Nonparaphilic Sexual Addiction

Patrick Carnes defines sexual addiction as “a ‘pathological relationship’ with a mood-altering experience … Sex addicts have lost control over their ability to say no; they have lost control over their ability to choose. Their sexual behavior is part of a cycle of thinking, feeling, and acting which they cannot control.” (Patrick Carnes, Contrary To Love, Minneapolis, MN, 1989, pp. 4–5) Schwartz and Brasted call it “a syndrome in which a person is excessively preoccupied with sex; sexual thoughts persistently intrude and distract, and some individuals become involved in repetitive compulsive sexual activity that becomes undesirable.” ( Mark Schwartz F. , and William ScD , Brasted S. Ph.d. , “Sexual Addiction,” Medical Aspects of Human Sexuality, Vol. 19(10), Oct./85, p. 103). Kafka includes under the description of nonparaphilic sexual addiction “culturally acceptable sexual interests and behaviors which increase in frequency or intensity so as to significantly interfere with the desired capacity for a sustained intimate sexual relationship.” (Martin P. Kafka, M.D., “Successful Antidepressant Treatment of Nonparaphilic Sexual Addiction and Paraphilias in Men,” Journal of Clinical Psychiatry, Vol. 52 (2), Feb./91, p. 60).

Carnes , Contrary To Love, p. 22.

Carnes , “I believe that we are currently at the same stage of understanding sexual addiction as we were when we believed that the typical alcoholic is a street drunk. We know now that the housewife who drinks alone is in as much need of strong recovery as the street drunk or the acting-out alcoholic. The sexual anorexic is as desperate inside as the rapist or the child molester. Her behavior may not be as dangerous to society … it is dangerous to her …” (Ann Wilson Schaef, Escape From Intimacy, San Francisco, CA, 1989, p. 26).

DSM-III-R applies the name “paraphilias” to the following list of sexual disorders: “pedophilia, exhibitionism, voyeurism, sexual sadism, sexual masochism, fetishism, transvestism, zoophilia, and frotteurism.” (Frank Costin and Juris G. Draguns, Abnormal Psychology: Patterns, Issues, Interventions, Toronto, ON, 1989, p. 218).

DSM-III-R According to Kafka, a number of researchers “have noted a continuity between paraphilias and nonparaphilic sexual addictions.” (Martin P. Kafka, M.D., “Successful Antidepressant Treatment of Nonparaphilic Sexual Addictions and Paraphilias in Men,” p. 60).

Costin , and Draguns , Abnormal Psychology, p. 358.

Costin , and Draguns , Abnormal Psychology, p. 358.

