by Justin Mckibben | Sep 17, 2018 | Addiction, Addiction Treatment, Dual Diagnosis, Mental Health, Relationships, Sex Addiction
When they hear the words “sex addiction” most people probably have a similar, simplistic assumption of what that means. They will picture someone who has sex a lot throughout the day, or maybe someone who has a lot of sexual partners. Some people associate it with over-indulging in pornography or engage in an inappropriate sexual behavior.
However, these are not necessarily the defining features of sex addiction. Not everyone who suffers from it will have multiple partners, and they most certainly don’t all act out inappropriately. While some of these scenarios may be present in those who experience sex addiction, many advocates believe the vital element of sex addiction has to do with the consequences of their behaviors and their inability to control them. Other terms for sexual addiction include:
- Hypersexual Behavior Disorder
- Hypersexuality
- Sexual dependency
- Compulsive sexual behavior
It is also known as nymphomania in females and satyriasis in men. So what is sex addiction, and can it be treated?
The DSM Debate
The most difficult part of the conversation is trying to talk about what sex addiction actually means when it is not officially recognized as a mental health disorder.
One of the most essential tools we use for understanding and treating mental health is the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a widely recognized compendium of mental health diagnostics. This crucial resource receives regular updates from the American Psychiatric Association (APA).
At this point in time, the DSM does not include criteria for sex addiction. Among mental health professionals in the APA, this is the cause of a great deal of debate. For a quick timeline:
(DSM-III-R), referred to “distress about a pattern of repeated sexual conquests or other forms of non-paraphilic sexual addiction, involving a succession of people who exist only as things to be used.” The reference to sexual addiction was subsequently removed.
The DSM-IV-TR did not include sexual addiction as a mental disorder.
Some authors suggested that sexual addiction should be re-introduced into the DSM system; however, sexual addiction was rejected for inclusion in the DSM-5, which was published in 2013.
Darrel Regier, the vice-chair of the DSM-5 task force, stated:
“Although ‘hypersexuality’ is a proposed new addition… [the phenomenon] was not at the point where we were ready to call it an addiction.”
The proposed diagnosis does not make the cut as an official diagnosis due to a lack of research into diagnostic criteria for compulsive sexual behavior, according to the APA.
As of 2017, none of the official regulatory bodies for Psychosexual Counselling or Sex and Relationship therapy, have accepted sex addiction as a distinct entity with associated treatment protocols.
The World Health Organization produces the International Classification of Diseases (ICD), which is not limited to mental disorders. The ICD-10 includes “excessive sexual drive” as a diagnosis (code F52.7), subdividing it into satyriasis (for males) and nymphomania (for females).
However, the ICD categorizes these diagnoses as “compulsive behaviors” or “impulse control disorders” and not specifically addiction.
The most recent version of that document, ICD-11, includes only “compulsive sexual behavior disorder” as a diagnosis, but does not use the addiction model.
Opposing Expert Opinions
Some opposing it believe that it is an agenda put forth by “sex-negative” clinicians trying to control the private behaviors of their patients. Indeed, some practitioners regard sex addiction as a potentially harmful diagnosis. Some even draw parallels with controversial gay conversion therapy that has caused a great deal of outrage over the years.
Of course, this is an understandable reservation to have. No one should be made to feel that their sexual preferences are an illness. So the debate is not an easy one to solve. When does one draw the line and say what should be considered “healthy” sexuality? In the end, some do fear that having a sexual addiction classification will make problems out of nonproblematic experiences.
However, there are still many experts and mental health professionals advocating for the inclusion of sex addiction as an official psychiatric condition. Many therapists and psychiatrists say that excluding sex addiction from the DSM completely disregards the pain, confusion, trauma, fear, and hopelessness of sex addicts and their families.
What Advocates Consider Sex Addiction
Even though there are no official DSM criteria for sexual addiction, provisional diagnostic criteria for sexual addiction that follow DSM format have been derived from DSM-IV-TR criteria for substance dependence.
