Why the Sprout

By Ross Rosenberg

In creating a logo for our company, we searched for a symbol that would capture the heart of Clinical Care Consultants. After considering several options, we unanimously saw our "heart" in the photo of the hand tenderly cupping the green sprout.
This image embodies both the essence of who we are as therapists and why we are invested in our work.

This photo was more than just an image to us; it represents our collective professional identity. The symbolic nature of the sprout speaks to the spirit of the counseling experience.

The hand signifies the counselor who "holds the space" where problems are solved, healing occurs and hope is revived. Counselors support and protect their clients while helping them to grow and mature into the "plants" they were meant to be.

The soil symbolizes the counseling process without which sprouts would not grow, thrive and flourish. Because of the counseling process, or fertile soil, the sprout has an opportunity to spread its roots, create stability, endure hard times and thrive. From the soil, the spout can grow into the healthy version of itself. 


The final symbol is the sprout, which represents the person seeking counseling. Each and every one is a "sprout" at one time or another. As "sprouts," clients come to therapy as tender, vulnerable and unimagined versions of their hurt, stuck or unhealthy self. At Clinical Care Consultants, we are passionate and invested in the "growth" of all our clients. To us, it is a privilege to be included in our clients' growth.

Alcohol and Anxiety a Risky Mix for Some By Anne Harding, Health.com

(Health.com) -- Many people who experience chronic feelings of anxiety about social situations, work and relationships, or other aspects of everyday life often reach for a beer or a glass of wine to quell their unease.

Alcohol may help anxious people cope in the short term, but over time this strategy can backfire. According to a new study in the Archives of General Psychiatry, self-medicating with alcohol or drugs can increase the risk of alcoholism and other substance-abuse problems, without addressing the underlying anxiety.

"People probably believe that self-medication works," says James M. Bolton, M.D., the lead author of the study and an assistant professor of psychiatry and psychology at the University of Manitoba, in Winnipeg. "What people do not realize is that this quick-fix method actually makes things worse in the long term."

Self-medication for anxiety symptoms is common. In the study, which included a nationally representative sample of 34,653 American adults, 13% of the people who had consumed alcohol or drugs in the previous year said they'd done so to reduce their anxiety, fear, or panic about a situation.

An even greater proportion, roughly one-quarter, said they had similarly self-medicated with drugs. (Detailed data on the drug use was not available, but Bolton says most people were probably using prescription sedatives -- such as Xanax -- without a prescription, rather than using marijuana or illegal drugs.)

Self-medication and anxiety proved to be a hazardous combination for some of the study participants. People with diagnosed anxiety disorders who self-medicated at the start of the study were two to five times more likely than those who did not self-medicate to develop a drug or alcohol problem within three years, the study found. (The increase in risk depended on the anxiety disorder.)

In addition, people with anxiety symptoms but in whom a full-blown anxiety disorder had never been officially diagnosed were more likely to receive a diagnosis of social phobia by the end of the study if they self-medicated. Social phobia, also known as social anxiety disorder, is characterized by pronounced fear or anxiety about specific situations, such as parties or speaking in public.

"Serious consequences can develop very quickly," Bolton says. "People can develop alcoholism and anxiety disorders within just three years, and these are illnesses that can have a devastating impact on a person's health, their relationships, and their financial situation."

Experts have long known that people with anxiety disorders are vulnerable to substance abuse, and vice versa, but they haven't been able to determine whether one problem precedes the other.

The new findings are significant because they are among the first to examine the relationship of anxiety symptoms and substance use in a group of people over time, says Kristen Anderson, Ph.D., a clinical psychologist and assistant professor of psychology at Reed College, in Portland, Oregon. Anderson was not involved in the new study.

Bolton and his colleagues reanalyzed data from a nationwide survey, led by the National Institute on Alcohol Abuse and Alcoholism, that began in 2001. Thirteen percent of the participants with an anxiety disorder who reported self-medicating with alcohol developed an alcohol problem over the three-year study period, compared with just 5% of those who did not self-medicate. Likewise, 10% of people with an anxiety disorder who self-medicated with drugs developed a drug problem, versus 2% of those who did not.

Having a glass of wine to ease the tension of a stressful day doesn't necessarily put a person at risk for becoming an alcoholic, of course. Substance abuse is heavily influenced by a person's genes and environment, Anderson says, but she adds that habitually relying on alcohol or drugs to ease anxiety at the expense of healthier coping strategies -- such as working out, talking with a friend, or taking a hot bath -- can be risky.

"I think all of us, whether we're disordered or not, need to consider the reason why we choose to use alcohol or other drugs," Anderson says. "When any of us decide to try to cope with external agents, I think it's a very slippery slope."

The shame some people feel about their anxiety and a reluctance to seek help for psychological problems are likely major factors contributing to self-medication, Bolton says.

"Unfortunately, people often do not seek the help they need because of the stigma around mental illness," he says. "People are likely to stay at home and use the resources that they have at their disposal, which in this case would be alcohol or drugs."

Maureen Carrigan, Ph.D., a professor of psychology at the University of South Carolina-Aiken who studies addictive behaviors and anxiety disorders but wasn't involved with the new research, sees widespread self-medication as a symptom of our "quick-fix society."

Talk therapy and other treatments for anxiety are effective and can even solve the problem for good, Carrigan says, but they can be time-consuming and aren't always covered by insurance. People experiencing anxiety may not even be aware of these treatments, she adds.

"The average person doesn't always know that there are good psychological treatments that exist for some of these problems," she says.

Copyright Health Magazine 2010

(Dr. Morris) Rosenberg Self-Esteem Scale

The Rosenberg Self-Esteem Scale is perhaps the most widely-used self-esteem measure in social science research. Dr. Morris Rosenberg was professor of Sociology at the University of Maryland from 1975 until his death in 1992. He received his Ph.D. from Columbia University in 1953, and held a variety of positions, including at Cornell University and the National Institute of Mental Health, prior to coming to Maryland. Dr. Rosenberg is the author or editor of numerous books and articles, and his work on the self-concept, particularly the dimension of self-esteem, is world-renowned. 

LINK TO THE SELF_ESTEEM SCALE

Seasonal Affective Disorder

Seasonal Affective Disorder (SAD)

Season Affect Disorder Counseling Beata Jankiewicz

SEASONAL AFFECTIVE DISORDER (SAD)

Beata D Jankiewicz, LCPC, CADC, ATR

Clinical Care Consultants

01/15/2012

I can’t find the joy within my soul
It’s just sadness taking hold
I want to come in from the cold
And make myself renewed again.
It takes strength to live this way
The same old madness every day
I want to kick these blues away
I want to learn to live again…
- Annie Lennox, “Dark Road”

For the fifth time, you push the snooze on the alarm and you muster all the energy within your body to open your eyes. Your eye lids feel heavy, but you are compelled to get up — not out of enthusiasm to begin the day, but out of guilt that this will have been the third or so consecutive day you would have arrived to work late. Upon finally arriving to the office, you still feel exhausted and depleted of the energy and focus that once powered your day with excitement and creativity. Going to bed earlier last night didn’t help, in fact you feel more tired. Later, friends ask if you want to catch that new movie or try out a new restaurant, but you decline, for no particular reason. Family calls to ask if you want to spend time with them, reminding you that it has been a long time since your last visit. You let the calls go to voicemail, with no intention of calling back. So, you return home where you spend the rest of your evening on the couch, watching TV or playing video games and eating junk food. You look up at the calendar and sigh.