“Paraphilic behaviors are currently characterized as impulse control disorders. Nonparaphilic sexual behaviors, however, are considered ‘addictions’ in current nosology. This distinction could imply a difference in their respective etiology as well as treatment. Paraphillias and nonparaphilic sexual addictions collectively have also been described as addictions, obsessive compulsive spectrum disorders or affective spectrum disorders.” (Martin P. Kafka, M.D., and Robert Prentky, Ph.D., “Flouxetine Treatment of Nonparaphilic Sexual Addictions and Paraphilics in Men,” Journal of Clinical Psychiatry, Vol. 53 (10), Oct./92, P. 351). Kafka notes the difficulty involved in attaining unanimity among researchers for this particular classification; he admits to ongoing “controversy as to whether the form of these behaviors constitutes an addiction, a compulsion, forms of hypersexuality, or a disorder of impulse control.” (Kafka, “Successful Antidepressant Treatment of Nonparaphilic Sexual Addictions and Paraphilias in Men,” p. 60). For example, according to Stein, et al., the obsessions and compulsions of obsessive-compulsive disorder (OCD) patients may at first “appear markedly different from the symptoms of patients with paraphilias and sexual addictions. Thus, patients with OCD typically experience their symptoms as intrusive or senseless. On the other hand patients with parahilias and sexual addictions typically experience their sexual urges and acts as pleasurable. Whereas OCD patients may experience relief after completion of rituals, patients with paraphilias and sexual addictions may experience guilt or shame on completion of their behaviors. “Nevertheless, paraphilias and related disorders may lie on the obsessive compulsive spectrum. OCD patients frequently have obsessions with a sexual content and may be plagued by religious and moral concerns about sexual issues. Patients with paraphilias and sexual addictions, on the other hand, may have comorbid OCD. Furthermore, OCD patients do not always experience their symptoms as senseless and may obtain a sense of relief from completion of rituals. Conversely, patients with paraphilias and sexual addictions may experience their sexual urges as alien to their self-image, and while enactment of fantasies may be anxiety-relieving, it may also lead to discomfort.” (Dan J. Stein, M.B., Eric Hollander, M.D., Donna T. Anthony,. M.D., Ph.D., Franklin R. Schneier, M.D., Brian A. Fallon, M.D., Michael R. Liebowitz, M.D., and Donald F. Klein, M.D., “Serotonergic Medications for Sexual Obsessions, Sexual Addictions, and Paraphilias,” Journal of Clinical Psychiatry, Vol. 53 (8), Aug./92, pp. 267–8). For a discussion on the practicality of the use of the term “addiction” to denote sexually obsessive-compulsive behaviour, see Sally Satel, “The diagnostic limits of ‘addiction’,” Journal of Clinical Psychiatry, Vol. 54 (6), June/93, p. 237 and Dan J. Stein and Eric Hollander, “The diagnostic limits of ‘addiction’: reply,” Journal of Clinical Psychiatry, Vol. 54 (6), June/93, pp. 237–8.

Costin , and Draguns , Abnormal Psychology, p. 14.

American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 3rd ed., rev., (DSM-III-R) Washington, D.C., 1987, “Impulse Control Disorders Not Elsewhere Classified,” p. 321. DSM-III-R also makes allowance for this particular disorder under the category of “Sexual Disorder Not Otherwise Specified,” wherein it lists as such an example “distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used.” (p. 296) Compare Kafka and Prentky, “Fluoxetine Treatment of Nonparaphilic Sexual Addictions and Paraphilics in Men,” p. 351: “… nonparaphilic sexual addictions (NPSAs) have not been rigourously operationalized and have been relegated as Sexual Disorders Not Otherwise Specified (NOS)” in DSM-III-R.

“Sexual addiction is a progressive disease and … results in destruction and early death for addicts and often those with whom they are involved. Sexual addiction is of epidemic proportions in this society and is integrated into the addictiveness of the society as a whole …” (Schaef, Escape From Intimacy, p. 10)

Carnes , Contrary To Love, p. 14.

Carnes , Contrary To Love, p. 14.

Carnes “When left unchecked, the adaptive response that led to compulsivity and addiction becomes embedded in the system. Many times adaptive responses are necessary for survival, for example, in the case of childhood sexual abuse. However, when the adaptive response develops into part of an established addiction, only a substantial environmental shift can help stop the self-destructive behavior. Most often, this change in environment is treatment. An intervening system of which the therapist is part helps the damaged system establish a new set of responses and behaviors which brings balance - not another extreme.” (Contrary To Love, p. 229)