According to Aviel Goodman, MD, sexual addiction is a maladaptive pattern of sexual behavior that leads to clinically significant impairment or distress, as manifested by at least 3 of the following within a 12 month period.
- A distinctly increased amount or intensity of the sexual behavior to achieve the desired effect or markedly diminished effect with continued involvement in the sexual behavior at the same level of intensity.
In other words, needing more in order to feel something. This is often seen in relation to substance abuse when people develop a tolerance to a drug over time.
- Characteristic psychophysiological withdrawal syndrome. When someone discontinues a sexual behavior and experiences
- Physiologically described changes
- Psychologically described changes
- The sexual behavior is often engaged in over a longer period, in greater quantity, or at a higher level of intensity than was intended.
- Persistent desire to engage in sexual behavior and being unable to control the sexual behavior.
- Excessive time is spent on activities necessary to prepare for the sexual behavior, to engage in the behavior, or to recover from its effects.
- People reduce or discontinue important social, occupational, or recreational activities because of the sexual behavior.
- The sexual behavior continues despite knowledge of the harmful consequences of the behavior.
This outline is not the final word on sex addiction. It is possible that our understanding of sex addiction will evolve as research grows. For now, this is a starting point to better understanding how sex addiction impacts people.
What Sex Addiction Is NOT
Due to there being no clear-cut definition of sex addiction, there are also those who mislabel certain behaviors. While everyone may not agree on sexual addiction as a condition, those who do typically agree on what is NOT sex addiction. Most notable examples are the controversies surrounding allegations of sexual misconduct and how certain individuals have used sex addiction as an alibi for inappropriate sexual activity.
Also, some people may be mislabeled by others as sex addicts because of their preferences. However, this is also incorrect. It is significant to point out that no form of sexual behavior in itself constitutes sexual addiction. A pattern of sexual behavior does not qualify as sexual addiction based on things like:
- The type of behavior
- The object of the behavior
- Frequency
- Social acceptability
Sexual addiction is determined by how it impacts the individual’s life. Essentially, any sexual behavior has the potential to be engaged in addictively. That does not make the behavior itself inherently wrong. Again, we reiterate that the key features distinguishing sexual addiction from other patterns of sexual behavior are:
- The inability to control the sexual behavior reliably
- Continuation of the sexual behavior despite significant harmful consequences
There are plenty of situations where people find it very difficult to determine what constitutes a sexual addiction and what does not.
Paraphilia
A great example of a circumstance that isn’t so black and white is paraphilia.
Paraphilia is a condition where people have sexual desires that typically involve extreme or dangerous activities. Again- this is another term that causes contention because some people label the behavior as abnormal, while others say it is simply a fetish. The symptoms of sex addiction and paraphilia overlap to some extent, but they are not identical. Some sex addicts are not paraphiliacs, and some paraphiliacs are not sex addicts.
A similar distinction exists between a sex addict and sex offender, where the area of overlap is considerably smaller. However, this does not mean the behaviors of a sex offender are justified by sex addiction.
Sex Addiction Treatment
After all that, we have to ask- can sex addiction be treated? According to an article published on healthresearchfunding.org, an estimated 12 to 30 million people in America experience sexual addiction. So do they have opportunities to get help?
This is why it is important to have more research on sex addiction so that more can be done to create better opportunities for treatment. For now, some people find a great deal of help utilizing the same concepts presented in substance abuse treatment. Most people who do get help for sex addiction receive help from addiction professionals.
Current treatment options aim to reduce any excessive urges and to encourage the nurturing of healthful relationships. An important element in treating sexual addiction is not to shame people for their preferences or their experiences and try to help them design a personalized recovery plan that will help them have a happier and healthier life. A lot of people who get treatment for sex addiction do find help with options such as:
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Residential treatment programs
Residential treatment programs exist to help individuals struggling with various addictive disorders. These are in-patient programs where individuals live on-site at a facility while receiving direct care from specialized therapists in a safe and controlled environment.