Yes, here it is again, that familiar feeling of gloom overpowering your winter season, year after year. If this story seems somewhat familiar, you may be like the thousands of individuals suffering from Seasonal Affective Disorder (SAD) with the arrival of the winter months.
SYMPTOMS
An offshoot of Major Depression, Seasonal Affective Disorder (SAD) manifests itself as a mild depression with a predictable winter pattern, and is often left underdiagnosed despite its yearly appearance. In most places in the United States, symptoms present themselves somewhere between September and October, when the days become shorter and darker; trickling off around April or May, when sunshine becomes more available and the weather more welcoming. Initially, mostly mild forms of lethargy, forgetfulness and carb cravings turn into more pronounced behaviors such as withdrawal from social activities and friends, an overall sense of worry and sadness and an uncharacteristic decrease in abilities to deal with stress and daily routine.

Typical symptoms of Seasonal Affective Disorder (SAD) may include:
•    Difficulty waking up in the morning
•    Tendency to oversleep
•    Loss of energy, fatigue during the day
•    Over-eating, especially carbohydrate foods
•    Weight gain (due to loss of energy and increase in food consumption)
•    Difficulty in concentration and task completion
•    Withdrawal from friends, family and social activities
•    Decreased sex drive
•    Depressed mood, pessimism and guilt, feelings of hopelessness, unusual guilt

RISK FACTORS
Since first identified and brought to the public’s attention in the mid-1980s, Seasonal Affective Disorder (SAD) has raised the interest of researchers and mental health practitioners worldwide. Nonetheless, despite fascination and research, causes of SAD remain enigmatic. According to SAD researcher, Barry Whitehead, “75% of individuals suffering from seasonal depressed mood are women. Initial onset appears between the ages of 18 and 30, although both teenagers and senior citizens have been afflicted with SAD.” Genetic predisposition may have its role to play; however, is not nearly as important as geography. Individuals living in areas where there is a significant decrease in sunlight during the winter are more likely to develop SAD than individuals in generally more sunny areas.

SAD appears to be related to several biological and chemical systems in the human body. Some of the “chemicals” include the neurotransmitter serotonin, the hormone melatonin and various vitamins. The amount of sunlight we are exposed to, as well as our “internal clock’s” ability to sufficiently stabilize our sleep and rest patterns also are related to SAD. Further information about the causes of Seasonal Affective Disorder (SAD) are speculative and no one knows for sure how and why so many of us feel down during the winter time; however, most experts point to the sun.

MISDIAGNOSIS
Many people afflicted with SAD are able to tolerate the condition and compensate with the sadness, melancholy or depression. It is important, however, to recognize this as a legitimate psychological and medical disorder. Because most people simply misidentify SAD as laziness, holiday blues or just “a bad day,” the condition is under-diagnosed and under reported. However, these symptoms should be heeded and not dismissed as easily as they may, in fact, be warning signs of more serious issues. As a relative of Major Depression, SAD may actually be a precursor to a depressive episode and could pose risk of a more serious mental health disorder, such as serious depressive episodes, suicidal thoughts or plans or symptoms of Bipolar Disorder (mania and debilitating depression).

A visit to a physician is highly recommended, not only to consider undiagnosed mood disorders, but to rule out potential underlying physical ailments which share common symptoms with SAD. Chronic Fatigue Syndrome (CFS) shares numerous common features with SAD, including lethargy, impaired cognition and memory, depressed mood and sleep disturbance. Likewise, anemia also shares symptoms of fatigue, lack of concentration and general uneasiness. Behavioral and emotional manifestations of hypoglycemia also include irritability, cognitive disturbances, confusion and lethargy. Symptoms of hypothyroidism also include depressed mood, fatigue, weight gain and memory impairments, similar to SAD. This list is by no means exhaustive and treatments for these illnesses vary, with the prognosis largely dependent on seeking the attention of a medical professional to ensure proper diagnosis.

TREATMENT
Depending on how debilitating or frustrating the symptoms are, the antidote to SAD is typically a combination of interventions. The three mainstream treatments include light therapy, medication management and/or psychotherapy.

Light therapy involves sitting in front of a specially manufactured (for SAD) light box for one or more sessions per day. These sessions can be as short as 15 minutes and as long as several hours, depending on the strength of the box’s illumination.

Medications, in the form of anti-depressants, can also be utilized; however, caution must be paid to undetected Bipolar disorder so that a manic episode is not triggered by the medication. A psychiatrist will be able to discern these conditions during the evaluation and will recommend the best options for medical treatment of SAD.

Psychotherapy addresses the negativistic thoughts and pessimism arising from the decrease in motivation, loss of energy and increase in withdrawal seen in SAD. In some situations, individuals may acquire adverse coping skills to deal with their sadness and depressed mood. Some may attempt self-medicating with drugs, alcohol, overeating and excessively watching TV or playing video games. These activities, although initially helpful as a distraction from the unpleasant emotional state, soon morph into unhealthy and sometimes addictive behaviors, which lead to further isolation, depression and hopelessness. Through therapy, deterrents are discovered and healthy behaviors promoting a proactive engagement in life are explored. Insight is gained and life becomes increasingly meaningful and hopeful.

Although alternative treatments are known to be effective, they have not been approved by the FDA, so using them should be done prudently and pursued with caution. Homeopathic remedies, including over-the-counter supplements such as St. John’s Wart, SAMe, Melatonin, Omega-3 fatty acids and Vitamin D have been suggested in the treatment of SAD. Please consult your physician before you make a decision about making these a part of your regimen as side effects and dosage implications exist and possible adverse reactions may occur.

Simple interventions, however, may actually be the best catalyst for beating the winter blues. Mind-body activities such as yoga, Pilates and meditation offer relaxation and presence of mind. Outdoor activities such as hiking, walking or even building a snowman, not only increase the likelihood of exposure to the sun’s rays, but also offer a healthy diversion from stress and encourage socialization. Arts and crafts, poetry and journaling and music and dance are all activities which offer inspiration to further challenge and express feelings, while connecting with others in a unique way.
CONCLUSION
Each year, the trees lose their leaves and wildlife gather reserves for the chilly months ahead. Nature slows down and rests, conserving its energies and nurturing its resources in anticipation of the birth of Spring. Winter is a time of hibernation, not of idle laziness, but peace, calm and reflection. On some level, Seasonal Affective Disorder (SAD) is also just that – hibernation in anticipation of the renewal of energy with the coming of Spring. We are part of the natural cycle of life, which includes slowing down in spite of our busy itineraries, and finding meaning and balance in our activities, as well as in our stillness. Look within and reframe your sadness into hope. Allow yourself patience; jubilation is right around the corner, with the falling of the snow. And if this feels too impossible and you wish to reach out for help, please don’t hesitate to seek my psychotherapeutic services.

