What is Sexual Addiction? Sex Addiction is a pathological relationship with a mood-altering experience. This presentation will cover the types of sex addiction, the levels and many other aspects.

1. “Because our sexuality is one of the
most fundamental life processes,
sexual compulsivity is extremely
threatening to all of us”.
(P. Carnes, 2001, P.5)
Sex Addiction
The Secret Obsession

2. What is Sexual Addiction?
An Illness
Definition of sexual addiction: “a pathological relationship with a mood-
altering experience”. (P. Carnes, 1989, P. 4)
Sexual addiction is not about sex – it is about an individual’s (obsessive-
compulsive) RELATIONSHIP with sex.
An obsessional illness which transforms sex in to an individual’s primary
relationship or need – where a sex addict will rely on sexual acting out as a
source of nurturing, comfort from pain or relief from stress. Unfortunately
this is to the huge detriment of family, friends, work and personal values,
which are relentlessly sacrificed in pursuit of compulsive sexual acting out.
“Sex addicts have lost control over their ability to say no; they have lost
their ability to choose. Their sexual behaviour is part of a cycle of thinking,
feeling and acting which they cannot control”. (P. Carnes, 1989, P. 5)

3. Characteristics of a Sex Addict
According to Dr. Carnes (1989) sex addicts share several important common
characteristics;
Exhibit a constellation of preferred sexual behaviours – arranged in a clear ritualized
order – acted out in an obsessional scenario
Experience periods of ‘escalation’ and ‘de-escalation’
Continue to act out despite severe consequences (e.g loss of family, financial losses,
health risks)
Have delusional thought patterns: rationalization, minimization, projection, reality
distortion (denial patterns)
Make repeated unsuccessful attempts to control their behaviour
Spend most of their time in obsession in a ‘trance-like state’ – disassociated from
reality.
Feel severe shame and depression – prone to suicidal ideation
Behave in an abusive and exploitative manner – often violating own sense of values
Live a ‘double-life’ shrouded in secrecy and dishonesty.
Go to extreme lengths to maintain their appearance – high achievements, excessive
religiosity.

4. Sexual Addiction has also been described as a
‘Trauma-induced Intimacy Disorder’
These include:
A high probability of being sexually abused (81% of sex addicts) in childhood
and/or adolescence (even though an individual may have not seen it as abuse or
indeed it’s connection to their current behaviour).
A high probability of being raised in a dysfunctional family – where self-esteem
has been damaged resulting in severe problems with intimacy (how to be close)
and dependency (whom to trust).
Carnes also points to a history of emotional (97%) and physical (72%) abuse –
intensifying a sense of unworthiness and a chronic fear of abandonment.
Sex addiction or other types of addiction are in evidence among immediate and
extended family (87%).
A strong likelihood that the individual will be suffering from other addictions and
compulsions as well: chemical dependency (42%), eating disorders (38%),
compulsive spending (26%) and compulsive gambling (6%).
(P. Carnes – ‘The making of a sex addict’ – Facing the Shadow Seminar. Cape Town. 2008).

5. Other common characteristics of Sex Addiction
based on counseling experience
Sex addicts SEXUALISE THEIR FEELINGS – stress, anger, resentment,
loneliness, rejection/abandonment, feeling victimized, self-pity, and I
cannot underline the importance of the pivotal role of TOXIC SHAME
(versus Healthy Shame).
Compartmentalize their sexual behaviour.
Sex addiction is about POWER – sexual acting is an attempt at a
falsified and delusional restoration of power.
Suffering from an Attachment Disorder.

