00:09:54.380She dives deeper into this very complex topic.
00:09:57.600But nowadays, the ICD called it compulsive sexual behavior disorder.
00:10:04.280You're probably curious why you heard that sound just now.
00:10:08.240I'll explain in a while after Javi finishes.
00:10:10.540So now that our field is shifting into that language, using compulsive sexual behavior disorder versus sex addiction, however, there's still an underlying addictive component here when it comes to sex addiction.
00:10:24.180And so when we think about addiction, there's those usual criteria that we're looking for.
00:10:28.540So when it comes to sex addiction, we're looking for those exact same criteria.
00:10:32.620Loss of control, preoccupation, withdrawal, escalation, negative consequences, all of those things that we would typically look for in an addictive process, we're also looking for in sex addiction.
00:10:45.060If those things are not present for that client, then maybe we're not working with a sex addiction.
00:10:51.000Maybe we're just working with someone who has a higher sex drive, someone who has different interests.
00:10:59.140It's a theme that echoes throughout history.
00:11:01.980We've seen how unchecked sexual compulsions have destroyed public figures, from Hollywood moguls to CEOs.
00:11:10.040Daniel, who we will check in with later, may not be on magazine covers, but his struggle is the same.
00:11:17.760And when we think about compulsive sexual behavior, we often only imagine it as a modern issue.
00:11:24.200But allow me to take you back to 1812, where Dr. Benjamin Rush, regarded in 1965 by the American Psychiatric Association as the father of American psychiatry, is examining a, quote, morbid state of sexual appetite in his book, Diseases of the Mind.
00:11:44.160Rush recognized the profound personal and societal impacts of unregulated sexual desires long before modern psychology coined terms like hypersexuality.
00:11:56.820He believed such urges could lead to moral and physical decay.
00:12:01.000In Chapter 18, Rush included not just his reflections, but also personal letters he received from distressed patients or their loved ones.
00:12:12.020One such letter detailed the anguish of a young man tormented by uncontrollable desires.
00:12:19.100My dear sir, I write to you in confidence and great shame.
00:12:23.700My son, a bright and hopeful youth, now wastes away under the burden of desires he cannot quell.
00:12:31.300His pursuits, once innocent, have turned toward ruin.
00:13:28.040Mental Health Rewritten is an educational podcast.
00:13:31.380I'm pretty sure you got that gist from the history lesson we just gave you.
00:13:34.740But after all, we are an education company.
00:13:37.940And much of the content you will hear on this podcast
00:13:40.200is guided by the Diagnostic and Statistical Manual of Mental Disorders,
00:13:45.040or the DSM, which is in its fifth edition,
00:13:48.200and the International Classification of Diseases,
00:13:51.340or the ICD, which is in its 11th edition.
00:13:54.440For a full explanation of what those things are,
00:13:56.880be sure to check out our explainer trailer on our RSS feed.
00:14:01.280But when you hear that sound, that means someone on the show,
00:14:04.960more than likely a mental health professional,
00:14:07.140has mentioned something that we want to provide a full and detailed definition of,
00:14:12.340and that is usually a disorder of sorts from the ICD-11 or DSM-5.
00:14:18.400This is there to combat the sometimes harmful and misinformation
00:14:21.740that you often see on social media and the internet.
00:14:25.600We will share the definition and sometimes maybe even create a fictional scenario to help further explain.
00:14:32.740So let's get to the first one, compulsive sexual behavior disorder in the ICD-11.
00:14:39.560It is classified under impulse control disorder.
00:14:42.680This disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges, leading to repetitive sexual behaviors.
00:14:53.520The individual may engage in these behaviors despite negative consequences or derive little satisfaction from them.
00:15:02.220The diagnosis requires that the symptoms persist for an extended period, typically at least six months,
00:15:08.820and cause significant distress or impairment in personal, family, social, or important areas of functioning.
00:15:16.940It was added to the 11th edition of the ICD in 2018 and effective for global use in January of 2022.
00:15:26.040But there is something interesting here.
00:15:28.420The ICD-11 and the DSM-5 often work in tandem, but neither compulsive sexual behavior disorder or sex addiction is in the DSM-5.
00:15:44.640The DSM is still kind of figuring it out, right? They're still working on it. They're still trying to see if it fits into the addiction section. So I think there's definitely movement towards that. The ICD was able to make it fit into the compulsive nature of the diagnosis. So there's that compulsivity that comes with this too.
