“Understanding the Assessment, Diagnosis and Treatment of Sexual Addiction in the Digital Age”
A Review of the April 2012 presentation by Robert Weiss to the Santa Cruz chapter of the California Association of Marriage and Family Therapists
by Amy Cooper, PhD.
This April CAMFT workshop was led by Robert Weiss, LCSW. Weiss is the director of Sexual Disorder programs at several treatment facilities around the U.S. and author of “Cruise Control: Understanding Sex Addiction in Gay Men.” He studied with Patrick Carnes, PhD, who pioneered the founding of the Certified Sex Addiction Therapist (CSAT) program and has written numerous books on the topic of sexual addiction.
Weiss started out by describing what sex addiction is not. He assured us that the term “sexual addiction” is not based on a moral or religious stance. It is not a term for sexually repressed people to use to judge or condemn another’s sexuality. Sexual behaviors such as masturbation, fetishism, homosexuality, polyamory, BDSM, use of pornography, or even engagement in illicit sexual affairs or prostitution, are not synonymous with sexual addiction. Also, a diagnosis of sexual addiction can only be given upon ruling out other mental health disorders, such as ADD, OCD, bipolar disorder and substance abuse.
So what is sexual addiction? Weiss believes its root is the use of intense fantasy to release neurochemicals in the nervous system. In other words, sex addicts use sexual fantasy to generate their body’s own pharmaceuticals- serotonin, dopamine, adrenaline, endorphins, and oxytocin. Creating neurochemical cocktails through intense sexual preoccupation can become very addictive. It becomes sexual addiction when it compels a person to act out in uncontrollable or harmful ways.
According to Weiss, sexual addiction is not about sex or orgasm. It is about the search for sex and the desire for orgasm. He considers it a “process addiction.” Sex addicts will often refer to the addictive state as “the bubble,” “the trance.” They may stay in such a state for hours, sometimes dissociating. Typical sex addict behaviors include compulsive and extended use of pornography (with or without masturbation), anonymous sex, cruising, intriguing, objectifying, seduction, pushing boundaries, and frequenting prostitutes, massage parlors, adult bookstores, and strip clubs. These activities, however, are not always indicative of a sexual addiction.
Weiss believes it is important to have a diagnosis in the DSM, both to keep people from being misdiagnosed, as well as to keep religious and moral judgments at bay. The proposed Hypersexual Disorder Diagnosis defines the disorder as enduring for a period of at least 6 months, and involving recurrent and intense sexual fantasies, urges and behaviors. The proposed diagnosis requires a minimum of four out of five of the following criteria:
1. Excessive time is consumed by the behavior,
2. Repetitively engaging in the behavior in response to anxiety, depression, boredom, or irritability,
3. Repetitively engaging in behavior in response to stressful life events,
4. Repetitive but unsuccessful efforts to control behavior, and
5. Repetitively engaging in behavior with disregard to the risk of physical or emotional harm of self or others.
With regards to technology, Weiss believes that the advancements of technology are making it easier for sex addicts to act out, perhaps fueling the “disorder” somewhat. Sexual media and sexual connections have become more accessible, more affordable, and more easily anonymous with the internet. This makes it easier for people to become consumed with their addiction. Fortunately, technology is also there to help sex addicts- with online 12-step chats, skype meetings and sponsorships, and virtual reality de-sensitization techniques.
Weiss also discussed the treatment needs of a sex addict’s spouse, who will often feel traumatized, betrayed and grief-ridden. They may even be experiencing a form of PTSD. It is important to initially help them address any health and safety issues for them or their family. Then treatment involves educating them about sexual addiction, empathizing with their feelings, helping them get social support, providing a structure for them to move forward, and giving them hope. It may take awhile for the betrayed spouse to trust again. They may question whether to leave the relationship. The outcome is likely to correlate somewhat with the treatment progress of the sex addict.
Weiss views sexual addiction as a behavioral problem, requiring behavioral forms of intervention and treatment. He considers group work to be more effective than individual therapy. Weiss’s basic treatment protocol for sex addicts is as follows: After doing a thorough psycho-sexual history/assessment, a therapist works with the client to create a sexual sobriety contract. The therapist then holds their client accountable to this contract, confronting any deviations.
The therapist also educates and teaches the addict about relapse prevention, and refers them to long-term group therapy, 12-step groups, faith-based support groups or individual therapy. Sexual sobriety for a sex addict does not mean they can never sex again. It is defined by abstinence from the agreed upon behaviors in their individualized contract. While there have been no studies done to show the efficacy of this treatment protocol, Weiss claimed there is anecdotal evidence.