NYC Psychotherapist Blog

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Saturday, February 25, 2023

How Existential Anxiety Contributes to Out of Control Sexual Behavior (OCSB)

I began a discussion about Out of Control Sexual Behavior in two prior articles, What Causes Out of Control Sexual Behavior (OCSB)? and Treating Out of Control Sexual Behavior in Sex Therapy.

Existential Anxiety and Out of Control Sexual Behavior

Although there is no one particular cause for OCSB, in the last article I discussed certain common contributing factors to OCSB such as Attention Deficit Hyperactivity Disorder (ADHD) and mood disorders such as depression and anxiety.  

Before going further, I want to emphasize that even though I'm discussing contributing factors to Out of Control Sexual Behavior, I'm in no way implying that people are unable to control their behavior or aren't responsible for their behavior.  Regardless of the possible contributing factors involved, each person is ultimately responsible for their own behavior.

What Are Existential Thoughts?
Basically, existential thoughts focus on the meaning and purpose of life and one's own mortality.  

For instance, people, who allow themselves to engage in these thoughts, struggle for a while with the aging process and thoughts of death.  But many of them eventually come to accept the limitations of their particular life, including death, and this acceptance allows them to find meaning and purpose in their life (see my article: Making Peace With the Aging Process).

Erik Erikson's 8 Stages of Psychosocial Development include the 7th Stage, Generativity vs Stagnation, which occurs during middle adulthood, which was originally thought to be from about the age 40 through to 65 (although with longer life expectancy, as compared to Erikson's time, many people believe that middle adulthood or midlife now extends into the 70s and beyond).

With regard to existential issues, Erikson's 7th Stage of Psychosocial Development represents a time when people consider the meaning and purpose of their life and what they can contribute that will have a lasting impact and legacy beyond their life.

This stage can last years and it can bring much anxiety, referred to as Existential Anxiety, along the way, especially if people try to avoid or suppress these thoughts.

What is Existential Anxiety?
In the current article, I'm focusing on Existential Anxiety as a contributing factor to OCSB as discussed in Sex Therapist Dr. Daniel N. Watter's book, The Existential Importance of the Penis.

Existential Anxiety

Existential Anxiety is the dread or panic someone experiences when they confront the limitations of their existence, including death.

For instance, one example is someone who experiences Existential Anxiety in midlife when they realize they feel stifled in their current circumstances or they haven't accomplished the things they wanted to accomplish earlier in their life (see my articles: Midlife Transitions: Reassessing Your Life and Midlife Transitions: Living the Life You Want to Live).

To make matters worse, they might realize that, due to their age and other life stage circumstances, they won't achieve what they hoped for in their life.  This realization can precipitate Existential Anxiety and an emotional crisis.  Some people refer to this as a "midlife crisis." 

Part of grappling with Existential Anxiety is accepting that death is an inevitable part of life.  This acceptance can serve to enrich life by encouraging people to live a meaningful life in whatever time they have left.

How is Existential Anxiety Related to Out of Control Sexual Behavior (OCSB)?
I believe the vast majority of people get through the psychological challenges of midlife and resolve their Existential Anxiety--even if they struggle with it for a number of years.  

However, there are many people who go through a long and difficult time with this stage and, in an attempt to ward off their Existential Anxiety, they engage in out of control behavior, including Out of Control Sexual Behavior (OCSB).

According to Dr. Watter, Existential Anxiety, especially fear of death, often involve sexual thoughts and behavior because sex is experienced as a life force--the opposite of death.  As a result, Out of Control Sexual Behavior is often used a maladaptive way of coping by repressing or neutralizing these fears.

Other instances where OCSB can manifest is when someone reaches the age when a parent died.  For instance, when a married man reaches the age when his father died from a massive heart attack, he can experience such overwhelming anxiety that he attempts to suppress this fear by engaging in extramarital affairs (see the clinical vignette below).