Carnes Patrick , Out of the Shadows: Understanding Sexual Addiction, 2nd Ed., Minneapolis, MN, 1992, p. 9. Jim Orford, in an article on hypersexuality, sees the common element in all forms of compulsive sexuality as that of uncontrollable desire: “Preoccupation with the object of these desires and with the means of consuming or partaking of it is another recurrent theme. The behavior itself is felt inapproriate and in excess of what the individual or other people or both would consider normal. The activity is often engaged in response to the experience of unpleasant affect. Most significantly is described the experience of conflict and the attendant ambivalence and guilt. Attempts at self-control, through a variety of tactics, are usually described as well.” (Carnes, Contrary To Love, p. 29) Note the similarities between Carne's stages of the addiction cycle and that of Gorski's which he applies to the alcoholic and drug addict: 1. euphoric recall; 2. positive expectance; 3. a trigger event; 4. obsession; 5. compulsion; and 6. craving. “If the compulsion is strong and persists for a long time, our brain chemistry can change and a craving can be triggered. Craving is a body or tissue hunger for alcohol or drugs.” (Terence T. Gorski, Passages Through Recovery, San Francisco, 1989, pp. 39; 42). Gerald May argues that a similar neurological event occurs in all addictive processes: “As a first step toward appreciating how the brain functions in addiction, we need to review the importance of balance and equilibrium in brain activity … All brain functioning, like the rest of bodily activity, depends upon delicate shifts of balance among chemical, cells, and systems of cells. Like human beings, nerve cells can never act in complete isolation from one another. Their interconnections are so extensive that anything happening anywhere within the nervous system is bound to have effects elsewhere. A change in one cell shifts the balance of its local group and of all its functional systems. These changes, in turn, affect the larger systems of the brain, and these then cause changes in other systems of the body … Adaptions occur through physical changes in the cells of the nervous system: synapses formed and dissolved, connections established and broken, neurotransmitters changed in kind and amount, neuroreceptors altered in number and responsiveness. Adapting to change, then, means going through the stress of withdrawal from the old normality and finding relief when a new normality is established. At this most basic level of human functioning, attachment has made its appearance. I am attached to whatever makes things normal for me. I don't let normality change without a struggle.” (Gerald May, Addiction and Grace, San Francisco, 1988, pp. 72; 78) For a more elaborate and detailed explanation of this neurological process of addiction, see pp. 72–90.

Carnes , Out of The Shadows, p. 9. “… sexual addiction is an obsession and preoccupation with sex, in which everything is defined sexually or by its sexuality and all perceptions and relationships are sexualized … In all its forms, sexual addiction is destructive to the self, to others, and to relationships. Sexual addiction is a source of pain, confusion, and fear for the addict and also for those with whom the addict attempts to relate.” (Schaef, Escape From Intimacy, p. 11) “Sexual addicts escape from their daily troubles by withdrawing into a secret world of fantasy or by having a sexual ‘fix.’ Frequently, they feel compelled to have sexual releases over and over in a short period, each time feeling different from and alienated from other people, and guilty or shameful. Their sexual preoccupation usually interferes with their relationships and often affects their careers and friendships, to the extent that some sexual addicts risk being arrested or attempt suicide. Each time they act out their sexual addiction, they vow to quit, but like addicts of other activities, they are unable to stop.” (Schwartz and Brasted, “Sexual Addiction,” p. 103)

Carnes , Out of The Shadows, p. 10. “The obsession with the intoxication of new love moves into the intoxication of the thrill … their addiction is fully as mind altering as any drug or chemical.” (Schaef, Escape From Intimacy, p. 66)

Compare with the following statements by Craig Nakken (The Addictive Personality, New York, 1988): “… no matter what the addiction is, every addict engages in a relationship with an object or event in order to produce a desired mood change.” (p. 4) “For the addict, acting out is a way to create certain feelings that cause an emotional and mental shift within the person. It is this shift that the addict desires. By acting out either through thoughts or actual behavior, the addict learns to create feelings of being relaxed, excited, or in control …” (p.6) “Addiction and the mood change created by acting out is a very seductive process. The addict is seduced emotionally into believing that one can be nurtured by objects or events.” (p.7) Nakken believes it is the consistency and predictability of the mood change which leads to a sense of trust: “Addicts rely upon a mood change and the mood change comes through for them. People, on the other hand, may not always come through.” (p. 12) Thus, for those raised in abusive or dysfunctional environments and have learned that people cannot always be trusted, the “trustworthiness” of the mood change can seem all the more desirable.

Carnes , Out of The Shadows, pp. 10–11. Typical examples include “the attorney who is married, has a family, and spends his lunch hour in a pornographic bookstore placing his penis through a hole to be anonymously fellated; or the man who cruises local department store bathrooms in search of sexual excitement. The illicit activity produces ‘hits of adrenalin,’ and the risk of apprehension seems to satisfy a need to be caught and punished, or to sabotage successes …” (Schwartz and Brasted, “Sexual Addiction,” p. 103).

