Importance of Sex Addiction Research

Dr. Jennifer Weeks — Sat, 20 Mar 2021 14:56:34 +0000

One of the unfortunate, but predictable, outcomes of the horrific Georgia shooting at the massage parlors is the rash of news articles talking about how Sex Addiction isn’t real. Most of what people are saying tends to focus on the lack of inclusion in the DSM-V. It never occurs to many how sex addiction can be confused with moral incongruence. What we need is a thorough discussion of the massive body of sex addiction research.

A full blown narrative of the research on sexual addiction conducted since the publication of the DSM-V in 2013 would be beyond the scope of this blog. I will, however, leave you with a few paragraphs regarding the topic that I recently included in a sentence mitigation report.

Diagnostic and Statistical Manual of Mental Disorders– V: (DSM-V)

In the current edition of the DSM, there is no stated mental disorder that encompasses the concept of sexual addiction. Be that sexual addiction, sexual compulsivity, hypersexual disorder, etc. To simply negate a mental health phenomenon because it is not in a version of the DSM that is currently almost 8 years old is to negate both the history of the disorder with the DSM and the body of research that has been conducted since the DSM-V work group decided against including Hypersexual Disorder.

Prior to the publication of the newest edition of the DSM-V in 2013, the Sexual and Gender Identity Disorders Workgroup (Kafka, 2014) considered the inclusion of Hypersexual Disorder into the upcoming edition of the DSM. The suggested diagnostic criteria were as follows:

The “Almost Officially” a Disorder

Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, and sexual behavior in association with four or more of the following criteria:
1. Excessive time is consumed by sexual fantasies and urges and by planning for and engaging sexual behavior.
2. Repetitively engaging in these sexual fantasies, urges and behaviors in response to dysphoric mood states (e.g., anxiety, depression, boredom, and irritability).
3. Engaging repetitively in these sexual fantasies, urges and behavior in response to stressful life events.
4. Repetitive and unsuccessful attempts to control or significantly reduce the sexual urges, fantasies, and behavior.
5. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.
There is clinically significant personal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of sexual fantasies, urges or behavior.
These sexual fantasies, urges and behavior are not due to the direct physiological effects of exogenous substances (e.g., drugs of abuse or medication), a co-occurring general medical condition or to a manic episode.
The person is at least 18 years of age.

Specify if masturbation, pornography, sexual behavior with consenting adults, cybersex, telephone sex and strip clubs.

It was ultimately decided that Hypersexual Disorder would not be included into the DSM-V. The main reasons cited for the lack of inclusion were concerns around diagnostic accuracy, moral and cultural confounds and a lack of research supporting the concept (Kafka, 2014).

Do you believe you have an online pornography addiction? Take the free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

What’s changed in Sex Addiction Research since 2013?

In the nearly 8 years since the publication of the DSM-V, a vast body of scientific research in peer reviewed journals has been published seeking to understand the concept of sexual addiction and compulsivity which has also been termed hypersexuality.

A recent metanalysis was published by Grubbs et. al. (2020) that systematically reviewed the scientific research on the topic. Research on the topic, alternatively called sexual addiction, sexual compulsivity, hypersexuality, and compulsive sexual behavior began in the mid 1990’s. Research increased during the time that the DSM-V was in development. Knowledge on the topic continues to expand. The Grubbs et. al. (2020) metanalysis included 371 papers published in peer reviewed scientific journals documenting the results of 471 individual scientific studies.

The Grubbs et. al. (2020) meta-analysis yielded several findings. On the negative side, the study found that there was a lack of rigorous outcomes studies for the treatment of Compulsive Sexual Behavior. Therefore, to date, there is no gold standard approach to treating the issue. The study did reveal that the Hypersexual Behavior Inventory (Reid et. al., 2011) is a well validated and clinically useful tool to assess Compulsive Sexual Behavior. The main finding pertinent to this case is that there is “clear evidence that CSB is a real phenomenon with clinical implications.” (Grubbs et. al., 2020, p 11)

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International Classification of Diseases – 11 (ICD-11) and Sex Addiction Research

The ICD-11 is the international equivalent of the DSM-V in the United States. The International Statistical Classification of Diseases is published by the World Health Organization and its most recent version was published in 2019 (WHO, 2019). Like the DSM, prior to any condition being accepted into the ICD there is a process of extensive debate and consideration. The ICD-11 does include a diagnosis of Compulsive Sexual Behavior Disorder (CSBD) which is classified under impulse control disorders. The diagnostic criteria share some traits with the proposed DSM-V diagnostic criteria for Hypersexual Disorder.

The Diagnostic criteria for Compulsive Sexual Behavior Disorder (ICD-11)

Essential (required) features for compulsive sexual behavior disorder:

A persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior, must be manifested by one or more of the following:
1. Engaging in repetitive sexual activities has become a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, or responsibilities.
2. Person has made numerous unsuccessful efforts to control or significantly reduce the repetitive sexual behavior.
3. The person continues to engage in repetitive sexual behavior despite adverse consequences (repeated relationship disruption, occupational consequences, negative impact on health, etc.).
4. Person continues to engage in repetitive sexual behavior even when the individual derives little or no satisfaction from it.
The pattern of failure to control intense sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more.)
The pattern of repetitive sexual behavior causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning NOTE: Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges or behaviors is not enough to meet this criterion.

The inclusion of the rule out relating to erotic conflict or moral incongruence is a necessary criterion to address historical concerns about pathologizing sex with a label of addiction or compulsivity. Simply engaging in a sexual behavior that is non-normative or outside of a person’s religious or moral belief is not sufficient to diagnose Compulsive Sexual Behavior Disorder according to the ICD-11.