According to Dr. Watter, this is often uncharacteristic behavior for this person who doesn't understand what's driving this sexual behavior.  

It's important to note that, Existential Anxiety, doesn't always lead to OCSB--even among people who increase their sexual behavior due to the anxiety.  Existential Anxiety can lead to increased sexual activity that's not always out of control.  

But for the purpose of this article, I'm focusing on OCSB and how Existential Anxiety contributes to it.  

Clinical Vignette: Existential Anxiety and Out of Control Sexual Behavior (OCSB)
The following clinical vignette illustrates how Existential Anxiety contributes to OCSB.  As always, this vignette is a composite of many different cases with all identifying information changed or removed to protect confidentiality.  

When Jack was 10 years old, his father died suddenly from a massive heart attack.  His father, who was only 40 years old, had hardly ever been sick in his life, so his sudden death was a shock to the whole family, especially to Jack, who was close to his father.

Early Loss and Trauma

After his father died, as a young boy, Jack would often worry that his own heartbeat was irregular and that he might die suddenly too.  He would ask his mother repeatedly to feel his heartbeat and she would assure him that he wasn't having a heart attack.  

During adolescence, Jack and his friends were preoccupied with girls, and his fears of death weren't as much a part of his awareness.  He went on to date, enter into relationships, and he eventually got married to Celia.

Jack often thought about his father throughout his life, but he was especially preoccupied with these thoughts as he approached his 40th birthday because this was his father's age when he died.

Several months before his 40th birthday, Jack became so anxious that he had difficulty sleeping through the night.  He had frequent nightmares about seeing his father in the distance and trying to overcome obstacles--crowds of people or other physical barriers--to get to his father, all to no avail. He often woke up shaking in terror and bathed in sweat.  

During that time, Jack was assigned to manage a project at work where his boss, Alan, asked him to mentor a junior employee, Tina.  Alan assigned Tina to be Jack's assistant on the project, which included a trip to California to visit the project's client. 

Tina was an attractive single woman in her early 30s who admired Jack and who was eager to learn. Until then, throughout his 10 year marriage, Jack had never been faithful to Celia.  He often had sexual fantasies about other women, but he never thought of actually having an affair with another woman.  He loved his wife and he was satisfied with their sex life.  

But spending a week at a California hotel with Tina, who made it known that she was sexually attracted to Jack, turned out to be too much of a temptation, and they began having a passionate affair which continued when they returned to New York.

Although Jack felt guilty about cheating on his wife and lying to her about his late nights, he couldn't remember a time when he felt more alive.  His fear of death and nightmares about his father subsided.  

Although the affair ended when Tina moved out of state, Jack sought out other younger women who would be willing to have sexual affairs. At the time, Jack had no awareness that his sexual affairs were related to his fear of death.  

A few months later, Jack was having multiple affairs with several women during the same time period. He was upfront with these women that he was only interested in having affairs and he had no intention of leaving his marriage because he loved his wife and son.  He justified his uncharacteristic behavior to himself by telling himself that what his wife didn't know wouldn't hurt her.  

A year later, Jack was involved with three simultaneous affairs. He didn't know any of these women well and he was unaware that one of them, Becky, was emotionally unstable.  Even though their agreement was just to enjoy sex with no strings attached, Becky became emotionally attached to Jack. 

In a desperate and misguided attempt to have Jack to herself, Becky contacted Celia and told her about the affair.  Becky hoped that, by revealing the affair, Jack's wife would leave him and then he would be available to her.  

Celia was shocked and devastated by Becky's call. When Celia confronted Jack about Becky's call, he admitted that he was having multiple affairs and he was deeply upset that he hurt Celia.

During the two weeks when he stayed at a hotel at Celia's insistence, Jack had time to think about his infidelity and how it might cost him his marriage (see my article: Why Do People in Happy Relationships Cheat?).

