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.

Treating Sexual Compulsivity in Sex Therapy - Is It a Sexual Addiction or Out of Control Sexual Behavior (OCSB)?

Language matters, especially in the field of mental health.  When mental health professionals pathologize compulsive sexual behavior by defining it as a "sexual addiction," they do clients a disservice.  

This article will focus on the difference between treating sexual compulsivity as out of control sexual behavior (OCSB) as defined by Doug Braun-Harvey, LMFT and Michael A. Vigorito, LMFT in their book Treating Out of Control Sexual Behavior: Rethinking Sex Addiction and treating the problem as a "sexual addiction," as in the work of Dr. Patrick Carnes (see my article: What is Sexual Health?).

Treating Sexual Compulsivity in Sex Therapy

What is Sexually Compulsive Behavior?

Let's start by defining sexually compulsive behavior.

Sexually compulsive behavior is an excessive preoccupation with sexual thoughts, urges and behavior where this behavior is disruptive and has a significant negative impact on a person's health, relationships, work and other important areas of life, including (but not limited to) the following issues:

• Recurrent sexual thoughts, urges and behaviors take up a lot of your time.

• These thoughts, urges and behaviors feel out of control to you.

• Despite repeated attempts, you have been unable to reduce or control these thoughts, urges and behavior on your own.

• Despite serious consequences, you continue to engage in out of control sexual thoughts, urges and behavior.

• You have problems establishing and maintaining relationships, jobs or other important areas in your life because of your sexually compulsive behavior.

Sexual Addiction vs Out of Control Sexual Behavior (OCSB)

As of this writing, there is a heated debate in the mental health field about whether sexually compulsive behavior should be seen as a sexual addiction or as out of control sexual behavior (OCSB).

Treating Out of Control Sexual Behavior in Sex Therapy

Proponents of the sexual addiction perspective see compulsive sexual behavior as similar to other forms of addiction, including alcoholism and drug addiction.  In this model people who engage in compulsive sex are seen as "powerless" over their behavior.  Dr. Patrick Carnes, who has written extensively about "sexual addiction" is one of the biggest proponents of this view.

The main proponents of the out of control sexual behavior (OCSB) perspective are Doug Braun-Harvey, LMFT and Michael A.  Vigorito, LMFT.  They define six principles of sexual health in their book, 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 is a sexual problem but not a sexual disorder or an illness.

Treating Out of Control Sexual Behavior in Sex Therapy

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.

Treating Out of Control Sexual Behavior in Sex Therapy

OCSB is not a diagnostic term.  The term OCSB refers to problems with self regulation of sexual thoughts, urges and behavior despite negative consequences.

Why Does It Matter How Compulsive Sexual Behavior is Labeled?

In my opinion (and the opinion of many others in the sex therapy field), labeling someone who engages in compulsive sexual behavior as an "addict" is harsh and shame inducing.  

Treating Out of Control Sexual Behavior in Sex Therapy

People who are labeled in such a shame-inducing way are often too embarrassed to admit they have a problem or to get professional help.

Unlike drug and alcohol misuse, people who engage in sexually compulsive behavior cannot be expected to give up having sex so labeling behavior as a sexual addiction is counterproductive to resolving the problem.

Getting Help For Sexually Compulsive Behavior

If you are struggling with sexual compulsivity, you're not alone.  Help is available to you.

Depending upon the particular circumstances, sexually compulsive behavior can be treated in individual sex therapy or in couples therapy with a sex therapist.

Working with a sex positive sex therapist who treats sexual compulsivity as out of control sexual behavior (OCSB) rather than as an addiction is affirming to your sexual health and overall well-being.

About Me

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

I am a sex positive therapist who works with individual adults and couples (see my article: What is Sex Therapy?).

I have helped many clients to overcome psychological trauma (see my article: What is Trauma Therapy?

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.

Romantic Obsessions and the Thrill of the Chase - Part 2: Getting Help in Therapy

In Part 1 of this topic, I began a discussion about the psychologically and physically addictive problem of romantic and sexual obsessions.  I also provided two clinical vignettes to illustrate two different but related problems involving these obsessions and the thrill of the chase (see my article: Understanding Sexually Addictive Behavior).

Romantic Obsessions and the Thrill of the Chase

In this article, I'm focusing on the first vignette from Part 1 about the fictional character, Ed, to delve deeper into this subject and show how experiential psychotherapy can help people with romantic or sexual obsessions to overcome their problem (see my article: Why Experiential Therapy is More Effective Than Regular Talk Therapy).

In a future article, I'll focus on the second vignette from Part 1 about the fictional character, Jane, where the symptoms are similar but the outer manifestation of the problem is different.