Hope is the thing with feathers -
That perches in the soul -
And sings the tune without the words -
And never stops – at all –
- Emily Dickinson, “Hope”

The Emergence of Female Sex Addiction: Understanding Gender Differences

Ross Rosenberg, M.Ed., LCPC, CADC
Clinical Care Consultants

 
Unlike alcohol or drug addiction, there is still no formal diagnosis for sex addiction.  To make matters worse, female sex and love addiction is similarly not recognized as a bona fide addiction disorder.  However, most addiction specialists agree that it has risen to “epidemic” proportions (R. Weiss, 2011).   

The term “sex addiction” was coined by Patrick Carnes.  Carnes first used the term in his 1983 seminal book on the topic: “Out of the Shadows: Understanding Sexual Addiction.”  Carnes is largely responsible for popularizing the study and treatment of sex addiction, as well as establishing a valid and commonly used diagnosis.  

 Because most statistics are based on sex addicts who seek treatment, statistical representation of this disorder is considered to be low.  Women are less likely than a man to seek help for her problem sexual behavior for a variety of reasons – mostly related to shame. (Weiss 2011).  Research and treatment fields have directed little attention to women’s struggle with this addiction.  Other than an early treatment by Charlotte Kasl (author of Women, Sex, and Addiction: A Search for Love and Power) and some writings by Carol Ross and Jennifer Schneider, sex addiction in women has been largely ignored (Feree, 2001).  According to Carnes, 3% of the total U.S. population is female sex addicts.  In other words, of all American sex addicts, 37.5% are female.  Carnes’ research also indicates that approximately 20% of those seeking help are female.  This statistic is consistent with similar statistics regarding females seeking alcohol treatment (Carnes, 1983).  According to Robert Weiss (2011), an international sexual addiction expert, author, educator and founder of the Sexual Recovery Institute, 8 to 12% of those seeking sexual addiction treatment are women.  

Statistical support for the prevalence of sex addiction is starting to build.  According to Dr. Patrick Carnes, a nationally known speaker and expert on sex addiction issues and recovery, estimates that 5-8% of Americans are sex addicts.  The National Council on Sexual Addiction and Compulsivity estimates that between 6-8% of Americans are addicted to sex.  Mary Ann Miller, a psychologist who founded the Chicago chapter of Sexual Addicts Anonymous (SAA), estimates that up to 6% of Americans are (sex) addicts.  Robert Weiss, another well-known expert and founder of the Sexual Recovery Institute, guesses that 3-5% of the U.S. population suffers from sexual addiction.  The Mayo Clinic estimates that 3-6% of adults in the United States are sex addicts.

“Many others (Coleman, 1995; Goodman, 1993, 1998; Irons & Schneider, 1999; Kafka & Hennon, 1999; Money, 1986; Orford, 1978; Schneider, 1991; Schneider & Irons, 1996) have described problematic hypersexuality and, as Goodman (1992) observed, there is general agreement that the pattern of behavior exists…” (Finlayson,Seal & Martin 2001). Therefore, the estimated number of sex addicts in the U.S. is between 9,200,000 (3%) and 24,500,000 (8%) individuals.   

Sex addiction is not just a modern problem.  “It has existed at all times in human history.  Sexual excess and debauchery have been described and catalogued from antiquity. Nymphomania, a term derived from the Greek, has been used in the past to describe female sexual excess.  Don Juanism, after Don Juan…has denoted male hypersexuality.” (Finlayson, Seal, & Martin 2001).   

“(in 1886) Krafft-Ebbing…described a case of abnormally increased sexual appetite, “to such an extent that permeates all his thoughts and feelings, allowing no other aims in life, tumultuously, and in a rut-like fashion demanding gratification and resolving itself into an impulsive, insatiable succession of sexual enjoyments. This pathological sexuality is a dreadful scourge for its victim, for he is in constant danger of violating the laws of the state and of morality, of losing his honor, his freedom, and even his life.” (Finlayson, Seal, & Martin 2001).

Our societal gender bias significantly affects the accurate statistical representation of female sex addiction.  A society that regards male hyper-sexuality in positive terms has created a shameful backdrop and societal prejudice for women.  Hypersexual men are commonly considered “virile” or “studs,” whereas hypersexual women are considered “sluts,” “whores” or “nymphomaniacs.”  These unfair and egregiously incorrect conceptions of sex hyper-sexuality and addiction have marginalized and minimized the seriousness of female sex addiction.  Gender bias is also found in addiction-related research.  In most addiction studies, females are underreported; underdiagnosed and overlooked (S. O’Hara).  For example, the American Medical Association recognized male alcoholism as a disease in 1956; but it was not until the late 1980s that significant findings regarding female alcoholism was represented in research studies. 

Sexual addiction in women rarely receives the same research and popular media attention received by men, so it continues to be underreported and minimized.  Moreover, media and news coverage seems to cover female and male sex addiction differently.  Female sex addicts are often portrayed as manipulative, power hungry, sex crazed and shameless individuals.  On the popular VH1 reality series, “Sex Rehab with Dr. Drew (Pinsky),” female sex addicts are mostly porn stars.  On the other hand, media reports on male sex addicts include powerful celebrities whose sex drive has led them astray (Tiger Woods, Michael Douglas and David Duchovny).  At the end of the day, men seem to remain famous, while the “famous” female sex addicts’ careers crumble and end in shame and disrespect.     

There seems to be a mistaken assumption that sexual addiction is a “one size fits all” disorder.  This could not be further from the truth.  Female addiction is often misunderstood, incorrectly diagnosed and inappropriately and ineffectively treated.  Although female and male addiction share many similarities, female addiction is distinctly different. 

In actuality, sex addiction tends to parallel our society’s gender stereotypes.  For example, men tend to prefer face-to-face anonymous contact and are more aggressive and dominant.  They typically favor sexually explicit chat, cyber-porn and interactive sexual play - virtual and in person.  They gravitate toward the voyeuristic forms of sexual behavior, i.e., chronic masturbation, Internet pornography, strip clubs and the use of real-time videos (webcams).  The goal for most male sex addicts is to seek sexual stimulation – not the sexually stimulating relationship.  To the male addict, the euphoric “fix” is in the act, not the relationship.

Another gender difference in sex addiction is found in the relational boundaries of the acting out behavior.  Men tend to maintain distinct and clear emotional boundaries with the “object” of their compulsive and lustful desires – not as often seeking a romantic or personal experience.  They seek sexual opportunities that come from discreet, anonymous and disconnected “hookups.”  To the typical male sex addict, the relationship is the vehicle by which his lustful obsessions and compulsions are satiated.  If there is a “relationship,” it is often fantasy based – lasting just long enough to satisfy his out-of-control pursuit of sexual contact.  For the typical sexually addicted male, at the conclusion of the sexual act – usually at orgasm – he becomes disconnected, disinterested and even repelled by the object of his lust. 

