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.

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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.

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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.

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?

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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? 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.

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

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:

1. Sit and listen to the talk from a position of defensiveness based on my belief in CSBD.
2. 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.

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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.

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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? 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.

The post How to Un Villain: Listening with an Open Mind first appeared on Dr. Jen's Recovery Readings.

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. 

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

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.

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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. 

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?

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

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:

1. This is global recognition that CSBD is a real and valid issue that many people struggle with.
2. 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.

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.

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

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.

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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

1. 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.
2. 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. 
3. 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.
4. 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)

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?

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

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:

1. 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.
2. 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.)
3. 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? 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.

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. 

1.  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. 
2. 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.

As a therapist, how do we determine whether a pornography problem is erotic conflict or an addiction?

When I started in this field, sex addiction was not a common term. Therapists who treated sex addiction were not that prevalent, therefore you never heard about sex addiction on the news. 

Today, it’s a different story. 

You hear the term sex addiction all the time, bandied about every time there’s a celebrity sex scandal. Therapists who treat sex addiction, whether specifically trained to do so or not, are much more common now too.

The same goes for pornography addiction.

For some reason, this feels less stigmatizing to many. There are now large numbers of therapists who treat pornography addiction. There are also many new programs popping up to help men deal with their pornography addictions. These programs are often not run by a therapist or affiliated with a 12-step program, but instead created and run by independent agents or religious institutions.

The Impact of Media Discussion of Addiction

As the visibility of pornography addiction grows, the type of clients we have coming to the office have changed. In the beginning, over 8 years ago, the (predominantly) men who were coming in to address problems with pornography were men who had struggled for most of their lives with pornography use. 

They were:

• Watching more than they wanted to
• Couldn’t stop
• Were experiencing serious repercussions in
  • Their work
  • Their relationships
  • The legal system 

I would diagnose these men as pornography or, more broadly, sex addicts.

The Changing Face of Sex and Pornography Addicts: The Pornography Problem

Today, many of the men who are coming in with self-diagnosed addictions are men who look at some pornography. 

They don’t:

• Look at it a lot; once or twice a week, sometimes less
• Look at it for hours and hours on end
• Look at anything illegal
• Often look at any pornography that is more “hardcore” 

Their pornography use is usually causing a conflict in their relationship. These are not men that I would diagnose with a pornography addiction, but they call themselves pornography addicts.

So, are these men who come in pornography addicts? Or are they men who are experiencing an erotic conflict?

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Licensed Professional Counselors: Dr. Weeks’ course Sex Addiction, Erotic Conflict, Moral Incongruence looks at what can be mistaken for sex addiction and offers treatment considerations for distinguishing those problems.

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.

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What is an Erotic Conflict?

And how do we know what type of pornography problem it is

An erotic conflict is experienced by a person who is engaging in, or fantasizing about, a sexual behavior that conflicts with his or her moral values or religious values. 

For example, a person who is attracted to sex with the same sex might experience an erotic conflict because their religious beliefs tell them that same sex attraction is wrong. Therefore, their behavior conflicts with their religious beliefs. 

A person who uses escorts might be experiencing an erotic conflict because breaking the law is against their personal moral values. 

A man who is watching pornography occasionally, a few times a month, might feel as though he has a sexual addiction or pornography addiction because his religious beliefs tell him that lust and pornography are bad. Therefore, he equates any use of pornography with addiction.

What does the DSM-V say about the Pornography Problem?

There is no DSM-V definition of sexual addiction or pornography addiction but we can extrapolate the criteria from drug and alcohol and gambling addictions. These are all use disorders in the DSM-V. This means that someone who is a pornography addict would experience at least two of the following issues: 

• Watching pornography more often than they intended and for longer periods of time than intended
• An inability to stop watching pornography
• Spending a lot of time creating opportunities to watch pornography
• Craving pornography use
• Failure to fulfill obligations at work, home or school due to using pornography
• Continuing to use pornography even after interpersonal problems resulting from use
• Social isolation due to pornography use
• The need for more pornography or more intense pornography to get the same feeling and difficulties when they try to stop using pornography or can’t access it

Here is my plea to clinicians and to society as well:

Can we please be more discerning in diagnosing sexual and pornography addiction?

What happens when we over diagnose pornography addiction?

1. We never get to the underlying issue. If someone is actually experiencing an erotic conflict, they may never get to the root of the issue. They may work a 12-step abstinence model and therefore condemn any experiences of lust as bad or problematic. This can place moral good or bad judgements on sexual behavior, in other words more psychological harm if the client continues to engage in the behavior. It can shame the normal biological process of attraction by labeling it as lust. It may prevent the client from learning about healthy sexuality and what truly arouses and attracts them. Ultimately, they may never work through the conflict between their body and their beliefs to a healthy resolution.
2. We cause more shame. Though being a pornography addict is less shameful than it used to be, being named an addict will create very shameful thoughts for most people. This shame must be worked through when the person actually has an addiction. When the person is mislabeled, it can cause more shame and isolation than necessary. This adds to the “I’m a bad person” thoughts the pornography consumer might have for looking at pornography.
3. We trivialize sexual addiction. The therapeutic community and, often, the media hotly debate whether sexual or pornography addictions are “real.” The con side often uses the argument that those who support the idea of sexual addiction are religious conservatives who are condemning normal sexual practices. When someone with an erotic conflict, often based on religious beliefs, is diagnosed with an addiction, this reinforces the argument that we are trying to morally dictate sexual practices and label them addictions

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 Takeaways

My goal here and in my practice is not to condemn or judge. We all have our own set of values that we would like to live by. 

