Roots of Sexual Addiction (etiology)

http://www.tgsrm.org/Sexual%20Addiction.html

Early in childhood we learned not to trust. Many of us share a common history of some type of childhood abuse. We were yelled at, put down, laughed at, criticized, and told we were worthless or stupid or ugly, or responsible for everything wrong in our family. Today we recognize this as emotional abuse. We were neglected, ignored, minimized or overlooked. Today we call this emotional abandonment. We were slapped, punched, hit, beaten, knocked down, or struck with objects. Today we know this to be physical abuse. Lastly, we were touched, leered at, pawed, told sexually lewd or explicit jokes, and coerced or forced into sexual activities. Today we call this sexual abuse. Whatever abuses we suffered we learned that to survive we had to find a way to not feel the overwhelming and unbearable pain. ...

We have always been aware that we are alone. As children we interpreted the abandonment and/or abuses we experienced as justified. We believed that we were at fault for what had happened to us. Unconsciously we knew that we were somehow defective, that we were different from other human beings and not “normal.” Sex with ourselves or with others gave us the illusion of acceptance and thus the “cure” to our worthlessness. We became addicted to the “cure.” We needed a constant supply of sexual activity to stay “cured.” So we used others for sex instead of having relationships, or we bought our “cure” through magazines, or male prostitutes, or we sold our bodies to others, did sexually inappropriate acts, or we masturbated, but always we lusted. To lust was to live. ...

For many of us, our “Problem” began as a valiant attempt on the part of a child to cope and survive in an abusive world. This abusive world was one with which children are not designed to cope, much less experience. However, our “solution” became a part of our problem and eventually, it became “The Problem”. We were hopelessly addicted to lust.

Unresolved Family Trauma

Sexual addiction can be viewed as symptomatic of childhood traumas. It is a mask for sexual and emotional trauma. Sexual addiction is indicative of a human being's attempt to discover intimacy. It is an attempt that is gone awry (arrested developmental task). The human sex drive is, at its core, a search for human connection.

All families and individuals encounter trauma at some point in their lives; the way we handle trauma often determines how it will affect our lives and our family’s life for years to come.

In dysfunctional families common reactions to stress include:

Denial of trauma
Avoidance of working through trauma issues
Running from pain and grief emotions
Not allowing resolution or healing of an issue or problem

The first three reactions all involve a form of emotional escapism.

Individuals and families that are more dysfunctional than healthy resist dealing with trauma. This denial process is very strong and is often accompanied by a strict belief system that does not acknowledge difficult issues. In other words, dysfunctional families believe that if a problem or trauma is not acknowledged, it will disappear.

Trauma within families produces powerful emotions such as anger and grief. Some people try to hide these emotions, creating repressed grief and passive aggressive responses. Others try to deny these emotions, but denial doesn’t always work.

Survival rules of families of trauma

Don’t Trust

Trust is one of the most important aspects of any relationship. The issue of whether we trust or don’t trust others is a part of the first stage of child development.

Were the parents consistently present? How did their parents respond to needs? Were they loved and accepted by them?

If parents were responsive in a consistent and caring manner, then children would learn to trust their parents and approach the world with an attitude of trust.

However, if they were not accepted, if their parents were not consistent, if they were often under a lot of stress, if they were absent, or if they were treated in an harsh manner, then children are more likely to learn to distrust their parents.

If a person cannot trust his or her parents, then no other adult is worthy of trust. This inability to trust has devastating consequences for all future relationships.

Don’t Feel

Everyone has emotions, but in families of trauma, to feel is to be vulnerable. Vulnerability is perceived as the cause of emotional pain and so people avoid it at all costs.

The “Don’t Feel” rule includes survival behaviors that help a person avoid feelings.

Behaviors include repressing emotions, trying to forget pain, blaming others for our feelings, denial, and trying to change how we feel.

Families of addictions and other trauma will often try to control the few emotions that are allowed. For some people anger is acceptable and yet others in the family are not allowed to express it.

Crying in response to a painful conflict is often criticized and repressed by other family members. There are families where expressions of grief are not allowed. A family that does not tolerate respectful and honest expressions of emotions is a family that is not safe.

It is important to understand that anger, crying, grief, and other “negative” emotions are natural responses to trauma. Although many families of trauma do not allow such emotions to be displayed, only when individuals are safely allowed to express such internal feelings will health and healing begin.