It is important to note that females can also look like stereotypical male sex addicts, as males can also look like stereotypical female sex addicts. 


Female Sex Addiction Myths
Female sex addiction has been largely underrepresented because of misunderstandings and the subsequent development of myths.  Such myths or commonly-held erroneous beliefs have contributed to the ignorance, fear, shame and consequent silence concerning female sex addiction (Ferree 2011).

Myth One: Females Cannot Be Sex Addicts.
Within the addiction treatment field, it is a well-known fact that women, like men, can be addicted to sex.  However, the general public believes that sexual compulsivity is mostly a male phenomenon.  The belief that women do not struggle with sexual compulsivity comes from societal prejudices, double standards and ignorance rooted deeply in the American culture.  A female “sex” addict, like her male counterpart, is addicted to uncontrollable compulsive sexual behavior.  Even with the similarities, women tend to use sex for power, control and attention.  “They score high on measures of fantasy sex, seductive role sex, trading sex and pain exchange.” (S. O’Hara) 

Prior to the mid 1950’s, women who had sex outside of marriage were subjected to harsh and unfair judgment.  Female sexuality outside of marriage, especially masturbation, was viewed as the closest thing to moral bankruptcy.  It was with the 1953 Kinsey study, “Sexual Behavior in the Human Female,” that normative data regarding female sexuality was made available to the public at large.  The Kinsey Reports played a significant role in changing the public perception of female sexuality.  Fifty-eight years later, women with aberrant sexual behavior, such as sex addiction, are still viewed through the lens of hypocrisy and condemnation.  That which was acceptable for men was considered “ugly” and “perverted” for women. 

A myopic society that scorns, rejects and unfairly judges female sex addiction (while being more tolerant with men) places roadblocks for support, education and counseling/treatment.  A fear of being disparaged, blamed, shunned and, ultimately, isolated by their loved ones prevents many women from feeling safe enough to seek help.  It is no wonder that women sex addicts maintain their silence and secrecy about their addiction.
 

Myth Two: Female Sex Addicts Are Only Addicted to Relationships or Love - Not Sex. 
Even though most female sex addicts are “relationship” or “love” addicts, many others are addicted to sex, masturbate compulsively, use pornography, engage in a variety of Internet sexual activities, have affairs with multiple partners, engage in anonymous sex or phone sex and are exhibitionists.  According to Kelly McDaniel, licensed professional counselor and author of “Ready to Heal: Women Facing Love, Sex and Relationship Addiction,” therapists have recently seen more women with (sex addiction)…in connection with Internet porn, which has become a “gender-neutral” addiction.  “Before, female sex addicts generally tended to have affairs or become sex workers.”

Most female addicts avoid the term “sex addiction” because it carries negative connotations of sexual perversion, nymphomania and promiscuity.  When given a choice, women prefer the romantic and nurturing connotations of “love” or “relationship” addiction.  The “sex addiction” label is resisted because women are often not motivated by the pursuit of sex only – but instead by a deep and insatiable desire for love, acceptance, affection and affirmation.  Naturally, female sex addicts prefer a term that represents their femininity.  


Myth Three: Women Who Are Sex Addicts Know About Their Problem.
Rarely do women identify themselves as sex addicts.  Similarly, when a sexually addicted female seeks mental health services, it is likely that the clinician will misdiagnose her.  It is common for untrained clinicians to only diagnose a comorbid (co-occurring) mental health problem, while completely missing the sex addiction diagnosis.  As a result of a scarcity of research, training and effective screening protocols, the female sex addict who is in denial of her problem is likely to interface with professionals who share her ignorance and denial systems.      

If sex is the core addiction, it may be hidden beneath a more obvious and less shameful concurrent addiction.  Having more than one addiction, women are prone to only seek professional help for the addiction that is more obvious and socially acceptable.  Shame, embarrassment and fear of consequences, i.e., divorce or social alienation, may push the sex addiction – the primary or core addiction - to the addict’s unconscious.  Simply, sex addiction is easier to deny than another addiction such as alcohol or drugs.          


Myth Four: Consequences Are the Same for Females and Males.
Although female sex addicts experience the same consequences as men, a societal sexual double standard also creates more painful and harsher consequences.  Additionally, women are more prone to suffer health concerns such as unwanted pregnancies or sexually-transmitted diseases.  Because of the power and strength differential of men and women, women face a higher probability of physical harm such as rape or aggravated battery.  Women suffer unique and agonizing consequences because they often feel responsible for the shame, embarrassment and punishing social judgment that their male partner and children endure.   


A Sexual Double Standard
Our culture/media encourages women to be sexually provocative and available, while holding them in contempt if they cross the boundary of society-determined rules concerning sexual decency.  Male sex addicts are afforded greater tolerance and freedom than females.  “The belief that women and men are held to different standards of sexual conduct is pervasive in contemporary American society.  According to the sexual double standard, men are rewarded and praised for heterosexual sexual contacts, whereas women are derogated and stigmatized for similar behaviors.” (Kreager & Staff, 2009) 

Sexual double standards date back to earliest recorded history.  Biblical archeologists and religion historians point to frequent sexist and misogynist references in religious documents and art.  These scholars believe that references to sexism in religious texts were at least partially influenced by patriarchal, tribal, violent and intolerant societies.  The sexual double standard also can be traced back to the 13th century during the crusades when a knight required his lady to wear a chastity belt to ensure her sexual fidelity.  As hard as it may be to believe, this punishing and humiliating device is still in use today; in 2004, the USA Today reported that a 40-year old British woman set off a security alarm because of her steel chastity belt.  This woman said her husband had forced her to wear the device to prevent an extramarital affair while on vacation in Greece.

Yet another historical reference of sexual double standard is illustrated in Nathanial Hawthorne’s classic novel, “The Scarlet Letter,” which was written in 1850.  The main character, Hester Prynne, was placed in prison with her infant daughter for conceiving a child through an adulterous affair.  Hester struggled to redeem herself in a society that was harshly judgmental and punishing to females who defied the sexual mores of her time.  Hawthorne’s “The Scarlet Letter” has become a symbol of modern society’s harmful, harsh and punishing sexual double standard. 

Fifty-eight years after the publishing of the “The Scarlet Letter,” Sigmund Freud further perpetuated the myth of sexual inequality in his 1908 article "On the Sexual Theories of Children," in which he introduced the concept of “penis envy.”  According to Freud, the defining moment of gender and sexual identity for a woman occurs when she realizes that she doesn’t have a penis.  Freud believed that girls wished they were born with penises instead of vaginas.  Critics of Freud’s work argue that he was a patriarch, anti-feminist and misogynistic.  One could argue that Freud was merely a product of the sexually repressed Victorian society in which he lived. 

