Women & Sex Addiction
Patrick J. Carnes, Ph.D.
© 2010
The Past
• Sex addiction was regarded as primarily a
male problem.
• The numbers paralleled alcoholism and
gambling: for every three men (75%) there
was one woman (25%).
Women & Sex Addiction © Carnes, 2006
© 2010
The Present
• In treatment, our female patient population
has equaled and sometimes exceeded our
male patients.
• Evidence of this shift is also shown in recent
large studies of internet sex in which
problematic cybersex behavior by women
was over forty percent (40%).
Women & Sex Addiction © Carnes, 2006
© 2010
Gender Differences
• Journal article: Patrick J. Carnes, “Gender
Differences in Normal and Sexually Addicted
Populations”, Am J Preventive Psychiatry &
Neurology, 3:1, Spring 1991, pp.16-27
Women & Sex Addiction © Carnes, 2006
© 2010
Men
• Men in this study tended towards “behaviors
that objectify their partners and require little
emotional involvement.”
• Specific examples of these behaviors:
anonymous sex, prostitution, pornography,
exhibitionism, and fratteurism.
Women & Sex Addiction © Carnes, 2006
© 2010
Women
• Women in this study tended towards
“behaviors that distort power – either in
gaining control over others or being a victim.”
• Examples here included: sexual conquest,
working as prostitutes, and sadomasochism.
Women & Sex Addiction © Carnes, 2006
© 2010
Today
• Many of these trends persist; however, a new
pattern of trends are emerging.
• We are seeing more “male” types of behavior
in women: pornography collections,
compulsive use of prostitutes, and
aggressiveness in approaching prospective
sex partners.
Women & Sex Addiction © Carnes, 2006
© 2010
Why the Shift
• Much speculation exists as to why.
• Does cybersex play a role, due to the
anonymity and safety of ones own home?
• Is it a shift in culture and sexual mores?
• Is exercising greater sexual freedom causing
women to accidentally manifest compulsive
behaviors?
Women & Sex Addiction © Carnes, 2006
© 2010
The Story of Angie
Women & Sex Addiction © Carnes, 2006
© 2010
In Search of Patterns
• One of the key issues to be aware of is that
sexual aversion or “anorexia” (DSM –
302.79) is a frequent companion to sexual
addiction.
• Like eating disorders, the binge/purge
phenomenon is common.
• In treatment we encounter all three –
addiction, avoidance, and binge/purge cycles.
Women & Sex Addiction © Carnes, 2006
© 2010
In Search of Patterns
Table 1. Sexual addiction
vs. anorexia.
% “Yes”
% “Yes” % “Yes”
Females
Males Gay Males
(N = 590)
Assessment –
Sexual Addiction
59
90
94
Assessment –
Sexual Anorexia
70
36
48
Women & Sex Addiction © Carnes, 2006
© 2010
In Search of Patterns
% “Yes”
Females
% “Yes”
Males
% “Yes”
Gay Males
(N = 588)
(N = 894)
(N = 121)
Alcoholism
46
46
49
Bulimia/Anorexia (Food)
27
5
8
Caffeine
37
37
33
Compulsive Eating
34
18
20
Compulsive Spending/Debting
36
27
41
Compulsive Violence/Raging
18
14
12
Compulsive Working
29
37
36
High-risk Behaviors/Danger
30
33
46
Nicotine
34
26
26
Substance Abuse
41
40
54
Table 2. Other addictions.
Women & Sex Addiction © Carnes, 2006
© 2010
In Search of Patterns
% “Yes”
Inpatient
Females
(N = 585)
% “Yes”
Online
Females
(N = 4979)
Were you sexually abused as a child or adolescent?
57
57
Have you stayed in romantic relationships after they
became emotionally or physically abusive?
75
74
Does your spouse (or significant other) every worry or
complain about your sexual behavior?
58
59
Do you ever feel bad about your sexual behavior?
79
89
Has your sexual behavior ever created problems for you
and your family?
63
76
Have you ever sought help for sexual behavior you did
not like?
28
28
Has anyone been hurt emotionally by your sexual
behavior?
66
79
Have you ever felt degraded by your sexual behavior?
75
86
When you have sex, do you feel depressed afterwards?
60
50
Has your sexual activity interfered with your family life?