The “Don’t Feel” rule leads to a growing army of repressed emotions. These emotions can contribute to experiences of being overwhelmed, anxious, easily angered, and depressed. As these emotions build, people become increasingly vulnerable to addictions that are often used to temporarily quiet repressed feelings.

Don’t Talk

The “Don’t Talk” survival rule does not mean people don’t communicate. It means they do not speak the truth about the real and significant individual and relationship issues. They hide the problems or gloss over any subject that may create conflict. Above all, they don’t talk about personal needs or solving problems. If an issue is not mentioned, the family perceives the issue as being resolved.

When the “Don’t Talk” survival rule becomes a part of a person’s approach to life they fail to develop problem solving and conflict resolution skills. Instead, these are replaced by a belief that problems should not be a part of a healthy relationship.

When conflict issues arise, they are often treated as a problem with the relationship rather than a problem to be resolved.

It becomes easier to blame each other than work through the difficulty. The problem still exists, however, and will continue to gnaw at a person until resolved.

When issues are not resolved then they are repressed. These repressed emotions lead to frustration, anger, depression, and resentments. They also impair the person’s ability to cope with new issues of relationship and life stress. This opens the door for addictive behaviors that relieve the building anxiety in life that results from not coping with problems.

Child abuse

About 80% of Sex Addicts experienced some form of child abuse in their developmental years.

The majority of sex addicts experienced some type of childhood trauma - sexual abuse, physical abuse, emotional abuse.

Child abuse is any experience that leaves a child feeling shamed, especially if the experience is at the hands of a caregiver who is behaving shamelessly.

Examples of Child Abuse:

Forcing a child to kiss or hug other people
Criticizing child’s sexual development
Attacking a child’s thinking process
Making a child the butt of any joke
Screaming or shouting at a child
Imposing unfair punishments
Slapping or hitting a child
Not allowing a child privacy
Degrading or insulting a child
Forcing a child to keep secrets
Demanding perfection from a child
Blaming a child for family problems
Failure to provide supervision or security
Punishing a child’s normal sexual curiosity

Emotional abuse

Using a child as a best friend

Emotional incest - children are used to satisfy parental needs that should be satisfied by other adults while the children's needs are ignored.

The beginnings of sexual addiction are typically rooted up in the childhood / adolescence.

Families characteristics

The majority grew up in families in which addiction already flourished, including alcoholism, compulsive eating, and compulsive gambling.

Families characteristics: rigid, closed, secretive, and detached, or they were chaotic, intrusive, confusing, and enmeshed.

Sex addicts grow up in an environment of significant dysfunction which may be passed from generation to generation. These people live with chronic stress. They are constantly in a war zone (addicted parents: physical, emotional, and/or sexual abuse). They try to survive and to find that "bandage" which will help them cope with the pain (post-traumatic stress disorder - PTSD).

Shaming experiences involving sexuality along with other abuse (emotional, physical, spiritual) set the stage for the development of addictive sexual behaviors in adolescence.

The child may have grown up in a hostile, chaotic or neglectful home, the child grows up emotionally starved for love because affection is rarely expressed.

Childhood trauma sets up several core issues. For example, if a child is not maturely loved by his parents, he will develop self-esteem issues. If he is not protected and taught containment, he will develop boundary problems. If he is forced to do too much adapting, he will lose his sense of self and have trouble being real. If he is not taught to take care of his basic needs and wants, he will have difficulty doing this as an adult. And, if he is severely shamed into containing himself and not taught containment, he will have trouble establishing moderation in his adult life.

Both trauma and core issues drive addictions, be it addiction to substances, processes, or to other people. Trauma, core issues, and addictions create severe relational problems where sex, love, and relational matters all seem to become entwined.

Child emotional abuse (emotional abandonment) examples

yelling at, putting down, laughing at, criticizing, telling the child that he is worthless or stupid or ugly, or responsible for everything wrong in the family
neglected, ignored, minimized or overlooked.

Physical abuse - examples:

slapping, punching, hitting, beating, knocking down, or striking with objects.

Sexual abuse - examples:

inappropriate touching, leering at, pawed, telling sexually lewd or explicit jokes
coerced or forced into sexual activities.

The child finds a way to not feel the overwhelming and unbearable pain.

Sex addicts developed the capacity to dissociate - this predated their sexual addiction.

Gradually sex becomes a replacement act to turn to in times of any kind of need, from escaping boredom, to feeling anxious, to being able to sleep at night.

The child may repeatedly turn to masturbation for escape.