While he was at the hotel, he ended all his affairs, including his affair with Becky.  She tried to manipulate him into continuing the affair with her by threatening to commit suicide. But although her threats frightened and angered him, Jack refused to allow her to manipulate him.

When Celia allowed Jack to come home, she told him that, although she was very hurt and she didn't know if she could trust him, she felt she had invested too much emotionally in their life to end the marriage.  So, she said she would be willing to work on their relationship if he was willing to attend couples therapy (see my article: What is Emotionally Focused Therapy For Couples?).

Couples Therapy For OCSB

Their couples therapist recommended that Jack also attend sex therapy to deal with his Out of Control Sexual Behavior (see my article:  What is Sex Therapy?).

Over time, he realized in sex therapy that he never overcame the loss of his father and, as he approached the same age as when his father died, his Existential Anxiety contributed to his OCSB.

His sex therapist was also a trauma therapist so, over time, Jack worked through the unresolved trauma of his father's death and his related existential fears about his own death.  

Gradually, as Jack worked through his early loss, he no longer felt the urge to ward off his existential fears of death by having extramarital sex.  He and Celia also gradually reconciled their marriage in couples therapy.

Out of Control Sexual Behavior (OCSB) can have many different contributing factors so there is no one-size-fits therapeutic approach.

An important component to overcoming OCSB is to understand the underlying issues, which are often unconscious, as in the vignette above about Jack.

Although the vignette is about a heterosexual man and OCSB is often associated with men, OCSB can occur with heterosexual women or in the LGBTQ population.

Unresolved trauma often leads to compulsive behavior due to the overwhelming anxiety involved.  This is true even for people who wouldn't normally engage in sexually compulsive behavior but who seek comfort in the sense of aliveness or distraction they experience in sexual affairs.

Understanding the underlying reasons for OCSB in no way condones it but, along with sex therapy, it's a positive step in changing this behavior.

Getting Help in Therapy
Out of Control Sexual Behavior is difficult to change on your own.

Rather than struggling on your own, seek help.

Individuals and couples attend sex therapy.

A skilled sex therapist who is also a trauma therapist can help you to overcome OCSB so you can lead a more fulfilling life.

About Me
I am a New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist (see my article: What Are the Most Common Misconceptions About Sex Therapy).

In addition to being a Sex Therapist, I am also a Trauma Therapist (see my article: What is a Trauma Therapist?).

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Sunday, February 19, 2023

What Causes Out of Control Sexual Behavior?

Is Compulsive Sexual Behavior a "Sexual Addiction" or "Out of Control Sexual Behavior"?
The topic of compulsive sexual behavior (also known as hypersexuality) is a controversial topic in the mental health field because there are opposing views as to how to define it, what causes it and how to treat it. 

Treating Out of Control Sexual Behavior in Individual Sex Therapy

Some mental health experts believe compulsive sexual behavior is a sexual addiction and others see it as out of control sexual behavior (see my article: Treating Sexual Compulsivity: Is It a Sexual Addiction or Out of Control Behavior?).

As I mentioned in my previous article, language matters, especially in the mental health field.  

In the interest of being transparent about my professional views as a sex therapist who is sex positive, I want to emphasize that I do not see compulsive sexual behavior as an addiction, and I believe psychotherapists and other healthcare practitioners do clients a disservice by labeling it as an addiction.  

In my professional opinion (and the opinion of many contemporary sexual therapists in the field), not only is labeling sexual compulsivity as an addiction harsh and shame-inducing, it's also counterproductive in terms of treating it.  

Unlike alcohol and drug misuse, people who engage in compulsive sexuality can't be expected to give up sex.  Rather than pathologizing compulsive sexual behavior, a sexual health approach is more effective when a sex therapist looks for the underlying issues for each individual rather than taking a one-size-fits-all cookie-cutter approach that is often found in sexual addiction treatment.

The main proponents of the Out of Control Sexual Behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT who wrote Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.  