My plea is that we, both clinicians and consumers, really look at the behavior: Is the client presenting in your office who uses pornography an addict or someone with an erotic conflict? The treatment is different.

If they have an erotic conflict, the work is to process through the beliefs, sexuality and the conflict to come to a resolution that fits the client’s moral and personal compass. 

If the client is an addict, the treatment will likely follow a more traditional addiction model with 12-step attendance, abstinence from certain behaviors and recovery work.

I leave you with my plea again: CAN WE PLEASE BE MORE DISCERNING IN DIAGNOSING SEXUAL AND PORNOGRAPHY ADDICTION?

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 Pornography Problem: Erotic Conflict or Addiction? first appeared on Dr. Jen's Recovery Readings.

Many people are becoming accustomed to hearing about sex addiction or seeing something about sex addiction in the news. Political scandals and movies such as Shame can make it seem like sex addiction is something new. The truth is those who work in the field have been battling to create legitimacy for sex addiction in the medical field for years.

Anyone who tries to seek treatment for sexual addiction quickly comes to find that most Certified Sex Addiction Therapists do not accept insurance. While there may be multiple reasons for this, one reason is that insurance does not cover the treatment of sexual addiction or sexual compulsivity. While this may be confusing to someone who is not in the mental health field, there is actually a reason for the lack of coverage. Insurance companies will cover treatment for mental health issues that have made it into the DSM. The current version of the DSM is the DSM-IV-TR. Sexual Compulsivity is not in the DSM.

There is a new version of the DSM, the DSM-V, which is slated for publication in spring of 2013. There has been a solid flight by those in the field of sexual addiction treatment to have sexual addiction; termed Hypersexual Disorder, included in the next DSM. This debate was placed in the hands of the Work Group on Sexual and Gender Identity Disorders. The call for research on this subject was taken up by several researchers including Dr. Rory Reid, a prominent researcher in the field of Hypersexual Disorder. Recently, Dr. Reid and his fellow researchers published the findings in a field trial for the DSM-V in the Journal of Sexual Medicine.

The term sex addict has been bandied about in popular culture in the same way the term bi-polar is sometimes been used to describe a moody person. To clarify what the DSM-V committee is talking about it helps to share the criteria for Hypersexual Disorder:
A. Over a period of at least six months, recurrent and intense sexual fantasies, sexual urges, with four or more of the following criteria:
a. Excessive time is consumed by sexual fantasies and urges, and by planning for and engaging in sexual behavior.
b. Repetitively engaging in these sexual fantasies urges and behavior in response to dysphonic mood states (e.g. anxiety, depression, boredom, and irritability).
c. Repetitively engaging in these sexual fantasies urges and behavior in response to stressful events.
d. Repetitive and unsuccessful efforts to control or significantly reduce these sexual fantasies, urges and behavior,
e. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional harm to self or others.
B. There is clinically significant impersonal distress or impairment in social, occupational, or other important areas of functioning associated with the frequency and intensity of these sexual fantasies, urges or behavior.
C. These sexual fantasies, urges and behavior are not due to direct physiological effects of exogenous substances (e.g. drugs of abuse or medications), a co-occurring general medical condition or to manic episodes.
D. The person is at least 18 years of age.
Specify if masturbation, pornography, sexual behavior with consenting adults, cybersex, telephone sex and strip clubs.

Now that we know what we are looking for, let’s look at Reid et. als study. First, why do we need studies like this? Before the APA can include a mental health disorder they need to know that it is not only valid but that there are reliable diagnostic criteria that can be used to assess the presence of the disorder. The recent study published by Reid et. al. aimed to assess the reliability and validity of the proposed diagnostic criteria for Hypersexual Disorder.

The study was conducted at out-patient treatment sites in four states. The clinicians used nine measures to gather information about the clients coming into treatment for Hypersexual Disorder. As this is an academic article, I am not going to discuss the details of the study measures or statistics. The main finding of importance is that the proposed criteria for Hypersexual Disorder can be applied in a reliable fashion as well as are stable over short periods of time.

The question for someone not in the academic community might be, so what? What does this mean? Honestly, for the person suffering from sexual compulsivity, this study really doesn’t help! What this study is, is a first step towards legitimizing Hypersexual Disorder as an accepted mental health issue. That acceptance can help reduce the societal stigma of being a sex addict and could, hopefully, eventually increase access to treatment for those unable to pay for treatment out of pocket.

Reid et. al (2012). Report of Findings in a DSM-5 Field Trial for Hyperseuxal Disorder. Journal of Sexual Medicine, VOl 9, Issue 11, 2868-2877.

The post Hypersexuality and the DSM first appeared on Dr. Jen's Recovery Readings.