Sunday, November 11, 2007

What is sexual compulsivity?

A definition and universal term is perhaps the most difficult dilemma in the field of sexual compulsivity. How do we define a concept that has been widely misused and overused? Simply looking at the concept, there are multiple terms to describe the same phenomenon including sexual compulsivity and sexual addiction. These terms are the most prevalent; however additional terms that are used include sexual impulsivity, sexual obsession, sexual anorexia, sexual compulsion, out of control sexual behavior, sexaholism and, finally but certainly not the last, love addiction. As you can see, the field itself is far in agreement on a universally accepted term. And, each term reflects a different theoretical foundation and treatment approach. While the differences are varied, nevertheless, there is perhaps more overlap when talking about the concept, even if there is not agreement on the terminology. Generally, I prefer the term sexual compulsivity. It is the term that I use in my work. Part of the rationale of my choice of the term reflects a behavioral model over an addiction model.

A large number of resources ranging from websites, journal articles to self-help books discussing sexual compulsivity exist. Simply complete a web search, and the number of hits is about 2 million. My goal here is not to replicate what is already available. In this venue, I’ve chosen to summarize and simplify the definition. Remember, my goal is not a theoretical treatise, or academic journal article. My goal is to identify a definition that works in the majority of circumstances to provide a resource for individuals struggling with sexual compulsivity.

The definition of sexual compulsivity that I use has two parts. The first part is a subjective level. On some level, the individual recognizes that his/her sexual behavior interferes with his/her life. The second level is an objective level. The interfering sexual behaviors sometimes will breach an external boundary with consequences.

Each part requires additional exploration. On the first part, the individual recognizes that their sexual behavior is a problem. Sexual compulsivity is when as any sexual behavior or thought violates your personal values and boundaries. These behaviors often lead to negative feelings of guilt, shame, and self-recrimination. In psychology we call this egodystonic. In my treatment approach, there is a failure of integrity between what they say they want and what they do. The vast majority of people seeking help realize they need help. Because of the recognition by the individual that he or she has a problem, it is usually sufficient to focus on the first part of the definition in my work.

The second part of the definition allows external feedback to the person regarding the impact of their sexual behavior on others. In some cases this can be a legal consequence such as an arrest. In other cases, the behaviors create financial consequences. And yet in some other cases, relationships end because of the violation of the boundaries. This objective part of the definition may not always be present, but is useful when the level of denial regarding the individual’s internal awareness is so great that they fail to recognize the impact of the behavior.

Two of the dilemmas with this definition are what some critics of the field say is sex negativity, and labeling of many types of sexual expression as sexual compulsivity as a form of social control. A classic example is how homosexuality was previously illegal or an illness; now control is exerted by labeling homosexuality a sin. I am aware of these concerns. In later posts, I will write about sexual positive and sexual health.

What behavior is considered compulsive is hard to define. Often the answer is “depends.” Often, the answer will depend on the presence of consequences, your values, your agreements with others (i.e., marriage/partnership). The basic premise I have is that YOU define healthy and unhealthy behaviors in relationship to others. At the same time, there are behaviors that automatically raise questions. For example, researchers in the field suggest that spending 11 or more hours a week checking out Internet Pornography is one threshold of Internet Sexual Compulsivity. This number, however, does not answer the question with any sense of finality. As you work through the workbook, you may find that the same behavior may or not be compulsive depending on the day, your mood, and other circumstances.

Just to note, sexual compulsivity is not the same as sexual promiscuity or pedophilia. Sexual compulsivity also can occur in the absence of sexual behavior (obsessive thoughts, fear of sex). Sexual compulsivity is also not the same as pedophilia (defined as an attraction to children). And while they may sometimes (rarely!) overlap, the two issues are separate therapeutic concerns.

In the end, the goal of this post was to help people recognize the concept of sexual compulsivity. The key component is the individual’s recognition that their sexual behavior creates a problem in their life. The key to treatment, however, requires additional information as to why, what, who, when, and where the problem lies.

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