Sexual Addiction

Clinical Presentations & Treatment Approaches

Ben Hughes
IRCHSS Scholar
School of Social Work and Social Policy
Trinity College Dublin
Presentation Overview
o Current Research
o Clinical Presentations
o Treatment Approaches
Research Project - Aim
to investigate and analyse the experience of adults
who self- identify as sexual addicts
and of the
experience of treatment providers
who work with this issue in clinical practice
Progress to Date
q Focus Groups - Questionnaires - Interviews
q 80 Participants - 2 Groups
q Life Histories, Patterns, Impact, Recovery
Classification
o Historically
o Paraphilic / Deviant
o NonParaphalic / Conventional 86%
o Sexual Disorder Not Otherwise Specified DSM
o Hypersexuality DSM 5
Definition
o An increase in intensity and frequency of normophilic
sexual behaviours that are associated with significant
adverse consequences. Kafka (2010)
Hypersexuality
Recurrent, intense fantasies, urges, & behaviour
CRITERIA
Time consuming
Dysphoric
Stress
Volitional impairment
Risk-taking
Negative consequences
Not linked to other condition
18 Years +
BEHAVIOURS
Masturbation
Pornography
Behaviour Consenting Adults
Cybersex
Telephone Sex
Strip Clubs
(Proposed revision DSM 5)
Current Reality
o Controversy
o Clinical - recognize & diagnose 7%
o Intrinsically normal - treatment
Criteria
o Extreme / Preoccupation
o Loss of control
o Continues despite negative consequences
o Generally not about sex
o Intimacy / emotional dysfunction
o Escape
Behavioural Presentation
o Consenting adults
o Pornography
o Cybersex
o Telephone sex
o Masturbation
o Strip clubs
o Adult stores
Clinical Characteristics
o Out of control
o Self destructive
o Desire to limit
o Coping mechanism
o Increasing amounts
o Mood changes
o Neglectful
Carnes (1992)
Research Results - Aetiology
o Family of Origin
o Childhood Trauma
o Early Sexualisation
o Emotional regulation
Who are these people?
o Male / Female 70% / 30%
o Age 21- 63
o Hetrosexual 62%
o Employed 93%
o University Educated 41%
o Middle Class + Upper 45%
o Relationships 50%
o Children 35%
o Other Addictions 82%
Who are these people?
o Sexual Abuse 48%
o Mental Illness 69%
o Age when recognised addiction:
n Teens 16%
n 20s 24%
n 30s 28%
n 40s 32%
o Counselling 65%
o Progress - Good / Excellent 60%
Diagnosis
Assessment
Treatment
Impediments to Diagnosis
o Complex
o Normal
o Low index of suspicion
o Lack of criteria / knowledge / training
o Denial
o Cultural / Moral
Differential Diagnosis
o Neurological / Endocrine conditions
o Bipolar / Psychotic disorders
o Personality Disorder
o Substance abuse
o Attend to concurrent psychiatric disorders
o Reconsider independent / coexisting
Diagnosis
o Not presented - Disclosure
o Associated symptoms
o Depression, Addiction, STDs,
o Unwanted Pregnancies, Abuse
o Relationships, Sexual Dysfunction
Assessment
o Have they lost control over sexual behaviour?
o Continuation despite harmful consequences?
o Are they constantly thinking about sex?
o Sexual Addiction Screening Test SAST
Treatment
o Pharmacological intervention
o Psychotherapy
o Emotional, Conflict, Intimacy, Sexuality
o Healing abuse, Shame, Education, Spirituality
Medical
o GP 7% Psychiatrist 17%
o Antidepressants SSRIs
o Antiandrogens
o Reduce sex drive
o Improve impulse control
o Affect regulation
Clinical Issues
o Similar / Different
o Sexual Sobriety
o Abstinence
o Ethical Issues
Thank you
Questions ?
This research is funded by the
Irish Research Council for the Humanities & Social Sciences