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Cognitive behavioral therapy (CBT)
Many programs that work to treat sexual addiction provide cognitive behavioral therapy. This comprehensive approach gives people a variety of techniques that help the individual change their behavior. CBT can equip a person to avoid relapses and reprogram harmful sexual behaviors by helping them recognize patterns and develop healthier coping skills.
Beyond traditional addiction treatment options, there are always self-help organizations and support groups. Numerous 12-step programs offer to help the individual in self-managing their sexual addiction, including:
- Sex Addicts Anonymous
- Sexaholics Anonymous
- Sexual Compulsives Anonymous
- Sex and Love Addicts Anonymous
For some, sex addiction goes hand-in-hand with a substance use disorder, such as alcoholism. In cases like this, medical detox is always a good idea in order to get professional support through the initial process of withdrawal. Also, it is important for those struggling with co-occurring disorders to consider dual diagnosis treatment in order to address both issues for a stronger foundation for recovery.
Despite the debate about how sexual addiction should be classified, the reality is that a lot of people have seen the damage done to their lives as a result of their behaviors. So without trying to punish the sexuality of an individual, there should be resources available for those who want help. If you or someone you love is struggling with an addiction, please call toll-free now.
CALL NOW 1-888-922-5398
by Justin Mckibben | Sep 13, 2018 | Coping Skills, Drug Abuse, Family, Mental Health, Parenting, Relationships
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
Most people in the world would say that nothing is more important than family. They say that you can choose your friends, but family is forever. If you subscribe to the philosophy of blood being thicker than water, then it makes sense that when those closest to you suffer, you suffer right along with them. For many, this concept is never more painfully clear than when living with an addict in the family. Even though plenty of people struggling with addiction say they are only hurting themselves, most of us know that addiction is a family disease.
While there are many obvious ways that addiction affects a family, like domestic violence, financial troubles or death, there are also some more subtle consequences. When someone is suffering, their loved ones will often develop specific family roles for dealing with addiction. Depending on the household, and how the addiction manifests itself, some people may take on multiple roles in order to try and create a balance at home. However, many of these family roles can cause adverse effects of personal development over time.
Here are 6 family roles people use when coping with addicted loved ones.
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The Victim
Addiction and its effects draw a lot of attention, so it may seem to the addict that the world revolves around them. They take on a victim mentality, often causing others in the family to feel the need to save them, or at least to avoid disturbing them.
The victim is central to all the other family roles that develop around it. As the roles are defined, the victims loved ones unconsciously take on other family roles to complete the balance after the problem has been introduced.
Although this person’s actions are the key to their own recovery and overcoming the victim mentality, it is important to remember they are not necessarily vital for a family to recover on its own.
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The Hero
In the family, there will be someone who tries to be the champion for the victim and the family. This is someone who needs the family to look good, and they will work hard to make it so. The problem with the Hero is that they try to ignore the addiction and its effects. Instead, they want to dress everything up and act as if all is well.
The Hero will present things in a positive manner as if the family roles don’t actually exist. They are often perfectionists and overachievers, who seek to unite the family and offer hope through their own accomplishments. But taking on all this pressure can cause a lot of stress and anxiety for this family member. Very often this is the child of an addict or alcoholic.
If the Hero is able to finally overcome this role, they can ultimately play a crucial part in the addiction recovery process, both for the individual and for the family.
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The Mascot
The Mascot’s is often thought of as the comic relief. This is the member of the family who uses humor as a defense mechanism and a distraction tactic. They try to soften the impact of an addicts behavior or ease tensions between family roles through laughter.
On the bright side, the Mascot does bring humor to the family roles people use for coping with addicted loved ones. They have a talent for making others feel better, even in the worst situations. But ultimately, they are also people-pleasers to a fault, which can foster feelings of anxiety.