Clinical Vignette: Romantic Obsessions and the Thrill of the Chase: 
The following fictional vignette is a continuation of Part 1 and it will illustrate how experiential psychotherapy can help:

Ed
In Part 1, I presented a fictional case about someone named Ed, a married man in his mid-40s.  Although the vignette is fiction, the problems involved are real and common to many people who get caught up in romantic and sexual obsessions.

To Recap:
During five years of marriage, Ed had numerous sexual affairs.  Typical for people who become obsessed with the thrill of the chase, Ed got a dopamine high from these obsessions and the anticipation of "catching" the women he was obsessed about.

Even though he loved his wife and he didn't want to jeopardize his marriage, Ed couldn't stop chasing after women--even after one of the women contacted his wife out of anger and sent his wife a videotape, which she secretly recorded without Ed knowing, of one of her sexual encounters with Ed. She also told Ed's wife about his numerous other sexual affairs.

When confronted with the videotape, Ed admitted to his wife that he had been having sexual affairs throughout their marriage. He felt ashamed of his behavior and very sad that he hurt his wife. After he admitted his infidelities, he vowed to his wife and to himself that he would stop chasing other women. Although his wife was hurt by Ed's betrayal, she forgave him when he promised her that he would stop having affairs.

Ed struggled to keep his promise for a short time.  However, he felt himself being dazzled and tantalized by the attractive women he met when he wasn't with his wife, and his struggle turned out to be too much for him to bear. He gave in to his obsessions during a time when he felt bored, and he resumed having secret extramarital affairs with women he met in person as well as on the dating app, Tinder (see my article: Married, Bored and Cheating Online).

The Story Continues:
As time went on, Ed became increasingly obsessed, especially once he began using Tinder to meet women.  Realizing that he could meet hundreds of women online, who were also only interested in hooking up for sex, fueled his obsession.  He rationalized his behavior by telling himself that he was upfront with these women about his marital status so they knew what they were getting into. He also rationalized that he wasn't hurting his wife because he believed he could do a better job of hiding his affairs and what she didn't know wouldn't hurt her.

What Ed didn't realize was that his addictive behavior was not only driven by seeing attractive women--he was also now responding to the pings he heard from Tinder whenever a woman responded to his request for sex. The sound of the pings were now paired in his mind with sexual conquests, and he was unknowingly also getting a dopamine high just from the sound.

One night while he was out to dinner with his wife with his phone next to him on the table, Ed tried to resist responding to the pings from his phone while he and his wife were talking.  But the urge to look at his Tinder responses became overwhelming and he glanced at his phone several times.

Telling his wife that the pings were emails from work, Ed told her that he had to call his office. Then he went outside to look at his Tinder responses.  Once outside, Ed couldn't wait to look at the responses he received.  As he looked through the responses, he felt giddy with excitement as he saw the sexually provocative pictures from these women.  The dopamine rush he experienced was like electricity going through him, and he had to suppress an urge to laugh from the sheer thrill of it all.

He was especially thrilled that one of the women who had initially resisted his responses was now asking for sexually explicit photos of him which, as usual, he was only too willing to provide.  He could feel the thrill of pressing send to this woman's personal cellphone number as he sent her several nude pictures of himself and he requested that she do the same.

Ed was so caught up in responding to his Tinder requests that he didn't realize how much time had gone by while he was standing outside the restaurant.  It was as if he had fallen down a rabbit hole where he lost awareness of time and place.  By the time he looked up, he was shocked to see his wife, Megan, was standing next to him and looking over his shoulder at his Tinder account.

On the taxi ride home, Ed attempted to apologize to Megan, but she refused to talk to him.  By the time they were back in their apartment, he was desperately trying to make amends with her, but she told him to move out to a hotel until she had time to think about what she would do next.  Then, what she said next shocked him, "At least we don't have children!"(see my article: Your Spouse Cheated on You: Should You Stay or Should You Go).

This remark hurt Ed deeply because he and Megan had been trying to have a baby for the last two years.  They both loved children and it had been their dream to have a baby. Prior to this, they had even talked about going for fertility treatment.  Now, Ed felt his marriage to Megan and any possibility of having children was lost.

During the next few weeks, while he was staying at a nearby hotel, Ed reached out to his wife, but Megan refused to take his calls.  He didn't blame her for being upset.  He knew he hurt her again by continuing to have sexual affairs and breaking his promise to her.  He blamed himself and he wished he could go back in time to undo the pain and anger he caused his wife.