“For the sexual addict, conventional lovemaking becomes undesirable. Closeness, vulnerability, and touching or courting an attractive partner no longer produce sufficient sexual arousal …” The problem “is primarily a disorder of intimacy in which the individual has difficulty consistently in combining sexuality and closeness with a desired partner. The addictive thoughts or behavior become a destructive means of coping with stress. When conflict or problems occur with loved ones or at work, the addict copes by sexual acting-out, thereby never solving the problems or changing the ineffective coping strategies.” (Schwartz and Brasted, “Sexual Addiction,”, p. 106).

Carnes , Out of The Shadows, p. 12.

“Following his intense sexual pleasure after acting out, he has a brief escape from the loneliness, boredom, or rage. The escape, however, is short-lived and consequently, the cycle continually repeats itself.” (Schwartz and Brasted, “Sexual Addiction,” p. 106).

Carnes , Contrary To Love, p. 23.

“In order to appreciate fully the importance of bad habits, we must consider their physical as well as their spiritual aspects. The facility of acquired modes of behavior is explained by the empirical fact that stimulatory processes connected with each activity will occur more readily the more often the process is repeated. Metaphorically speaking, the mechanism of reflexes becomes smoother. The psychic contents habitually connected with each other become more firmly knit through habit into a stronger psychic association. This psychic association will be stronger still if certain cravings are connected with corresponding phantasies that serve those cravings and furnish a hitherto unconscious tendency with a definite object. This linking of cravings (instincts) with imagination turns impulses into desires (eg., concupiscence). If such desires are not kept under control the connection between the impulse and its object grows stronger and stronger. The satisfaction of the desire yields pleasure. In turn this pleasure stimulates the desire anew. Its appeal will be the stronger the more intimately desire and the desired object have been connected. If a person has repeatedly indulged in his desires, each new temptation will be accompanied by the recollection of similar, equally sinful acts that have yielded satisfaction in the past. Thus, the inclination to evil will be strengthened. At first, such offenses will be accompanied by countermotives like repentance and the sting of conscience. But as the habit strengthens, these correctives will weaken. Habit encourages the soul, the conscience becomes dull and ineffective, and all countermeasures fail. In order to break such habit, the harmful associations must be gradually disconnected by an attempt at redirecting the will of the afflicted person. This is the best way to fight those inclinations that are directed towards forbidden pleasure. At the same time the inhibiting influence of despondency must be resolutely attacked. Victory over a habit formation will depend on the roots of this habit formation. Habits that are merely acquired may be broken more easily than those rooted in dispositional and hereditary traits….” (William Demal, O.S.B., D.D., Pastoral Psychology In Practice, New York, 1955, pp. 12–13).

Carnes , Contrary To Love, p. 23.

Carnes , Contrary To Love, p. 23.

“…we have discovered that these are not just psychological diseases, they are also spiritual and affect every aspect of one's being. To recover does, indeed, require an entire systems shift. The ‘Big Book’ of Sex and Love Addicts Anonymous says it very well: ‘Yet, whether we were aware of it or not, an entire being had been molded by our failure, or refusal, to solve from within the problems of our real lives: insecurity, loneliness, and lack of any abiding sense of personal worth and dignity. Through sex, charm, emotional appeal, or persuasive intellect, we had used other people as ‘drugs’ to avoid facing our own personal inadequacy. Once we saw this, we realized that in surrendering our addictive behavior we would inevitably have to question the whole foundation of our self-image, our personal identity….’ It further states: ‘As we came to appreciate the magnitude and mind-altering nature of sex and love addiction, and the extent to which it had perverted our value system, we had to admit that we could not reshape our whole identity unaided….”’ (Schaef, Escape From Intimacy, p. 110).

Carnes , Contrary To Love, p. 23.