6. Male and Female Addicts
Seems to be severely underdiagnosed in females and far more prevalent in
terms of male diagnosis – why is this?
MALE SEX ADDICTS:
Often enmeshed relationship with their mother.
Father is emotionally absent (unavailable) and may be physically absent as
well (deceased or has abandoned the family).
Compulsive sexual acting out; to restore an individual’s (false) sense of
masculinity.
A possible element of BORDERLINE PERSONALITY DISORDER – e.g severe
intimacy issues, living a ‘double-life’, chronic abandonment issues.
NARCISSISM seems predominant within male sexually addicted patients;
they are highly sensitive individuals with extremely fragile ego-defense
mechanisms.
Behaviours often include: self-pity, sexual grandiosity, sexual entitlement
(chronic aspect), self-righteousness, attention-seeking, highly manipulative,
avoiding responsibility (blaming others), highly controlling – to name a few.

7. Co-morbidity
CRITICAL FACTOR: Carnes claims 7 out of 10 COCAINE
ADDICTS have an underlying sex addiction (‘fusing’).
ADHD and anxiety disorders seem quite widespread
in sex addicts.
Anxiety is about controlling their feelings – common
in, for example, compulsive users of prostitutes.
Depression is about avoiding their feelings – common
in, for example, Cybersex addicts.

8. Sexual Addiction Cycle
Crucial to look for patterns of regularity
1: Preoccupation
Trance or mood altering high – sex addicts thoughts become obsessively focused on sexual
stimulation. This ‘trance-like state’ disconnects the sex addict from reality. As this obsessive
preoccupation (exciting sexual feelings) intensifies the sex addict reaches a ‘tipping-point’
where there is rarely an ability to turn back.
2: Ritualization
These are specific routines and patterns of behaviour as the addict prepares for sexual
acting out. Rituals intensify the preoccupation and only serve to aggravate a sex addicts
sense of arousal and excitement.
Some examples are:
The compulsive prostitute user who frequents topless strips shows in the evenings
The compulsive masturbator browsing adult book stores
The exhibitionist who drives regular routes or settings
The female sex addict who frequents the local hotel’s cocktail hour

9. 3: Sexual Compulsivity
The sexual act – the end goal of the preoccupation and ritualization – sex
addicts are unable to control or stop this behaviour.
• Carnes (1989) asserts; “Sexual compulsivity, then, is the inability to control
one’s sexual behaviour, and the behaviour is the cornerstone of the
addiction” (P. 65).
• Additionally, he says; “when the sexual behaviour becomes the most
important aspect of the addict’s life, the addict now has a pathological
relationship with a mood altering behaviour” (P.66)
It is important as a therapist to gain a sense of the numerical details in
terms of acting out: e.g number of prostitutes, number of anonymous sex
partners, number of sexual partners, number of sexual material stored on
the computer, number of pornographic magazines, number of times and
individual masturbates a day etc.
Once the sexual release has been achieved (and this is not always about
orgasm) the trance- like state is broken and the dread of what awaits the
sex addict is terminally unbearable.

10. 4: Shame and Despair
The feelings of utter hopelessness sex addicts have about their
behaviour and their powerlessness to control it - the despair often
has to do with the shame at the loss of control.
Crucially this shame and despair become the fuel to reignite the
compulsion to begin the sex addiction cycle again. Once again the
sex addict re-enters the cycle in to the preoccupation-obsession
phase – to take away the pain of the shame and despair.

11. The 4 core beliefs of a Sex Addict -
A shame based system
1: ‘I am basically a bad, unworthy person’
Experiencing oneself or one’s behaviour as unacceptable – toxic shame – ‘I am a mistake (as
opposed to healthy shame – ‘I made a mistake’).
2: ‘No one would love me as I am’
By judging themselves as shameful – sex addicts build an impenetrable wall that keeps
others out. The belief is ‘If I cannot accept myself – I am sure others will do the same’.
3: ‘My needs are never going to be met if I have to depend on others’
This implies to survive means to be in control. Carnes (1989) contends; “Children depend on
the family structure to get their needs met. When consistent failure to meet these needs
occurs, either because of parental inflexibility (rigidity) or inability to follow through
(chaos) a child concludes that to survive one can only count on oneself”. (P. 120).
Thus the greater the increase in distrust – the greater the need to control.
4: ‘Sex is my most important need’
Since no one can be counted on - sex becomes the one ‘dependable’ source of nurturing
that will always be readily available. Sex becomes more critical to emotional survival than
family, friends, work or values.