Ed also felt deeply ashamed.  For the first time in his life, he considered whether he was in the grips of addictive behavior.  He felt so upset and overwhelmed that he disabled his Tinder account, he stopped seeing the women he had been having affairs with, and he blocked their numbers on his phone.  He had no appetite for chasing women and the thought of it only made him feel more ashamed and angry with himself.

Several weeks later, Megan agreed to talk to Ed at their apartment.  Ed took this as a hopeful sign, but as soon as he arrived, Megan told him that she decided she wanted a divorce.  Upon hearing this, Ed was shocked and he felt like the floor had dropped out from under his feet.  She told Ed calmly that she was very hurt and she didn't trust him anymore (see my article: When Trust Breaks Down in Relationships).

She said she knew he loved her and she believed him when he first told her he would stop having affairs.  But, she said, all that changed when she discovered that he was continuing to have affairs and she knew now that his problem was much deeper than she had realized before.  She also told him that she had a consultation with a divorce attorney and she had a one-way ticket to fly home to her family in California in two weeks.

When he heard what Megan had to say, Ed felt like his life was over.  Nothing mattered to him if he couldn't be with Megan.  He told her that he realized he didn't deserve it, but he begged Megan to give him another chance.  He promised to get into individual therapy to overcome his problem and he begged Megan to come with him to couples therapy.

During the next week, Megan continued to refuse to give Ed another chance.  As she said she would, she flew out to California to stay with her parents temporarily.  She and Ed talked on the phone, but she was only willing to talk about practical matters like their apartment in Manhattan where Ed was now living alone.  She refused to attend couples therapy with Ed, but she told him she thought he should get help for himself in individual therapy, "Don't do it for me.  Do it for yourself."

Getting Help in Individual Experiential Therapy:
Not knowing what else to do, Ed sought help in individual therapy.  Although he felt desperate to get Megan back, he knew it was pointless to try to persuade her.  Initially, his motivation for individual therapy was to let Megan know that he started therapy so he could convince her to take him back.  But as he continued to attend his therapy sessions and he learned about himself, his external motivation turned into internal motivation to do it for himself.

Romantic Obsessions and the Thrill of the Chase: Getting Help in Therapy

Over time in therapy, Ed began to understand his obsessive and addictive behavior with women.  He realized that he was obsessed with women from the time he was a teenager.  He never thought much about his behavior and his inability to remain faithful before.

When he was a teenager, he told himself, "Boys will be boys" and he used this rationalization to cheat on his girlfriends.  Then, when he got older and he was married, he rationalized his infidelity by telling himself that he wasn't harming her by having affairs because Megan didn't know about it and it didn't change how much he loved her.  Even after Megan found out and he lost his initial resolve to stop chasing women, he thought all he needed to do was to get better at hiding his affairs.

But now that he was on the brink of losing his marriage, Ed began to make connections between his infidelity and his father's infidelity.  Even though his parents never talked to Ed about his father's numerous extramarital affairs, Ed heard them arguing about it late at night.

Ed felt deeply ambivalent about his father's behavior.  Part of him hated his father for hurting his mother.  But another part of Ed admired his father for being "a ladies' man."  And when, by chance, as a teenager, he saw his father in his car with a beautiful woman, Ed felt a rush throughout his body at the thought of being able to have affairs with multiple beautiful women at the same time.

Working Through Early Trauma in Experiential Therapy
As Ed recounted his family history to his therapist, he realized for the first time that he often felt lonely and lost as a child. As the middle child of three children, he longed for his parents' attention.  But they focused on their older son, who excelled academically and in sports, and they doted on his younger sister, who was spoiled by his parents.  They compared Ed unfavorable to his older brother and he often depressed by his parents' emotional neglect (see my article: What is Emotional Neglect?).

As time went on, Ed could see that his feelings of low self worth were temporarily alleviated by his sexual conquests.  But he realized that after the chase was over with each woman, he no longer felt the initial thrill. He also realized that after a while he needed to have numerous sexual affairs in order to feel that boost to his mood, and he could see the addictive pattern.

His therapist recommended EMDR therapy, also known as Eye Movement Desensitization and Reprocessing Therapy, to work through the underlying issues that fueled his addictive behavior, including the emotional neglect he experienced as a child (see my article: Experiential Therapy, Like EMDR, Helps to Achieve Emotional Breakthroughs).

Prior to EMDR therapy, Ed had always thought, "I love women," but as he delved deeper into his problems, he realized that he also had hostile feelings towards women, especially his mother whom he experienced as cold and emotionally withholding.  He realized over time that with each sexual conquest, he was attempting to prove to himself that he was a lovable person (see my article: Overcoming the Emotional Pain of Feeling Unlovable).

