A Case Study of One Sex Addict's Recovery

Steve is a professional musician. A man in his 50's, virile yet sensitive, he is sexually compulsive around fetishistic sex. Since his early teens, Steve had masturbated nearly every night before going to sleep. As he matured, his need for masturbation increased until he was masturbated five or six times a day. He found that if he did not act on these urges, he would remain "horny" all day, which would make him restless, distracted, and irritable. When asked about his masturbatory fantasies, he related that they centered on feet, stockings, worshiping at the feet of a dominant woman to whom he would avow love, and visiting professional sex workers to whom he would also confess love.

By his mid-twenties, he was routinely acting out on these fantasies. Again, if he did not act out his sexual fantasies, he would become very uncomfortable and would be unable to focus on anything except playing music during the day. When the Internet became available, he started spending multiple hours each day surfing the net, looking for fetishistic images to which he would masturbate. Stating that he was never interested in "fucking real women", he was eager to view websites that featured feet, legs, stockings, heels and dominatrixes.

When he would begin a romantic/sexual relationship with a woman, he would vow to stop acting out with aberrant sex to devote his attention to the girlfriend. He could, however, never bring himself to tell the "real girlfriend" he loved her. Within a few months after he began a relationship, he would lose sexual interest in his partner and the relationship would fall apart.

At some point, he started using telephone sex services. He would enjoy having elaborate fantasy relationships with the workers and would often "fall in love" with one of them. When he had "maxed out" his credit cards, he applied for new ones and then ran them up their limits. He got behind in the rent, and the power company threatened to cut him off unless he paid his bill. Socially isolated, deeply in debt, and about to lose his job, Steve realized his preoccupation with sex was ruining his life, but he felt powerless to change his behavior. Moreover, he was fighting the urge to visit a dominatrix/transvestite which he felt was a significant increase in the level of deviance he required to achieve sexual satisfaction.

He also was beginning to sense that pornography and phone sex no longer excited him as much as they used to. Increased levels of novelty, excitement and risk were required to achieve orgasm. At the same time he had met a woman whom he greatly admired, but for whom he had no sexual feelings despite her very real physical attractiveness. When he lost interest in her sexually and episodes of emotional intimacy would provoke anxiety, he began to examine his relationship patterns. Fearful that he was perpetuating his life-long pattern of not being able to be sexual or to have loving feelings for a real woman, he was concerned that yet another relationship would painfully fall apart. This, combined with persistent job jeopardy and chronic debt, propelled him into treatment.

Personal History

Steve was the youngest child in the family, with a sister who was five years his senior.

His sister was a bit sadistic, tormenting him with teasing when he began to develop sexually. He relayed an incident wherein he had given an ID bracelet to a girlfriend and his sister confronted him about the missing bracelet at the dinner table which incited fear in him about his projection of his mother's enmeshed and hysterical reaction.

His mother, it seemed, was the stereotypical "Jewish mother." She was adamant that he not see girls who were not Jewish (and most of his girlfriends were not). When starting treatment, Steve relayed that he had a very "loving" relationship with his mother. She would tell him that she loved him "every 10 seconds" and would incur his guilt about abandoning her whenever he made an effort to explore his interest in girls. As treatment proceeded, he began to realize that a fear of engulfment was an underlying factor about his anxiety about true intimacy and was able to connect this to his relationship to a mother who was too insecure to allow him to become his own person. He spent his childhood feeling that he could not retain a sense of himself and still maintain his relationship to mother, whom he put on a pedestal. Unable to risk his mother's emotionally abandoning him, he clocked himself in an armor of a "false self", which was a people-pleasing self. Constantly seeking validation from the outside, sexual ap
provable and acceptance from sex workers made him feel real, vital and alive. It defined his identity.

His love and need for mother represented a conflict for him. At some point, he began to realize how emotionally arbitrary his mother was. He could never trust her telling him that she loved him "every 10 seconds" because she would act differently from one moment to the next, giving Steve mixed messages. What disturbed him most as a child were his mother's rage attacks, which were unpredictable and could be triggered by almost anything. Inevitably, whenever Steve would make an attempt to appropriately separate from family, his mother would rage about an unrelated event. He sometimes would feel "crazy" by his mother's enmeshment and abandonment patterns.

Steve's father worked in the hardware store that his father (Steve's grandfather) had started and had successfully run until he sold it to cover his gambling debts. Steve's father had intended to save his money and eventually either to buy out the hardware store's current owner or else to open his own store. After many years, however, he was still working for little more than minimum wage, while the store's owner would regularly rebuke him for not having his father's knack for hardware. Steve's father was not ready to be a father when Steve was born. Steve understood that his father was planning on leaving his mother but could not bring himself to leave her with two small children. Steve came to blame himself for being responsible for holding his father in a marriage he did not want to be in. Later he realized that his father would not have had the guts to leave. Steve noted that his father never stood up for himself or for his family, and that he never stood up to Steve's mother. While his mother held Stev
e up on a pedestal, she, at the same time, demoralized his father with her constant belittling about his failure as a man.

