I’ve moved! I’m still producing great, thought-provoking content just now at my own domain:
Visit me at https://drjensrecoveryreadings.com
I’ve moved! I’m still producing great, thought-provoking content just now at my own domain:
Visit me at https://drjensrecoveryreadings.com
Recently, researchers from the Franciscan University of Steubenville published the results of their study looking at pornography use and mental health in college students. Their aim was to explore any relationship they might find between pornography use and mental health concerns such as loneliness, depression, and stress in students.
The study found that 56.6% of the students (male and female) had viewed pornography at some point in their lifetime with male respondents reporting significantly more use than female respondents. The study also found that the emotional state of loneliness predicted depression, anxiety and stress in the students.
While not the main focus of the study, what I found most interesting were the data about the age of first exposure to pornography and how that occurred. The age of first exposure to pornography is often younger than most people imagine. This is especially the case for parents who often do not even talk to their children about sex and/or pornography until after the average age of first exposure.
This study found that the majority of males (63.7%) were exposed to pornography between the ages of 9 and 13 years old. Thirty nine percent of female respondents reported exposure in the same age category. For males, the primary method of first exposure was personal curiosity, meaning that the boys were curious about sex and pornography and looked it up themselves. For females, they were most often exposed to pornography through unintentional exposure.
The take aways from this study, for me, in clinical work and in talking to parents about sex and pornography, is that we really, really have to find a way to talk about these subjects when children are young. If almost 64% of boys and 39% of girls are exposed to pornography between the ages of 9 to 13, discussions on the topic that happen after this age range will come as too little too late.
Parents have to find the courage and resources to talk to their children about sex, sexuality and pornography in age appropriate ways from the time they are young. I know this makes most parents very uncomfortable. However, children who have some knowledge about sexuality and no shame are more likely to not turn to the internet to answer sexual questions or to come to a care giver when they have an unintentional exposure to the material.
I have written about it before, but the Educateempowerkids.org programs are amazing. They now offer books, webinars and a podcast to help you talk to your children about anything, including sex.
Reference Camilleri, C., Perry, J.T. & Sammut, S (2021). Compulsive internet pornography use and mental health: A cross-sectional study in a sample of university students in the United States. Frontiers in Psychology, 11, 1-24
I have always been interested in the concept of masculinity and the ramifications men and women face from our conceptions of it. As we learn more, concepts change, and often people are reluctant to change if it effects their perception or lifestyle critically.
In Contemporary Male Sexuality: Confronting Myths and Promoting Change by Barry and Emily McCarthy, the authors do just what the title says. They identify and critique traditional male views regarding sex and relationships by calling those views myths. They question the efficacy of said views and demonstrate how those views place women as “second class”. This substantiates their reasoning for promoting more of a cohesive platform between both men and women. McCarthy & McCarthy call this bridge the female-male sexual equity model.
The female-male sexual equity model is essentially a dialogue that promotes a roadmap and guidelines for change (p.11). This concept is a great solution to the conflicts that surround what sex is and isn’t for both men and women. The model challenges both men and women to dive deeper into themselves to find their own healthy sexuality. Once that is harnessed and articulated between partners, the relationship can grow, not only with emotional intimacy but also sexually (which statistically is 15-20% of relational happiness).
One statistic at that was redundant was the 15-20% efficacy of the role sexuality plays in the well-being of relationships (p.8). I and you will never forget this statistic. Whether you agree with that statistic, is up to you. The language that McCarthy & McCarthy use is moderately blaming of men for their oppressive views. Moreover, male readers should try to not take it personal and look at it more of a critique of male sexual culture. Which without a doubt needs to be updated and challenged.
This book could be useful for clients that are open to challenging the perception of masculinity and their own preconceived notions of intimacy and sex. For the reluctant client that does not want to challenge their perceptions, it could be difficult. However, having this in your arsenal for challenging the reluctance could be useful to promote healthy male sexuality vs the contrary.
As soon as I saw this book, I bought it and was excited to read it. Though that may sound odd to someone not in my field, there is so little published on sibling sexual abuse that any new readings on the topic catch my eye.