A few months later, as Ed explained to Megan what he learned about himself and how he was working through his sexually addictive behavior.  He revealed to her that he no longer felt a compulsion to see other women.  After she thought about it for a few days, Megan agreed to come back to New York City to attend couples therapy with Ed.  She told him that, although she didn't trust him, she still loved him and she wanted to see if they could salvage their marriage.

Getting Help in Emotionally Focused Therapy (EFT) For Couples
When Megan returned to New York, she moved back into their Manhattan apartment to live with Ed again and entered into her own individual therapy to deal with the hurt, mistrust and anger she felt.  They also began seeing a couples therapist who used Emotionally Focused Therapy for couples, also known as EFT (see my article: How EFT Couples Therapy Can Help Your Relationship).

Putting the Pieces Back Together and Salvaging a Marriage:
Over time, Ed and Megan began to put the pieces of their life together. It took a while for Megan to trust Ed again.  As part of their agreement, she had access to his phone, his texts and all his computer accounts, and Ed remained faithful to Megan (see my article: Broken Promises - Surviving Infidelity).

Conclusion
Romantic and sexual obsessions usually get worse over time due to the physically and psychologically addictive behavior involved.  Since addiction gets worse without help, over time it takes more of the addictive behavior to get the same high--even when the high is fueled by dopamine.

People usually rationalize their addictive behavior, but these rationalizations often fall apart as the consequences to their behavior bring them back to reality. 

To overcome any addictive behavior, beyond stopping, it's important to understand and resolve the underlying issues that fuel the addiction.  These underlying issues often involve psychological trauma (see my article: How Trauma Affects Intimate Relationships).

Experiential therapy, like EMDR therapy, AEDP, Somatic Experiencing, clinical hypnosis, and EFT, which all take a bottom up (as opposed to a top down) approach, is are much more effective in getting to the root of the problem than regular talk therapy (see my article: What's the Difference Between "Top Down" and "Bottom Up" Approaches in Therapy).

Getting Help in Therapy
Overcoming romantic and sexual obsessions takes a commitment to work through the underlying issues involved in therapy.

Developing intellectual insight, while important, usually isn't enough to help people to overcome addictive behavior.  These problems require experiential therapy that helps people to shift on an emotional level and not just on an intellectual level.

If you're struggling with problems that you have been unable to resolve on your own, you owe it to yourself to get help from an experienced psychotherapist so you can free yourself from your addictive patterns to live a happier life.

About Me
I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and EFT therapist (see my article: The Therapeutic Benefits of Integrative Therapy).

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.

Romantic Obsessions and the Thrill of the Chase - Part 1

Romantic obsessions might be funny or entertaining in movies, but they can be very painful and self destructive in real life.  If your pattern is to chase after people, you know just how painful it can be--and yet, you might have a problem changing your behavior on your own (see my article: The Connection Between Obsessive Love as an Adult and Unmet Childhood Emotional Needs and Understanding Sexually Compulsive Behavior).

Romantic Obsessions: The Thrill of the Chase

When life seems boring and routine, "the thrill of the chase" can seem sexy and exciting.

The real thrill in chasing someone isn't about "catching" them--it's about the pleasure of the dopamine high you get from the anticipation.

The more uncertainty there is, the more exciting it is. This is especially true when someone is pursuing a person who is either not interested or comes across as highly ambivalent (see my article: What Makes So-Called "Bad Boys" So Irresistible to Woman? Brain Chemistry Might Be Part of the Answer).

The surge of dopamine can reach euphoric levels, which fuels the obsession and the chase even more.  This behavior can become highly addictive as a person continuously looks for the next dopamine high.

Clinical Vignettes: Romantic Obsessions and the Thrill of the Chase

The following fictional vignettes illustrate how these dynamics often work for both men and women:

Ed

Even though Ed was happily married and he loved his wife, he couldn't resist flirting with every attractive woman that he met. Throughout his five year marriage, Ed, who was in his mid-40s, had dozens of sexual affairs.  Many of the women knew that he was married, and they didn't care.  Like him, they were only interested in having a casual sexual relationship with him (see my articles: The Allure of the Extramarital Affair and Married, Bored and Cheating Online).

Initially, when he met an attractive woman, he was filled with euphoric feelings in anticipation of having sex with her. If a woman didn't respond to his flirtation at first, he would become obsessed with chasing her. He would try to find ways to be where he knew she would be, talk to her, make her laugh and win her over.

Since Ed was very attractive, more often than not he would succeed in winning women over.  But after having sex with a woman several times, his interest would wane, and he would be on the prowl again looking for the next attractive woman and the next high.  This pattern would continue over and over again.

