… And Where To Go From There: A Review of Current Research

I recently was invited to give a presentation on common (mis)perceptions of relationship and sexual compulsivity at the 2018 Ensure Justice Conference, hosted by Vanguard University. Here are some of the keynote’s highlights on common perceptions with regards to compulsivity (especially in relationships), current research, and research-based communication about this important subject.

Perception # 1: Sexual Addiction/Compulsivity does not exist.
Where To Go From There: Let’s Go To Current Research:
The Diagnostic and Statistical Manual, 5th edition (DSM V) lists hypersexuality as a condition that requires further research. The DSM V conceptualizes sexual compulsivity as an impulse control disorder, not as an addiction. No diagnostic criteria formulated for adolescents and emerging adults are specified. Recent brain scans of individuals with sexual compulsivity show similar brain patterns to those found in people with addictions to cocaine. The World Health Organization defines an ›Addiction: a progressive brain disease that, if left unattended, may lead to premature death.

Preferred Communication To Replace Perception # 1:
Even if there is a lack of consensus on how to define problematic behaviors, sexual compulsivity needs to be taken seriously.

Perception # 2: Sex work is a choice. Women consent to it and can make a lot of money.
Current research:
›-45 % of self-identified female sex addicts had traded sex for money/gifts:

-›8.4% for money (in comparison to 2.2% of non-sexually addicted females);

›-26.3% for gifts (in comparison to 5.7% of non-sexually addicted females); and

›-7.8% of female sex addicts identified themselves as sex workers (in comparison to 4.4% of non-sexually addicted females) (Corley & Delmonico, 2011).

-Sex work in sexually addicted women coincided with the use of drugs plus More partners; A higher frequency of sex; Use of drugs before and during sex more often; and A higher incident rate of STDs than women who were not addicted (Logan, 2000).

Preferred Communication To Replace Perception # 2:
Even if free will exists, the complexity of the impact on (drug-induced) addiction on women’s’ sexuality cannot be underestimated. The presence of an addiction impairs decision making (including the ability to consent).

Perception # 3: The absence of “old” acting out compulsive/addictive behaviors shows that the person is no longer at risk.
Current Research:
›Complex interactions between the brain’s reward center facilitate that a formerly exhibited problematic behavior can be replaced by one or more of four types of addictions:

›(1) Substance (that is, legal or illegal drugs); (2) Process (that is, shopping, gambling, online behavior); (3) Emotion (that is, intensity, drama, depression, anxiety, self-hatred); and/or (4) Unhealthy attachment/”trauma bonding” to another person (that is, for example, patterns such as “rescuing” another person, pathological giving, impression management). What to abstain from is a “moving target” (Carnes, 2012): one needs to watch if the addictive behavior switches to another of the aforementioned four types of addiction.

Furthermore, 97-99% of sex addicts reported at least one of various types of abuse (e.g., sexual, verbal, physical). Such unwanted events can produce complex layers of so called trauma. Often times, chronic trauma manifests itself in the re-enactment of trauma in relationships.The withholding of or absence of addiction behaviors, especially if underlying trauma is not decreased, may activate the brain’s reward center in the same way that the addictive behaviors once did.

Therefore, addiction and complex trauma require two tracks of treatment:

Track 1: Decrease of the impact of trauma;

Track 2: Completion of recovery tasks (Carnes, 2006) to create healthy thoughts and healthy attachment.

Preferred Communication To Replace Perception # 3:
Even if problematic behaviors stop, a comprehensive treatment and multi-faceted level of support to replace addictive behaviors with long-term, holistic health is needed.

Perception # 4: Once a person reaches the age of majority, he/she can be held accountable for her actions.
Current Research:
The exposure to chronic trauma may stunt a woman’s emotional development and predispose her to anxiety and depression due to a hyperactive nervous system. The effects of chronic trauma may continuously impact the women when she reaches the age of majority (Heim et al., 2002; Nemeroff, 1998). Furthermore, so called “trauma bonding” (that is, an attachment pattern to unhealthy behaviors and/or people due to the impact of trauma on the brain (not driven by free will)) may occur.

Preferred Communication To Replace Perception # 4:
Underdeveloped decision making, information processing, and lack of emotional maturity (including trauma bonding) is likely in individuals affected by trauma and addiction.

Perception # 5: In professional trainings, health care and medical professionals learn to address one (addiction) issue at a time, one day at a time. This means that this approach to treatment is sufficient.
Current Research:
The engagement in ›12 Step Programs has been found to be very helpful for successful recovery from addictions. In addition, attending to addiction interaction and multiple addiction patterns, one needs to tackle as many of the addictive behaviors at the same time, systematically.

Preferred Communication To Replace Perception # 5:
In today’s addiction producing environment and culture (e.g., chronic overstimulation via technology, overworking as a virtue, social isolation), one needs to tackle as many problematic behaviors as possible at the same time, including sexual ones.

Perception # 6:
In most professional trainings, health care providers and medical professionals learn to work individually with clients, not as a multi-disciplinary team. This should be enough to help a client.
Current Research:
Sex and relationship addictions: ”intimacy disorders” due to genetic vulnerability, complex trauma, and lack of skills to connect with another person in a healthy way. Health care providers and medical professionals get to be proactive psycho-educators, on a joint mission with his/her colleagues from other disciplines to establish holistic, long-term, sustainable mental, physical, spiritual, and relationship health in their clients. This can happen through role-modeling of successful behaviors, constructive thoughts, how to create rewarding circumstances, and physical vitality.

Preferred Communication To Replace Perception # 6:
Today’s complex disorders requires a “village” approach to serving our clients: collaborations with other providers to help our clients in establish holistic health. In addition, health care providers and medical professionals should engage in their development of healthy self-regulation and consistent self-care. This will allow us to pass along health and resilience to our clients through healthy role-modeling. They are worth it. We are worth it!


Carnes, P. J. (2006). Children of wrath: Women and sex addiction. Counselor, 7, (3), 34–40.

Corley, M. D., & Delmonico, D. (2011). Closing the gap: Results from the Women’s Sexuality Survey on Female Sex and Love Addicts. Presentation at Society for the Advancement of Sexual Health Conference, La Jolla, CA.

Georgianna, S. (2015). Addressing Risk Factors Associated With Women’s Sexually Compulsive Behaviors Through Psycho-Education and Self-leadership Development. Sexual Addiction & Compulsivity, 22:314–343. DOI: 10.1080/10720162.2015.1072489

Heim, D., Newport, J., Wagner, D., Wilcox, M. M., Miller, A. H., & Nemeroff, C. B. (2002). The role of early adverse experience and adulthood stress in the prediction of neuroendocrine stress reactivity in women: a multiple regression analysis. Depression and Anxiety, 15, 117–125. DOI:10.1002/da.10015

Logan, T. L. (2000). Sexual and drug use behavior among female crack users: A multi-site sample. Drug and Alcohol Dependence, 58, 237–245.

Nemeroff, C. B. (1998). The neurobiology of depression. Science America, 278, 42–49.