46
58
Table 3. Contrast of inpatient and online
assessments - Similar.
© 2010
In Search of Patterns
Table 4. Contrast of inpatient and online
assessments - Dissimilar.
% “Yes”
Inpatient
Females
(N = 585)
% “Yes”
Online
Females
(N = 4979)
Do you often find yourself preoccupied with sexual
thoughts or romantic daydreams?
52
92
Do you feel that your sexual behavior is not normal?
37
53
Do you have trouble stopping your sexual behavior when
you know it is inappropriate?
50
88
Have you ever worried about people finding out about your
sexual activities?
63
91
Have you made efforts to quit a sexual activity and failed?
38
78
Do you hide some of your sexual behavior from others?
61
93
Do you feel controlled by your sexual desire or fantasies of
romance?
36
73
Do you ever think your sexual desire is stronger than you
are?
39
79
© 2010
Gambling
(N=103)
100%
83%
50%
Sexual Addiction
Sexual Anorexia
Both
48%
31%
0%
Women & Sex Addiction © Carnes, 2006
© 2010
Alcoholism
(N=740)
100%
80%
Sexual Addiction
Sexual Anorexia
Both
52%
50%
33%
0%
Women & Sex Addiction © Carnes, 2006
© 2010
Substance Abuse
(N=664)
100%
82%
50%
Sexual Addiction
Sexual Anorexia
Both
49%
33%
0%
Women & Sex Addiction © Carnes, 2006
© 2010
Eating Disorder
(N=213)
100%
65% 66%
Sexual Addiction
Sexual Anorexia
Both
50%
33%
0%
Women & Sex Addiction © Carnes, 2006
© 2010
Addiction Interaction
100%
100%
Sexual
Addiction
Sexual
Anorexia
Both
50%
Sexual
Addiction
Sexual
Anorexia
Both
50%
0%
0%
Gambling
Eating Disorder
100%
100%
Sexual
Addiction
Sexual
Anorexia
Both
50%
0%
Sexual
Addiction
Sexual
Anorexia
Both
50%
0%
Alcoholism
Substance Abuse
Women & Sex Addiction © Carnes, 2006
© 2010
• Mothers …
“discover in machine gambling a highly
addictive relief mechanism – a means of
escape from what they experience as an
excess of demands and responsibilities
to care for others.”
Natasha Schull on
Female Machine Gamblers
Women & Sex Addiction © Carnes, 2006
© 2010
Common Language of
Technological Change
Internet sex as the “crack cocaine” of sexual
compulsivity
– Al Cooper Ph.D.
Machine video poker as the “crack cocaine” of
compulsive gambling
– Robert Hunter, Ph.D.
Women & Sex Addiction © Carnes, 2006
© 2010
Definition of a Black Hole:
A celestial phenomenon when a
massive star collapses from its own
gravity. A black hole has such a
strong pull that not even light can
escape from it.
© 2010
Addiction Interaction
An addiction phenomenon where
multiple addictions combine to
overwhelm a person by their
complexity and power. Phenomenon
is so strong, no specific focus is
strong enough to escape from it.
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
•
•
•
•
•
•
Compulsive Attachment: Key
Characteristics
Troubled people
Hero and pathological giving
High Intensity and Drama
Boundary Collapse
Impression Management
Conflict Avoidance
Women & Sex Addiction © Carnes, 2006
© 2010
“The addictive dependence
on feelings of pain…”
Alice Miller, The Drama of the Gifted
Child
© 2010
•
•
•
•
•
•
despair
intensity/risk
self-loathing
shame
misery
rage
Women & Sex Addiction © Carnes, 2006
© 2010
Addiction
Interaction
Disorder
Addictions more than coexist, they
interact, reinforce, become part of
one another. They become packages.
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
Cross Tolerance
A. Simultaneous increase in addictive behavior
in two or more addictions.
B. Transfer of a high level of addictive activity
with little or no developmental sequence.
Women & Sex Addiction © Carnes, 2006
© 2010
Withdrawal
Mediation
One addiction serves to moderate,
relieve, or avoid withdrawal from
another.
© 2010
Replacement
One addiction replaces another with
majority of emotional and behavioral
features.
© 2010
Alternating
Addiction Cycles
Addictions cycle back and forth in a
patterned systemic way.
