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Psychology 1000

Addiction Behaviours - Sexual Addiction - Internet Addiction - Change and motivation Sexual Addiction Sexual Addiction – Towards An Understanding - A progressive intimacy disorder characterized by sexual thoughts and acts - Negative impact on addict and family increases as disorder progresses - Addict has to intensify addictive behaviour over time to achieve same results Terms Used In The Past - Nymphomania  term used for females only - Satyriasis  term used for men only - Erotomania - Don Juanism  term used for men only; has a predatory quality/connotation - Paraphilia-related Disorders  Paraphilias are sexual disorders listed in the DSM referring to what we may consider quirky sexual behaviours; e.g. foot fetish - Hypersexuality  interchangeable with sexual addiction term - Last 2 terms are still in use Origins Of Term “Sexual Addiction” - Patrick Carnes (1983) popularized the concept of compulsive sexual behaviour as an addiction in his book Out of the Shadows: Understanding Sexual Addiction – now widely used in treatment centers - Himself a recovering sex addict, he is largely responsible for the current common use of the term - Executive Director of Gentle Path program at Pine Grove Behavioural Centre, Mississippi Definition - “Engaging in persistent and escalating patterns of sexual behaviour acted out despite increasing negative consequences to self and others” (National Council on Sexual Addiction) - Consequences, i.e. potential health risks, financial problems, shattered relationships, or even arrest American Psychiatric Association (2010) - Hypersexual Disorder - “Over a period of at least 6 months, a person experiences recurrent and intense sexual fantasies, sexual urges, and sexual behaviour in association with four or more of the following five criteria”: 1. Excessive time consumed by sexual fantasies and planning of sexual behaviour 2. Repetitively engaging in fantasies and behaviours in response to dysphoric mood 3. Or in response to stressful life events 4. Repetitive but unsuccessful efforts to control or reduce fantasies and behaviours 5. Disregarding risk of physical or emotional harm to self or others DSM IV (1994) - De-listed Sexual Addiction from DSM II - Referred to as “Sexual Disorders Not Otherwise Specified” o “Distress about a pattern of repeated sexual relationships involving a succession of lovers who are experiences by the individual only as things to be used” o “Compulsive searching for multiple partners, compulsive fixation on an unattainable partner, compulsive masturbation, compulsive love relationships and compulsive sexuality in a relationship” DSM V (2013) - Does not contain diagnostic criteria or treatment suggestions for sex addiction or hypersexuality - However, it is listed among the conditions that require more research Definition - Key concepts – failure to control the behaviour and continuing despite harmful consequences - “Addictive sexual disorders that do not fit into standard DSM IV categories can best be diagnosed using an adaptation of the DSM-IV criteria for substance dependence” - Sexual addiction is not referring to frequent sex, multiple partners, unusual behaviours (paraphilias) – reference alcoholism/drug addiction - Criteria must include the impact the behaviours have on individual’s functioning, emotional and psychological well-being, negative consequences to others, loss of control, tolerance, psychological withdrawal, etc. Sex Addicts/Sex Offenders - Sex addicts do not necessarily become sex offenders - Not all sex offenders are sex addicts - About 55% of convicted sex offenders can be considered sex addicts - About 71% of child molesters are sex addicts Etiology - Possible biochemical abnormality (antidepressants and psychotropic medications have shown more efficacy) - Seek pleasure, avoid unpleasant feelings or respond to outside stressors such as work or interpersonal problems - More likely to have been abused as children (82% of sex addicts report being sexually abused as children) - Often come from dysfunctional families - Parents often described as rigid, distant, uncaring - Parents more likely to be substance abusers - 80% of recovering sex addicts report some type of addiction in their families of origin Continuum Of Behaviours Of Sex Addiction: - Compulsive masturbation - Extensive use of pornography, phone or internet sex services - Anonymous sex - Repeated infidelity - Compulsive use of escort services and prostitutes - Exhibitionism - Obscene phone calls - Voyeurism - Child molestation - Rape/sexual assault - Continuum  Least harmful to most harmful - Exhibitionism is illegal - Voyeurism  Watching other people; voyeurs often “peeping Toms”; invading on people’s privacy Diagnosis - Poorly understood and difficult to diagnose - Controversy about what to call it - Inconsistencies in the way it is diagnosed make it hard to determine prevalence, but best estimate indicate between 3 and 6% of Americans (National Association of Sexual Addiction and Compulsivity) Symptoms For Assessment - Frequently engaging in more sex and with more partners than intended - Preoccupation with or persistent craving for sex - Wanting to cut down and unsuccessfully attempting to limit sexual activity - Mental obsession – thinking of sex to the detriment of other activities or continually engaging in excessive sexual practices despite a desire to stop - Spending considerable time in activities related to sex, such as cruising for partners or spending hours online visiting pornographic websites - Neglecting obligations such as work, school or family in pursuit of sex - Continuing despite negative consequences - Escalating scope or frequency of sexual activity to achieve the desired effect - Feeling irritable when unable to engage in the desired behaviour - Organizing their lives around sex as the primary goal Treatment And Recovery - 60 – 90 day self-imposed abstinence often recommended - Facing guilt, shame and depression - Exploration of emotional cues and circumstances that trigger sexual thought and compulsive behaviour - Exploration of arousal templates and contamination of same - Facilitated disclosure in couples work - 12-step program - CBT (cognitive-behavioural therapy) - Trauma therapy - Group therapy - Development of healthy sexual behaviours template - Medication – Particularly antidepressants may have some benefit in reducing sexual obsessions Support Groups - Sex Addicts Anonymous (SAA) - Sexaholics Anonymous - Sex and Love Addicts Anonymous – 12-step - Sexual Compulsives Anonymous – 12-step - Sexual Recovery Anonymous – 12-step Support Groups For Family Members - S-Anon – 12-step program - Co-Dependents of Sexual Addiction (COSA) - And for couples: o Recovering Couples Anonymous – 12-step Internet Addiction Some Facts About Internet Use - 71% of office workers use the internet for personal purposes during work hours - Cybersex, online affairs, and online gambling are the most common forms of internet addiction - Internet predators are twice as likely to have an internet addiction - Chinese government banned the opening of internet cafes in 2007 o 2004 boot camp for males 14 – 19 years old - Serious epidemic in China, Korea and Taiwan - Studies have documented internet addiction in Australia, Italy, Pakistan, Iran, Germany, Amsterdam, India and the Czech Republic Death By Internet - Daniel Petric, June 2007 – 16 years old, home sick with a staph infection, became obsessed with video games – When parents tried to limit him, he shot them both in the head o Tried as minor and received 23 years in prison o His attorney used Internet Addiction as the defense, arguing that the boy thought he was still in the game - Chris Stanforth, July 2011, 20-year-old Xbox addict from Sheffield, England, who died suddenly after playing 12 straight hours o Died of DVT (Deep Vein Thrombosis), a blood clot from inactivity that travelled from his left calf into his lungs - South Korean couple, May 2010, remained at an internet café all night on a video game bender, ironically playing a game in which they raised a virtual child o Meanwhile, their real child, born premature and weighing only 5 pounds, died of malnourishment at home alone o Were to serve 2 years in prison, but wife given amnesty because she was pregnant at sentencing - South Korea one of highest rates of internet addiction and most-wired countries in the world - Roughly 1 in 20 internet users is an internet addict - Chen Shi, 16, September 2010, China – Killed at Beiteng School in Changsha, China, a boot-camp for internet addiction – Intensive labour and beatings o Chen beaten to death for not following an order – Parents were told it was sunstroke o China – Internet epidemic, 1 in 10 Chinese internet users is allegedly an addict - 13-year-old Vietnamese boy, 2007 – Strangled an 81-year-old woman with a rope and buried her under a pile of sand in his front yard o Told police he killed her in order to steal money for a video game that he wanted to buy o Stole 100,000 Vietnamese dong (about $6.20) - Too young for prison, he was sent to a re-education camp until he could exercise “good behaviour” - Wang Gang, 31, China, May 