The occurrence of sibling sexual abuse is not that uncommon. However, it is VERY UNCOMMON for this type of abuse to be reported to parents, care givers or the authorities. There are so many people in the world who experienced this type of sexual abuse who have remained silent for decades. It is a taboo topic that is not talked about, though it should be.
In my continued effort to be totally honest, I am going to say that I really wanted to like this book a lot more than I actually did. Here are some of my struggles with the book.
So, after I write my list of complaints about the book, I need to take a step back and check my perspective. I do a large amount of forensic work which means I am steeped in research articles and science. I actually love it too! I realize that not everyone looks at what is basically a self-help book through a scientific lens. I am, perhaps, being way too hard on this book and the author.
So, after I check my perspective and realize that this is a book that is not written for the scientific community but the lay community, I can then truly see the value in this book. We NEED to talk about sibling sexual abuse. The people who were victims of this form of abuse need a voice and this book is a starting point for them to understand that we see them, and they are not alone. The book also offers some very solid treatment options, as well as very honestly looks at the issues that can arise for a family dealing with sibling sexual abuse. This can include Children and Youth involvement, legal issues, family separation and possible placement of the child that has committed the sexually abusive behavior.
To order a copy of the book https://bradwattslpc.com/
I read this book for several reasons. The first is that we sometimes have individuals referred to us for potential sexual addiction who have intrusive sexual thoughts. Frequently these individuals are not dealing with a problematic sexual behavior, but intrusive sexual thoughts and we refer them out to a great area clinician who specializes in treating Obsessive Compulsive Disorder. Secondly, we do have a lot of clients who have some version of intrusive thoughts. So, I thought the more I could learn about it the better.
The subtitle of the book is A CBT based guide to getting over frightening, obsessive or disturbing thoughts. My initial assumption was that the book was going to more traditionally CBT focused, and I did not find it so. It reads more like a book that is advocating some level of mindfulness-based practice. This is perfect for me as we often use this in our practice.
One helpful part of this book is how much it normalizes intrusive thoughts. Many people have thoughts that pop into their heads that are about violence, sexualized content or doing or engaging in what the author calls “disgusting” acts. Anytime we can work to reduce shame it is a great thing!
I want to focus this review on the authors six steps to reduce distress over a thought. They are very mindfulness based and are also extremely applicable to dealing with urges and cravings in any type of addiction.
The steps are:
J Just Thoughts
A Accept and Allow
F Float and Feel
T Let time Pass
The first step is to just recognize that an intrusive thought is just a thought. To adapt this to addiction recovery, a craving is just a craving. We can recognize it for what it is. That means we pause and label it. Thought. Craving, etc. The next step is to remind oneself that it is just a thought or craving. From there we Accept and Allow the thought or craving. The author says that this means we actively allow the thoughts to be there. We don’t act on it, but we also do not need to give the thoughts or cravings attention. For example, someone in recovery might say to themselves, this is just a craving.
The Float and Feel step requires perhaps a bit more explanation. The author says to float above the fray and allow the feelings to just stay there. This is described as an attitude of “non-active, non-urgent, non-effortful observation.” This is also called the Wise Mind. Float and Feel is to passively allow the thought or craving to be and not engage with it. Perhaps one of the hardest steps is to just let time pass. This is to learn to sit with the feelings that come up and not try to immediately do something to get rid of them. Recognize that a thought or a craving is just a false message from our brain. The last step is to Proceed or just keep going. Continue with whatever it was that you were doing.
Of course, as with most difficult things we need to change, this process is much easier said than done. These steps take time to learn and even more time to master. A good first step is to just be able to recognize a thought or a craving and label it for what it is. I am having a craving. I am just going to try to sit with it as long as I can without judging it. Thoughts and cravings pass.
Overcoming Unwanted Intrusive Thoughts is a nice primer to help individuals start to understand their intrusive thoughts. It also helps them come to understand if the thoughts are simply intrusive thoughts or indicative of something else, such as OCD, that might require professional help to master.