Instead of viewing this behavior as an addiction, they see it as sexual behavior that is out of control.  In their view it's a sexual problem but not a sexual disorder or an illness.  This is an important distinction between the OCSB and the sexual addiction approaches.

Other proponents of the OCSB view, like Dr. Neil Cannon, see sexual compulsivity as being related to unresolved trauma, unresolved mental health issues, relationship issues and problematic habits.

Out of Control Sexual Behavior (OCSB) and Problems With Self Regulation
The Out of Control Sexual Behavior perspective is a newer concept as compared to the sexual addiction model.  

The term OCSB, as defined by Braun-Harvey and Vigorito, refers to problems with self regulation of consensual sexual thoughts, urges and behavior despite negative consequences where the thoughts, urges and behavior feel out of control to the individual (the emphasis on "consensual" means that the OCSB model isn't meant for nonconsensual urges which lead to criminal behavior, like sexual assault or rape, which is treated by specialists in the mental health field who work with offenders).

OCSB focuses on hard to control sexual thoughts, urges and behavior rather than seeing the problem as a diagnosis or clinical disorder.  When someone engages in OCSB, they find it difficult to stop when they try to stop.  

Assuming that the sexual behavior is consensual, feeling out of control doesn't necessarily mean that an individual is out of control.  It's a subjective experience, so what feels out of control can mean different things to different clients.  This means that clinicians need to explore how each client experiences their sexuality.

What's the Difference Between Enjoying Sex and Out of Control Sexual Behavior (OCSB)?
Sex between consenting adults is a normal part of adult life among people who enjoy sex. Consensual sex is meant to be an enjoyable and pleasurable part of life.  

Out of Control Sexual Behavior, on the other hand, isn't about pleasurable sex. It's also not determined solely by sexual frequency because many people have pleasurable and frequent consensual sex which isn't problematic.  

OCSB involves repetitive thoughts, urges or behavior that create negative consequences including (but not limited to):

Treating Out of Control Sexual Behavior in Sex Therapy For Couples

  • An excessive preoccupation with sex that interferes with daily activities, including work, studying and other activities
  • Sexually inappropriate behavior on the job or in other areas of life, including sexual harassment or predatory behavior
What Causes Out of Control Sexual Behavior?
The causes of OCSB are not well understood and the sex therapy field could benefit from more research in this area.

Here are some of the current day hypotheses about what causes OCSB:

    OCSB and Attention Deficit Hyperactivity Disorder
Many mental health experts believe there is a correlation between OCSB and Attention Deficit Hyperactivity Disorder (ADHD).  

However, this doesn't apply across the board to everyone with ADHD. 

Some people with ADHD experience hypersexuality, which is a very high sex drive and others experience hyposexuality, which is a very low sex drive or lack of interest in sex.  

Both hypersexuality and hyposexuality can cause problems in a relationship.  

Hypersexuality related to ADHD can also cause problems with 
  • Impulsive and compulsive sex 
  • Risky sexual behavior
  • Unprotected sex
  • Unwanted pregnancy
  • Cheating on partners in both monogamous and consensually nonmonogamous relationships
  • Other related problems
It has been hypnothesized that the connection between OCSB and ADHD can be linked to:
  • A Need For Stimulation: Some people with ADHD have a strong need for stimulation which can lead to excessive urges for new and exciting sexual activities that lead to higher stimulation.
  • A Propensity For Risky Behavior: ADHD can involve an increased risk of sexually compulsive behavior as well as substance abuse.
  • Escapism: People with ADHD often use sex as a form of self-regulating behavior to escape or self-medicate for stress and anxiety.
A comprehensive psychological assessment by a psychologist or a knowledgeable psychiatrist is necessary to either diagnosis ADHD or rule it out.

Currently, children who exhibit ADHD symptoms can be evaluated through their school psychologist and treated accordingly.