However, Mascots sometimes make inappropriate jokes about other family members or situations, which can causes friction. They also run the risk of avoiding their own feelings or being inconsiderate of the feelings of others. Sometimes their harmful humor can hinder addiction recovery.
Also, the Mascot is likely to self-medicate as they grow up, perpetuating the cycle of addiction.
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The Lost Child
In every family that deals with an addicted loved one, there is usually someone who tries their best to disappear. They are silent, withdrawn, and avoid drawing much attention to themselves from other members of the family. This is the Lost Child.
The Lost Child is typically careful to not make problems. They avoid any kind of conflict, along with conversations regarding the addiction or the underlying family roles that take shape around the victim.
The Lost Child will spend as much time as possible in isolation or away from their family. They are the child who sits in their room playing video games or watching TV for hours without any interaction. The Lost Child will often develop feelings of neglect and resentment, which can lead to depression. They often grow up to have a very difficult time developing healthy relationships later in life.
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The Scapegoat
The Scapegoat is a problem child. Usually, this is the black sheep of the family who often acts out in front of others. They take on this role, knowingly or subconsciously, to divert attention from the person who is addicted. They rebel home, get in trouble at school, make a lot of noise to mask the underlying issues in the family. Male scapegoats are often prone to violence, while female scapegoats frequently act out sexually.
This person may even adopt substance use in order to run interference for a parent or sibling. They may develop other issues as well, such as eating disorders or a tendency to self-harm.
The Scapegoat covers or draws attention away from the real problem. They grapple with feelings or anger and shame, and they often offer the other family roles a sense of purpose- being someone to watch out for or try to fix.
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The Enabler
The Enabler is also commonly referred to as the Caretaker but is always the person who makes all the other family roles possible. Most often this is a spouse, but it can also be a child of an addict.
Caretakers will take it upon themselves to keep everyone happy, believing it is the best way to protect the family. Their mission is to maintain balance in order to make the family look good on the outside. They are notorious for minimizing the addiction, making excuses for all behaviors and actions. They have a knack for blaming everything on something else, without acknowledging the real problem.
This person protects the addict from consequences, while constantly cleaning up after their messes.
Additionally, the Enabler frequently embraces the other family roles when they are convenient for maintaining the family balance. They will laugh at the Mascots harmful jokes, or adamantly put the focus on the Hero’s achievements. They will support the Lost Child’s “independence”, and run interference for the Scapegoat, all while catering to and caring for the needs of the victim.
Functional Dysfunction
At the end of the day, the family roles people adopt as part of coping with an addicted loved one are a kind of functional dysfunction. It is a system that people create in order to survive situations at home that can be toxic and unpredictable. Human beings by nature will behave in accordance with their surroundings. Out of self-preservation, we will get used to unhealthy strategies for dealing with unhealthy relationships. Even if they are not effective, if they help us get by there is a lot of damaging stuff we will get used to.
All of these family roles demonstrate how important it is for families to be supported and involved in a loved one’s recovery from addiction. Because we can see how addiction impacts the family, we know that the family also needs help in overcoming those adversities. Having a recovery program designed specifically for family members and loved ones of people with addiction can make all the difference. Not only does it help the family support their loved one, but it helps the family recover on its own. Family can also play a very important role in relapse prevention. It teaches them what their loved ones may experience during the medical detox phase of treatment. It helps them better understand the science of addiction and the process of recovery, while also showing them how their own behaviors have an impact.
The Palm Healthcare Family Program is all about helping the family come together to face addiction and overcome all the unique challenges that come with it. If you or someone you love is struggling with addiction, please call toll-free now. You are not alone. We want to help your family be stronger together.
CALL NOW 1-888-922-5398
by staff | Aug 16, 2018 | Family, Mental Health, Recovery, Relationships, Self Improvement, Sobriety
(This content is being used for illustrative purposes only; any person depicted in the content is a model)
By: Thomas G. Beley, PhD, LCSW
There is a German fable that states that relationships are like two porcupines trying to keep warm in the dead of winter. Move in too close, or too quickly, in the anticipation of feeling the warmth, chances are the porcupines are going to experience some discomfort and pain from their respective ill-positioned quills. Yet, being afraid of getting too close to each other, the porcupines are likely to run the risk of dying from the winter cold.
