Sexual Addiction: An Alternative Approach to Treatment
by Mark Schwartz, Sc.D.
Many years ago, following my work on an inpatient program that specialized in trauma and dissociation disorder, I began to work primarily with eating disorder clients. To my shock the journals and leaders in the field had not begun to mention dissociation, even though clients would verbalize that the image they saw in the mirror was “fat” when they were starving to death. I concluded that therapists are often dissociative!
I also remember seeing adolescent trauma survivors cutting on their wrists, pulling their hair, and describing their experience as pleasurable— ‘pleasure from pain’, deserving punishment from shame. Understanding the dissociative perspectives of self-injurious behavior allows for a new lens from which to peer into treatment strategies.
One of my favorite authors, Richard Chafetz (2015), reminds us that “the intersection of traumatic experience and dissociative process has a lot to teach us about addiction.” Almost every addict we work with has more than one addiction, and as they become sober with their eating disorder or alcoholism, sexual addictions quietly increase.
My dietician once warned me that eating-disorder clients’ experience of food does not resemble my own— since I do not have an eating disorder. Could it also be, sexual addicts similarly do not experience sex, let alone the passion or sensuality of it. in the context of affection, intimacy, or connection as others do?
Well, perhaps. Sexual addicts are sometimes observing a scene in their minds, rather than connecting to the “live action” happening right there with their lover. That is, they dissociate— move away, showing an avoidance of connection—in order to become sexually arousable.
Both eating disorders and sexual compulsivity have in common that the addiction often reveals an indirect expression of anxiety, fear, sadness, anger, or rage. Sexual interactions without sensuality, suggests Chafetz, the absence of being in the body. Instead, there is an isolative experience of being alone with people, accompanied by a dissociative isolation from awareness of somatic expression.
Findings show that avoidantly attached girls report feeling numb when touched and do not actually enjoy sex much. They say, “\What’s the big deal?”
Also, the scripts for sexual arousal often reflect physical pain, rape or being raped, or the individual experiences boredom and seeming tolerance as they stare at their computer screen for hours, hardwiring to more and more sexually explicit visuals that are antithetical to their value system—which leads to “watching the scene” rather than participating in it with a partner.
In studying brain systems to understand trauma and reenactments, it’s hypothesized that there is a natural tendency towards coherence. When uninterpreted, affect and cognition are split between left and right brain processing, and there is a greater tendency towards the unconscious becoming conscious and by establishing a personal narrative as the individual differentiates. Obsessive behavior seems to unfold in the context of binding anxiety, wherein the individual is terrified and unsafe. Thus, obsessions are an attempt to facilitate survival in the face of perceived, unsafe experiences and environments. Therefore, the individual requires addiction to not feel so alone and to feel safe and protected.
Another aspect of dissociation is depersonalization, which is detachment from oneself. A woman who calls a stranger she finds on the Internet at 3:00 a.m. for sex is often disconnected from the body, similar to a gay man ‘tricking’ with 10 partners in an evening with whom he has little attraction. The client often presents with a cognition, affect split and talks about feelings rather than experiencing them. Accompanying such splits is often a sense of feeling like a “leaf blowing in the wind.” “I don’t know who I am, what my life is about.” An absence of meaning, connection to self and others, and an inability to experience joy on simple pleasures are hallmarks of dissociation and depersonalization.
In summary, sexual addiction is a disorder of self. There’s a lack of an “I.” Without an “I,” it becomes difficult to create a we. The therapeutic model, therefore, must move from abstinence and trauma-resolution interventions to much deeper levels of facilitating differentiation of mindful experiences of joy, for both self and other.
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