Sex, Love and Poly-Behavioral Addiction

Proposing a New Diagnosis and Theory for Patientsattention, but could it possibly be that patients with
with Multiple Addictionsmultiple addictions are being under diagnosed (with a
single dependence) simply due to a lack of diagnostic
Experts in the field of addictions are presentlytools and resources that are incapable of resolving the
purporting that between 3 and 6 percent of the world'scomplexity of assessing and treating a patient with
population (193 to 386 million people) are presentlymultiple addictions?
affected by a sexual dependency or compulsivityDiagnostic Delineation
(Carnes, 2005). Sexual dependency is a diagnosableThus far, the DSM-IV-TR has not delineated a
and treatable disease, which today is generally,diagnosis for the complexity of multiple behavioral and
regarded in about the same way that alcoholism andsubstance addictions. It has reserved the
drug addiction (chemical dependency) was regardedPoly-substance Dependence diagnosis for a person
40 years ago. Even so, there still exists a wide rangewho is repeatedly using at least three groups of
of understandable misunderstandings about compulsivesubstances during the same 12-month period, but the
sexual acting out, created out of ignorance about thecriteria for this diagnosis do not involve any behavioral
nature of sexual addiction, and supported andaddiction symptoms. In the Psychological Factors
perpetuated by the multibillion dollar pornographyAffecting Medical Condition's section (DSM-IV-TR,
industry.2000); maladaptive health behaviors (e.g., unsafe
Sexual Dependency - is a global term that covers asexual practices, excessive alcohol, drug use, and over
wide range of maladaptive and self-defeating behavioreating, etc.) may be listed on Axis I, only if they are
patterns and relationships such as:significantly affecting the course of treatment of a
1. Love Addiction - a disorder in which individualsmedical or mental condition.
repeatedly become involved in enmeshed, intense,Since successful treatment outcomes are dependent
codependent relationships, even when thoseon thorough assessments, accurate diagnoses, and
relationships or partners are destructive;comprehensive individualized treatment planning, it is no
2. Romance Addiction - a disorder in which individualswonder that repeated rehabilitation failures and low
become obsessed with the intrigue and the pursuit ofsuccess rates are the norm instead of the exception
romance and thrive on the thrill of the chase, but find itin the addictions field, when the latest DSM-IV-TR does
impossible to sustain a committed, intimate relationshipnot even include a diagnosis for multiple addictive
with another person;behavioral disorders. Treatment clinics need to have a
3. Sexual Anorexia - a disorder in which individualstreatment planning system and referral network that is
become dominated and obsessed with the emotional,equipped to thoroughly assess multiple addictive and
physical, and mental task of avoiding sex; andmental health disorders and related treatment needs
4. Sex Addiction - a disorder in which individualsand comprehensively provide education/ awareness,
become obsessed with sexually-related, compulsiveprevention strategy groups, and/ or specific addictions
self-defeating maladaptive behavior.treatment services for individuals diagnosed with
But can one really be addicted to love as the popularmultiple addictions. Written treatment goals and
80's song proclaims? In a recent research study, (Aron,objectives should be specified for each separate
A. 2005) published in the June issue of the Journal ofaddiction and dimension of an individuals' life, and the
Neurophysiology, researchers used functional MRI todesired performance outcome or completion criteria
watch the real-time brain activity of 17 college studentsshould be specifically stated, behaviorally based (a
(10 women, seven men), all of whom were in the earlyvisible activity), and measurable.
weeks or months of new love. These researchersNew Proposed Diagnosis
concluded that, love may vie for the same real estateTo assist in resolving the limited DSM-IV-TRs'
in the brain as drug addiction. "Early love, rooted as it isdiagnostic capability, a multidimensional diagnosis of
in the caudate nucleus, is all about addiction." "It is a"Poly-behavioral Addiction," is proposed for more
drug addiction." "It's certainly got some of the mainaccurate diagnosis leading to more effective treatment
characteristics of drug addiction -- as with drugs, onceplanning. This diagnosis encompasses the broadest
you fall in love you need that person more and more,category of addictive disorders that would include an
so much so that, after a while, you have to marryindividual manifesting a combination of substance
them. There are other things, too -- real dependence,abuse addictions, and other obsessively-compulsive
personality changes, withdrawal symptoms." "And justbehavioral addictive behavioral patterns to pathological
like the need for cocaine or heroin, love can makegambling, religion, and/ or sex / pornography, etc.).
people do crazy, sometimes dangerous things."Behavioral addictions are just as damaging -
According to Aron (2005), the findings help explainpsychologically and socially as alcohol and drug abuse.
instances where people fall in love with people theyThey are comparative to other life-style diseases such
aren't even sexually attracted to; or why others canas diabetes, hypertension, and heart disease in their
feel equally strong, sudden emotion for a newborn childbehavioral manifestations, their etiologies, and their
or even God.resistance to treatments. They are progressive
So does this mean that all people who are newly indisorders that involve obsessive thinking and
love have an addiction? Are all men who look atcompulsive behaviors. They are also characterized by
pornography addicted? Are all women who reada preoccupation with a continuous or periodic loss of
romance novels addicted? Are all people who avoidcontrol, and continuous irrational behavior in spite of
sex considered sexual anorexics? No, no, no, and no.adverse consequences.
