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):

• Friction or conflict in a relationship, including the demise of a relationship due to infidelity (see my article: Why Do People in Happy Relationships Cheat?)

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.

The Counterphobic Defense and Hypersexuality

In my prior article, What is the Counterphobic Response?,  I began discussing the counterphobic defense mechanism by defining it and giving some general examples of it.  In this article, I'm focusing specifically on the link between the counterphobic response and hypersexuality.

The Counterphobic Response and Hypersexuality

As I mentioned in my prior article, there are many different ways that the counterphobic defense mechanism manifests.

It's easier to understand the counterphobic response and denial involved in situations where people, who are fearful, deny their fears by becoming daredevils about the very situations that they fear.

The counterphobic response is more difficult to see in situations where a man or a woman is hypersexual.

What is Hypersexuality?  
Hypersexuality, also known as sexual addiction, is defined as a dysfunctional preoccupation with sexual fantasy or in combination with obsessive pursuits of casual/non-intimate sex.  It can involve pornography, compulsive masturbation, romantic intensity or objectification of a sexual partner.  Usually, it occurs for at least six months or more.

Hypersexuality affects both men and women.

Like most addictive behavior, this adult obsessive pattern of thoughts and behaviors will continue despite the person affected by hypersexuality:

• making attempts to stop this problematic sexual behavior
• making promises to him/herself and significant others to change sexual behavior
• experiencing significant negative life consequences

Let's take a look at common situation in a fictionalized scenario where early childhood trauma leads to hypersexuality as an adult:

Marie
When Marie was five, her parents split up and Marie and her older siblings didn't see their father again for many years.  Neither their father nor their mother talked to them about the separation.  They learned about it when they came home from school one day and their father, who was normally there, was gone.

Marie felt responsible for her father leaving the family

When Marie asked her mother where her father was, her mother, Ann, slapped her and told her not to be disrespectful by asking her this question.  Then, her mother told her to go to her room and do her homework.

As most children at her age would react, Marie assumed that she did something "bad" and her father went away.  She believed that she was the cause of the problems in her family and she prayed every night that she would become a better person so that her father would return.

Neither her mother nor the other adult relatives would talk to her or her siblings about why her father "disappeared."  It became the "family secret."

Marie felt so ashamed of what she thought her role was in this that she felt too guilty to talk to anyone else about it, so she kept her fear and sadness to herself.

A year later, Marie's mother, Ann, began seeing a man she met at a party, John.  A few weeks later, John moved into the household and Marie and her older siblings were told that he was their "new father."

John tended to be irritable and bossy.  He expected the children to adhere to his demands without any back talk.  When Marie's teenage brother protested that he didn't want to do a chore that John demanded that he do, John knocked him to the ground and told him to never disobey him again.  When Ann came home and Marie brother told her what happened, Ann sided with John.

After that, Marie and her siblings were more afraid of John than ever.  They tiptoed around him and hoped not to experience his rage.

Marie became to anxious that she began wetting her bed at night, which angered John and brought on the first of many spankings from him.

When Marie turned six, John came into her bedroom late after Ann and the other family members were asleep and he began fondling her breasts.  Marie was shaking with fright, but she pretended to be asleep because she didn't know what to do.

John knew that she wasn't asleep and began taunting her, telling her that she was a "bad girl" and she "liked it."

When he told her to open her eyes, she was too afraid not to do as he said, so she did and, as she did, she saw his leering smile and penetrating gaze.

She began to feel very confused about what was happening.  On the one hand, she felt terrified and helpless.   She knew that what he was doing was "bad."  But, on the other hand, no one else in the household paid any attention to her, and she liked the attention.

John told Marie that if she told anyone about it, no one would believe her.  And, if they did, he would her mother and siblings and he would beat her.

Having already felt responsible for her father leaving the household, Marie didn't want to cause any more problems, so she kept quiet about it.  Whenever she heard his footsteps as he approached her room, she close her eyes and pray.  Then, when he began touching her, she went into a traumatic dissociated state to the point she felt she could look down on herself from the ceiling and see what was going on.