As individuals, our relationships are not too different than the porcupines. Whether it is with family, friends, co-workers or strangers, we are constantly in a natural process of trying to determine just how close we need to be with someone while at the same time not sacrificing our own individual beliefs, values, or needs. It is the negotiation of these two natural forces of individuality and togetherness that determines the success of any relationship. Too much of either or an imbalance can have unsettling effects.
It is important to understand that individuals are subject to an inherent process of trying to reach a successful balance between these two natural forces. Research has shown that this is a process rooted in nature and all living organisms. Being a part of all life means we have the desire to be our own person yet at the same time desire the safety and security of the group.
Finding Balanced Relationships
In humans, this process happens both consciously and unconsciously. We seek out relationships that will give us both the opportunity to pursue our own individual needs while at the same time involve ourselves in a relationship that is nurturing and comforting. Our behavior, whether good, bad, or indifferent, is often influenced by these forces of nature of trying to find that right balance between one’s need for individuality and togetherness. The successful balance of these two life forces is what brings us a sense of well being and contentment. It is our ability to maintain this delicate balance between individuality and togetherness that determines the quality of any given relationship.
It is also important to note, here, that the quest for individuality or togetherness is not to say that one is more important than the other. They are both extremely critical. However, it is how a person balances these two forces within their life and the relationship systems in place that makes the difference between staying calm and collected and being in a state of turmoil and conflict.
Relationship conflicts often occur when there is an imbalance in these two natural forces. Imbalances can occur both within the individual and within the relationship system itself. A common scenario that often develops is when one person within the relationship system desires more individuality and the other person in the relationship system desires more togetherness and closeness. As is often the case, one person begins to feel overwhelmed in the relationship while the other person may feel neglected. Typically, the person desiring more individuality is running away from the relationship system while the person seeking more closeness is chasing the relationship system.
The Dance of Conflict
This “dance” can occur in a variety of ways. One such way is when an individual requires an excessive amount of one or the other. Too much of an individuality influence may make it difficult for that person to make a meaningful connection with others, particularly those who desire more closeness and togetherness. In that desire to achieve a sense of individuality, a person can easily cut him or herself off from others. Along the same lines, a person with a high degree of individuality may find others having a difficult time making a meaningful connection with him or her. The same holds true for the person needing a great deal of togetherness. The desire to achieve closeness can result in the person becoming excessively dependent on others or not maximizing their own individual potential.
Another common scenario that is when one person desires individuality and the other person is requiring a sense of togetherness. A person who requires a sense of individuality will likely create a conflict in the relationship system of the person who has the desire to achieve more togetherness. The same dilemma holds true if two people have inordinate amounts of the same needs. Two people desiring a great deal of individuality will likely experience the cold of winter. Two people desiring a great deal of togetherness will likely feel the quills of another person. When there is an imbalance of these needs, anxiety occurs and the potential for conflict exists.
Find What Matters
It is important to emphasize that there is no magic formula that constitutes what is the right amount of togetherness or individuality within a relationship system. What truly matters is how a person manages their respective needs and the awareness of the needs of the other within the relationship system.
Doctor Thomas G. Beley, Ph.D., LCSW is the Executive Director of Palm Healthcare Company. For over 25 years, Doctor Beley has worked in the field of substance use disorder and mental health disorders. Through the years of helping people who struggle with drugs, alcohol and mental health issues, Doctor Beley has proven to be an expert clinician and an innovative and compassionate leader in the treatment industry. Palm Healthcare Company is grateful to have an executive team with experience and incredible commitment to helping others. If you or someone you love is struggling, please call toll-free now. We want to help.
CALL NOW 1-888-922-5398