However, many adults with ADHD were not diagnosed when they were children because ADHD was either unrecognized or not understood, so many individuals with adult ADHD need to seek out their own assessment, diagnosis and treatment by ADHD mental health professionals.

    OCSB and Mood Disorders: Anxiety and Depression
Although many people with ADHD suffer with OCSB, not all OCSB involves ADHD.

Many people with anxiety or depression have problems managing their emotions, and they engage in hypersexuality as an attempt to regulate their emotions (see my article: Developing Skills to Manage Your Emotions).

They engage in hypersexuality as a way to seek temporary relief from their depressive or anxiety-related symptoms.  In those cases, what appears to be a sexual craving is often a maladaptive way of coping.

Hypersexuality can relieve symptoms related to the mood disorder, but since it only provides temporary relief, individuals with mood disorders will feel the urge to  be hypersexual again when their symptoms of anxiety or depression re-emerge.

    OCSB and Existential Anxiety
Existential anxiety is a dread or panic when an individual confronts the limitations of their existence.

Out of Control Sexual Behavior and Fear of Aging and Death

Dr. Daniel N. Watter, an existential psychologist and sex therapist, writes eloquently about the connection between men with existential anxiety and Out of Control Sexual Behavior in his book, The Existential Importance of the Penis.

Among other topics, Dr. Watter discusses how a fear of aging and death can precipitate uncharacteristic out of control sexual behavior among men.

Existential anxiety and Out of Control Sexual Behavior will be the topic of my next article.

Getting Help in Sex Therapy
Out to Control Sexual Behavior is treated in sex therapy because most other mental health professionals have no training or expertise in OCSB (see my article:  What is Sex Therapy?).

Sex Therapy is talk therapy. There is no physical exam, nudity or sex during sex therapy sessions (see my article: What Are the Most Common Misconceptions About Sex Therapy?).

Fear, shame and guilt often prevent people from getting help in sex therapy.  This is one reason why it's important to choose a sex therapist who has a sexual health perspective instead of an addiction or illness perspective.  

Understanding the unconscious underlying reasons for OCSB is key to achieving sexual health.

Whether the underlying issues involve anxiety, depression, ADHD, trauma, existential dread or other issues, once the underlying issues are discovered, a skilled sex therapist can help you to resolve these issues so you can have a pleasurable sex life without feeling out of control.

If you believe you're suffering with OCSB, seek help from a licensed mental health professional who is a sex therapist.

Taking the first step of contacting a sex therapist is often the most challenging, but it can also bring you a step closer to feeling in control and having a pleasurable sex life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT, Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Saturday, February 18, 2023

The Mind-Body Connection: Developing a Felt Sense of Your Internal Experiences

In a prior article, Developing Your Inner Sense of Being Calm, Grounded and Centered, I began a discussion about developing the ability to be calmer and more grounded and centered in your body. I also provided techniques for how to do that.  But what if you don't have a sense of what's going on in your body and you're having a hard time connecting? That's the topic for this article (see my article: The Mind-Body Connection: The Body Offers a Window Into the Unconscious Mind).

Mind-Body Connection: Developing a Felt Sense of Your Internal Experience

Developing a Felt Sense of Your Body
Since the mind and the body are connected, it makes sense that what goes on in the body affects the mind and what goes on in the mind affects the body.

Most people are so accustomed to focusing on their thoughts that they don't have experience paying attention to their bodies.  When asked to sense into their bodies, they have no idea how to do this, so this is something I teach many clients in my psychotherapy private practice in New York City and I'll address in this article.

What is a Felt Sense?
A felt sense is an internal bodily awareness that develops as you become more attuned to what's going on in your body.

The concept of a felt sense was developed by the American philosopher, Eugene Gendlin, and it refers to the connection between the mind and the body.  According to Gendlin, who developed Focusing therapy, the felt sense is a combination of emotion, awareness, intuitiveness, and embodiment.

When people begin to practice getting a felt sense, the experience is often unclear to them. Initially, people often describe it as a vague sense of their inner experience.