Then how can we differentiate between addiction andPoly-behavioral addiction would be described as a
healthy relationships? Like other forms of addictivestate of periodic or chronic physical, mental, emotional,
diseases and lifestyle disorders such as chemicalcultural, sexual and/ or spiritual/ religious intoxication.
dependency, pathological gambling, eating disorders,These various types of intoxication are produced by
and religious addiction -repeated obsessive thoughts and compulsive
Sexual dependency is characterized by an addictivepractices involved in pathological relationships to any
cycle of:mood-altering substance, person, organization, belief
1. Obsession or preoccupation;system, and/ or activity. The individual has an
2. Ritualization;overpowering desire, need or compulsion with the
3. Compulsive behaviors;presence of a tendency to intensify their adherence to
4. Loss of control and despair; andthese practices, and evidence of phenomena of
5. Shame and guilt that perpetuates a maladaptivetolerance, abstinence and withdrawal, in which there is
belief system of impaired thinking and unmanageability.always physical and/ or psychic dependence on the
Typically, sexual addictive patterns are consideredeffects of this pathological relationship. In addition, there
pathological problems when issues concerning sexualis a 12 - month period in which an individual is
behaviors become the focus of life, causing feelings ofpathologically involved with three or more behavioral
shame, guilt, and embarrassment with relatedand/ or substance use addictions simultaneously, but
symptoms of depression and anxiety that causethe criteria are not met for dependence for any one
significant maladaptive social and/ or occupationaladdiction in particular (Slobodzien, J., 2005). In essence,
impairment in functioning. Addicts don't use sex forPoly-behavioral addiction is the synergistically integrated
affection or recreation, but for the management ofchronic dependence on multiple physiologically addictive
anxiety and/ or emotional pain.substances and behaviors (e.g., using/ abusing
We must consider that some people developsubstances - nicotine, alcohol, & drugs, and/or acting
dependencies on certain life-functioning activities suchimpulsively or obsessively compulsive in regards to
as sex that can be just as life threatening as druggambling, food binging, sex, and/ or religion, etc.)
addiction and just as socially and psychologicallysimultaneously.
damaging as alcoholism.Conclusion
Sexual addiction takes many forms with various levelsConsidering the wide range of sexual behaviors in our
of severity to include:world today, one should always take into account an
1. Controversial behaviors (obsessions withindividual's ethnic, cultural, religious, and social
pornography, and sex with strangers to engaging inbackground prior to making any clinical judgments, and
cyber-sex);it would be wise to not over-pathologize in this area of
2. Unacceptable behaviors (exhibitionism, voyeurism,Sexual Dependency. However, since successful
indecent phone calls); andtreatment outcomes are dependent on thorough
3. Profound Sex offender behaviors (rape, incest, andassessments, accurate diagnoses, and comprehensive
child molestation).individualized treatment planning - poly-behavioral
Though solitary forms of this addiction may not beaddiction needs to be identified to effectively treat the
overtly risky, they can be part of a pattern of distortedcomplexity of multiple behavioral and substance
thinking and identity conflict that can escalate to involveaddictions.
harming the self and others. An example of a SexualSince chronic lifestyle diseases and disorders such as
Disorder (NOS) or Not Otherwise Specified in thediabetes, hypertension, alcoholism, drug and behavioral
DSM-IV-TR, (2000) includes: distress about a patternaddictions cannot be cured, but only managed - how
of repeated sexual relationships involving a successionshould we effectively manage poly-behavioral
of lovers who are experienced by an individual only asaddiction?
things to be used. (It should be noted that theThe Addiction Recovery Measurement System
Diagnostic and Statistical Manual of Mental Disorders(ARMS) is proposed utilizing a multidimensional
has never used the word "addiction" to describe anyintegrative assessment, treatment planning, treatment
of its disorders).progress, and treatment outcome measurement
The defining elements of this kind of addiction are itstracking system that facilitates rapid and accurate
secrecy and escalating nature, often resulting inrecognition and evaluation of an individual's
diminished judgment and self-control (Carnes, 1994).comprehensive life-functioning progress dimensions.
