BlueSideFinch

I am not a mental health or medical professional. 

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Some articles on the link between experienced trauma (sexual or otherwise) and problematic sexual behavior.

It has been known for a long time that samples of individuals who self identify as sex addicts, are far more likely to have people with experiences of childhood sexual abuse, than control samples. But what about sexual abuse experienced in adolescence or adulthood?

I was recently asked to find some articles relating trauma and risky/compulsive sexual behavior, by a young woman who was struggling with her compulsive sexual behavior after she was sexually abused and/or assaulted in her adulthood. Although I couldn’t find anything that directly answered her questions I found some links between experienced trauma of all sorts, and hypersexuality. Here I post snippets from these articles so you can decide whether you want to read them or not.

First article is a research paper on collage women, who suffered abuse after the age of 11.

"the  results of this study suggest that sexual assault, multiple trauma   exposure, and especially ongoing abuse, even if they occur only in   adolescence, and even if the event(s) are non–sexual in nature,   contribute to risky sexual and self–destructive behaviors that have the potential to impair health and even to threaten life. Psychological   reactions, in the form of the psychiatric disorders of MDD and PTSD, may  further increase these behaviors".

Green,  B. L., Krupnick, J. L., Stockton, P., Goodman, L., Corcoran, C., &  Petty, R. (January 01, 2005). Effects of Adolescent Trauma Exposure on  Risky Behavior in College Women. Psychiatry Washington Then New York William Alanson White Psychiatric Foundation Then Washington School of Psychiatry-, 68, 4, 363-378.

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Second article is related to compulsive sexual behavior in combat veterans as a coping mechanism.

“In  response to this stress, the person will often turn to something that he or she knows will block the pain. Typically this is alcohol, drugs, or food, but if clinical observations are correct, growing numbers of   these returning veterans are turning to compulsive sex for the relief.   The resultant sexual behavior varies in type, but in every case, it has a  direct and profound impact on the individual, the couple, and the   family unit as a whole.”

Howard,  M. D. (January 01, 2007). Escaping the Pain: Examining the Use of   Sexually Compulsive Behavior to Avoid the Traumatic Memories of Combat. Sexual Addiction and Compulsivity, 14, 2, 77-94.

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Third article is about compulsive sex in response to trauma, in the African American community.

"A  driven sexuality is another mechanism that may have evolved over time as an attempt at mastery, but, shaped by trauma-bonding, it constitutes a  replaying at some level of the original rape scene but now with some  illusion of control.

The aspect of  control is illustrated by Jeff, a 28-year-old African American man with  3 years of recovery from chemical addiction, when he described his  participation in multiple relationships and casual sex with females from  various support groups as “the only sense of control I have in my life,  it’s as though I’ve finally found something that I’m good at”.

Robinson,  D. W. (January 01, 1999). Sexual addiction as an adaptive response to posttraumatic stress disorder in the African American community. Sexual Addiction & Compulsivity, 6, 1, 11-22.

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The last article explores childhood trauma in gay and bisexual men reporting compulsive sexual behavior, though this bit is about trauma in general.

Blain  at al. (2012), note that "PTSD, one of the most common diagnosis  following interpersonal assault, is associated with increased risky  sexual behavior. . . . [and is] related to lower perceived control over  sex".

Blain,  L. M., Muench, F., Morgenstern, J., & Parsons, J. T. (May 01,   2012). Exploring the Role of Child Sexual Abuse and Posttraumatic   Stress Disorder Symptoms in Gay and Bisexual Men Reporting Compulsive   Sexual Behavior. Child Abuse & Neglect: the International Journal, 36, 5, 413-422.

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To summarize, the research seems to show that there is a link between experienced trauma (sexual or otherwise) and problematic sexual behavior. This appears to be true independently of race, gender or when the trauma was experienced.

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"Treating the sex addiction may worsen the marriage or relationship."