Eventually, one of the women, who wanted something more from Ed and felt used by him, contacted his wife to tell her about the sexual affair. She sent Ed's wife a video she took (without Ed knowing) that was unmistakable.  She also told his wife about many of the other women Ed had affairs with over the years.  

When his wife confronted him with the video, Ed admitted he had numerous sexual affairs over the years.  He was ashamed and felt remorse for his behavior.  Although his wife was deeply hurt, she forgave Ed when he promised her that he would change.

After that, Ed didn't want to hurt his wife again, and he didn't want her to leave him.  So, for a while, he just barely managed to control his obsession for women.  But after a few months, he felt bored, and even though he knew he was risking his marriage, he couldn't resist pursuing attractive women, and he went back to having affairs (see my article: Coping with Addiction: Boredom as a Relapse Trigger).

Jane

Jane, who was in her late 30s, often complained to her friends that she usually wasn't interested in men who were interested in her.  She realized that she tended to become obsessed with men who were emotionally unavailable and who often weren't interested in her.  Even though this made her feel miserable, she felt she couldn't help herself. The more detached and emotionally aloof men were, the more obsessed she became with them. 

Even though her friends tried to warn her about the men that she was obsessed with, Jane said she couldn't stop herself.  She would chase after these men by calling them, texting them and trying to get them to go out with her.  

Just thinking about one of these men all day long would make her feel high. If she dated a man who showed initial interest in her but who ultimately didn't want to continue to see her, Jane would try to persuade him of all the reasons why he should continue to see her--even when she knew he was dating someone else.  

During her last six month relationship with a man who told her that he wanted an open relationship, she tried to force him into making a an exclusive commitment to her.  No matter how many times he told her that he didn't want to be monogamous, she didn't want to hear it.  In the end, when he broke up with her, he told her that he had been upfront with her about wanting to date other women and he couldn't stand her constant complaints that he wasn't meeting her emotional needs.

After numerous similar experiences, Jane's self esteem continued to plummet.  She tried to date men who were interested in her, but she just wasn't attracted to them.  She began to feel a sense of despair that she would ever be in a reciprocal relationship.

Conclusion

A tendency to pursue romantic or sexual obsessions is high risk, addictive behavior.  Even when there is so much at stake, including the erosion of self esteem or the risk of losing a loving spouse, the dopamine high involved can prove too much for many people to resist.

I'll expand upon this topic in my next article:
Romantic Obsessions and the Thrill of the Chase - Part 2: Getting Help in Therapy.

Getting Help in Therapy

If you're struggling with addictive, obsessional behavior in your relationships, you're not alone.

An experienced psychotherapist can help you to overcome self destructive patterns that are ruining your life.

Rather than struggling on your own, seek help from a licensed mental health professional so you can lead a healthier, more fulfilling life.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP and Somatic Experiencing therapist (see my article:  The Therapeutic Benefits of Integrative Therapy).

I work with individual adults and couples.

Currently, I am providing teletherapy sessions, which are also known as telemental health, online therapy or telehealth sessions (see my article: The Advantages of Online Therapy).

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.

Infidelity: How to Save Your Relationship After You Have Had an Affair

In my last article, I focused on how an injured partner can cope with intrusive thoughts and emotions after finding out about a spouse's affair.  In this article, I'm discussing what the unfaithful partner can do to try to save the relationship (see my articles: Coping With Infidelity).

Infidelity: How to Save Your Relationship an Affair

Research on infidelity reveals that 20-40% of all marriages experience some form of infidelity.  In my opinion, this is a very high number and more research needs to be done to determine why so many people cheat on their partners and what, if anything, can be done in terms of prevention.

Generally, the research reveals that men tend to cheat more than women, but women also cheat.  This article assumes that either a man or a woman is capable of cheating.

After an affair has been discovered, if the relationship is to survive, the partner who cheated has certain responsibilities, especially during the initial stage of this process.

For the Partner Who Cheated:
If you're the partner who cheated, at a minimum, you need to be willing to do the following:

• Be Honest With Yourself About the Infidelity: If you have been minimizing the fact that you are or were having an affair, be honest with yourself about what's going on for you.  Was this a one-time sexual affair, an emotional affair or some combination of the two?  Or, are you someone who has multiple or serial affairs?  Although all infidelity is damaging to a relationship, there is an obvious difference between getting drunk on a business trip and going to bed with someone you met once vs. going online and seeking multiple or serial affairs.  If your behavior is compulsive, you might have a problem with sexual addiction that needs to be addressed (see my article: Infidelity: Married, Bored and Cheating Online, Sexually Compulsive Behavior as a Split Off Part of Yourself and Understanding the Healthy Needs Underlying an Addiction).