Brief History of Sex AddictionThe ARMS hypothesis purports that there is a
In 1976, a suburban hospital administrator asked Dr.multidimensional synergistically negative resistance that
Patrick Carnes to start an experimental program forindividual's develop to any one form of treatment to a
chemically dependent families. The theoreticalsingle dimension of their lives, because the effects of
constructs of the program originated in generalan individual's addiction have dynamically interacted
systems theory, especially as it applied to families andmulti-dimensionally. Having the primary focus on one
the 12-steps of Alcoholics Anonymous. One of thedimension is insufficient. Traditionally, addiction
many factors which stood out from a familytreatment programs have failed to accommodate for
perspective was that the addictive compulsivity hadthe multidimensional synergistically negative effects of
many forms other than alcohol and drug abusean individual having multiple addictions, (e.g. nicotine,
including overeating, gambling, shoplifting, and sexuality.alcohol, and obesity, etc.). Behavioral addictions interact
Members of groups like Overeaters Anonymous andnegatively with each other and with strategies to
Gamblers Anonymous had already pioneered inimprove overall functioning. They tend to encourage
applying the 12-steps to other addictions so the Familythe use of tobacco, alcohol and other drugs, help
Renewal Center extended its programming based onincrease violence, decrease functional capacity, and
the 12-steps, to sexual addiction.promote social isolation. Most treatment theories today
In 1983, Dr. Patrick Carnes formally introduced theinvolve assessing other dimensions to identify dual
concept of sexual addiction to the world in a textdiagnosis or co-morbidity diagnoses, or to assess
entitled "Out of the Shadows." Since then the field ofcontributing factors that may play a role in the
sexual addiction and compulsive sexual behavior hasindividual's primary addiction. The ARMS' theory
developed dramatically. Terms such as addiction,proclaims that a multidimensional treatment plan must
compulsivity, hyper-sexuality, and "Don Juanism," allbe devised addressing the possible multiple addictions
have been used to describe what generically could beidentified for each one of an individual's life dimensions
called "out of control sexual behavior." Regardless ofin addition to developing specific goals and objectives
its name, clinicians from all fields agree that afor each dimension.
syndrome exists in which individuals have a sense thatPartnerships and coordination among service providers,
they have lost control over their sexual behavior.government departments, and community
According to the Society for the Advancement oforganizations in providing addiction treatment programs
Sexual Health (SASH), sexual addiction is a persistentare a necessity in addressing the multi-task solution to
and escalating pattern or patterns of sexual behaviorspoly-behavioral addiction. I encourage you to support
acted out despite increasingly negative consequencesthe addiction programs in America, and hope that the
to self or others. The fundamental nature of all(ARMS) resources can assist you to personally fight
addiction is the addicts' experience of helplessness andthe War on poly-behavioral addiction.
powerlessness over an obsessive-compulsiveFor more info see:
behavior, resulting in their lives becomingPoly-Behavioral Addiction and the Addictions
unmanageable. The addict may be out of control. TheyRecovery Measurement System (ARMS)
may experience extreme emotional pain and shame.By James Slobodzien, Psy.D. CSAC at:
They may repeatedly fail to control their behavior.National Council on Sexual Addiction & Compulsivity
They may suffer one or more of the followingP.O. Box 725544
consequences of an unmanageable lifestyle: aAtlanta, GA 31139
deterioration of some or all supportive relationships;(770) 541-9912
difficulties with work, financial troubles; and physical,Sexual Addiction Resources
mental, and/ or emotional exhaustion which sometimesJames Slobodzien, Psy.D. CSAC, is a Hawaii licensed
leads to psychiatric problems and hospitalization.psychologist and certified substance abuse counselor
Addictions tend to arise from the same backgrounds:who earned his doctorate in Clinical Psychology. The
families with co-dependency including multipleNational Registry of Health Service Providers in
addictions; lack of effective parenting; and other formsPsychology credentials Dr. Slobodzien. He has over
of physical, emotional and sexual trauma in childhood.20-years of mental health experience primarily working
The Society for the Advancement of Sexual Healthin the fields of alcohol/ substance abuse and
(SASH, 2005) report that the symptoms of sexualbehavioral addictions in medical, correctional, and judicial
compulsivity often accompany other addictivesettings. He is an adjunct professor of Psychology and
behaviors:also maintains a private practice as a mental health
Alcohol and Drug Addiction - Alcohol and drugs alterconsultant.
libido, enhancing it early in drug addiction and inhibiting itReferences
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