One of the unfortunate, but predictable, outcomes of the horrific Georgia shooting at the massage parlors is the rash of news articles talking about how Sex Addiction isn’t real. Most of what people are saying tends to focus on the lack of inclusion in the DMS-V and how sex addiction can be confused with moral incongruence. (Click here for a previously written post regarding moral incongruence)
At the moment, I do not have the time to write a full blown narrative regarding the research on sexual addiction that has been conducted since the publication of the DSM-V in 2013. I will, however, leave you with a few paragraphs regarding the topic that I recently included in a sentence mitigation report.
Diagnostic and Statistical Manual of Mental Disorders– V: (DSM-V)
In the current edition of the DSM, there is no stated mental disorder that encompasses the concept of sexual addiction, be that sexual addiction, sexual compulsivity, hypersexual disorder, etc. To simply negate a mental health phenomenon because it is not in a version of the DSM that is currently almost 8 years old is to negate both the history of the disorder with the DSM and the body of research that has been conducted since the DSM-V work group decided against including Hypersexual Disorder.
Prior to the publication of the newest edition of the DSM-V in 2013, the Sexual and Gender Identity Disorders Workgroup (Kafka, 2014) considered the inclusion of Hypersexual Disorder into the upcoming edition of the DSM. The suggested diagnostic criteria were as follows:
Specify if masturbation, pornography, sexual behavior with consenting adults, cybersex, telephone sex and strip clubs.
It was ultimately decided that Hypersexual Disorder would not be included into the DSM-V. The main reasons cited for the lack of inclusion were concerns around diagnostic accuracy, moral and cultural confounds and a lack of research supporting the concept (Kafka, 2014).
In the nearly 8 years since the publication of the DSM-V, a vast body of scientific research in peer reviewed journals has been published seeking to understand the concept of sexual addiction and compulsivity which has also been termed hypersexuality.
A recent metanalysis was published by Grubbs et. al. (2020) that systematically reviewed the scientific research on the topic. Research on the topic, alternatively called sexual addiction, sexual compulsivity, hypersexuality, and compulsive sexual behavior began in the mid 1990’s. Research into the topic increased during the time that the DSM-V was in development. Research on the topic continues to expand. The Grubbs et. al. (2020) metanalysis included 371 papers published in peer reviewed scientific journals documenting the results of 471 individual scientific studies.
The Grubbs et. al. (2020) meta-analysis yielded several findings. On the negative side, the study found that there was a lack of rigorous outcomes studies for the treatment of Compulsive Sexual Behavior. Therefore, to date, there is no gold standard approach to treating the issue. The study did reveal that the Hypersexual Behavior Inventory (Reid et. al., 2011) is a well validated and clinically useful tool to assess Compulsive Sexual Behavior. The main finding pertinent to this case is that there is “clear evidence that CSB is a real phenomenon with clinical implications.” (Grubbs et. al., 2020, p 11)
International Classification of Diseases – 11 (ICD-11)
The ICD-11 is the international equivalent of the DSM-V in the United States. The International Statistical Classification of Diseases is published by the World Health Organization and its most recent version was published in 2019 (WHO, 2019). Like the DSM, prior to any condition being accepted into the ICD there is a process of extensive debate and consideration. The ICD-11 does include a diagnosis of Compulsive Sexual Behavior Disorder (CSBD) which is classified under impulse control disorders. The diagnostic criteria share some traits with the proposed DSM-V diagnostic criteria for Hypersexual Disorder.
The Diagnostic criteria for Compulsive Sexual Behavior Disorder (ICD-11)
Essential (required) features for compulsive sexual behavior disorder:
The inclusion of the rule out relating to erotic conflict or moral incongruence is a necessary criterion to address historical concerns about pathologizing sex with a label of addiction or compulsivity. Simply engaging in a sexual behavior that is non-normative or outside of a person’s religious or moral belief is not sufficient to diagnose Compulsive Sexual Behavior Disorder according to the ICD-11.
Bothe, B., Potenza, M.N., Griffiths, M.D., Kraus, S.W., Klein, V., Fuss, J., & Demetrovics, Z. (2020). Journal of Behavioral Addictions 9(2), 247-258.
