Defining Compulsive Sexual Behavior and Relationship Dependency

Problems related to compulsive sexuality and loving too much have existed for ages, but these behaviors have only recently been seen by some as "addictions." Self-help groups such as Sex and Love Addicts Anonymous (SLAA) began in the mid-1970s based on the 12-Step recovery model pioneered by Alcoholics Anonymous. Drs. Eichel and Dubrow-Marshall have been treating sexual compulsivity since 1990.

What is an addiction? How can sex and love be "addictive"?

Any compulsive, self-destructive behavior that involves an alteration of mood or awareness, and that persists in spite of negative consequences, might be considered an addiction. Addictions have in common the pursuit of a "high" (mental obsessions, compulsive behavior, being "out of control"), tolerance, withdrawal, and progression. All of these can apply to problems with love and sexuality. While many sex and love addicts "act out" behaviorally, others may "act in" (become completely controlled and nonsexual). Still others primarily experience recurring thoughts, images, or fantasies related to sexual behaviors or romantic relationships. In all cases, sexuality is used as a primary method for coping with unpleasant or disturbing feelings, ideas, and stresses.

Dr. Patrick Carnes, in his book Out of the Shadows: Understanding Sexual Addiction (1983), identified three levels of sexual addiction:

Levels of Sexual Compulsivity

• Level One: Compulsive masturbation; compulsive heterosexual relationships; compulsive affairs; obsession with pornography, prostitution, massage parlors, and pornographic book stores; compulsive homosexual "cruising," and anonymous sex.
• Level Two: Exhibitionism (both male and female); voyeurism; indecent liberties (inappropriate touching); obscene phone calls.
• Level Three: Child molesting; incest; rape.

Treating Compulsive Sexual Behavior and Relationship Dependency

We view sexual compulsivity as a shame-based psychological problem. It is not due to "perversion," immorality, sinfulness, or lack of will-power; it is a treatable illness similar to alcoholism. In addition, addicts may have histories of trauma and abuse, and comorbid dissociative, depressive, or affective disorders. Humiliating, shaming or "guilt-tripping" the sex and love addict makes the problem worse! Sex and love addiction is treated using some combination of six treatment modalities:

• Psychoeducation: sexual compulsivity is not well-understood, even by some addictions specialists and sexologists. Through reading and attending workshops and lectures, recovering sex and love addicts begin to understand the dynamics of the addictive and recovery processes.
• Individual psychotherapy: for shame reduction, insight into the causes of the addiction, resolution of trauma, and establishment of new coping strategies.
• Group psychotherapy: for shame reduction, group support, and to practice healthy interpersonal skills.
• Family/couples psychotherapy: to help the family understand the nature of addictive behavior, to reduce shame, to improve communication, to set and respect individual boundaries, and to assist the spouse, significant other, and/or family member(s) evaluate and cope with any codependency issues.
• Medication: some sex and love addicts find antidepressant or antianxiety medications very helpful in reducing the urge to act out. Others may have underlying affective disorders that respond to medication (e.g., lithium).
• 12-Step self-help groups: regular participation in one or more "S"-group (SLAA, SAA, SA, SCA) is, for many, a vital means for redefining intimate friendships, finding and utilizing peer support, reducing shame, and enhancing spirituality.

The addict who suffers repeated relapses, or who continues to place him/herself at risk for a particularly serious consequence (e.g., HIV or other sexually transmitted diseases, arrest, divorce, loss of child custody) may be better helped through inpatient treatment. To find an inpatient treatment program, please go to http://sash.net/component/option,com_mtree/task,listcats/cat_id,44/Itemid,55/ . 

Drs. Eichel and Dubrow-Marshall have authored chapters in Dr. Eric Griffin-Shelley's second book on sex and love addiction, Intensive Outpatient Treatment of Sex and Love Addiction (Praeger, 1993). They have conducted numerous workshops on the treatment of sexual compulsivity for a large variety of regional and national professional psychology and counseling associations.

Back to Specialized Services Page