Check out my more recent article about Compulsive Sexual Behavior Disorder for more information about CSBD and its classification.

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.

References

Bothe, B., Potenza, M.N., Griffiths, M.D., Kraus, S.W., Klein, V., Fuss, J., & Demetrovics, Z. (2020). Journal of Behavioral Addictions 9(2), 247-258.

Gola, M., Lewczuk, K., Potenza, M.N., Kingston, D.A., Grubbs, J.B., Stark, R. & Reid, R. (2020). What should be included in the criteria for compulsive sexual behavior disorder. Journal of Behavioral Addictions published online November 25, 2020.

Grubbs, J.A., Hoagland, K.C., Lee, B.N., Grant, J.T., Davison, P, Reid, R.C. & Kraus, S.W. (2020). Sexual Addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clinical Psychology Review (82), 1-15.

Kafka, M.P. (2014). What happened to hypersexual disorder? Archives of Sexual Behavior, 43(7), 1259-1261.

Reid, R.C., Garos, S. & Carpenter, B.N. Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sexual Addiction and Compulsivity, 18(1), 30-51.

Are you looking for more reputable data-backed information on sexual addiction? The Mitigation Aide Research Archive is an excellent source for executive summaries of research studies.

Do you feel your sexual behavior, or that of someone you love, is out of control? Then you should consult with a professional.

Have you found yourself in legal trouble due to your sexual behavior? Seek assistance before the court mandates it, with Sexual Addiction Treatment Services.

The post The Importance of Sex Addiction Research first appeared on Dr. Jen's Recovery Readings.

Georgia Massage Parlor Shooting

Dr. Jennifer Weeks — Thu, 18 Mar 2021 14:56:29 +0000

Mapillary user lvl5, CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons

Last night, after my final session ended at 8 pm, I looked at the news quickly before I packed up to leave the office. The biggest piece was the horrific murder of eight people in a massage parlor shooting. Many of the victims were women of Asian descent.

These stories were followed by news that the shooter said he did this because of his sex addiction.

In a moment of full transparency, I will acknowledge that my thought after seeing sex addiction being brought up as a motive for a mass shooting was, “oh no, we don’t need this.”

The legitimacy of sex addiction continues to be hotly debated in some circles and when horrible things happen and sex addiction is spoken about in conjunction with these horrific acts, it can add fuel to the debate fire.

Condolences

I would like to start this post by saying that I am deeply saddened for the victims and their families. The tragedy is compounded by the fact that many women who work in these massage parlors are victims of sex trafficking. I am also very sorry that the man who committed these crimes felt such despair. This extreme violence shouldn’t ever be the only option.

Much of my work is in forensic psychology, that is the lens through which I am viewing this. When a person commits a crime, there are both aggravating and mitigating factors. As I have no knowledge of the specifics in this case, I am going to speak in generalities.

Do you believe you have an online pornography addiction? Then take this free Cyber Pornography Addiction Test (CYPAT) and have the results to speak with your therapist.

Mitigating Factors

Mitigating factors are things that may influence the person to commit the act. They are in no way, shape or form an excuse for the commission of the crime. They are the things that can explain the underlying factors that drove the person to the final criminal act.

It is well established that addiction is frequently a mitigating factor in many crimes. We know that there is an association between drug addiction and crimes such as forgery, theft, etc. Other crimes may be influenced by a person’s untreated mental health issues.

In this case, it may well be that a mitigating factor was sexual addiction.

This would mean that the perpetrator felt he had an addiction to sexual behaviors and that he could not control them.

Per newspaper reports, he sought treatment for these issues. At some point, his behavior continued to feel out of control and he likely had deep feelings of shame around his sexual behavior; news reports have claimed that his religious beliefs fueled this shame.

Obviously, there may be other mitigating factors as well.

Aggravating Factors

On the other side of mitigating factors are aggravating factors. These are issues that make the crime particularly heinous.

Again, not having reviewed the case, I can speculate that an aggravating factor here is the fact that many women who work in massage parlors are victims of sexual trafficking. Research from many nonprofit advocacy groups that work to stop sex trafficking has shown that many of these women are often from China or South Korea. These women are often under extreme financial pressure, have limited resources and are recruited to work by fraudulent means and often do not know that they will be expected to perform work of a sexual nature.

If the victims in this case were also victims of sexual trafficking, it makes them even more of a vulnerable population.

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.

The Realities

In this case, we can speculate that this man’s feelings of despair over his inability to control his sexual behavior overrode his sense of right and wrong. As I stated before, mitigating factors are explanations and not excuses. A person who has been to treatment has knowledge of coping skills and resources that could have been used instead of resorting to an act of violence.

There were other options.

There are two major takeaways from this horrible act of violence in Georgia.

Sex trafficking is a major problem in the United States. If you are unaware of this, please do some research on the topic. Please also support the many great nonprofit organizations that work to stop the trafficking and help the victims of sex trafficking.
Problematic sexual behavior is treatable. Violence is NEVER an acceptable answer.

If you feel that you are suffering from a sexual addiction or are having difficulty controlling your sexual behaviors, please reach out to our office. We will be happy to direct you to treatment in your area.

Resources to learn about Sex Trafficking

Office of Juvenile Justice

Human Trafficking Hotline

Minnesota Coalition Against Sexual Assault

Valley Against Sex Trafficking

Resources for Treatment

Sexual Addiction Treatment Services

International Institute for Trauma and Addiction Professionals

Society for the Advancement of Sexual Health

The post Georgia Massage Parlor Shooting first appeared on Dr. Jen's Recovery Readings.