By Paul Casey


This paper will explore the underlying current of what is called ‘sex addiction’ and find the true connection between core beliefs and sex. It will also explore what causes the compulsive behaviors exhibited by individuals resulting in thoughts and actions toward the sexual act. Let us take a studied look into the world of sexual addiction.

Defining Sexual Addiction

There have been many arguments about how to define sexual addiction. The fact is that most people are engaging in non-compulsive, “normal" sex acts. However there is a sub group of individuals for which a compulsive disorder is present in which anxiety is relieved by participation in behaviors that are sexual in nature. “To accept the term sexual addiction one must accept that the basis for addiction is not the substance or behavior itself, but rather the changes in one’s emotional state associated with the substance or behavior.(Carnes, 1983) Just like the alcoholic that uses alcohol to calm and numb the problematic core beliefs swirling in his/her mind, the sex addict uses sex in the same unhealthy fashion to escape. Since it is only temporary relief, hence the compulsive behavior to do it over and over again.

Carnes (2001) argues “that many sex addicts follow a progression in which behaviors escalate to provide a more exciting experience. Specifically Carnes classifies sexual addiction behaviors into three levels. The level one behaviors include compulsive masturbation, compulsive relationships, watching pornography, strip shows, prostitution and anonymous sex. Level two behaviors can result in serious consequences and include exhibitionism, voyeurism, and indecent phone calls. Level three behaviors are serious boundary violations that include child molestation, incest, and rape. Just like the drug addict that needs more drugs to reach the required effect, the sex addict has to intensify the acts to reach more excitement.

Sexual addiction is a disorder of intimacy that is rooted in early development (Carnes, 2001). Children develop attachment problems with primary caregivers that cause emotional distress. Core beliefs are then ingested into the mind set. An example of an unhealthy core belief could be ‘I am not a good person and no one will love me.’ The sex addict needs something to provide comfort, so the core beliefs set the map for addiction, ‘Sex is my most important need.’ “Although the pleasure associated with sex and orgasm temporarily relieves emotional distress and provides comfort, sex never really meets the individual’s basic needs for validation and intimacy and sex addicts become ensnared in an addictive cycle.(Carnes, 2001) The beginning of the cycle is being caught up in thoughts of sex. It then moves into routines that lead up to sexual behavior. The last part of the cycle is the addict acts out and performs a sex act. The whole cycle combined just leads the addict into a cycle of despair. The individual feels hopeless and unworthy with the inability to stop, which is created from the core belief that he/she is a bad, unlovable person. In any addictive behavior, the vicious cycle continues even though the end result is negative reinforcement.

Sexual Impulsivity/Compulsivity and Dependence

In 1877 Freud described masturbation as the original addiction. He wrote, “Masturbation is the one great habit that is a primary addiction and that the other addictions only enter into life as a substitute and replacement for it.(Halliday & Fuller, 1974) There are definite evolutionary stages with the sex addict starting with compulsive and impulsive behaviors (Guigliano, 1974). A compulsion is a repetitive behavior or mental act the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. Impulsions are the failure to resist an impulsive drive or temptation to perform an act that is harmful to the person or others. The individual feels an increasing sense of tension or arousal before committing the act and then experiences pleasure or relief at the time of committing it.

The link between the compulsive and impulsive behavior is that they are both coming from an emotionally distressed state. The compulsive behavior is the need for immediate gratification, which is directly connected to the impulsive behavior to relieve anxiety. The dependent stage results in needing the behavior more and more over time to maintain the same effects. Then of course these behaviors lead to the next phase of dependence or addiction. The unconscious distress in the individual stays in the dark so the addict becomes caught in the cycle of dependence.

Therapy for the Sex Addict

Like any addiction, to break the cycle takes serious, integrated therapy and the individual’s conscious desire to change. A sex addict has to agree to a long-term therapy group that allows them to enter into relationships to help manage the addictive behavior. Clients are given the choice to define the behaviors they need to stop. Sobriety may differ with each individual as some may go to the extreme of excluding all sexual activities including masturbation. Other clients may just narrow it down to sexual activities with only his/her partner. “When discussing sexual behaviors clients are encouraged to tell the microscopic truth, which involves complete honesty among group members.