Carnes , Contrary To Love, p. 24. “… each of us is shaped by our past; who you are today is a mix of what you came into the world with and all your subsequent experiences. In that mix your family of origin has probably played one of the most powerful roles, not only in who you are, but in how you live today. Families hand down across generations not only their genetic pool but also their blueprint for how to live in the world.” (Stephanie Covington and Liana Beckett, Leaving The Enchanted Forest, San Francisco, 1988, p. 14) According to Sprenkle, “current addiction theory suggests the etiology of many addictive behaviors may be related to a common set of experiences in the family of origin of the addict. Specifically, there is often a form of family intimacy dysfunction such as child abuse or neglect. In response to this trauma, the young person develops feelings of shame. These feelings are in part due to a belief that he/she was the cause of the abuse (Coleman, 1986). Feelings of shame lead to low self-esteem and dysfunctional interpersonal functioning which intensify loneliness in the child. In order to alleviate this psychological pain, the child begins to search for a ‘fix’ or some agent that has analgesic qualities. This agent may be alcohol, drugs, certain foods, working patterns, gambling, or sexual behavior. While these agents provide temporary relief, the shame, low self-esteem, and loneliness return. Consequently, there is a need to return to the ‘fix,’ the behavior becomes repetitive, and a vicious cycle develops which leads to a greater need to engage in the behavior for its analgesic qualities (Coleman, 1986).” (Douglas H. Sprenkle, “Treating a Sex Addict Through Marital Sex Therapy,” Family Relations Journal of Applied Family and Child Studies, Vol. 36 (1), Jan./87, p. 12)

Carnes , Contrary To Love, p. 24.

Carnes , Contrary To Love, p. 26.

Carnes , Contrary To Love Nakken agrees with this theory, going so far as to see the potential for addiction in everyone: “The foundation of the addictive personality is found in all persons. It's found in a normal desire to make it through life with the least amount of pain and the greatest amount of pleasure possible.” (Nakken, The Addictive Personality, p. 26) The desire to seek pleasure or avoid pain is not bad in itself, according to Nakken; the problem lies with the inability to regulate and control such desires. “The true start of any addictive relationship is when the person repeatedly seeks the illusion of relief to avoid unpleasant feelings or situations. This is nurturing through avoidance - an unnatural way of taking care of one's emotional needs. At this point, addicts start to give up natural relationships and the relief they offer. They replace these relationships with the addictive relationships.” (Contrary To Love, p. 23) This “illusion of relief,” in Carne's view, emerges again and again when the sexual addict moves from phase four back to phase one of the addiction cycle - the preoccupation phase.

Carnes , Contrary To Love, p. 24.

Carnes , Contrary To Love, pp. 31–32.

Carnes , Contrary To Love, p. 47.

Carnes , Contrary To Love, pp. 47–51.

Carnes , Contrary To Love, p. 52.

Carnes , Contrary To Love, p. 53. Gerald May describes the attachment process which, he believes, occurs in three stages: learning; habit formation; and struggle.”… the learning stage is characterized by associating a specific behavior with a feeling of pleasure or relief from pain … My brain automatically associates these effects with the behavior. If the pleasurable effect is immediate and powerful, my brain will make a strong association between the behavior and its effect in this single experience, and already it will be pushing to repeat the behavior. If the feelings are weaker or less immediate, it may take many reenactments of the behavior for my brain to solidify the association and start to request repeat performances. Either way, each time the behavior occurs, the association is reinforced, making me more likely to repeat it. Thus, certain attachments can develop almost instantaneously, while others may take a long time. This form of learning is known as conditioning; it is the primary way we ‘learn’ to be addicted, and it can happen altogether unconsciously… When the conditioned pattern becomes associated with other experiences in my life, I will become more active in repeating the behavior. Then a full-fledged habit develops Doing the behavior for its effects seems much more intentional than the automatic repetitions of Stage One, but it can still happen completely outside of consciousness. In most cases, I will be totally unaware that I am using the behavior in this way until Stage Three, when something prevents me from performing the behavior, or when it starts to cause problems.” (May, Addiction and Grace, pp. 57–59).