Instinctively a child is learning to built walls around his heart. At first the wall serves merely to protect him from another abuse, but later the child/grown-up founds himself a prisoners in his self-made fortresses.

Children interpret the abandonment and/or abuse as justified. A child believes that he is at fault for what is happening to him. A child believes that he is somehow defective.

Thematic explanations for sexual behavior

Based on "Out of Control Sexual Behavior: A Qualitative Investigation" in "Sexual Addiction & Compulsivity"

Hypotheses of what might explain the phenomenon of out-of-control sexuality - many theorists have provided divergent hypotheses of what might explain the phenomenon of out-of-control sexuality. Some approaches / theories:

a disorder involving faulty regulation of sexual desire
this is not a disorder of desire but one of control
self-medication theories can explain the use of external substances to alter mood, sexual activity produces internal substances, which alter mood also (e.g. mood altering effects of endorphins that create a euphoria following sexual orgasm)
compulsive behaviors are “arousal” modes of gratification that probably have effects on neurotransmitters similar to those of amphetamines and cocaine (the individual becomes dependent on sexual orgasm to regulate affective states, sex becomes the primary tool that addict is using to regulate his emotional life)
sexual compulsivity as an aspect of some post-traumatic-stress and dissociative disorders (neurobiological changes that takes place in the hippocampus, which results in the increasing possibility for dissociative and amnestic symptoms of PTSD. Note the the high frequency of sexual victimization in the history of individuals who later became sexually compulsive)
The self-psychological perspective talks about the chemically dependent individuals suffering from narcissistic deficits
Sexually addicted individuals yearn for admiration and mirroring responses because they lack the inner resources to supply themselves with esteem and approval.
The behavior becomes habitual because it can only temporarily relieve feelings of inadequacy, while the deficit in the self remains and the addict returns to feelings of emptiness (Kohut, 1977). Habitual sex is also an effort to ameliorate sadness and boredom resulting from the feelings of emptiness. For some the sexual excitation is used as a source of vitalization—to feel alive. This habitual use of sex to restore a person’s narcissistic needs is central to the concept of sexual addiction.
...a need to be seen, reflected, or mirrored, and to achieve the feeling of being wanted, desirable, alive, or powerful. The habitual sexualization of others to see themselves admiringly reflected in the other’s eyes seemed to restore these informants’ narcissistic supplies. To compensate for their lack of inner resources and to supplement self-esteem, sexual conquests and external validation were employed to meet emotional and psychological needs.
... use sex to feel important, desirable, wanted, powerful, admired, alive, and sometimes tranquil
As a result of the sexual encounter, the addict experiences intense pleasurable feelings of grandiosity, invulnerability, tranquillity, and numbness to the pain of emptiness. The repeated sexualization of others for mirroring renews narcissistic supplies.
a reenactment of earlier sexual abuse - sexualized post-traumatic reenactments are stereotyped, literal, and follow the same format time after time. This suggests that an individual’s inability to meaningfully integrate experiences of early sexualization leads to repetitive attempts (possibly unconscious) to articulate and work through the conflict about the events

Desire for Human Affection or Connection

Attempts to feel connected to another human being (sexual behavior as a substitute for real intimacy. The feeling of warmth and caring, even when ephemeral, sufficiently reinforced the sexual behavior)
Feeling narcissistically vulnerable
Having difficulty integrating sex with love
A history of having problems sustaining long-term intimate relationships
An inability to experience any emotional intimacy (problems with intimacy are always a core-contributing factor to sexual addiction)

Compensation for Feelings of Low Self-Esteem

Low self-esteem is associated with narcissistic and relational problems, sexual identity/orientation issues, early childhood trauma, and negative affect. Individuals who do not think highly of themselves often have difficulty maintaining functional and intimate relationships.
Difficulty managing affective states in adulthood due to unstable self-concepts and inadequate learning of affect regulation in childhood.
Sexual behavior with attractive partners is used to elevate the self-esteem. The sexual activities function as ways to compensate for deficits in self-acceptance and self-worth.

Avoidance of Disturbing Feelings

This formulation supports addiction paradigms and self-medication theories that maintain substances or behaviors are utilized to soothe or comfort an individual similar to medications for depression or anxiety.

using sexual activities to avoid or escape from negative feelings such as loneliness, boredom, and sadness.
an impelling desire to anesthetize feelings of worry about life’s responsibilities, and to escape painful feelings.