Clients in group therapy are in a relationship with each other and hold each other accountable for a variety of actions related to their goals.?(Hook, 2008) The clients are taught to identify any behavior that marches them down the addictive path. Microsettings can be a huge green light for a person with a sexual addiction. If a male sex addict has shared with the group that he frequently goes to bars and in this setting he loses control, he is then held accountable by the group not to go to the bar. Clients are encouraged to enter into relationships that explore the dynamics of the addictive process. This helps to bring light into the family-instilled core beliefs. “Psychodrama is often used to help a group member explore a family of origin experience. A client can reenact a family experience and gain insight into the messages he or she received as a child which often contribute to the client’s core belief.(Hook, 2008)

Through this entire process clients are creating intimate relationships with each other thus they learn and trust that they can receive intimacy without confusing it with sex. Thus the process is giving the client the self-esteem, trust, knowledge and skills to gain intimacy. A sex addict is encouraged to call a fellow sex addict; to reach out and vocalize the thoughts that are encouraging the addictive behavior. The slogan ‘reach out before you act out’ is the motto. By opening up and being honest the cycle of addictive behavior can be stopped.

To summarize, the long-term goal is for clients to get help managing sexually addictive behaviors, explore the dynamics of their own addictive process, and most importantly, develop long term bonds with other addicts.

Sexual Co-Addiction

Partners of a sex addict usually respond to their significant others’ problematic behavior in two ways. “They can either act in a nurturing manner toward their partner out of denial or in the hopes that their patience and willingness to please will motivate their loved one to quit the behavior, or they can withdraw nurturing from their partner in the hopes that the withdrawal induces enough discomfort to refrain from acting out the addiction in the future.?(Wright, 2008) It seems that initially they are so concerned and out of control about what to do to stop the addictive behavior of their partners, that they think that positive reinforcement will actually have the opposite effect and get the partners to stop the behaviors. This continues for awhile until the co-addict breaks out of denial and sees that their partner’s actions are not stopping. The co-addict then turns the tide by punishing their partner. The punishments can include getting kicked out of the house, setting clean expectations for the future, or emotional and physical withholding. The co-addict will go back and forth with these strategies of nurturing and punishing to desperately try to control their partner’s addictive tendencies. Co-addicts have been known to have more sex with their partners more frequently with no desire to be intimate (Wright, 2008). The co-addict then flips the coin by withholding sex. Again positive or negative reinforcement does not change the addict’s behavior.

True recovery for the co-addict thus becomes engaging in personal therapy for his/her co-dependent behaviors. The co-addict must learn self-love, how to enforce boundaries, and how not to get sucked into their partner’s addictive world, in other words, how to have a productive life of his/her own. It is crucial for the therapist to state very clearly that nothing that the co-addict does or does not do will guarantee any change in his/her partner’s sexual addiction. “The therapist can instill a sense of relief to their client, letting them know that they are doing their part at least to facilitate positive change in their partner. (Wright, 2008)


In summary, sex addiction is a complex disorder starting in childhood when unhealthy programming causes a negative set of core beliefs to be instilled. The addict tries to escape the painful and unconscious internal programming by using compulsive and impulsive sexual behaviors. These behaviors can escalate until they hurt others at which point the person becomes caught in a vicious cycle of anxiety, acting out, slight relief, and more pain and anxiety. Help is available in the form of long term, integrated group therapy. The addict can bring core issues into the light and change addictive behaviors. Help is also available for the co-addict in the form of one-on-one therapy.


Carnes, P. (1983). Out Of The Shadows: Understanding Sexual Addiction. Minneapolis, MN: Compcare Publications.

Carnes, P. (2001). Out Of The Shadows: Understanding Sexual Addiction, 3rd edition. Center City, MN: Hazelden.

Guigliano, J. (2008). Sexual impulsivity, compulsivity and dependence: an investigative inquiry. Sexual Addiction and Compulsivity, 15:139-157.

Halliday, J. and Fuller, P. (1974) The Psychology of Gambling. London, England: Harper and Row.

Hook, J. N. (2008). Reach out or act out: long term group therapy for sexual addiction. Sexual Addiction and Compulsivity, 15:217-232.

Wright, P. (2008). Sexual co-addiction: A new context for inconsistent nurturing as control theory. Sexual Addiction and Compulsivity, 15:1-13.