Gola, M., Lewczuk, K., Potenza, M.N., Kingston, D.A., Grubbs, J.B., Stark, R. & Reid, R. (2020). What should be included in the criteria for compulsive sexual behavior disorder. Journal of Behavioral Addictions published online November 25, 2020.
Grubbs, J.A., Hoagland, K.C., Lee, B.N., Grant, J.T., Davison, P, Reid, R.C. & Kraus, S.W. (2020). Sexual Addiction 25 years on: A systematic and methodological review of empirical literature and an agenda for future research. Clinical Psychology Review (82), 1-15.
Kafka, M.P. (2014). What happened to hypersexual disorder? Archives of Sexual Behavior, 43(7), 1259-1261.
Reid, R.C., Garos, S. & Carpenter, B.N. Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sexual Addiction and Compulsivity, 18(1), 30-51.
Last night, after my final session ended at 8 pm, I looked at the news quickly before I packed up to leave the office. The biggest piece of news was the horrific murder of eight people, many of whom were women of Asian descent, who were murdered in a shooting spree. These stories were followed by news that the shooter said he did this because of his sex addiction.
In a moment of full transparency, I will acknowledge that my thought after seeing sex addiction being brought up as a motive for a mass shooting was, “oh no, we don’t need this.” The legitimacy of sex addiction continues to be hotly debated in some circles and when horrible things happen and sex addiction is spoken about in conjunction with these horrific acts, it can add fuel to the debate fire. I spent the night pondering if I was going to write about the event and obviously decided to do so.
I would like to start this post by saying that I am deeply sorry for the victims and their families. The tragedy of these violent deaths is compounded by the fact that many women who work in these massage parlors are victims of sex trafficking. I am also very sorry that the man who committed these crimes felt such despair that he thought his only option was to resort to such an extreme and violent act.
As much of my work is in the field of forensic psychology, that is the lens through which I am viewing this. When a person commits a crime, there are both aggravating and mitigating factors. As I have no knowledge of the specifics in this case, I am going to speak in generalities.
Mitigating factors are things that may influence the person to commit the act. They are in no way, shape or form an excuse for the commission of the crime. They are the things that can explain the underlying factors that drove the person to the final criminal act. It is well established that addiction is frequently a mitigating factor in many crimes. We know that there is an association between drug addiction and crimes such as forgery, theft, etc. Other crimes may be influenced by a person’s untreated mental health issues.
In this case, it may well be that a mitigating factor was sexual addiction. This would mean that the perpetrator felt he had an addiction to sexual behaviors and that he could not control them. Per newspaper reports, he sought treatment for these issues. At some point, his behavior continued to feel out of control and he likely had deep feelings of shame around his sexual behavior (news reports have claimed that his religious beliefs fueled this shame). Obviously, there may be other mitigating factors as well.
On the other side of mitigating factors are aggravating factors. These are issues that make the crime particularly heinous. Again, not having reviewed the case, I can speculate that an aggravating factor here is the fact that many women who work in massage parlors are victims of sexual trafficking. Research from many nonprofit advocacy groups that work to stop sex trafficking has shown that many of these women are often from China or South Korea. These women are often under extreme financial pressure, have limited resources and are recruited to work by fraudulent means and often do not know that they will be expected to perform work of a sexual nature. If the victims in this case were also victims of sexual trafficking, it makes them even more of a vulnerable population.
In this case, we can speculate that this man’s feelings of despair over his inability to control his sexual behavior overrode his sense of right and wrong. As I stated before, mitigating factors are explanations and not excuses. A person who has been to treatment has knowledge of coping skills and resources that could have been used instead of resorting to an act of violence. There were other options.
There are two major take aways from this horrible act of violence in Georgia.
If you feel that you are suffering from a sexual addiction or are having difficulty controlling your sexual behaviors, please reach out to our office. We will be happy to direct you to treatment in your area.