00:16:01.600And so it was able to show up in the ICD, which I think is great because, again, as clinicians, we can put more of a solid diagnosis on it and be able to continue to treat, whether it is a sex addiction, if it's there, there's that addictive process.
00:16:16.140But compulsive sexual behavior disorder is very encompassing in that sense.
00:16:21.400So it could really encompass anyone who is maybe acting out sexually with others or even if it's just more of a virtual presence.
00:16:28.720What Javi touches on is a critical shift in how we understand and experience compulsive sexual behavior today.
00:16:36.140The internet, social media, and mobile technology have made sexual content interactions more accessible than ever before, blurring the line between healthy exploration and compulsive use.
00:16:48.740And this accessibility changes not just the how, but the who.
00:16:52.920The landscape of sex addiction is evolving from what we once saw as the classic sex addict is something more insidious and hidden, existing quietly behind screens.
00:17:06.460A big part of that now is without proper protections.
00:17:09.760A much younger demographic now has access to this type of content.
00:20:59.180The line between hypersexuality and a high libido isn't always clear.
00:21:03.900If we're not careful, diagnosing sex addiction can feel more like a moral judgment than a clinical one.
00:21:10.300As you can see, this debate isn't just cultural, it's clinical.
00:21:14.640There is ongoing debate over whether compulsive sexual behavior is best treated through addiction frameworks
00:21:19.740or if it reflects deeper emotional and neurological issues rooted in trauma.
00:21:24.640The lack of consensus doesn't just affect diagnosis, it shapes how treatment unfolds.
00:21:30.700For clients like Daniel, this debate isn't academic.
00:21:34.300It's important because it shapes how people like him receive care
00:21:38.380and whether their struggles are met with either compassion or skepticism.
00:21:43.280And for many, just finding a name for what they're going through can be the first step towards healing.
00:21:49.740But this isn't the first time mental health professionals have debated sexuality.
00:21:54.460In the 1940s and 50s, Alfred Kinsey's groundbreaking research on human sexual behavior shook the foundations of what we thought we knew.
00:22:03.620His work was controversial, but it paved the way for many of the conversations we are having today.
00:22:11.700These differing opinions highlight the challenge facing researchers and clinicians alike.
00:22:16.920And as Javi points out, even those working to expand our understanding of compulsive sexual behavior face significant hurdles, not least of which is the lack of long-term studies and the individuals willing to participate in the research.
00:22:33.280there's a lot of research that's being done right now too with the addictive uh process when it
00:22:39.580comes to sex to porn um and I think there's just not a lot of research backing it just yet so I
00:22:45.140think that part of what the panel and the folks that working for the DSM is trying to get more
00:22:50.000research trying to get more information there's not enough people who can even say hey I'm a sex
00:22:55.280addict do research on me right so there's the it's like that lack of consensus or lack of like
00:23:01.180having people to even do the research on.
00:23:04.800There's just insufficient empirical evidence at this point.
00:23:08.840But there's a lot of folks out there who are doing that currently.
00:23:12.160There's lots of testing that's being done, lots of studies being done, short-term, long-term.
00:28:22.780And I've seen men where they can stop it.
00:28:24.960And then once they open that door, it's Pandora's box again, because they haven't learned how
00:28:29.660to truly execute and replace the behavior.
00:28:32.980And sometimes it just depends on the resources that man and the motivation in order to undo the learning.
00:28:40.720But it's possible. It's easier to catch it earlier on versus 20 years of doing something the same way all the time and there not being a true consequence.
00:28:49.960Healing from hypersexuality starts with recognition.
00:28:52.760As Dr. Dotson explains, the line between high sex drive and compulsive behavior becomes clear when trust goes away and secrecy grows and relationships suffer.
00:29:07.420Change takes time and unlearning old habits requires new, healthier ones.
00:29:12.960That's why Dr. Dotson guides men through key questions because honest reflection reveals the door to healing.
00:29:20.680So these are some questions that I'd want men to ask themselves. Do you feel like you need sex constantly? Are you constantly thinking about it? Is it hurting your relationship? So even if you're only doing it with your partner, are you bending the boundaries of your partner or are you treating them in a way that makes them feel sexualized or not good?
00:29:41.260You go behind your partners back to watch porn.
00:29:44.060Are you exhibiting behavior that would make them feel bad?