Carnes , Contrary To Love, p. 53. Interestingly enough, Golwyn and Sevlie have argued that there may be a connection between sexual addiction and social phobia. For example, they point to one recent study where almost all the participants “had symptoms associated with atypical depression,” (Daniel H. Golwyn, M.D. and Carol P. Sevilie, R.N., M.S.N., “Paraphilias, Nonparaphilic Sexual Addictions, and Social Phobia,” Journal of Clinical Psychiatry, Vol. 53 (9), Sept./92; p. 330) a disorder which, much like social phobia, is “characterized by rejection sensitivity.” (Ibid.) Another study found that its participants “‘may have had a greater capacity to achieve sexual excitement in relation to fantasy objects than within intimate relationships.”’ (Ibid.) Our authors argue that since “‘fantasy objects’ would be less likely to reject and therefore less threatening to patients with rejection sensitivity than would adults in an intimate relationship,” (Ibid.) it makes sense to suggest that “in these patients it is social anxiety that is blocking the normal capacity for reciprocal sexual activity and this leads to abnormal sexual behavior as the only sexual outlet.” (Ibid.)

Carnes , Contrary To Love, pp. 53–4.

Carnes , Contrary To Love, p. 54.

Carnes , Contrary To Love, p. 56.

Carnes , Contrary To Love, p. 59.

Carnes , Contrary To Love, p. 78.

According to Schwartz and Brasted: “All addictions are chronic disorders that require rehabilitation rather than cure. Treatment is difficult and the prognosis variable.” (Schwartz and Brasted, “Sexual Addiction,” p. 106)

Carnes , Contrary To Love, p. 189.

Carnes , Contrary To Love, p. 190. One of the reasons for this, says May, is that “the brain never completely forgets its old attachments, so the absence of conscious desire does not necessarily mean attachment is gone. In fact, because of the tricks our minds play on us, many of our addictions are able to exist for years completely outside our awareness; it is only when our addictions are frustrated or cause us conflict that we have an opportunity to notice how attached we truly are.” (May, Addiction and Grace, p. 25) And again: “… Because of the deep and pervasive physical power of strong attachments, their potential exists forever in us, even after we have effectively broken the habit of acting upon them … It stands ready to come back to us with only the slightest encouragement … Years after a major addiction has been conquered, the smallest association, the tiniest taste, can fire up old cellular patterns once again… From the standpoint of psychology, this means we can never become so well adjusted that we can stop being vigilant. From a neurological viewpoint, it means the cells of our best-intentioned systems can never eradicate the countless other systems that have been addicted. And from a spiritual perspective, it means that no matter how much grace God has blessed us with, we forever remain dependent upon its continuing flow.” (Contrary To Love, pp. 89–90)

Carnes , Contrary To Love, p. 190.

Carnes , Contrary To Love, pp. 190–191.

Carnes , Contrary To Love, p. 191.

Carnes , Contrary To Love, p. 191.

Carnes , Contrary To Love, p. 199. According to Schwartz and Brasted (“Sexual Addiction,” p. 106), “Many sexual addicts are ex-alcoholic or drug abusers and simply present with a new or dual addiction.” Sprenkle claims there are many sex addicts who use alcohol as “a means of anesthetizing pain related to their sexual behavior.” (Sprenkle, “Treating a Sex Addict Through Marital Sex Therapy,”, pp. 11–12) Kafka's work suggests that “some paraphilias and nonparaphilic sexual addictions, found in association with a mood disorder, can be effectively treated with antidepressant medications” such as “fluoxetine, imipramine, or lithium.” (Kafka, “Successful Antidepressant Treatment of Nonparaphilic Sexual Addictions and Paraphilias in Men,” p. 60) cf. Kafka and Prentky, “Fluoxetine Treatment of Nonparaphilic Sexual Addictions and Paraphilias in Men,” pp. 351–358; see also Stein, Hollander, Anthony, Schneier, Fallon, Liebowitz, and Klein, “Serotonergic Medications for Sexual Obsessions, Sexual Addictions, and Paraphilias,” pp. 267–271, who argue that paraphilic and nonparaphilic sexual addictions, as well as sexual obsessions each respond in varied ways to medication.