Resources to learn about Sex Trafficking
Resources for Treatment
I saw ACE: What Asexuality Reveals About Desire, Society and the Meaning of Sex by Angela Chen mentioned on the list serve for the Association for the Treatment of Sexual Abusers (ATSA). As a clinician who works nearly entirely with clients with some type of problematic sexual behavior, I was keen to read this book. In years of doing this work, I had not been exposed to any work specifically about asexuality. In all honesty, I had been exposed to truly little relating to asexuality. If I dig back into the recesses of my brain for work in college and graduate school, I cannot recall the topic being brought up. In CSAT training, there was talk of sexual anorexia, but nothing about asexuality.
First, I need to admit that I am guilty of saying that sexuality is a part of being a human being and everyone has a sense of sexuality. In our work with problematic sexual behavior and sexual offending, don’t I say that our work is to find out what their sense of healthy sexuality is? Yes, I do. And I have not given too much thought to whether or not my clients are asexual. They do not really bring it up but neither do I. So, the first thing I need to say about this book is that it made me take a very hard look at my own assumptions about sexuality and the work I do. As a sex positive therapist, I am incredibly open about all types of sexuality. I have never not believed in asexuality; I just never gave it too much thought. If it did nothing else, this book made me a better therapist for making me investigate my own assumptions and challenge myself to be better.
This book is also a great way to introduce a person to the preferred language around sexuality that includes asexuality. Again, owning my ignorance, I had not heard the term allosexual. Someone who is allosexual experiences sexual attraction to another person. This contrasts with someone who identifies as asexual, meaning they have a persistent lack of sexual attraction to any gender. This book also introduced me to the term demisexuality. A person may identify as demisexual if they do not experience sexual attraction to another person unless they have formed a strong emotional bond with them. My clients had spoken of this before, but I (we) never named it.
This book also makes the reader take a hard look at their assumptions. Many people might assume that if a person is asexual, that they do not then feel romantic love and are never in relationships. This delve into asexuality provides us with the reality. Many people who identify as asexual find romantic love, have great relationships and can even be kinky! The nuances of these relationships are many and require honesty and communication between the parties. But don’t all relationships require this anyway?
The only downside to this book for me (and it is a small matter) is that, at times, it feels a bit preachy. However, if I look at how our culture ignores, talks about or judges asexuality, I can understand how the author could end up writing in this tone for some of the book. When you are part of a community that has been basically invisible, you want to be heard and heard authentically.
I highly recommend this book to anyone who works in therapy or sexual education. Particularly this book is important for those of us who work with clients with sexual issues of any kind. It can help us be better at our work and meet our clients where they are without judgement.
Rob Weiss’s latest contribution to the recovery community is his book Prodependence: Moving Beyond Codependency. This book, and the philosophy of prodependence are an alternate take on the idea of codependency that has been rampant in the addiction recovery movement for decades.
Codependence has been defined as “a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition, such as an addiction (Merriam-Webster). In the recovery community the spouse, partner or family of someone suffering from an addiction is often labeled a codependent. This term came into the recovery lexicon in the 1980’s and became part of everyday language. A codependency diagnosis was rejected by the APA for the inclusion into the DSM but the “diagnosis” has persisted and there are 12 step meetings for Codependents (CODA).
Rob Weiss’s argument in putting forth the concept of Prodependence is that it codependence is not helpful to the family members of those in active addiction or in recovery from addiction. Family members loved ones or care givers of people with addictions, in the codependency model, are often told that they are part of the problem as opposed to just trying to cope with a very difficult situation.
Prodependence is as term to describe “attachment relationships that are healthfully interdependent, where one person’s strengths support the vulnerabilities of another and vice versa, with this mutual support occurring automatically and without question.” (p53.) Rob prefers this concept as it celebrates a loved one’s desire to help the addict in their life without shame or blame.
Prodependence looks at the behaviors of the partners or family members of an addict as attempts to maintain or restore healthy attachment and not as enabling. Treating prodependence is similar to treating co-dependence in terms of encouraging healthy boundaries and self care. However, it differs by being a strength based, attachment driven model that values loved ones of an addict.