On the most basic level, they might experience it as various sensations in their body, aches, tension, soreness, tightness and so on.

As they practice and become more attuned to their body, they might begin to become aware of other physical sensations as well as emotions that are linked to those sensations.

How to Begin to Develop a Felt Sense of Your Body
When I work with clients, I often teach them how to develop a felt sense of their body so they can be aware of their emotions and where they feel these emotions in their body.  This is a valuable skill to have in therapy because it allows you to sense what you're feeling and the progress you're making in therapy.

Whether you realize it or not, you've had the experience of having a felt sense of your body many times.  You just might not be accustomed to thinking about your experience in that way.

For instance, when you wake up in the morning and you have a vague sense that you have a sore throat, in order to figure out if your throat is dry or if you really have a sore throat, you might sense into your throat when you wake up, then again after you have a drink of water and later on when you have your coffee or tea.

This sensing in is an initial experience of having a felt sense, and it could include any part of your body.

You can practice doing this when you wake up in the morning by sensing into different parts of your body to develop an increased awareness of your body.

Becoming More Attuned to the Mind-Body Connection Through a Felt Sense
As you become more aware of what's going on in your body, you can begin to connect bodily awareness with your emotions.

I often teach my psychotherapy clients, who are disconnected from what's going on for them physically and emotionally, to develop this skill.

Since emotions are held in the body, you can begin to become more attuned by paying attention to muscle tension in your body.

For instance, you might become aware that whenever you feel angry, you feel tension in your stomach.  Or when you're anxious, you feel tension in your shoulders or lower back, and so on.

How Trauma Affects the Mind-Body Connection
By definition, trauma is a psychological response to an experience that's overwhelming for the individual. What matters is the individual's subjective experience of the event(s).  What might be overwhelming for one person might not be overwhelming for another.

When someone experiences trauma, s/he can lose an ability to experience the felt sense and the mind-body connection.  This is called "dissociation"  or "emotional numbing" which is a self-protecting mechanism to keep the traumatized person from being completely overwhelmed.

There are various degrees of dissociation on a spectrum from mild to severe.  Usually, the greater the impact of the trauma on the individual, the more dissociated s/he becomes.

Although this emotional and physical numbing is self protective, it also creates problems for the individual because s/he has a decreased awareness of emotions and bodily sensations (see my article: What is Emotional Numbing?).

Emotional numbing can decrease awareness of emotional pain but, unfortunately, it also decreases awareness of positive emotions too like joy and happiness.  It can create a feeling of emotional flatness and rob the individual of a rich emotional life.

Emotional numbing can make it difficult for the individual to know what s/he feels at any given time.  Aside from making it difficult for the individual, emotional numbing can create problems in a relationship (see my article: How Trauma Affects Relationships).

Getting Help in Therapy
Many people have a difficult time sensing the mind-body connection, especially if they have suppressed their emotional and bodily awareness because of traumatic experiences.

Experiential therapists, who use mind-body oriented therapy, like EMDR, Somatic Experiencing and AEDP, work with clients to overcome the clients' blocked sense of emotions and bodily sensations so they can be aware of their felt sense and live a richer, more fulfilling life (see my articles:  Why Experiential Therapy is More Effective Than Talk Therapy and Experiential Therapy Helps to Create Emotional Breakthroughs).

If you're struggling with unresolved problems that create obstacles for you emotionally and physically, you could benefit from working with an experiential therapist.

Many therapists, including me, are providing online therapy (also known as teletherapy or telehealth) while they're out of the office due to the COVID-19 crisis.

Overcoming your problems in therapy will allow to live your life to the fullest.

About Me
I am an experiential therapist who is licensed to provide psychotherapy services, which include psychodynamic psychotherapy, EMDR trauma therapy, AEDP, Somatic Experiencing, sex therapy, clinical hypnosis and EFT for couples.

I work with individual adults and couples.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.