Even today, the double standard continues to be inexorably entwined in our culture - so much so now that women themselves are guilty of discriminating against their own gender.  A significant percentage of women judge highly sexually experienced women more negatively than men (Milhausen and Herold, 1999).  It is still commonplace for women's sexual histories to be used against them in workplace harassment cases or in cases of sexual assault (Valenti, 2009).  The double standard creates a dangerous backdrop for women who are considering getting help for their sexual addiction. 

Concurrent Addictions
Especially with sex addiction, addictive disorders tend to coexist or fit together (Carnes, 1983).  Concurrent addictions, which are multiple addictions that are simultaneous expressed and/or ritually connected, are quite common for female addicts.  Examples include smoking marijuana before going online, drinking alcohol before an Internet date to lower inhibitions and taking stimulants in order to surf the net all night.   Concurrent addictions, like alcoholism, may have been started to hide or numb the pain or shame caused by out-of-control sexual compulsions.  Alcohol, especially, lowers inhibitions and alleviates anxiety – making the sexual acting out more “pleasurable” and “easier.”  Rarely does a sex addict have just one addiction (Carnes, 1983).  Carnes’ research on sexual addictions revealed that 83% of sex addicts reported multiple addictions:
•      Chemical dependencies - 42%
•      Eating disorders - 38%
•      Compulsive overworking - 28%
•      Compulsive spending - 26%
•      Compulsive gambling - 5%


Four Categories of Female Sex Addiction (Feree, 2001)
Female sex addicts may be categorized (in order of prevalence) into four groups: Relationship Addict, Pornography or Cybersex Addict, Stereotypical Sex Addict and Sexual Anorexic.

Category One: The Female Love or Relationship Addict
Female love addicts compulsively seek total immersion in a relationship – real or imagined.  The “lust” for an intoxicating relationship becomes a dramatic obsession that may be stronger and more compelling than the overwhelming desire for sex.  Love addiction creates an illusion of power, control and even dominance.  Love addicts compulsively seek exciting, exhilarating and mood-altering relationships, which by definition are unstable.  They practice serial monogamy: seeking multiple relationships, which begin with intense passion but end relatively quickly.  These unhealthy relationships become the organizing principle of the love addict’s life.  According to a renowned expert on love addiction, Pia Mellody, it is dependent on, enmeshed with and compulsively focused on taking care of another person (1992).  Like any addiction, the drug or process, in this case the relationship, persists despite the addict having no control over it and suffering obvious negative effects. 

Female love addicts are habitually preoccupied with romance, intrigue or fantasy.  They are driven by an insatiable desire for a romantic “fix,” which requires a steady stream of new and exciting short-term romantic monogamous relationships.  They rely on their exhibitionistic and seductive “powers” to “feed” their addiction.  They are entranced by the intoxicating “high” initiated at the point when they meet their love object.  Beginning with hope, excitement and a huge desire, these relationships usually devolve into disinterest; disillusionment and conflict.  The euphoric “fix” escalates and then maintains until the relationship does not deliver the drug-like euphoria anymore.  Like with other addicts, female love addicts try, but never succeed in satisfying their insatiable and compulsive need of romantic euphoria – their drug of choice. 
 
Signs of Love or Romance Addiction:
•      Thinking you are in love despite just meeting (“love at first sight”)
•      Valuing the time spent with love object over time and attention needed for self
•      Relationships create feelings of safety, happiness and optimism 
•      Mistaking sexual or romantic intensity for healthy love
•      Constantly “on the prowl” for a romantic partner
•      Short, intense and conflict-based relationships
•      Pattern of failed relationships
•      Using sex, seduction and intrigue to "hook" or hold onto a partner  
•      Using romantic intensity to hide, cover or “medicate”  emotional pain, conflict or problems
•      Pattern of “dating” abusers, narcissists and addicts (emotionally unavailable, distant and harmful)
•      Flirting and/or having an affair while in a relationship
•      Pattern of broken promises to stop the behavior/addiction
•      Sacrificing time with friends or family to act out
•      Avoiding relationships to control the addiction

Unlike sex addicts, love addicts tend to act out within a relationship.  Often, they are unable to avoid or let go of toxic relationships, even if they are unhappy, depressed, lonely, neglected or in danger.  Typically, love addicts are disinterested in the sexual aspect of the romance, including orgasm.  The “pull” and the power of the “love” in love addiction almost always exceeds the addict’s sexual desires.  It is not unusual for the female addict to report apathy or even dislike of sexual activity, including orgasm.  Love addicts tend to use sex to manage their feelings or to control their partner – the co-addict.  To the love addict, the sexual experience is a means to the end.  According to the Love Addiction Anonymous (LAA) website, “unlike sex addicts, love addicts crave an emotional connection and will avoid, at any cost, separation, anxiety and loneliness.” 

Many female love and relationship addicts report that they are addicted to the intoxicating, intense and all-consuming feelings experienced in the attraction phase of a relationship.  This “rush” is described in Dorothy Tennov’s 1979 book, “Love and Limerence: the Experience of Being in Love.”  Tennov coined the term “limerence,” which she described as an involuntary state of mind that results from a romantic attraction to another person, combined with an overwhelming, obsessive need to have one's feelings reciprocated.  

Symptoms of Limerence (Tennov, 1979):
•         Intrusive thinking about the limerent object (‘LO’)
•         Acute longing for reciprocation
•         Mood fluctuations based on LO's actions 
•         Can only feel it with one person at a time 
•         All-consuming obsession that the LO will relieve the pain 
•         Preoccupation (fear) with rejection
•         Incapacitating and uncomfortable shyness in the beginning
•         Intensification through adversity
•         An aching `heart' (in the chest) when there are doubts 
•         Buoyancy (“walking on air”) with reciprocation 
•         Intense obsessions demotivate the person from other responsibilities (friends, family, work)
•         Emphasis is placed on positive attributes of the LO, while ignoring the negative


Category Two: The Female Cybersex Addict
Cybersex is virtual sex where sexually explicit material is viewed or exchanged to evoke a sexual response.  The cybersex addicts act out their sexual compulsions through the use of and involvement with the Internet.  Cybersex requires vivid, visceral and sexually evocative sexual stimuli.  Female cybersex addicts typically do not meet in person, but in “virtual” places, i.e., email, chat rooms, with video cams, prolonged email interactions and role-playing activities.  While creating a safer experience, anonymity often enhances the sexual excitement for the female cybersex addict.  Cybersex addicts usually act out together in “virtual” places through masturbatory activities.  Female cybersex addicts are more prone to have phone contact or seek relationships through their activities (Schneider, 2011). 

Cybersex Addiction Activities
•      Viewing and masturbating to Internet pornography (photos or videos)
•      Live webcam sexual interaction
•      Sexual membership sites (Swingers, BDSM, etc.)
•      Membership in cyber affair sites (AshleyMadison.com)
•      Seeking sex through personal sex ads (Craigslist or Backpages)
•      Participating on sex-related chat sites
•      Adult dating sites (Adult Friend Finder)
•      Cell phone hook-up applications
•      GPS hook-up applications (Grindr)


Category Three: The Female Sex Addict
Female sex addicts can fit the stereotypical “male” pattern of sexual addiction.  This is an addiction driven by a lustful and compulsive preoccupation with a sexual activity.  Sex addicts typically engage in chronic masturbation, with or without pornography, and have anonymous sex with individuals who they either met online or “picked up” in a bar or other public place.  To the female sex addict, the relationship is less important than the thrill of the sexual experience.  While female sex addicts are less voyeuristic, they are more exhibitionistic.  Typically, they are exotic dancers or strippers, prostitutes or women who sell sex or trade it for something desired.  
 
