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.