Reenactment of Childhood Deficits or Trauma

emotionall abuse of children
parental neglect.
some type of childhood sexual abuse (e.g. incest, sexual activities with siblings, sexual experiences prior to the age of 7 with individuals who are significantly older).
feelings of fear, excitement, and confusion at the time of the early sexual encounter.

A Means to Cope with Issues of Sexual Identity/Orientation

innocently becoming involved with public sex during adolescence (e.g. a floundering internal and external search for a sexual identity as young gay men.
difficulty understanding the same sex attractions and sexual identity in a predominantly heterosexual culture.
a sense of fear, isolation, and alienation, as well as a lack of guidance and support

Need for Power and Control

the need for power and control. The researcher acknowledges that the need for power and control were indirectly expressed and interpreted as reflecting narcissistic needs. Narcissistic needs such as the need to feel superior, grandiose, and important can also be seen as qualities of power and control. Further probing and exploration is needed to examine if these men are speaking of an internal or external sense of control and power over themselves or others. Investigation is essential to assess if the need for control is a result of early feelings of powerlessness that later resulted in habitual sexual aggression or if the feelings of powerlessness progressed over the course of repeated problematic sexual activities.

Libidinal and Sexual Needs

Only two of the informants explained their problematic sexual behaviors in terms of strong libidinal needs. The first informant understood his behavior solely as a means of satisfying his sexual desires. He gave no other motives or meanings for his sexual behaviors. The second informant mentioned sexual libido and desire as one of many attributed reasons for his sexual behavior.

Loneliness, need for human affection, and low self esteem were among the other motivations he mentioned.

Some who see impulsive-compulsive sexual behavior as an addiction hypothesize that repetitive, high-emotion, high-frequency sexual behavior can result in changes in neural circuitry that help perpetuate the behavior. This is similar to current theories about chemical addiction except that instead of drugs causing the changes in neural circuitry, sexual behavior is purported to cause these changes.

What evidence should be mustered to respond to objections? Pathological gambling may provide an answer. Research on impulsive-compulsive sexual behavior is in its infancy and much of the work that has been done in pathological gambling has not yet been done in impulsive-compulsive sexual behavior. Using the same categories of evidence used by Potenza to assess pathological gambling, what evidence is there to group impulsive-compulsive sexual behavior with chemical addictions?

There are phenomenological similarities. Goodman has pointed out that there are many similarities between repetitive sexual behavior and addictions, including failure to control behavior and continuation of the behavior despite harmful consequences.

Martin and Petry have pointed out further phenomenological similarities chemical addictions and behavioral addictions. Both follow a pattern of an exposure to a rewarding chemical or behavior that can lead to an addiction. This exposure leads to an addiction if the exposed individual is biologically and psychologically predisposed. When an addiction develops, whether it is chemical or behavioral, individuals have great difficulty controlling their behavior (impaired control) and they become more focused on pursuing and finding the object of their addiction (salience). Individuals with behavioral addictions and chemical addictions also have cravings which are triggered in similar fashions. In both cases, cravings are triggered by memories, affective states, and situations associated with the behavioral or chemical addiction.

Besides phenomenological similarities, one can also look at comorbidity studies,17-21 which show a high co-occurrence of substance abuse and impulsive-compulsive sexual behavior. In the aforementioned studies, co-occurrence of substance abuse ranged from 25% to 71%.

The comorbidity data, one may argue, also supports conceptualizing impulsive-compulsive sexual behavior as either an anxiety or mood disorder.

In the studies, the prevalence rates for anxiety disorder ranged between 42% to 46% and 33% to 80% for mood disorder.

The high rate of mood disorder has caused some to theorize that impulsive-compulsive sexual behavior is a result of drive dysregulation in association with a mood disorder. The high rate of anxiety disorders has prompted some to conceptualize impulsive-compulsive sexual behavior as a variant of obsessive-compulsive disorder. According to this theory, sexual behavior is engaged in to relieve anxiety. This relief is only temporary and is followed by further distress. A self-perpetuating cycle of anxiety and distress and compulsive behavior ensues.

Other than phenomenology and comorbidity data, data which could justify the classification of impulsive-compulsive sexual behavior as an addiction are limited. Neuroimaging studies in individuals with impulsive-compulsive sexual behavior are not currently available, although one has been performed by Martin (P Martin, MD, personal communication, 2006).

There are no controlled investigations of neurotransmitter systems involved in individuals with impulsive-compulsive sexual behavior, genetic factors have not been studied, and there are no large-scale epidemiological studies of the disorder.