• Be Honest With Your Partner About the Infidelity: Assuming that you want to save your relationship, with time and effort, a relationship can survive infidelity if both partners are willing. What often ruins a relationship is when the partner who cheated lies about it--even when his or her partner shows evidence that the affair has been discovered.  If you want to save your relationship, rather than lying or having the truth come out piecemeal over time, answer your partner's questions honestly, thoroughly and patiently.  This isn't the time to get defensive or to become avoidant.  You owe it to your partner to be open about what happened and answer whatever questions s/he might have. If, on the other hand, you no longer want to be in your relationship, then, as difficult as it might be, you need to be honest about this and communicate this to your partner.  Sometimes, people who cheat do it unconsciously as a way to getting out of the relationship because they don't know how to tell their partner that they no longer want to be in the relationship.  Instead of communicating directly with their partner, they "act out" by having an affair.  Rather than "acting out," you need to be honest, direct (although considerate and tactful) and talk to your partner as soon as you realize you no longer want to be in the relationship.  

• Take Responsibility For the Affair: Rather than making up excuses, take full responsibility for having the affair--regardless of the state of your relationship at the time.  Making excuses, blaming your partner or being defensive will only exacerbate the problem.  

• Show Genuine Remorse: You have caused your partner a lot of pain and put your relationship at risk.  Don't expect to be forgiven the first, second, third or tenth time that you apologize for the affair.  You might need to apologize many, many times.  Also, your partner might not be ready to accept your apology for a while.  Surviving infidelity is a process and you will need to be sincere in showing your remorse and commitment to the relationship.  This can take months or years.  

• Be Attuned and Empathetic to Your Partner's Pain: If you want to save your relationship, you need to show that you're attuned to your partner's feelings and that you care.  This will probably mean that you're going to be on the receiving end of your partner's rage, hurt and sadness for however long it takes your partner to forgive you--assuming that s/he does eventually forgive you.  Be willing to take in your partner's emotions.  This is not the time to try to sweep your partner's feelings under the rug or rush him or her to "move on."  Infidelity is a serious breach and a betrayal.  Unless you can show that you're emotionally present to your partner's pain, your relationship probably won't work out. 

• Don't Dismiss Your Partner's Emotional Reaction: Related to being attuned and empathetic, don't dismiss your partner's reaction to discovering the affair.  Don't tell your partner that s/he is overreacting.  This will only reveal that you're not attuned to your partner's feelings.  Likewise, telling your partner that the "other woman" or "other man" meant nothing to you and you don't understand why your partner is so upset, will make you sound like you're being dismissive.  Even if it's true that the other person meant little or nothing to you, you have to understand that this sounds like you're making excuses and minimizing your partner's emotions. Your partner's response to this could rightfully be, "If she [he] meant nothing to you, why did you do it and risk our relationship?" If, on the other hand, your partner asks you about  your feelings towards the person you had the affair with, that's different--you can respond honestly about that.  In that case, you're responding to your partner rather than trying to minimize the affair.  Remember: Everyone is unique in terms of how s/he reacts to discovering infidelity and how long it takes (if ever) to forgive.

• Cut Off All Ties With the Person You Cheated With: If you're serious about saving your relationship, you must cut off all ties with the "other woman" or "other man."  This is non-negotiable.  No exceptions.  You can't try to salvage your relationship while you maintain a connection with the other person.  If the other person contacts you about reconnecting to resume the affair or "to be friends," you maintain your stance that there can be no contact.  You must let your partner know that the other person contacted you so that your partner doesn't discover this on his or her own.  That would make matters worse because it would look like you're trying to hide things.

• Deal With Triggers That Lead to Cheating: As part of your self reflection about your behavior, consider whether there are certain triggers that lead to your cheating.  For instance, if you know that drinking or drugging lead to cheating on your partner, get professional help for these issues.  If you continue to indulge in substances that usually precede cheating, you will leave yourself vulnerable to cheating and possibly lose your relationship.  Boredom is another possible trigger.  Another example is that if you know that going to certain places makes you vulnerable to cheating, avoid those places if you can or, if you can't, make a plan as to what you will do to avoid cheating and stick with that plan.  Ditto for certain online sites.  Don't delude yourself into thinking that you can be "strong" and deal with triggers.  You will only be kidding yourself, and there's too much at stake to put yourself and your relationship at risk (see my article: The Allure of the Extramarital Affair).

