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Patterns of Addictive Sexual Behaviors

  1. Fantasy sex: Person is obsessed with a sexual fantasy life. Fantasy and obsession are all-consuming.
  2. Seductive role sex: Seduction and conquest are the key. Multiple relationships, affairs, and/or unsuccessful serial relationships are present.
  3. Anonymous sex: Engaging in sex with anonymous partners, or having one-night stands.
  4. Paying for sex: Paying for prostitutes or for sexually explicit phone calls.
  5. Trading sex: Receiving money or drugs for sex or using sex as a business.
  6. Voyeuristic sex: Visual sex: Use of pornographic pictures in books, magazines, computer, pornographic films, peep-shope. Window-peeping and secret observation. Highly correlated with excessive masturbation, even to the point of injury.
  7. Exhibitionistic sex: Exposing oneself in public places or from the home or car; wearing clothes designed to expose.
  8. Intrusive sex: Touching others without permission. Use of position or power (eg, religious, professional) to sexually exploit another person.
  9. Pain exchange: Causing or receiving pain to enhance sexual pleasure.
  10. Exploitative sex: Use of force or vulnerable partner to gain sexual access. Sex with children.

Source: Carnes PJ. Don't Call it Love: Recovery from Sexual Addiction. New York, NY: Bantam Books. 1991;35:42- ­44.
Schneider JP, Irons RR. Primary Psychiatry. Vol. 5. No. 4. 1998.

Multiple Addictions
Addictive disorders tend to coexist. Nicotine dependency, for example, is highly correlated with alcohol dependence. The same is true of sex and drugs. Addictive sexual disorders often coexist with substance-use disorders and are frequently an unrecognized cause of relapse. In an anonymous survey of 75 self-identified sex addicts,9 39% were also recovering from chemical dependency and 32% had an eating disorder. In another study,3 70% of cocaine addicts entering an outpatient treatment program were also found to be engaging in compulsive sex. In Irons and Schneiders8 population of health professionals assessed for sexual impropriety, those with addictive sexual disorders were almost twice as likely to have concurrent chemical dependency (38% prevalence) as those who were not sexually addicted (21%). Thus, the presence of sexual compulsivity was a comorbid marker for chemical dependency.


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Case 2: A 40-year-old physician was actively involved in Alcoholics Anonymous and appeared to be doing well until the day he did not appear at work and was found at home, intoxicated and suicidal. He explained to his therapist that drinking was not the real problemhe had been engaging in anonymous unsafe sex with men in public restrooms, and could not stop. He felt such fear and anguish that his only options seemed to be suicide or drinking; he chose alcohol. Sexual issues had not been addressed during his prior inpatient treatment for alcoholism.10

Professional Sexual Exploitation
Sexual contact between a helping professional (eg, physician, counselor, or minister) and their patients or clients is condemned by professional organizations and licensing bodies, and is considered to be sexual exploitation.

Professionals may be sexually exploitative on the basis of

  1. naivety and lack of knowledge of appropriate boundaries,
  2. circumstances which for a time increase the professionals vulnerability,
  3. the presence of one or more Axis I addictive disorders, or
  4. the presence of Axis I mental illness or Axis II character pathology such as antisocial personality disorder. In many cases, the professional has a repetitive pattern of sexual exploitation of clients, and actually has an addictive sexual disorder.

Irons and Schneider reported the results of an intensive inpatient assessment of 137 health care professionals referred because of allegations of personal or professional sexual impropriety. After assessment, half (54%) were found to have a sexual disorder NOS with addictive features (ie, to be sexually addicted). Two thirds (66%) of the entire group were found to have engaged in professional sexual exploitation, and of this subpopulation, two thirds (66%) were sexually addicted. Thus, addictive sexual disorders are a common feature of sex offending by professionals. In addition, 31% of the entire group was incidentally found to be chemically dependenta condition for which many had not previously been treated.

Case 3: A 52-year-old married minister had a long history of sexual involvement with female parishioners who came to him for counseling. His family relationships were distant, because he was often away from home in the evenings "counseling" rather than spending time with his family. After several women came forward with their stories, the minister was fired, evicted from his church-owned house, and publicly humiliated. He resigned from his ministerial duties and changed his profession.