SEX ADDICTION 101:
SCREENING AND
TREATMENT
Christina Schmolke, R. Psych
Certified Sex Addiction Therapist Candidate, International
Institute for Trauma and Addiction Professionals
Objectives
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Overview
Screening
Resources
What is Sex Addiction?
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Found in DSM IV under Sexual Disorder, Not
Otherwise Specified (American Psychiatric
Association, 2001)
Distress about a pattern of repeated sexual
relationships where the individual is
objectified
What is Sex Addiction?

Sexual addiction is defined as any sexually-related,
compulsive behavior which interferes with normal
living and causes severe stress on family, friends,
loved ones, and one's work environment
(sexhelp.com)
What is Sex Addiction?


“An attempt to secure attachment without risking
emotional vulnerability” (Adams, personal
communication, January 28, 2011)
Courtship disorder
Prevalence

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3-10% of the general population (Carnes, 1992;
Lanngstrom & Hanson, 2006)
Past: 75% male, 25% female
Now: Women equally as likely to access inpatient
resources as men (Carnes, 2006)
40% of people with severe cybersex addiction are
women (Cooper et al., 2000)
Associated Factors (Carnes, 1992)

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Rigid (77%) and disengaged (87%) family
background
Emotional abuse (97%)
Sexual abuse (83%)
Physical abuse (71%)
Sex Addiction and Substances
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Genetic Factors
Co-morbid substance Abuse (42%)
Cocaine use (50-70%; Washton, 1989)
Types of Addiction

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Substances
 Alcohol
 Cocaine
 Methamphetamine
 Marijuana
Feelings
 Rage
 Fear
 Love
 Self-loathing
Process
 Sex
 Work
 Exercise
 Food
 Money

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Compulsive Attachments
 Rescuing
 Co-dependence
 Traumatic bonding
Levels of Behaviours

Level 1: Culturally accepted
behaviours
 Masturbation
 Compulsive
Relationships
 Pornography (cybersex)
 Anonymous sex
 Prostitution
Levels of Behaviours

Level 2: Clear violation of cultural
norms
 Exhibitionism
 Voyeurism
 Indecent
phone calls or liberties
Levels of Behaviour

Level 3: Profound Boundary
Violations
 Child
molestation
 Incest
 Sexual
assault (rape and violence)
Criteria for Sex Addiction
(Carnes, 2010)



1. Recurrent failure to resist impulses to engage
in specific sexual behaviour
2. Frequent engaging in those behaviours to a
greater extent or over a longer period of time
than intended
3. Repeated unsuccessful efforts to control, cut
back on, or to stop
Criteria for Sex Addiction


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4. Inordinate amount of time spent in obtaining sex,
being sexual, or recovering from sexual experience
5. Preoccupation with the behaviour or preparatory
activities
6. Frequent engaging in the behaviour when
expected to fulfill other obligations
Criteria for Sex Addiction
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7. Continuation of the behaviour despite
negative consequences
8. The need to increase the frequency and
intensity of behaviour to achieve the desired
effect
9. Giving up or limiting social, occupational, or
recreational activities because of the behaviour
10. Distress, anxiety, restlessness, or irritability
after engaging in the behaviour
Adverse Consequences (Carnes, 1992)
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Loss of a partner (40%)
Severe marital conflict (70%)
Suicidal obsession (72%)
Suicide attempts (17%)
Exposure to STIs (68%)
Legal risks (58%)
Financial consequences (58%)
Contributing Factors
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Genetic factors
Family dysfunction (child abuse)
Inability to sustain intimacy
Emotion Management
Addiction migration
Sexual Anorexia (Carnes, 1997)
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Extreme aversion to, or avoidance of, anything
sexual in nature
Loss of appetite for sexual interactions
Preoccupation with others’ sexuality
Sex is my most terrifying need
Patterns of Behaviour: The 10 Types
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1. Fantasy Sex
2. Voyeurism
3. Exhibitionism
4.Seductive Role Sex
5.Trading Sex
Patterns of Behaviour: The 10 Types
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6. Intrusive Sex
7. Paying for Sex
8. Anonymous Sex
9. Pain Exchange Sex
10. Exploitive Sex
Child Pornography
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