Another interesting paragraph from Rosenberg et al. (2014):

"Another  surprise for clinicians is how treating the sex addiction may worsen   the marriage or relationship. Steinglass (1980) noted how in families   where there is alcoholism, alcohol my be the glue that enables the   couple to meld, tolerate dysfunctional marriages, and/or avoid personal problems. Similarly, recovery from sex addiction puts new demands on   marital relationships. Significant others of sex addicts may suffer from  sexual anorexia, sexual aversions, and/or sexual dysfunctions,   explaining why partners have found it acceptable to live with the   frequent lack of sexual intimacy. As discussed, sex addiction patients   themselves often have sexual disorders. Therefore, conjoint treatment is  generally required to promote healthy relationships and satisfying   sexual experiences during recovery".

Reference:

Rosenberg, K. P., Carnes, P., & O'Connor, S. (January 01, 2014). Evaluation and treatment of sex addiction. Journal of Sex & Marital Therapy, 40, 2, 77-91.

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"sex addiction patients are generally not good at sex"

"What may surprise novice clinicians  is that sex addiction patients are generally not good at sex.They  function poorly in the bedroom. Sex addicts feverishly pursue their  dysfunctional sexual behaviors yet generally have sexual difficulties  with intimate partners, healthy sexual encounters, and/or stable  relationships. . . . Premature ejaculation, erectile dysfunction, anorgasmia, and sexual anorexia (extended periods when the addict has no sexual activity) are common".

Reference:

Rosenberg, K. P., Carnes, P., & O'Connor, S. (January 01, 2014). Evaluation and treatment of sex addiction. Journal of Sex & Marital Therapy, 40, 2, 77-91.

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Hypersexual Behavior Inventory

This test is meant to be a tool to rule out a diagnosis for Hypersexuality Disorder (HD). If your score is below 53, you most likely do not have to worry about HD. However if your score is equal to or above 53, then you could meet potential criteria for HD and further examination is needed.

  Hypersexual Behavior Inventory

Below are a number of statements that describe various thoughts, feelings, and behaviors. As you answer each question, select a response that best describes you. Only choose one response per statement and please be sure to answer every question. For the purpose of this questionnaire, sex is defined as any activity or behavior that stimulates or arouses a person with the intent to produce an orgasm or sexual pleasure (e.g., self-masturbation or solo-sex, using pornography, intercourse with a partner, oral sex, anal sex, etc.). Sexual behaviors may or may not involve a partner.

1 = Never, 2 = Rarely, 3 = Sometimes, 4 = Often, 5 = Very Often.

1. I use sex to forget about the worries of daily life.

2. Even though I promised myself I would not repeat a sexual behavior, I find myself returning to it over and over again.

3. Doing something sexual helps me feel less lonely.

4. I engage in sexual activities that I know I will later regret.

5. I sacrifice things I really want in life in order to be sexual.

6. I turn to sexual activities when I experience unpleasant feelings (e.g.,frustration, sadness, anger).

7. My attempts to change my sexual behavior fail.

8. When I feel restless, I turn to sex in order to soothe myself.

9. My sexual thoughts and fantasies distract me from accomplishing important tasks.

10. I do things sexually that are against my values and beliefs.

11. Even though my sexual behavior is irresponsible or reckless, I find it difficult to stop.

12. I feel like my sexual behavior is taking me in a direction I don’t want to go.

13. Doing something sexual helps me cope with stress.

14. My sexual behavior controls my life.

15. My sexual cravings and desires feel stronger than my self-discipline.

16. Sex provides a way for me to deal with emotional pain I feel.

17. Sexually, I behave in ways I think are wrong.

18. I use sex as a way to try to help myself deal with my problems.

19. My sexual activities interfere with aspects of my life, such as work or school.

© 2011 Rory C. Reid, Ph.D.

 More technical details. Read if interested.

The HBI was taken from Appendix A of Reid, Garos and Carpenter (2011). I chose to post this inventory because the HBI has been demonstrated to be both reliable and valid (Reid, Garos & Carpenter, 2011) . The inventory was later used on a sample of "participants recruited in a Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Field Trial for Hypersexual Disorder", where "scores ≥ 53 are suggested as an initial cutoff point for those experiencing difficulty with hypersexuality"(Reid, Bramen, Anderson & Cohen, 2013). Another 2018 study sought to test "the reliability and the generalizability of HBI and to determine a cutoff score on a large, diverse, online, nonclinical sample (N = 18,034 participants; females = 6132; 34.0%; Mage = 33.6 years, SDage = 11.1)" (Bőthe et al., 2018). However a reliable cutoff score could not be determined and hence why the authors warn, "when the prevalence of a behavior or addiction is low, as is likely in the case of hypersexuality, the most appropriate use of screening measures is to rule out a condition (rather than to rule it in). Therefore, the HBI can be used as the first step of a diagnostic process, but objective indicators and a clinical interview are essential to establish that a given individual’s behavior is truly pathological". And "Although estimations of up to 3% in general populations are available (Stewart & Fedoroff, 2014; Sussman, Lisha, & Grif fiths, 2011), the prevalence of hypersexuality in the population has yet to be properly established" (Bőthe et al., 2018).