2011 – Addicted to Dungeon Fighter – Collapsed in an internet café after seven months of living there and playing around the clock except for a few hours daily sleeping on the couch o Emanciated, dirty, pallid – Died of cardiac failure caused by tuberculosis o At time of death, was running 20 high-scoring Dungeon Fighter accounts China - World’s largest gaming market – 100 – 200 million users - Government imposed log-in system and 5 hour limit – Players go to another café or use someone else’s ID card - Proliferation of boot-camp treatment and more family-centered treatment programs since death of Chen Shi What Is Internet Addiction? - Impulse control problem - Subtypes: o Cybersexual – Internet porn, chat rooms, sexting o Cyber-relational – Chat rooms, IM, social networking o Net compulsion – Online gambling, investing, eBay o Information overload – Web surfing, databases o Internet Gaming Addiction – Now listed in Section 3 of DSM V Online Affairs - Online affairs account for a growing number of divorce cases o Most frequently treated problem at Center for Online Addiction o Partners rationalize that it is not really cheating without physical touching o Often imagine a better life with this fantasy-type person Symptoms Of Internet Addiction - Thoughts are preoccupied with internet - Use in increasing amounts of time to achieve satisfaction - Repeated, unsuccessful attempts to cut back, control, or stop use - Restless, moody, depressed, irritable when attempting to stop - Stay online longer than originally intended - Jeopardized or risked something significant - Lied to conceal the extent of involvement - Used as a way to escape problems or improve mood - Heightened sense of euphoria while online - Feeling guilty, ashamed, anxious or depressed as a result of online behaviour - Physical changes such as weight gain or loss, backaches, headaches, carpal tunnel syndrome - Withdrawing from other pleasurable activities Treatment & Recovery - Very new field, not many trained clinicians - Outpatient counseling – CBT - In-patient treatment – No specific center in Canada, at least two in U.S. o Individual, group and family counseling o Evidence-based therapy o Medically-supervised detox (10 days) o Intensive daily sessions o Daily reintegration of electronic devices and media o Family support is strongly encouraged Change - Thumb folding - Extreme hair change - New fitness regime What Motivates Change? - Negative and positive motivation (carrot & stick) - “Hitting bottom” - Others may influence the motivation to change – direct or indirect - Feeling sick and tired - Counsellor’s challenge – Push the right buttons for each individual Change – Leading To Personal Transformation - Gradual or Quantum change (coined by William Miller, 2001) – Sudden and immediate o Vivid o Surprising o Benevolent o Enduring o Involves conflict - E.g. Bill Wilson, co-founder of AA Resistance To Change - Resistance is common and normal - Laziness - Procrastination - #1 reason people do not implement change (train – studying, breaking a habit, etc.) - Fear of the change - Fear of failure - Fear of disappointment - Discomfort Denial & Delusion - Impossible to change if in denial - The purpose of denial is to protect the “love relationship” or addiction - More denial = delusion = more denial = more delusion - In order to protect the addiction and support the denial, psychological defenses are employed Cons & Defenses - Con – A means of consciously deceiving another in order to get or avoid something, “to swindle, dupe” - Defense – A way of protecting oneself emotionally from pain, intrusiveness, confrontation, etc.; a con which has become habitual, “something that protects, an argument that supports or justifies” - Denial – Unwillingness to face or accept truth - Minimization – Making behaviours seem less serious - Projection – Laying own issues on others - Diversion –Changing the topic, blaming, “Shift the focus” - Rationalization – Explaining away behaviours with seemingly rational excuses - Conflict avoidance and compliance – need to be liked – agreeable on surface only, actually rebelling, not in touch with feelings o “Sweet & Innocent” - Obsessive focusing – Perfectionist, B&W thinking - Acting out – Impulsive behaviour without self-reflection – Use behaviours to communicate, not words - Tough Guy/Bully – Uses hostility, intimidation, aggression to inflict fear and avoid confrontation - Playing Dumb – Pretending not to be aware or remember - Poor Me – Acting weak or sick, unable to cope with confrontation - Charmer –
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