Afterwards, she always felt "dirty" and would go into the bathroom and scrub her body hard with a towel until it was red.

These nightly visits continued for several months until Marie couldn't stand it anymore.  So one day, when she was alone with her mother and no one else was around, she told her mother about John touching her.  She just wanted to make it stop.

Ann reacted by getting angry with Marie and telling her that it must be Marie's fault if John is behaving this way.  She told Marie to lock her door at night and to stay away from John.  She refused to confront John and told Marie that she was being selfish.  After all, wasn't John helping to support the family?

Marie felt devastated that her mother wouldn't help her.   But she also believed that, if her mother said it was her fault, it must be true.  Even worse, she felt frightened, powerless and lonely.

When John realized that Marie locked her door, he got angry and jimmied the lock to get in.  Feeling helpless and frightened, Marie submitted to John and escaped into a dissociated state whenever he touched her.

The sexual abuse continued into Marie's adolescence.  By that time, Marie felt angry about feeling helpless and developed a counterphobic response to John's sexual advances.  She was tired of feeling like he was the predator and she was the victim.

So by the time she was 17, without realizing it, on an unconscious level, she decided that she would be in charge in the situation--no longer behaving like a powerless victim.

One night when John came into her room, Marie told him that she wanted to have sex with him.  Shocked at first, John had sexual intercourse with Marie.  Marie was sure that her mother, who was next door, heard them having sex, but she chose to ignore it.

After that, John seemed to lose interest.  He preferred when Marie was childlike and frightened.  He seemed confused and a little frightened by Marie's boldness, so he stopped coming to her room.

But because Marie was experiencing the counterphobic defense mechanism, she didn't want John to feel he was in charge any more about if they would be sexual, so she would be seductive around him when no one else was around, taunting him for being "less than a man" for ignoring her.

Each time after she seduced him and they had sex, he always blamed her for being "a tramp," but she didn't care--she felt she was the powerful one in the situation.

When Marie was 18, she became pregnant.  By that time, she was having sex with John as well as several other older men that she met in the neighborhood, so she didn't know the identity of the father of the baby.

She had an abortion without telling anyone and, by the time she was 22, she was had two other abortions.  Her hypersexuality included seducing many men that she didn't know.  Each time that she seduced a different man, she felt empowered.

When she was 25, she met a man her own age, Tom, that she liked.  She realized that her feelings for him were different and she felt frightened and emotionally vulnerable, which she didn't like.  When she tried to seduce him, she was surprised that he told her that he really liked her and he thought they should wait rather than crossing that boundary too soon.

Even though she liked him a lot, Marie felt confused by how he treated her and how she felt.  To alleviate her fears, she continued to sneak around with other men without Tom knowing.  These other experiences continued to make her feel empowered, but she also felt guilty about seeing these men behind Tom's back.

The Counterphobic Response and Hypersexuality

When Marie and Tom became sexual, Marie felt very uncomfortable and she couldn't understand why. She prided herself in being sexy and attractive, and she knew that Tom really liked her.  But, unlike how she felt with other men, she felt increasingly frightened by the feelings that she was developing for Tom.

Marie was tempted to break it off, but she knew she would also miss Tom and he was different from other men that she was with.  At the same time, her emotional vulnerability in this relationship made her feel like a helpless child.

Marie knew that she couldn't deal with her ambivalence on her own, so she sought psychological help.

Getting Help
The counterphobic response, as an unconscious defense mechanism, can manifest in many different situations where a person is in denial about their fear and trauma and wants to feel empowered.

This sense of "power" isn't really empowerment.  It's a way to deny the underlying fear by moving towards a feared situation or person as a defense against the fear.

If you feel that you're caught up in a counterphobic response and you want to get help, you could benefit from seeing a licensed mental health professional who can provide you with the psychological help that you need to overcome this problem.

Confronting underlying fears isn't easy but, in the long run, once you've overcome the counterphobic response, you have an opportunity to live a more meaningful and authentic life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works 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.