Female sex addiction occurs with the same 11 behavioral forms of sexual addiction that Patrick Carnes outlined in his breakthrough book on sex addiction, “Out of the Shadows.”  It should be noted that despite the commonalities, there are clear gender differences and gender behavior preferences. 
1. Fantasy Sex – Sexually charged fantasies, relationships and situations
2. Seductive Role Sex- Seduction of partners
3. Anonymous Sex — High-risk sex with unknown persons
4. Paying for Sex – Purchasing of sexual services
5. Trading for Sex – Selling or bartering sex for power
6. Voyeuristic Sex – Visual arousal
7. Exhibitionistic Sex – Attracting attention to the body or sexual parts of the body
8. Intrusive Sex – Boundary violations without discovery
9. Pain Exchange – Being humiliated or hurt as a part of the sexual arousal
10. Object Sex – Masturbating with objects
11. Exploitive Sex — Exploitation of the vulnerable


Category Four: Sexual Anorexia
The term “sexual anorexia” has been used to describe sexual aversion disorder (DSM code 302.79), a state in which the patient has a profound disgust and horror at anything sexual in themselves and others (P. Carnes, 1998).  The title of Carnes’ 1997 book, “Sexual Anorexia: Overcoming Sexual Self-Hatred,” describes the sex or love addict’s psychological motivation for this disorder - contempt and self-hatred – often for their sex or love addiction. 

Sexual anorexia is the inverse of sexual addiction.  Sexually anorexic women are as compulsive with their aversion to sex as sex addicts are trying to have sexual experiences.  Sexual anorexics suppress or repress their sexually addictive compulsions by denying their own sexuality, avoiding all sexual encounters, rebuking others for any and all sexual interest and/or vehemently condemning others for their sexual proclivities or desires.  Sexual anorexia includes a binge/purge cycle, during which a woman may uncontrollably sexually act out for an extended period of time, and which may be followed by a sexual shutdown – avoiding all forms of sexual expression and activity. 

Symptoms of Sexual Anorexia (Carnes, 1993):
·         Persistent fear of intimacy, sexual contact, sexual pleasure, sexually transmitted diseases, etc.
·         Preoccupation, to the point of obsession, with sexual matters, including the sexuality, sexual intentions and  
          sexual behaviors of others, and their own sexual inadequacy.
·         Negative, rigid or judgmental attitudes about sex, body appearance and sexual activity.
·         Shame and self-loathing over sexual experiences.
·         Self-destructive behavior in order to avoid, limit or stop sex.

Conclusion
The treatment of sex addiction as a gender neutral problem has created unnecessary roadblocks to females seeking services for sex and love addiction.  Although there are distinct gender differences with sex and love addiction, the problem is clearly universal.  Until the popular media represents female sexual addiction in a more socially acceptable and less derogatory manner, women will be "shamed" out of seeking the much needed help, support and services.  The mental health and addiction fields also need to overcome its own limitations regarding unsubstantiated and unsupported beliefs regarding women and sex and love addiction.  Until our society's gender blindness, sexist beliefs and double standards are corrected, scores of female sex and love addicts will be deprived of timely, effective and compassionate addiction services.  It is time that all mental health and addiction practitioners open their hearts, minds and offices to female sex and love addicts.

Bibliography

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Carnes P. (1991) “Don’t Call It Love: Recovery from Sexual Addiction,” Bantam Books.

Carnes, P. (1998) “The Case for Sexual Anorexia: An Interim Report on 144 Patients with Sexual Disorders,” Sexual Addiction and Compulsivity, Volume 5, Issue 4, 1998.  

Carnes, P. (2005) “Kaplan & Sadock’s Comprehensive Textbook of Psychiatry,” Vol. 1, Lippincott Williams and Wilkins.

Carnes, P. and Mariarty, J. (1997) “Sexual Anorexia: Overcoming Sexual Self-Hatred,” Hazelden Publishing Bantam Books.

Chandiramani, K. (2007) “A Role for Mindfulness Meditation in the Treatment of Sexual Addictions,”www.rcpsych.ac.uk (Royal College of Psychiatrists).

Ellis, H. (1905) “Studies in the Psychology of Sex,” New York, Random House.

Ferree  (2001)  “Females and Sex Addiction: Myths and Diagnostic Implications,”  Sexual Addiction & Compulsivity, 8:287-300,  Brunner-Routledge

Finlayson, R; Seal J; and Martin, P  (2001)  “The Differential Diagnosis of Problematic Hypersexuality  Sexual Addiction & Compulsivity”  8:241 Brunner-Routledge

Fitzgerald, S  (2009)  “A Devastating Mental Health Challenge”  Nashville Medical News  SouthComm, Inc.

Hirschfield, M. (1948) “Hyper-eroticism, Sexual Anomalies: the Origins, Nature and Treatment of Sexual Disorders,” 86-100, New York: Emerson Books.

 Kafka, M. (2009) “Hypersexual Disorder: A Proposed Diagnosis for DSM-V,” American Psychiatric Association. 

 Kasl, C. (1990) “Women, Sex and Addiction: A Search for Love and Power,” William Morrow Paperbacks.

Krafft-Ebbing, R. (1886) “Psychopathia Sexualis,” tr. F. J. Redman, New York: Stein & Day, 1965.

Kreager, D., and Staff, J. (2009) “The Sexual Double Standard and Adolescent Peer Acceptance,”Social Psychology Quarterly,June 2009, Vol. 72, No. 2 143-164.

Landau, E. (2008) “When Sex Becomes an Addiction,” www.cnn.com.  http://articles.cnn.com/2008-09-05/health/sex.addiction_1_relationship-addiction-patrick-carnes-addiction-cases?_s=PM:HEALTH

 Macnair, T. (2010) “What is Sex Addiction?”  www.bbc.co.uk/.http://www.bbc.co.uk/health/emotional_health/addictions/sex_addiction.shtml  

Mayo Clinic Staff (ch. 17, 2003) “Compulsive Sexual Behavior,” Mayo Clinic Website for the Mayo Foundation for Medical Education and Research at: www.mayoclinic.com/invoke.cfm?id=DS00144.  Last accessed 03/19/05.

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Milhausen, R. and Herold, E. (1999) “Does the Sexual Double Standard Still Exist?  Perceptions of University Women,” The Journal of Sex Research, Vol. 36, No. 4 (Nov. 1999), pp. 361-368. Published by: Taylor & Francis, Ltd.  http://www.jstor.org/stable/3813720.