Canadian law forbids the use of production,
distribution, and possession of child
pornography
Streaming child pornography
Have any of your sexual activities involved
minors?
Age of Consent

In 2008, the Tackling Violent Crime Act took effect
and raised the age of consent from 14 to 16 in
Canada. Exceptions for this act are that a youth of
12 or 13 can consent to activity if his/her partner is
less than two years older than them. A 14 or 15year-old youth can consent to sexual activity with a
partner who is less than five years older then them.
Core Beliefs

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I am basically a bad, unworthy person
No one would love me as I am
My needs are never going to be met if I have to
depend on others
Sex is my most important need
The Addictive Cycle
Belief
System
Unmanageability
Impaired Thinking
Addictive
Cycle
Preoccupation
Shame
Despair
Guilt
Ritualization
Compulsive
Behavior
© 2008
Online Tests
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Sexual Addiction Screening Test (SAST)*
Sexual Addiction Risk Assessment Test (SARA)
Internet Sex Screening Test (ISST)*
Betrayal Bond Test*
Assessment
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Sexual Dependency Inventory, Revised (SDI-R)
240 behaviours
Past versus current behaviours
Administered by CSATs
Task-Based Treatment
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Group Therapy (175 hours)
Twelve Step Meeting
Sponsor
Individual Counselling (2-3 years)
Steps One through Nine
Family Recovery
Couples Recovery
Exercise/Nutrition
Tasks 1–7
1.
2.
3.
4.
5.
6.
7.
Break through denial
Understand addiction
Surrender
Limit damage
Establish sobriety
Physical integrity
Culture of support
Facing the Shadow &
Recovery Start Kit
Tasks 8–19
8. Multiple addictions
9. Cycles of abuse
10. Reduce shame
11. Grieve losses
12. Closure to shame
13. Relationship with self
14. Financial viability
15. Meaningful work
16. Lifestyle balance
17. Building support
18. Exercise and nutrition
19. Spiritual life
Recovery Zone: Creating
Personal Recovery
Tasks 19–30
19. Spiritual life
20. Resolve conflicts
21. Restore healthy
sexuality
22. Family therapy
23. Family relationships
24. Recovery commitment
25. Issues with children
26. Extended family
27. Differentiation
28. Primary relationship
29. Coupleship
30. Primary intimacy
Recovery Zone II:
Creating Family
Recovery
Overview of 12-Step Fellowships

Sexaholics Anonymous (SA)
 Most
conservative and evangelical
 Only acceptable forms of sexuality are married
relationships
 Lesbians and Gay Males can’t be sexual by their
standards
Overview of 12-Step Fellowships

Sex Addicts Anonymous (SAA)
 Sobriety
personally defined using three circle method
 Uses Carnes’ materials
 Less clear on sexual anorexia
Overview of 12-Step Fellowships

Sex and Love Addicts Anonymous (SLAA)
 Largest
fellowship
 First to identify sexual anorexia and the love addict
 Women attend more often
Screening with PATHOS
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Preoccupied - Do you often find yourself
preoccupied with sexual thoughts?
Ashamed - Do you hide some of your sexual
behavior from others?
Treatment - Have you ever sought therapy for
sexual behavior you did not like?
Hurt Others - Has anyone been hurt emotionally
because of your sexual behavior?
Out of Control - Do you feel controlled by your
sexual desire?
Sad - When you have sex, do you feel depressed
afterwards?
Resources

International Institute for Trauma and Addiction
Professionals
 www.iitap.com

Canada Alcohol and Drug Rehab
 www.canadadrugrehab.ca
IITAP
International Institute for Trauma & Addiction Professionals (IITAP)
For more on the Certified Sex Addiction Therapist (CSAT)
trainings, the task-centered approach to addiction recovery, and
assessment testing for sexual, work and financial issues go to:
www.IITAP.com
or email
Info@IITAP.com
or call
(480) 575-6853
SexHelp
For additional information about
Dr. Patrick Carnes, links to other resources,
current topics in research, and popular literature, go to:
www.SexHelp.com
© 2008
Contact Information
Email: psychologistchristina@shaw.ca
Website: www.psychologistchristina.com
Blog: www.psychologistchristinablog.com
Phone: 780.239.3344