“Because of multisystem involvement, breaking an addiction usually requires changes in many different areas of life. A person trying to stop smoking will find the struggle much greater after eating … or at other times that have become associated with cigarettes … Multisystem involvement is also responsible for temporary experiences of freedom when a person's environment changes. A compulsive overeater, for example, will struggle in agony with his addiction to food while in his usual environment. But if he goes on a backpacking trip in the mountains, he may feel quite free of the addiction. In the new environment, he is sufficiently removed from other stimuli that have become associated with his addiction, and he can much more easily deal with his primary urge to eat. He may even think he has finally overcome the problem, only to be deeply disappointed when he returns to his usual surroundings and finds all of his associations triggered afresh …” (May, Addiction and Grace, pp. 85–86)

Carnes , Contrary To Love, p. 227.

Carnes , Contrary To Love, p. 228. “The first component of successful treatment is stopping the undesirable sexual activity. Aversive behavioral techniques of covert sensitization and fantasy satiation are used to temporarily stop the sexual acting-out. Occasionally, antiandrogen or tranquilizers can provide adjunctive, temporary amelioration.” (Schwartz and Brasted, “Sexual Addiction,” pp. 106–107)

Carnes , Contrary To Love, p. 234. “The first prerequisite for intimacy is to be intimate with oneself … In order to be intimate with another person, we have to know who we are, what we feel, what we think, what our values are, what is important to us, and what we want. If we do not know these things about ourselves, we can never share them with another person. Addicts cannot be intimate, because they have used their addictions to turn off their internal information systems and therefore cannot have available to themselves information about what they feel and think and who they really are… They must notice when they like something or do not like something. They must be able to notice when they are hurt, angry, afraid, lonely, needy, happy, or at ease …” (Schaef, Escape From Intimacy, pp. 123–124)

While admitting that the effectiveness of treatment for sexual addiction is still largely an unknown, Schwartz, like Carnes, views the assessing and modifying of the addict's thinking and belief system as essential for the treatment of sexual compulsivity. Such faulty cognitions and beliefs lead to interference with his/her ability to relate sexuality with intimacy. Arming the addict with this knowledge may help remove some of the shame involved, and thus, open the door to the possibility of behavioral change. (Mark F. Schwartz, “Sexual Compulsivity as post-traumatic stress disorder: Treatment Perspectives,” Psychiatric Annals, Vol. 22 (6), June/92, pp. 333–338.

Carnes , Contrary To Love, pp. 236–237. “An example of a common feature of the sexual addict who comes to a clinic is denial and rationalization. Patients may minimize the severity of their problem by claiming that they did not hurt anyone, by rationalizing that their partner once had an affair with another man, or by otherwise justifying their sexual deviance. To counteract such assertions, the addict is shown that he can be responsible for his own actions and does not have to blame other people or events. The therapist confronts such irrational beliefs, statements reflecting poor self-image, unrealistic expectations, anticipated failure, and easily elicited defensiveness, all of which are destructive to self-esteem, and replaces them with positive ways of thinking.” (Schwartz and Brasted, “Sexual Addiction,” p. 107)

Carnes, Contrary To Love, p. 238.

Carnes, Contrary To Love, p. 238.

Carnes, Contrary To Love, p. 245.

Carnes, Contrary To Love, p. 246. It is May's understanding that this powerlessness is the direct result of the binding power of attachment: “The word attachment has long been used by spiritual traditions to describe this process. It comes from the old French attache, meaning ‘nailed to.’ Attachment ‘nails’ our desire to specific objects and creates addiction. In this light, we can see why traditional psychotherapy, which is based on the release of repression, has proven ineffective with addictions. It also shows why addiction is the most powerful psychic enemy of humanity's desire for God.” (May, Addiction and Grace, p. 3)”… The usual psychiatric and psychological techniques have not been very effective with these behaviors. Yet when we treat them as addictions, improvement occurs …” (Schaef, Escape From Intimacy, p. 143.)