• Be Willing to Demonstrate Your Accountability to Your Partner: Whether this means that you allow your partner to have access to your phone, email or other online accounts, you need to show your partner that you're willing to be an open book.  If your partner wants you to call him or her when you're working late at the office or on a business trip, do it.  Do whatever is necessary to try to regain your partner's trust (see my article: Learning to Trust Again After an Affair).

• Work Actively to Repair and Rekindle Your Relationship: Beyond everything else that has already been mentioned above, you need to be willing to do major work on your relationship if it is going to survive.  You need to find meaningful ways to show your partner that you love him or her and that s/he is the most important person in the world to you.  If the two of you have been emotionally disconnected, find ways (once your partner is ready and willing) to reconnect emotionally.

Recognize that, ultimately, even if you're very committed to salvaging your relationship, it will be up to your partner to decide if s/he wants to remain in the relationship.  For many people, infidelity is beyond what they can forgive, and you might have to accept this as the consequence of your behavior.

Sometimes couples rush to put the pain behind them without going through the necessary emotional process of dealing with the betrayal and breach of trust.  Then, later on, they discover that just telling each other that they're "moving on" or "starting over" isn't enough.  The problem might have been swept under the rug, but it's still there.

Getting Help in Therapy

Depending upon the underlying issues that caused you to cheat, you might need individual therapy and, if and when your partner is ready, couple therapy.

Coping with the guilt and shame about an affair as well as triggering behavior can be very challenging on your own (see my article: Healing Shame in Therapy and Learning to Forgive Yourself).

Don't underestimate how easy it would be to resume an affair or start a new one, especially if you're not dealing with the root cause of your problem.  

A skilled psychotherapist, who has experience working with partners who cheat, can help you to get to the root of your problem and develop the necessary skills to remain faithful in your relationship.

Many couples, who decide they want to remain in their relationship after an affair, don't make it because they get stuck in a negative cycle and they don't know how to change it.

A skilled EFT therapist (Emotionally Focused Therapy) can help you and your partner to overcome the negative cycle so that you can rebuild trust and rekindle your relationship.

Getting help in therapy could make the difference between saving your relationship or breaking up.

About Me

I am a licensed NYC psychotherapist, hypnotherapist, EMDR, AEDP, Somatic Experiencing and Emotionally Focused (EFT) therapist for couples.

I have helped many individuals and couples to survive infidelity.

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.

Early Recovery: Overcoming Feelings of Emptiness and Loss

In previous articles about early recovery, I addressed problems with making major major adjustments to life to maintain sobriety (see my articles: Early Recovery: Focusing on the People Part of "People, Places and Things," Overcoming the Temptation to Use "Liquid Courage" to Cope With Social Situations and Early Recovery: You've Stopped Drinking. Now What?.  In this article, I'm addressing another common issue that people in early recovery experience, which is overcoming the feelings of emptiness and loss after you give up your addiction.

Early Recovery: Overcoming Feelings of Emptiness and Loss 

Many people in early recovery will say that one of the hardest things they had to do in order to get sober was give up the one thing they felt they could rely on--their addiction of choice.

For anyone who is unfamiliar with addiction and early recovery, these feelings of emptiness and loss for an addiction might seem confusing.

But as a psychotherapist in private practice in New York City, who has worked with people at all stages of addiction, I know that this sense of loss and emptiness is common and understandable.

After all, if the addiction, whether it's to alcohol, drugs, compulsive gambling, compulsive sexual behavior or any other addictive behavior, didn't serve a need, the person with the addiction wouldn't persist in it.

For many people, who are contemplating giving up an addiction, one of the most daunting aspects of attaining sobriety is the thought they won't have what feels to them as a "friend" who has served a need--whatever that need might be.

The need could be a way to relax, socialize, to temporarily forget problems, to elevate a mood, to feel empowered, and so on.  And if the addiction of choice didn't "work" in some sense, even temporarily, it would have been given up long before it became an addiction.

For someone who is unfamiliar with addiction, it would be hard to imagine just how scary and how courageous it is when someone who has an addiction gives it up.  Many people, who are not educated about addiction, think that the person with the addiction "should just stop."

But aside from the fact that there might be a physical danger to "just stopping" for many addictions where a detox is necessary, the person contemplating giving up the addiction is also taking a leap of faith that they will be able to survive physically and emotionally with the addiction.

This is why there's a high rate of relapse for people struggling to stay sober, especially if they try to do it without sober support and, eventually, working through the underlying emotional problems that led to the addiction in the first place.

What Will Take the Place of the Addiction for the Person in Early Recovery to Fill the Emotional Void?
Without the addiction, the person in early recovery will usually become aware of an emotional void and the sense of loss.