O’Hara, S. “How Are Female Sex Addicts Different From Males?” http://www.sharonohara.com/article12.html.

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New Definition of Addiction: Addiction Is a Chronic Brain Disease, Not Just Bad Behavior or Bad Choices

http://www.asam.org/

The American Society of Addiction Medicine (ASAM) has released a new definition of addiction highlighting that addiction is a chronic brain disorder and not simply a behavioral problem involving too much alcohol, drugs, gambling or sex. This the first time ASAM has taken an official position that addiction is not solely related to problematic substance use.

When people see compulsive and damaging behaviors in friends or family members -- or public figures such as celebrities or politicians -- they often focus only on the substance use or behaviors as the problem. However, these outward behaviors are actually manifestations of an underlying disease that involves various areas of the brain, according to the new definition by ASAM, the nation's largest professional society of physicians dedicated to treating and preventing addiction.

"At its core, addiction isn't just a social problem or a moral problem or a criminal problem. It's a brain problem whose behaviors manifest in all these other areas," said Dr. Michael Miller, past president of ASAM who oversaw the development of the new definition. "Many behaviors driven by addiction are real problems and sometimes criminal acts. But the disease is about brains, not drugs. It's about underlying neurology, not outward actions."

The new definition resulted from an intensive, four-year process with more than 80 experts actively working on it, including top addiction authorities, addiction medicine clinicians and leading neuroscience researchers from across the country. The full governing board of ASAM and chapter presidents from many states took part, and there was extensive dialogue with the National Institute on Drug Abuse (NIDA).

The new definition also describes addiction as a primary disease, meaning that it's not the result of other causes such as emotional or psychiatric problems. Addiction is also recognized as a chronic disease, like cardiovascular disease or diabetes, so it must be treated, managed and monitored over a life-time.
Two decades of advancements in neurosciences convinced ASAM that addiction needed to be redefined by what's going on in the brain. Research shows that the disease of addiction affects neurotransmission and interactions within reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors. Meanwhile, brain circuitry that governs impulse control and judgment is also altered in this disease, resulting in the dysfunctional pursuit of rewards such as alcohol and other drugs. This area of the brain is still developing during teen-age years, which may be why early exposure to alcohol and drugs is related to greater likelihood of addiction later in life.

There is longstanding controversy over whether people with addiction have choice over anti-social and dangerous behaviors, said Dr. Raju Hajela, past president of the Canadian Society of Addiction Medicine and chair of the ASAM committee on the new definition. He stated that "the disease creates distortions in thinking, feelings and perceptions, which drive people to behave in ways that are not understandable to others around them. Simply put, addiction is not a choice. Addictive behaviors are a manifestation of the disease, not a cause."

"Choice still plays an important role in getting help. While the neurobiology of choice may not be fully understood, a person with addiction must make choices for a healthier life in order to enter treatment and recovery. Because there is no pill which alone can cure addiction, choosing recovery over unhealthy behaviors is necessary," Hajela said.

"Many chronic diseases require behavioral choices, such as people with heart disease choosing to eat healthier or begin exercising, in addition to medical or surgical interventions," said Dr. Miller. "So, we have to stop moralizing, blaming, controlling or smirking at the person with the disease of addiction, and start creating opportunities for individuals and families to get help and providing assistance in choosing proper treatment."

To read the full Definition of Addiction, visit: http://www.asam.org/DefinitionofAddiction-LongVersion.html

The Sex Addiction Epidemic

 

Chris Lee of the Daily Beat author of Newsweek December 2011 cover story


Valerie realized that sex was wrecking her life right around the time her second marriage disintegrated. At 30, and employed as a human-resources administrator in Phoenix, she had serially cheated on both her husbands—often with their subordinates and co-workers—logging anonymous hookups in fast-food-restaurant bathrooms, affairs with married men, and one-night stands too numerous to count. But Valerie couldn’t stop. Not even after one man’s wife aimed a shotgun at her head while catching them in flagrante delicto. Valerie called phone-sex chat lines and pored over online pornography, masturbating so compulsively that it wasn’t uncommon for her to choose her vibrator over going to work. She craved public exhibitionism, too, particularly at strip clubs, and even accepted money in exchange for sex—not out of financial necessity but for the illicit rush such acts gave her.

For Valerie, sex was a form of self-medication: to obliterate the anxiety, despair, and crippling fear of emotional intimacy that had haunted her since being abandoned as a child. “In order to soothe the loneliness and the fear of being unwanted, I was looking for love in all the wrong places,” she recalls.

After a decade of carrying on this way, Valerie hit rock bottom. Facing her second divorce as well as the end of an affair, she grew despondent and attempted to take her life by overdosing on prescription medication. Awakening in the ICU, she at last understood what she had become: a sex addict. “Through sexually acting out, I lost two marriages and a job. I ended up homeless and on food stamps,” says Valerie, who, like most sex addicts interviewed for this story, declined to provide her real name. “I was totally out of control.”

“Sex addiction” remains a controversial designation—often dismissed as a myth or providing talk-show punchlines thanks to high-profile lotharios such as Dominique Strauss-Kahn and Tiger Woods. But compulsive sexual behavior, also called hypersexual disorder, can systematically destroy a person’s life much as addictions to alcohol or drugs can. And it’s affecting an increasing number of Americans, say psychiatrists and addiction experts. “It’s a national epidemic,” says Steven Luff, coauthor of Pure Eyes: A Man’s Guide to Sexual Integrity and leader of the X3LA sexual-addiction recovery groups in Hollywood.

In fact, some of the growth has been fueled by the digital revolution, which has revved up America’s carnal metab­olism. Where previous generations had to risk public embarrassment at dirty bookstores and X-rated movie theaters, the Web has made pornography accessible, free, and anonymous. An estimated 40 million people a day in the U.S. log on to some 4.2 million pornographic websites, according to the Internet Filter Software Review. And though watching porn isn’t the same as seeking out real live sex, experts say the former can be a kind of gateway drug to the latter.

“Not everyone who looks at a nude image is going to become a sex addict. But the constant exposure is going to trigger people who are susceptible,” says Dr. David Sack, chief executive of Los Angeles’s Promises Treatment Centers.

New high-tech tools are also making it easier to meet strangers for a quick romp. Smartphone apps like Grindr use GPS technology to facilitate instantaneous, no-strings gay hookups in 192 countries. The website AshleyMadison.com promises “affairs guaranteed” by connecting people looking for sex outside their marriages; the site says it has 12.2 million members.

This year the epidemic has spread to movies and TV. In November the Logo television network began airing Bad Sex, a reality series following a group of men and women with severe sexual issues, most notably addiction. And on Dec. 2, the acclaimed psychosexual drama Shame arrives in ­theaters. The movie follows Brandon (portrayed by Irish actor Michael Fassbender in a career-defining performance), a New Yorker with a libido the size of the Empire State Building. His life devolves into a blur of carnal encounters, imperiling both his job and his self-regard. In perhaps the least sexy sex scene in the history of moviedom, Brandon appears to lose all humanity during a frenzied ménage à trois with two prostitutes. “It’s a foursome with the audience,” says director and co-writer Steve McQueen. “What we were doing was actually dangerous. Not just in terms of people liking the movie, but psychologically.”