Another key idea behind the concept of prodependence is the idea that a person with an addiction has an attachment disorder and needs healthy attachment to truly heal from their addiction. Encouraging prodependence, treating addicts and their loved ones with kindness, empathy and respect, can help repair earlier attachment traumas and aid healing.
Another key difference between prodependence and codependence is that prodependence looks at addiction as an intimacy disorder. As opposed to the older idea of tough love, intimacy disorders are treated with the pursuit of healthy, intimate and ongoing connection.
While suggesting that codependence may be an outdated concept is risky, it does not feel groundbreaking. This book and the idea of prodependence feels like the natural conclusion when you take into account what we now know from the research about attachment, intimacy and shame. As Johann Hari suggests in his Ted Talk from a number of years ago, “What if all we were taught about addiction is wrong?” Perhaps, instead, we should treat people with addictions and their families and loved ones without shame and blame. We might get farther modeling healthy attachment and boundaries combined with compassion and empathy instead.
Halloween is at the end of this week. Those of us who work in the field know that this is the time of year that probation officers ask us if we have made sure all of our clients have a plan for Halloween and know they are not to participate in the holiday. Luckily, the area of the country where our practice is located does not ask for more than for our clients to not participate in the holiday. In other parts of the country, things are much different.
For example, here is a little summary of the news in the past week regarding sex offenders and Halloween.
The Patch, a news source all over the country, posted multiple articles providing detailed maps of the location of all of the registered sex offenders in their target areas. A town in Indiana performed a Halloween crackdown sweep of Sex offenders who failed to register. A news source in Ohio posted an article on how to keep your children safe from sex offenders on Halloween.
In Georgia, the Butts County Sheriff’s Office places warning signs in front of the homes of anyone on the sex offender registry for Halloween. Several people on the registry sued the Sheriff’s office and recently lost the lawsuit. The court ruled that this practice did not violate their rights.
In some states, registered offenders who are still on probation or parole are provided with a list of Halloween requirements that may include: being home after a certain time, not answering the door to children, not handing out candy, not having outside lights on, and having a sign on your door that specifically states you are not giving out candy.
We can all agree that sex crimes against children are profoundly serious and something that everyone should work to prevent. The question arises as to whether Halloween is a higher risk day than any other day of the year. To answer this question, Chaffin et a. (2009) conducted a study that analyzed child sex crime rates on Halloween.
The authors analyzed child sex crime victims from 1997 to 2005. The data came from up to 30 states. They looked at a span of days that included Halloween as some locations have trick or treat events before or after the actual date of Halloween.
There was a total of 67,307 abuse reports during the Halloween time frame over the 8-year period. The results of the analysis indicated that for the children who were abused on Halloween, 73% were female and 27% male. They were abused primarily by male offenders (94%) who had an average age of 24 years old. The main result of this study was that the distribution of sexual offenses against children during the Halloween time period did NOT significantly differ from all other days of the year.
The authors of this study also looked at other crimes committed during the Halloween time period. The most common types of crime during Halloween are theft, destruction of property and assault. Vandalism and destruction of property accounted for a significantly greater proportion of the crime around the Halloween time period. Sex crimes accounted for a little more than 1% of all Halloween crime and sex crimes against children accounted for less than .2% of Halloween crime incidents.
This data, and the fact that we know that the majority of sex crimes against children are committed by someone known to the child, call into question the efficacy of spending the valued time and resources of police and probation departments engaging in extra monitoring or policing of registered sex offenders on Halloween. Perhaps resources could be better spent policing other crimes on Halloween such as vandalism. The CDC has reported that children are four times more likely to be killed by a pedestrian/motor vehicle accident on Halloween than any other day of the year.
Extra policing of sexual offenders on the registry during Halloween might make the public feel better or feel that their children are safer. However, it appears that these efforts are more publicity than efficacy in reality.
Chaffin, M., Levenson, J., Letourneau, E. & Stern, P. (2009). How safe are trick or treaters? An analysis of child sex crime rates on Halloween. Sexual Abuse: A Journal of Research and Treatment. (21) 3, 363-374.