Steve's father died from a heart attack when he was 13. Steve felt nothing about the loss and when he went back to school he never told anyone about it.. About a year later, his mother was hit and killed by a bus after Steve asked her if she could walk the dog as a favor to him. He had wanted to stay home to look at internet porn and masturbate.

Extremes of parental depravation or indulgence have devastating effects on a child, and it is not surprising to find this dynamic in the backgrounds of many sexual compulsives.

In addition, he had a weak connection to a vulnerable father to whom he felt a guilt-inducing tie for "holding" him to a torturous marriage to a woman who loathed and belittled his manhood. There was no port in the storm for Steve; no sustaining environment where Steve could develop an arsenal of task -orienting coping strategies. Nor did he have any social connections that could have compensated for the lack of balance and consistency required for the development of a solid, adequate sense of self. Like many sexual compulsives, he sexualized his family-of-origin conflicts and developed an internal "split" to abide an unbearable childhood psychic reality.

As an adult, he felt he lived in two worlds - not unlike a Dr. Jekyll and Mr. Hyde syndrome. There was a vacillating connection between fetishistic love objects in his fantasy world where he could express none- threatening love feelings and "real" women who were his companions and intellectual equals, although he held no erotic feelings for them. He could remain alive and vital enough to succeed at a competitive career in the music industry by remaining in a dissociated "erotic haze" which served to regulate the amount of intimacy he could tolerate. The sexually compulsive person therefore frequently alternates between the isolated and anxious clinging to both the "fantasy" love object with whom he feels safe but dehumanized, demoralized and fraudulent, and the "real" woman with whom he feels emotionally vulnerable, terrified of engulfment and de-erotized.

In addition to a lack of self care and the repetitive, impulsive choices that result in damaging consequences to the self, the person enslaved by compulsive sexuality is ill- equipped to value, comfort, soothe, and care for his authentic self. Indeed, he has no authentic self because he has never separated from his family-of-origin. The lack of care and nurturing from a mother who only saw him as a "need-supplying object" for herself is his basic trauma and is acted out sexually as an adult.

With this case in mind, let us pick out specifically what makes for a description of a sexually compulsive person.

Compulsive Sexuality

Solidifies his identity

Feels shameful

Is illicit, stolen, or exploitive

Compromises values

Draws on fear for excitement

Reenacts childhood traumas

Disconnects one from oneself

Creates a world of unreality and fantasy

Is self-destructive and dangerous

Uses conquest or power

Serves to medicate and kill pain

Is dishonest

Requires a double life

Is grim and joyless

Demands perfection

Mistakes intensity for intimacy

Requires novelty - intensity always has to be more than the last "hit"

Gives way to self-hatred, loneliness and despair.

Has no sexual "boundaries"

Uses false intimacy as a way to avoid relational pain

Preoccupation and ritualizations

Is "doing to" someone

Is devoid of communication

Has no limits

Benefits one person

Is an uncontrollable energy

Is emotionally distant

Other considerations

-Behavior leads to increasingly negative consequences but addict unable to control acting out

-Denial of the behavior's seriousness.

-Is the product of intense, unmet needs, coupled with the demand for perfect fulfillment and control of relational pain.

-Demands that life provides an illusion of reassurance and predictability by getting self-centered physiological relief.

-Is always a narcissistic endeavor - people are seen as "need-supplying objects", not as real human beings; more interested in getting than giving.

-Is ephemeral - physical orgasm provides a welcome rush of adrenaline, but by itself can only offer the brief illusion of intimacy and belonging.

-Sex is a conquest and abates the terrifying sense of not belonging.

-Sexual fantasy conjures up a perfect world of nourishment, love, generosity and tenderness.

-Are trapped in the paradox of being terrified of loneliness even as they act in ways that create further loneliness.

-In fantasy sex, have the freedom to be vulnerable and nurtured without fear. At it's core, sexual fantasy is a worship of self.

-Carry a sense of parental betrayal; parents unable to provide a positive role model of healthy intimacy.

-Have no ability to regulate their emotions from within.

-Risk relationships, financial loss, job jeopardy and physical safety.

-Possesses a set of irrational cognitive distortions, including "Sex is my most important need"; "I am basically a bad, worthless person; no one could love me as I am;" "My needs are never going to be met if I depend on others;" "I am valuable only if I am sexualized; being sexually desired makes me feel alive;" (Patrick Carnes, Out of the Shadows: Understanding Sex Addiction)

-Have deficits in the areas of social skills, interpersonal communication, stress control, anger management and empathy for others.

-Learned in childhood that feelings are dangerous, so learned how to mask their feelings, even from themselves.

-Sexual addiction is not a moral issue; it is a coping mechanism born from childhood wounding.