© 2010
Masking
Addict uses one addiction to cover
up for another, perhaps more
substantive addiction.
© 2010
Ritualizing
Addictive behavior of one addiction
serves as a ritual pattern to engage
another.
© 2010
Intensification
Fusion dependence: neither addiction
separately is sufficient; only
simultaneous use is sufficient.
© 2010
Intensification
Partial Fusion: Addict combines
addictions in such a fashion to be
more potent than each addiction
separately; addictions are used
independently part of the time.
© 2010
Intensification
Binge Features: episodic multiple
use, yet functionally independent of
one another.
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
Women & Sex Addiction © Carnes, 2006
© 2010
Numbing
Addiction is used to medicate shame
or pain caused by other addiction or
addictive bingeing.
© 2010
Disinhibiting
One addiction is used to lower
inhibitions for other addictive acting
out.
© 2010
Combining
Mixing addictive experiences to
moderate responses due to
neuropathway interaction.
© 2010
Addiction Interaction:
Patient Recognition (N=650)
•
•
•
•
•
Cross Tolerance – 59%
Withdrawal Mediation – 59%
Numbing – 59%
Fusion –57%
Masking – 56%
Women & Sex Addiction © Carnes, 2006
© 2010
Addiction Interaction: Patient
Recognition (N=650)
•
•
•
•
•
Replacement – 47%
Disinhibiting – 46%
Ritualizing – 44%
Combining – 38%
Alternating Addiction Cycles –36%
Women & Sex Addiction © Carnes, 2006
© 2010
•
•
•
•
•
Addiction Interaction Paradigm
Changes:
Diagnostic Framework: revision of DSM
Treatment Process: depth and scope
Treatment Focus: the underlying issues
Relapse Prevention: addictions as packages
Altered Strategies: first step, screen,
neuropathways
• Mirror Patient Realities: professional
allegiances
Women & Sex Addiction © Carnes, 2006
© 2010
TRAP DOORS
• Have you ever sought Treatment for
problematic sexual behaviors? (Prior efforts
to seek help are a key variable.)
• Have any of your Relationships been
damaged or disturbed as a result of your
sexual behavior? (Almost always there is a
concern about relationship damage.)
• Were you sexually Abused as a child or
adolescent? (Sexual abuse is a key antecedent
for compulsive sex.)
Women & Sex Addiction © Carnes, 2006
© 2010
TRAP DOORS, cont’d
• Are you Preoccupied with thoughts about sex?
(Preoccupation is one of the defining issues in
diagnosis.)
• Do you experience any symptoms of Depression
because of your sexual behavior? (Despair, remorse,
and feelings of hopelessness result from failure to
manage sexual behavior.)
• Do you feel like your sexual behaviors are Out of
Your Control? (Loss of control is another key
defining variable for determining the presence of an
addiction)
Women & Sex Addiction © Carnes, 2006
© 2010
TRAP DOORS, cont’d
• Have you ever felt the need to keep your
sexual behavior Out of Sight? (Hiding
behavior and living a double life characterize
the sex addict’s experience and deep distrust.)
• Have you engaged in dangerous, illegal, or
otherwise Risky Sexual Behaviors? (Sexual
risk is one of the hallmarks of sex addiction.)
• Have you experienced Shame because of
your sexual behavior? (Feeling defective is
core to the sexual addict’s inner world.)
Women & Sex Addiction © Carnes, 2006
© 2010
Additional Information:
Women & Sex Addiction © Carnes, 2006
© 2010
IITAP
• International Institute for Trauma & Addiction
Professionals (IITAP)
• For more on the Certified Sex Addiction Therapist
(CSAT) trainings, go to:
www.iitap.com
Or email
Info@iitap.com
Or call
480-575-6853
Women & Sex Addiction © Carnes, 2006
© 2010
Gentle Path Press
• For books, workbooks, CDs & DVDs on the
subject of sex addiction and recovery, go to:
www.gentlepath.com
Or call
1-800-708-1796
Women & Sex Addiction © Carnes, 2006
© 2010
Sexhelp
• For more information about Dr. Patrick
Carnes, links to other resources, current
topics in research and popular literature, go
to:
www.sexhelp.com
Women & Sex Addiction © Carnes, 2006
© 2010