Early Recovery: Overcoming the Feelings of Emptiness and Loss

Since isolation and loneliness is often a part of addiction, many people in early recovery find support in 12 Step meetings like Alcoholics Anonymous or Gamblers Anonymous.

They discover that there are people in these self help meetings in all different stages of recovery--from early recovery to many years in recovery.

They also discover that they have much in common with the people in these self help rooms, including a continuing struggle to avoid relapse and to maintain the values and principles they learned in those rooms.

I usually recommend that people in early recovery give 12 Step meetings a chance by going to several beginners meetings to see if they find a particular meeting where they feel comfortable and where they can also find a sponsor to help them work the 12 Steps.

There is no one-size-fits-all approach to recovery, so I also understand that for some people in early recovery the 12 Step model doesn't resonate with them or they find the meetings too overwhelming after they've tried several meetings (see my article: The Early Stage of Recovery: What to Do If 12 Step Meetings Are Too Overwhelming For You?).

So, many people in early recovery prefer to go to structured treatment in either an inpatient or  outpatient substance abuse program, if they have health benefits that recovers this treatment, where they can also get group support from people with similar problems.

Other people seek out psychotherapists who have experience working with people in recovery, including early recovery.

For psychotherapy option to work well in early recovery, the psychotherapist needs not only to be familiar with addictions, she must also know how to assess the timing and what the client can tolerate in terms of working on the underlying issues.

It's essential that clients in early recovery have sufficient sober time, the coping skills and necessary internal resources to deal with the underlying emotional issues in therapy, so it's psychotherapists need to help clients to develop these internal resources before delving deeper (see my article: Developing Internal Resources and Coping Strategies).

All of these modalities--12 Step meetings, structured substance abuse programs, and psychotherapy--all have the potential to help clients to remain sober.

In addition, in many cases what's also needed is something deeper that will fill the void that's left from no longer engaging in the addiction.

Some people find meaning by discovering or rediscovering a sense of spirituality.

Spirituality doesn't necessarily mean religion, although it could (see my article: A Search For a Meaningful Life and Spirituality: Are You Contemplating Your Faith of Origin in a New Light?).

Spirituality can take on many different forms aside from formal religion.  For instance, many people feel a sense of spirituality when they volunteer to help others, including volunteering at 12 Step meetings or in schools or a local community program.  Others discover a sense of spirituality in nature and find a connection to nature a transcendent experience.

The important aspect of spirituality in whatever form it takes is that it is meaningful, fulfilling and transcendent.

I believe this applies to everyone--not just people in early recovery.  Whether you call it "spirituality" or something else, without a sense of meaning, purpose and transcendence, you're just living from day to day and it can feel empty.

Many people who don't struggling with addiction but who focus only on material things will often feel a sense of emptiness in midlife when money and possessions no longer serve elevate their moods.

Usually, midlife brings an awareness that money and material things, although necessary to a certain extent to meet basic needs and give some comfort, are never enough to fill up a sense of emptiness.

This is why many people in midlife, especially those who have more years behind them than ahead of them, recognize that they need to make changes (see my articles: Midlife Transitions: Part 1: Reassessing Your Life, Midlife Transitions - Part 2: Living the Life You Want to Live, Is That All There Is? When "Having It All" Leaves You Feeling Empty  and Redefining Happiness and Success For Yourself).

Conclusion
The early recovery stage presents certain challenges, including dealing with the sense of emptiness and loss that often occurs after giving up the addiction.

Early Recovery: Overcoming Feelings of Emptiness and Loss

Aside from the physical aspects of getting sober and maintain sobriety, people in early recovery need to find healthy and meaningful ways to fill the void.

Sober support from 12 Step meetings, substance abuse programs and psychotherapy offer various options for staying sober and, in the case of psychotherapy, working through the underlying emotional problems that led to the addiction in the first place.

Beyond these options, people in early recovery need to find a sense of meaning and purpose in their lives.  I refer to it as "spirituality," but it doesn't have to involve a formal religion or even a belief in a higher power.

Without a sense of meaning and transcendence, people in early recovery often struggle with the sense of loss and emptiness that usually follows after they become sober.

Getting Help in Therapy
Many people choose to attend psychotherapy to address underlying emotional issues at the core of their addiction (see my article: The Benefits of Psychotherapy).

As previously mentioned, it's important to find a psychotherapist who has an expertise in addiction and who can work with you in a way that feels emotionally manageable for you (see my article: How to Choose a Psychotherapist).

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist (see my article: The Therapeutic Benefits of Integrative Psychotherapy).

I work with individual adults and couples.

I have helped many clients in all stages of recovery to maintain their sobriety and work through the underlying emotional problems that were at the root of their addiction.

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.