 References:

Bőthe, B., Kovács, M., Tóth-Király, I., Reid, R., Griffiths, M., Orosz, G., & Demetrovics, Z. (2018). The Psychometric Properties of the Hypersexual Behavior Inventory Using a Large-Scale Nonclinical Sample. The Journal Of Sex Research, 56(2), 180-190. doi: 10.1080/00224499.2018.1494262

Reid, R., Bramen, J., Anderson, A., & Cohen, M. (2013). Mindfulness, Emotional Dysregulation, Impulsivity, and Stress Proneness Among Hypersexual Patients. Journal Of Clinical Psychology, 70(4), 313-321. doi: 10.1002/jclp.22027

Reid, R., Garos, S., & Carpenter, B. (2011). Reliability, Validity, and Psychometric Development of the Hypersexual Behavior Inventory in an Outpatient Sample of Men. Sexual Addiction & Compulsivity, 18(1), 30-51. doi: 10.1080/10720162.2011.555709

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Eyes open

Gambling disorder is the sole condition in a new category on behavioral addictions. It is the only addictive disorder included in DSM-5 as a diagnosable condition. However there are similarities between sex addiction and gambling disorder.

I found this paragraph in the DSM-5 about gambling disorder which I found interesting; “Gambling patterns may be regular or episodic, and gambling disorder can be persistent or in remission. Gambling can increase during periods of stress or depression and during periods of substance use or abstinence. There may be periods of heavy gambling and severe problems, times of total abstinence, and periods of nonproblematic gambling. Gambling disorder is sometimes associated with spontaneous, long-term remissions. Nevertheless, some individuals underestimate their vulnerability to develop gambling disorder or to return to gambling disorder following remission. When in a period of remission, they may incorrectly assume that they will have no problem regulating gambling and that they may gamble on some forms nonproblematically, only to experience a return to gambling disorder.”.

American Psychiatric Association., & American Psychiatric Association. (2017). Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA: American Psychiatric Association.

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Exclusion form the DSM

“...because of the lack of empirical research and clinical consensus validating sexual behavior as an addiction, the “non-paraphilic sexual addiction (SA)” terminology was removed form the DSM-IV. 

In the preparation of the latest version of DSM-5, the possibility of including the diagnosis of SA was discussed and and considered by the addictive disorders group, but eventually it was excluded due to lack of empirical evidence. The hypersexual disorder diagnosis was considered by the sexual disorders group, but also ultimately rejected.”   

Farré, J. M., Fernández-Aranda, F., Granero, R., Aragay, N., Mallorquí-Bague, N., Ferrer, V., More, A., ... Jiménez-Murcia, S. (January 01, 2015). Sex addiction and gambling disorder: similarities and differences. Comprehensive Psychiatry, 56, 59-68. 

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Definitions

Definitions for hypersexuality can vary. This is just one of them.

“recurrent and intrusive sexual thoughts and fantasies, excessive sexual behaviors, and the inability to control one’s sexuality despite negative consequences.” “[hypersexuality disorder] was ultimately conceptualized as a sexual desire disorder with an impulsivity component. A typical case of hyper sexuality disorder would be expected to display three major symptomatic clusters: unsuccessful attempts to control one’s sexuality, using sex as a primary coping mechanism, and experiencing negative consequences of one’s sexual behavior; nevertheless more profiles may exist as systematic research on this topic has recently just begun.” 

Carvalho, J., Štulhofer, A., Vieira, A. L., & Jurin, T. (January 01, 2015). Hypersexuality and high sexual desire: exploring the structure of problematic sexuality. The Journal of Sexual Medicine, 12, 6, 1356-67.