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Sexual Addition & Compulsivity

By: Joseph Winn, MSW, LICSW

Sex and sexuality are core to who we are. Each of us, regardless of whether we realize it or not, have preferred sexual styles, tastes and behaviors, as well as opinions and attitudes about what sex is and is not. We live in a culture that is both obsessed with and horrified by sex and sexuality. The media bombards us with images which sexualize men, women and children trying to convince us that in order to reach our full potential we must have more sex, more frequently and with greater intensity. The other side of this coin is a punishing moral judgment, shame and, quite frankly, ignorance about human sexuality. This dichotomous relationship with sex has resulted in powerful messages about sex which maintain an infantile relationship to one of out most basic human needs.


Sex can be a powerful expression of trust and intimacy. Sex with oneself or another can also be an expression of desire and intense physical pleasure. Over the course of one's lifetime, people experience periods of greater frequency and intensity of sexual behavior and experimentation. During other phases of the life cycle, sex and sexuality may diminish. As we grow, discover and incorporate our sexuality into the whole of who we are, most of us will develop the capacity to make appropriate choices about when, where and with whom to engage in sexual behavior. For people struggling with issues of sexual addition, also referred to interchangeably in this article as sexual compulsivity, the ability to make these choices becomes blurred, as the addict comes to rely on sexuality to deal with the challenges of living.

Sexual addiction occurs in men and women of all social classes, ethnicities and sexual orientations. Commonly reported sexually compulsive behaviors include internet pornography and cybersex, compulsive masturbation, frequenting prostitutes and massage parlors, engaging in phone sex, going to "cruising" areas where anonymous sex is known to occur and engaging in multiple infidelities.

Sexually compulsive individuals, by definition, have lost the ability to control their sexual behavior. Sexual addicted individuals, like those addiction to chemical substances, present with a series of behavioral markers that define the addictive process. These core behavioral markers include:

  1. Recurrent failures to distract oneself from sexual urges
  2. An increase in tolerance, requiring greater frequency and intensity of sexual experience to requiring the desired result
  3. A continuation of the behavior despite the risk of negative consequences
  4. Symptoms of withdrawal including restlessness, irritability and emotional lability, or "mood swings" if unable to engage in sexual acting out.

Causes of Sexual Addiction & Compulsivity

The causes of sexual compulsivity, and addiction in general, are complex and difficult to attribute to one single cause. What is known is that many who struggle with sexual compulsivity have survived histories of severe family dysfunction and violence, frequently reporting that they were the victims and witnesses of emotional, sexual and physical abuse. Other sexually addicted people report that their addiction developed over time, slowly escalating towards a need for greater sexual novelty and intensity, eventually eclipsing other forms of human interaction. Whatever the reason behind the sexual compulsion, the behavior has become unmanageable and diminishing to the individual's self worth and interpersonal relationships.

Sexually compulsive individuals struggle with shame. This shame manifests as a series of internalized statements such as: at my core, I am a flawed, bad and worthless human being; I am undeserving of love; others will never help me meet my needs. These painful statements about oneself serve the addiction in several ways. First, they trap the addict into believing he cannot turn to others for help, as to do so would result in his being rejected and judged - in short, the addict comes to see himself as alone and isolated. Secondly, feeling alone and isolated, the addict use of sexually compulsive behavior to deal with emotional challenges is increased. Lastly, as the addiction progresses, the addict associates people with pain, and the addiction with comfort. In short, this series of shame based beliefs become the addicts "operating system." Over time, the addict's shame organizes his behavior into a series of ritualized behaviors which are both predictable and personalized. These behaviors become the core of the addict's cycle of addiction. The cycle of sexual addiction presented in this article is a modification of the work of Dr. Patrick Carnes and presents a six stage model of the cycle of acting out.

  • Triggering events:
    As previously mentioned, many sexual addicts have survived overwhelming emotional experiences in their formative years. When confronted with emotional stresses, even those which would be considered positive, the addict is flooded with emotions he is unable to process. These emotions in turn trigger a need to regain some sense of control. The paradox here is that the more the client tries to regain control, through his addiction, the more out of control he becomes.

  • Preoccupation:
    During the preoccupation phase of the cycle, concentration becomes highly focused on sexualized thoughts and memories. As the addict becomes more focused on these sexualized thoughts and memories, he begins to formulate plans to act out sexually.

  • Ritualization:
    Ritualization is a highly predictable routine of behaviors used to prepare for the preferred form of sexual acting out. Some examples of ritualized behaviors include retiring to a favorite location to engage in phone sex or internet pornography, driving to a particular part of the city where the addict has paid for sex in the past. The intense focus of ritualization results in the addict experiencing a shift in perception referred to as depersonalization. Individuals experiencing depersonalization report that they feel detached from their experience, describing themselves as being on autopilot and feeling outside witnessing their own actions.

  • Acting-out stage:
    The actual sexually compulsive behavior itself. Physiological reward: With orgasm there is a cascade of neurotransmitters associated with pleasure resulting in the immediate cessation of emotional pain, anguish.

  • Despair:
    After the brief respite of acting out and neurochemical bliss, the sexually compulsive individuals commonly report a shift into despair. Compounding this despair is the onset of disgust at, and shame with, oneself. At this point, in an attempt to minimize feelings of despair and shame, addicts will engage in purging behaviors. These behaviors include throwing away paraphernalia associated with the addiction and "swearing off" the preferred sexual activity. However, many addicts realize that they have tried, and failed, to control their behavior once more, furthering their sense of despair and loss of control, prepping the addict for the next triggering event.

Sexually compulsive people often realize that they have a problem, but feel powerless to change unless they are confronted with the consequences of their behavior. Even after the behavior has been discovered, it is often difficult for the addict to break through the defenses that have been used to shield him from understanding how out of control the behavior has become. There are many avenues available for individuals, couples and families to begin regaining control, and rebuilding trust, over the pain of sexual addiction. What I generally recommend is the following course of treatment: psychotherapy with someone who is experienced working with sexually compulsive individuals and their loved ones; attending a 12 step self-help program, such as Sex and Love Addict Anonymous, and / or group therapy to break the isolation and shame of sexual addiction, while building a supportive community of others who struggled and regained control over their sexuality.

It can also be helpful for sexually compulsive individuals to be evaluated for the addiction of medication to their psychotherapy. Sometimes, much like people who struggle with chemical dependency, there is an underlying depression and/or anxiety that contributes to the addictive behavior. Medications such as antidepressants or anti-anxiety agents often help by relieving the symptoms of these struggles, allowing the addict to focus more closely on their recovery from sexual addiction.

Whatever method one chooses to regain control of their sexual behavior, it is important to realize that they are not alone. Recognizing that there is a problem is the first step towards breaking the isolation of sexual addiction and regaining personal dignity, rebuilding interpersonal relationships, and developing self respect.

If you or a loved one are having a difficult time with alcohol, drugs, or behavior disorders, please give us a call at 877.235.6131. Our treatment specialists are available to discuss your concerns and answer your questions 24 hours a day, 7 days a week.

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