However powerful and queasy Shame’s odyssey into full-frontal debasement may be, the film only begins to tap into the dark realities connected with sex addiction. Take it from Tony, a 36-year-old from the affluent Westside of Los Angeles, who found his life thrown into turmoil by compulsive sexual behavior. “I was crippled by it,” he says. “I would go into trancelike states, lose track of what I was doing socially, professionally, spiritually. I couldn’t stop.”

He was ashamed of his tireless efforts to find women. “I was meeting girls on the basketball court, in the club, pulling my car over to meet them on the street,” Tony recalls. It took joining a Sex and Love Addicts Anonymous 12-step program for him to realize that he wasn’t alone.

He also learned that his fixation on sex was a way of avoiding his insecurities and tackling the emotional issues that first led to his addictive behavior. “The addiction will take you to a place where you’re walking the streets at night, so keyed up, thinking, ‘Maybe I’ll just see if there’s anybody out there,’” he says. “Like looking for prey, kind of. You’re totally jacked up, adrenalized. One hundred percent focused on this one purpose. But my self-esteem was shot.”

Most treatment programs are modeled on Alcoholics Anonymous, but rather than pushing cold-turkey abstinence, they advocate something called “sexual sobriety.” This can take different forms, but typically involves eradicating “unwanted sexual behavior,” whether that’s obsessive masturbation or sex with hookers. “We treat it very much like sobriety for an eating disorder,” says Robert Weiss, founder of the Sexual Recovery Institute in Los Angeles. “They have to define for themselves based on their own goals and belief systems: ‘What is healthy eating for me? Can I go to a buffet? Can I eat by myself?’ We look at your goals and figure in your sexual behaviors and validate what’s going to lead you back to the behavior you don’t want to do.”

Although sex addicts sometimes describe behavior akin to obsessive-compulsive disorder, research hasn’t directly correlated the two. But a growing body of research shows how hypersexual disorder can fit into other forms of addiction. At the Promises treatment centers, clinicians have observed a number of sex addicts who have relapsed with drugs or alcohol in order to medicate the shame they felt. Severe depression can also follow after an addict starts to confront the condition. “I realized I was not comfortable in my own skin,” says Valerie, who checked herself into four months of treatment for sex addiction at Del Amo, a private behavioral-health hospital in Torrance, Calif. “My depression came from the fear I was going to be alone for the rest of my life. Fighting the obsession and rumination, the fear of loneliness and abandonment.”

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Sex addicts are compelled by the same heightened emotional arousal that can drive alcoholics or drug addicts to act so recklessly, say addiction experts. Research shows that substance abusers and sex addicts alike form a dependency on the brain’s pleasure-center neurotransmitter, dopamine. “It’s all about chasing that emotional high: losing yourself in image after image, prostitute after prostitute, affair after affair,” says the Sexual Recovery Institute’s Weiss. “They end up losing relationships, getting diseases, and losing jobs.”

Here’s what the experts will tell you that sex addiction is most decidedly not: a convenient excuse for sexual indiscretions and marital truancy. Chris Donaghue, a sex therapist who hosts the show Bad Sex, says Tiger Woods, for example, does not qualify as a sex addict, despite his well-documented sexcapades and treatment at a Mississippi rehabilitation center specializing in sex addiction. “Because he didn’t honor his integrity and marital boundary does not make him an addict,” Donaghue says, adding that people will say, “ ‘Because I get in trouble, because I cheat, I’ll just blame it on sex addiction. That’s my get-out-of-jail-free card.’ ”

Contrast Woods’s wild-oats sowing against the experiences of Harper, an Atlanta-born television executive who found himself caught in the grips of sex addiction for four years. After joining an online dating service, Harper fell into a pattern of juggling multiple relationships, sexting incessantly and focusing almost singlemindedly on hooking up. He discovered he could usually get his partners into bed on the first date—sometimes within the first hour of meeting. “And these weren’t desperate women,” he says.

But the fleeting ego gratification Harper derived from his conquests came at a steep price. He describes himself as living in a “stupor.” Friendships suffered, and he felt “pathetic” about his sexual urgency. The worst part, he says, was that his sex drive ultimately changed “what I think is normal,” as his tolerance grew for increasingly hard-core forms of pornography. “It really is like that monster you can’t ever fulfill,” says Harper, 30, who has avoided dating for the past eight months and attends a recovery group. “Both with the porn and the sex, something will be good for a while and then you have to move on to other stuff. The worst thing is, toward the end, I was looking at pretend incest porn. And I was like, ‘Why is something like that turning me on?!’ ”

The potential for abuse of online porn is well documented, with research showing that chronic masturbators who engage with online porn for up to 20 hours a day can suffer a “hangover” as a result of the dopamine drop-off. But there are other collateral costs. “What you look at online is going to take you offline,” says Craig Gross, a.k.a. the “Porn Pastor,” who heads XXXChurch.com, a Christian website that warns against the perils of online pornography. “You’re going to do so many things you never thought you’d do.”

Exhibit A: “We see a lot of heterosexual men who are addicted to sex and, because culturally and biologically women aren’t as readily available to have sex at all times of the day, these men will turn to gay men for gratifi­cation,” says sex therapist Donaghue. “Imagine what that does to their psychology. ‘Now am I gay? What do I tell my wife?’ ”

That wasn’t the issue for Max Dubinsky, an Ohio native and writer who went through a torturous 14-month period of online-pornography dependence. He says a big problem with his addiction was actually what it prevented him from doing. “I couldn’t hold down a healthy relationship. I couldn’t be aroused without pornography, and I was expecting way too much from the women in my life,” recalls Dubinsky, 25, who sought treatment at the X3LA recovery group and is now married.

If discussion of sex addiction can seem like an exclusive domain of men, that’s because, according to sex therapists, the overwhelming majority of self-identifying addicts—about 90 percent—are male. Women are more often categorized as “love addicts,” with a compulsive tendency to fall into dependent relationships and form unrealistic bonds with partners. That’s partly because women are more apt than men to be stigmatized by association with sex addiction, says Anna Valenti-Anderson, a sex-addiction therapist in Phoenix. “We live in a society where there’s still a lot more internalized shame for women and there’s a lot more for them to lose,” Valenti-Anderson says. “People will say, ‘She’s a bad mom’ for doing these sexual things. As opposed to, ‘She’s sick and has a disorder.’ But very slowly, women are starting to be more willing to come into treatment.”

Addicts and therapists alike say they hope a greater awareness of the disease will eventually help addicts of all genders and ages come forward and seek treatment. Many are likely to find that “sex addiction isn’t really about sex,” as Weiss puts it; it’s about “being wanted.”

X3LA’s Steven Luff says, “Sex is the perfect match for that. ‘I matter right now. In this moment, I am loved.’ In that sense, an entire culture, an entire nation is looking for meaning.”