Carnes , Contrary To Love, p. 246.

Carnes , Contrary To Love, p. 247.

Carnes , Contrary To Love, p. 250.

Carnes , Contrary To Love, p. 252. “The couple is ready to leave therapy when the presenting problem has been solved, the legitimate relationship and sexual needs of the parties are being met, and the couple has the interpersonal skills to handle future relationship and sexual problems ….” (Sprenkle, “Treating a Sex Addict Through Marital Sex Therapy,” p. 13)

Carnes , Contrary To Love, p. 252. “The sexual addict agrees to a contract specifying that he will stop acting-out for at least six months to allow therapy to take effect.” (Schwartz and Brasted, “Sexual Addiction,” p. 107)

Carnes , Contrary To Love, P. 252. “During this time the need for clear touching and physical contact may be important. It will be up to each person to know what threatens her or his sobriety; hugs, squeezes … may be very important …” (Schaef, Escape From Intimacy, p. 156)

Carnes , Contrary To Love, pp. 252–3.

“As the sedating effect of the addictions is removed, many feelings and memories that have been held down by the addiction will emerge. It is important to pay attention to these and find safe places to work them through. We can share these feelings in twelve-step groups …” (Schaef, Escape From Intimacy, p. 157)

This spiritual comes as a result of a shift in priorities. In the height of their addiction, their “fixation on the immediacy of sex forces them to always find new bodies. But they are unconsciously searching for transcendent love in their exploits.” ( Thomas J. Tyrrell , Urgent Longings, Whitinsville, MA, 1980, p. 60.) Compare with Robert Johnson (WE: Understanding the Psychology of Romantic Love, New York, 1983, p. 152), who writes: “… We walk through life longing for a transfiguring experience, the vision that will give our lives meaning and wholeness: We are searching for our souls, searching for the divine world … Unconsciously, impulsively, like men and women possessed, we seek it in passion, falling in love, delivering ourselves over to a power that envelops us and possesses us. It is ecstasy, it is suffering, it is a kind of death, but most of all it is a taste of what used to be sought in the afterlife: transfiguration …”

Carnes , Contrary To Love, p. 255.

Carnes , Contrary To Love This point is important, for as Schaef notes, “sexual addiction is a way of actively avoiding nurturance and intimacy. Sexual addicts use relationships to get their fix. They are not really interested in love, romance, or relationships; however, frequently, if they pretend they are, they stand a better chance of getting their sexual ‘fix’ under culturally approved circumstances …” (Schaef, Escape From Intimacy, pp. 33–34)

“Weekly psychotherapy is mostly cognitive-behavorial and directed toward reversing the patient's helplessness. At each session, addicts are given individualized behavorial suggestions geared to making them feel more powerful and effectual. Negative emotions areidentified as signals for problem solving or assertive action.” (Schwartz and Brasted, “Sexual Addiction,” p. 107)

Carnes , Contrary To Love, p. 262. In order to counter such stressors, “alternative means of coping with these feelings, including relaxation, socializing, exercise, problem solving, self-assertiveness, and self-disclosure with a lover, are taught and encouraged in weekly sessions …” (Schwartz and Brasted, “Sexual Addiction,” p. 107)

Carnes , Contrary To Love, p. 263.

Carnes , Contrary To Love, p. 264. “The therapist tries to replace the thrill of self-destructive behavior with the rewards of genuine intimacy. Successful treatment requires helping the individual to establish a healthy, committed primary relationship and a network of secondary relationships. Treatment is not complete until this is achieved; the patient is at risk of relapse until he can experience a state of intimacy with another adult …” (Schwartz and Brasted, “Sexual Addiction,” p. 107.)

Adrian van Kaam C.S. Sp. , Religion and Personality, Garden City, N.Y., 1968, pp. 122–123.

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