12. ‘Family of origin’ of a sex addict
Rigid
• Moralizing about sex as inherently bad, evil or sinful
• Descriptions about sex as an awful or degrading experience
• Parents react with physical or verbal abuse when children are discovered being sexual.
Chaotic
• Parents out of control sexually
• Parents who are sexually inappropriate in front of their children – create confusion.
• Parents organize sexual or swinging parties at home while intoxicated – child may feel
shamed – that there is something wrong with them and their family.
Enmeshed
• ‘Covert incest’ – sexually and emotionally
• A father who makes explicit comments to his daughter about her breasts – is not
affirming her sexuality, he’s sexualizing her.
• Mothers who turn to their sons to meet their emotional needs (often as a result of
their husbands being emotionally unavailable) are not affirming their ‘separateness’
they are creating a highly destructive enmeshed relationship (emotional dependency).
Disengaged
• Emotional abandonment
• Sex is a matter to find out by oneself

13. The 3 levels of Sex Addiction
LEVEL ONE
• Some degree of public tolerance. Victimization and exploitation are often components.
• Compulsive masturbation
• Heterosexual relationships (e.g womanizing)
• Pornography
• Prostitution
LEVEL TWO
• Behaviours are regarded as intrusive and a nuisance. There is always a victim.
• Exhibitionism
• Voyeurism (e.g ‘Peeping Tom’)
• Bestiality
• Transvestitism
• Indecent phone calls
• Indecent Liberties
LEVEL THREE
• Includes sexual behaviours that are highly abusive and dangerous or life threatening.
There is always a victim.
• Child molestation
• Incest
• Rape

14. 5 Types of Sex Addicts
Carnes (2001) produced an excellent workbook called ‘Facing the Shadows’; within this
workbook he proposed an analysis of the ‘10 types of sex addict’
1. Fantasy Sex
• Arousal depends on sexual possibility (what could be seen - if).
• Obsession and preoccupation is a way to delay the feelings of sexual excitement.
2. Seductive Role Sex
• Arousal is based on conquest and diminishes swiftly after first contact.
• Arousal is related to power; individuals use sexuality to gain control over others (seducing
victims through flirtation).
3. Voyeuristic Sex
• Use of visual stimulation to escape in to a trance.
• Behaviours include: viewing sexually explicit videos and photographs, attending strip
shows, visiting adult bookstores, and watching people through their windows, sometimes
this may include using binoculars (this is a classic violation of someone’s personal
boundaries).

15. 4. Exhibitionistic Sex
• Sexual arousal is based on the reaction of the viewer – whether shock or interest.
• Form of ‘attention-seeking’, violates cultural norms and laws.
• Often expose themselves from a car within a public area.
5. Paying for Sex
• Arousal is connected to paying for sex, with progression the arousal actually becomes
connected to the money itself.
• Often profoundly unable to protect or take care of themselves.
• Common pattern exists: 1. Having means (financial); 2. Searching; 3. Payment; 4.
Preferred acting out (usually a repetition of a childhood scenario); 5. Extreme shame.
Video 1

16. Assessment and Treatment of Sex
Addiction
SAST test www.sexhelp.com
Comprehensive investigation of their sexual acting out behaviours –
Where? When? How much? How many? What type of pornography?
What kind of sexual fantasy?
Sexual History – ‘Story Telling’ – helps them to face the reality of sexual
and emotional trauma in their childhood and adolescence.
Sex Addicts Anonymous
In-patient sex addiction treatment centers
Prolonged regular therapy – critical to identify trauma repetition/re-
enactment
Facing The Shadows closed groups
Therapeutic Alliance based on TRUST
Most important of all – empathy for their debilitating toxic shame
Video 2