Compulsive Sexual Behaviour
There is no doubt that some people have real problems around their sexual behaviours. What are these behaviours? They may be serial affairs, problematic porn use, cam-sex, seeing sex workers or anything else the clients identifies as a problem. Clients report having the feeling of being out of control, not necessarily that they are out of control.
And just to be clear, I also can provide therapeutic support for partners affected by the problematic sexual behaviours of another.
There is no agreed diagnosis of sex addiction as a disease or disorder. There is however a diagnosis of the term compulsive sexual behaviour disorder (CSBD) in the ICD-11 issued by the World Health Organisation. It’s classified as an impulse control disorder and not addiction. The clinical criteria to meet this diagnosis are very specific and it is rare for people to meet the criteria. Therefore, most people who struggle with their sexual behaviours do not have a psychological disorder, but they struggle with a sexual behaviour problem.
"Although the term 'sex addiction' has been taken up by the popular media, the Working Group concluded that available evidence did not support this conceptualisation." ICD-11. World Health Organisation.
"Materials related to the ICD-11 make very clear that CSBD is not intended to be interchangeable with 'sex addiction', but rather is a substantially different diagnostic framework." ICD-11. World Health Organisation.
Of course some clients who are having serious struggles in their life may regard themselves as sex addicts and I fully accept that.
A good question to consider is whether sexual behaviour is a problem because it’s upsetting you or because other people in your life have a problem with it. The answers to this may well take a little unpacking. Another question to bear in mind is, what does this behaviour provide for you, what makes it so compelling?
Often people look at online tests to see if they have a problem with sex addiction. These tests are moralising and full of hidden value judgments and assumptions. People are often quite surprised at how highly they are rated on the sex addiction scale. Consensual activities that clients might see in online quizzes as possibly indicative of sex addiction are:
· thinking about sex a lot, (what is a lot?),
· having sexual fantasies,
· wanting or having lots of partner sex, (again, what is a lot?),
· wanting or having group sex,
· frequent masturbation (who decides what is frequent?),
· being a woman and liking sex a lot, a woman will often be labelled a nymphomaniac, or sex addict long before a man is judged
· being polyamorous or in an open relationship,
· having a fetish,
· cross dressing,
· being into kink/BDSM,
· using porn,
· paying for sex
· anything else that others might strongly disapprove of?
There is an obvious feedback effect here, if someone finds themselves on a ‘signs of sex addiction’ list, it will stigmatise and make that person feel increasingly ashamed about what they are doing.
MY approach is to primarily seek to empower you and:
· Help identify the sexual behaviours that are wanted from those that are unwanted.
· Show ways to self-soothe and cope with negative feelings about life: stress, anxiety, feeling low, feeling bored, feeling unfulfilled.
· Explore your erotic mind, to find out who you actually are and not try to change your sexual nature.
· Examine and understand your sexual urges and desires, and help you to stop using problematic solutions or strategies to meet perfectly healthy needs.
· Provide tools and techniques to manage impulse control.
· Help you find balance in life: connections with friends and loved ones, a sense of self and meaning.
· Look to heal the possible trauma(s) underlying the roots of behavioursthat feel out of control.
· Treat possible sexual problems underlying the roots of behavioursthat feel out of control.
· Helping to heal relationships that have been injured as a result of sexual behaviours such as having an affair or multiple affairs. The disclosure of compulsive behaviours may be devastating to a partner
· Seeks to reintegrate a vibrant, diverse and fulfilling sexuality with self and others.
And so, to recap, there is plenty that can be done to resolve problematic sexual behaviours through psychotherapeutically informed sexual health approaches that aim to support clients in the acceptance and integration of their sexual preferences.