Health News, Obstetrics & Gynecology

There has been a lot in the media these days about "sexual addiction,?* but I think what we're reading and hearing is more about generating heat than light. Sexual compulsions are nothing to neither laugh at nor make light of. Here's a startling, different perspective:

Perhaps, if you understand the genesis of the addiction to unhealthy sexual behavior, you might find yourself feeling sympathetic toward sexual addicts! Certainly, sexual compulsions are not positive behaviors and they cause terrific personal, interpersonal, and societal problems. But that's not what I want to write about now. As a professional therapist, who treats men and women suffering from sexual compulsions, I hope I can draw a realistic picture of the "typical sexual addict." Most sex addicts? are not horrible people, certainly not cold-blooded murderers or sexual offenders who deserve to be punished. Actually, many people with sexual compulsions are reacting, in a self-destructive manner, to having been severely wounded by the people closest to them-- their parents, uncles, aunts, or siblings.

I have seen studies reporting that 72% of sexual addicts had been physically abused in childhood, with another 81% having been sexually abused, and 97% suffering from prior emotional abuse. These statistics are completely compatible with my clinical experience.

Raised in What World?

Children are supposed to be raised in an environment where their basic needs are consistently met; not just for food and shelter, but also for safety, love, touch, trust, empathy, and self esteem. Each of these Milestones of Sexual Development (Zoldbrod, 1998) is a building block for healthy sexual development.

This is how children learn that it's safe to love other people, to depend on other people. This is how they learn to reach out to others and connect in friendships and relationships. And it's what creates the motivation, as they grow up and mature sexually, to be brave enough to fall in love, to want to combine being emotionally and sexually dependent on another person.

When sexual addicts reveal their family history in treatment, their childhood stories are often hair-raising and horrifying, even to seasoned mental health professionals. Yet patients treat their pasts as completely normal. They are in denial... Patients seeking help for sexual addiction are full of shame and depression over their out of control behavior, but they are completely mystified by its origins.

My patients routinely fill out a questionnaire which screens for physical and sexual abuse, emotional abuse, and neglect. I've learned to screen in this very detailed way because if you don't ask people a long, specific list of what has happened to them, they won't give you the information. They "forget" the details, unless you remind them. It's too painful. They don't want to remember it.

Looking Deeper

Therapists don't relate the way people do at cocktail parties. We don't like it if people tell us they're fine. We ask for the truth. So we get the stories you never hear from your friends and neighbors.

You may know of woman in your social circle that is so well ??put together,? she seems to have the world on a string. Yet, you can't understand why she seems to have problems ??drinking too much. Well, when she was a little girl, her mother berated her every day, and one day Dear Old Mom threw her pet cat out of the window of a high rise apartment building. Dad just went to work and came home, pulled in the big bucks, blind to the destruction of this little girl's sense of trust and self esteem.

People, who are addicted to sex, often drink, or take drugs are avoiding looking inside at their pain. Many sex addicts had terrible childhoods, but they don't talk about them. They're numbing out by compulsively acting out sexually.

Here's the history of one of my patients, Gary, a "happily married" man with three kids who was addicted to computer pornography and occasionally visited prostitutes.

In Gary's family, children obeyed and did not disagree. On the checklist of abusive behaviors, he reports many forms of emotional abuse: getting called names, being belittled, being harassed or made the object of sadistic jokes, getting punished unfairly, having his independent thoughts punished, always being compared to others, being made to eat something that has been spilled on the floor, being isolated from others, being bullied, and not being allowed to leave his room for hours or days. He also was physically abused, including slapping, hitting, and spanking. Some of these episodes have led to broken bones or bleeding. There was no sexual abuse. The father was the primary abuser, but the mother did not try to stop the father. She "stood bywhile he did what he had to do." The other children were abused in some of the same ways by the father, but Gary seemed to be singled out for the worst abuse, as the oldest, and as a male. As a youngster, Gary used masturbation as a way to soothe himself after these episodes, and soon was masturbating every day.

Gary's story illustrates some common factors in the development of sexual compulsions. Children who grow up in homes where they are abused or neglected have no way of coping with the overwhelming fear, hate, hopelessness, longing and pain which they experience. When they're upset, their parents aren't holding them and soothing them. The parents are often the abusers.

How to Cope

Young men like Gary have very few inner resources to cope with what is happening to them, and they need some way to regulate their emotions. If you can imagine being treated like Gary, then perhaps you can allow yourself to feel how angry or depressed or helpless you would feel on a daily basis. The meta-message of being treated the way Gary was is, "You're worthless, not lovable." It's a message that abused children carry inside themselves throughout their adult lives.

There is a good reason why more males than females become sexually compulsive. Little boys tend to discover the pleasures of touching their penis, because boys have to touch their penises to urinate. For boys like Gary, masturbation, and later sexual fantasy, becomes the one soft, calming, pleasurable activity in a very bleak life.

There are two common pathways to becoming a sex addict, and they interact. First of all, it's likely that many of those who become sexually compulsive were born with a sexual drive at the higher end of the normal spectrum and when exposed to violence, aggression, profound emotional neglect or sexual abuse, many of these men and women, in childhood, used masturbation to soothe themselves.

Secondly, growing up in these kinds of environments, children learn not to trust other people or the world in general. Consciously or unconsciously, they don't want to

allow themselves to become emotionally and sexually dependent on one other person. It's putting "too many eggs in one basket." So developing a sexuality which avoids emotional intimacy with others in favor of casual encounters, prostitution, or cybersex makes sense.

High function, But

Many people with sexual addictions are quite high functioning in other areas of their life, particularly work. But they just don't have the coping mechanisms to deal with the day-to-day disappointments of the world.


In order to overcome his sexual compulsions, and to reconnect with his wife emotionally and sexually, Gary had to go on a long, involved, up and down journey, which included group support, individual psychotherapy, couples psychotherapy, and learning enough positive coping strategies to make it safe to confront the painful feelings he had about how he was treated by the very people who were supposed to love and comfort him. If sexual addictions and compulsions were treated more sympathetically and more deeply in the media, more people suffering with these problems might have the courage to undergo treatment. (Copyright, Dr. Aline Zoldbrod, November, 2007)

* Please note that the term "sexual addiction" is not coded in the Diagnostic and Statistical Manual of the American Psychiatric Association, and there is controversy in the field about whether that term should even be used. But there is no argument among professionals that people use sex in a compulsive way. I'll be using the terms "sexual addiction" and "sexual compulsivity" interchangeably throughout this article.

Dr. Z is a Lexington, MA-based AASECT-certified sex therapist and licensed psychologist. Her site is

Click to discuss this article on Bulletin Board, where you can ask Dr. Zoldbrod questions.