00:29:47.560A lot of people say, even though I'm only sleeping with you,
00:29:50.180some partners say watching pornography is cheating.
00:32:10.060And after working in that model for about eight years,
00:32:12.980I started to think about what was missing was a road toward sexual health,
00:32:18.180which, of course, was what a lot of his critics had said from the get-go.
00:32:21.860But he was only one man trying to figure out one problem.
00:32:25.520And so I started to look at the question of what is healthy sexuality for people who are in recovery from sex addictions.
00:32:32.240And so with that, just following my passion and my interests, I started to expand and had some interns working for me.
00:32:39.700And then together collaboratively with my husband, Douglas Evans, we built Center for Healthy Sex so that we could have intensive programs and groups and offer a full host of services for people struggling with this problem.
00:32:53.440One thing I know about recovery is that it's rarely linear.
00:32:58.380Dr. Katahakis' work has shown that many clients carry unresolved trauma from childhood,
00:33:04.920often manifesting as compulsive sexual behaviors in adulthood.
00:33:09.440Research indicates that approximately 70% of individuals with sexual addiction
00:33:14.440report histories of early life trauma or neglect,
00:33:18.680according to the College of Education at the University of Georgia.
00:33:23.020This led me to wanting to know more about the link between trauma and the disorder
00:33:27.560that led to Dr. Katahakis' book in 2016.
00:33:32.060In addition to that, how does she measure the impact of her work?
00:33:50.720But I do know that I feel incredibly grateful and honored to have had a front row seat to many, many men and women's healing process when it comes to this problem.
00:34:04.980And so many people whose sexuality was tampered with as a child, whether it was shamed or physically abused, become sexually addicted and compulsive because they don't know how else to regulate their nervous systems.
00:34:19.560And in 2016, I published a book called Sex Addiction as Affect Disregulation, which is a deep dive into the underlying science, the neuroscience of what makes human beings human and what happens when we don't get the appropriate nurturing that we need from infancy forward and how that is the beginning of the making of all types of addicts.
00:34:44.600That when a child is not getting soothing, comfort, connection, regulation of their nervous system, they start to look for other things to do that for them, whether it's video games or Internet pornography or eating or not eating, starving themselves.
00:35:01.600And then, of course, later in life as teenagers and young adults, drugs, alcohol, you name it.
00:35:07.260Dr. Katahakis' journey illustrates understanding sexual addiction and compulsive behavior often begins at the intersection of personal experience and clinical insight.
00:35:19.000The search for answers, whether for a client or oneself, reveals how deeply intertwined these behaviors are with our emotional histories.
00:35:29.260Sexual addiction rarely exists in isolation.
00:35:32.320It reverberates through relationships and not just intimate ones.
00:35:37.260creating distance mistrust and pain even when recovery begins rebuilding those fractured
00:35:44.380connections presents its own set of challenges this begins a new chapter in this conversation
00:35:52.700one that shifts from the personal experience of addiction to its ripple effects on relationships
00:35:58.540family and the very fabric of intimacy and it can be summed up in a fairly new clinical term
00:36:07.260As we explore the rival effects of addiction on relationships,
00:36:15.000one term emerges repeatedly, betrayal trauma.
00:36:18.820At its core, betrayal trauma refers to the deep psychological distress
00:36:23.760that occurs when someone we rely on for safety and emotional connection violates our trust.
00:36:31.060In the context of sexual addiction or compulsive sexual behavior,
00:36:34.180partners often experience this as a profound rupture,
00:36:38.300a shattering of the sense of security that forms the foundation of intimacy.
00:36:42.900Dr. Jennifer Freed, who pioneered the concept,
00:36:54.600the fact that the betrayal comes from someone integral to our emotional well-being.
00:36:59.820This can lead to symptoms similar to post-traumatic stress disorder
00:37:03.440or PTSD, but with the added complexity of navigating ongoing relationships with the
00:37:10.640person responsible for the harm. Dr. Katahakis explains this experience best through the lens
00:37:17.820of someone who is set with countless clients facing this very crisis. It's a really important
00:37:25.040topic and relatively new when we think about trauma, but imagine that you are living in an
00:37:31.380idyllic marriage, whether it's heterosexual, homosexual, doesn't matter. And you have a life
00:37:37.460that you're pretty, you know, perfect. You're grateful. You're both employed. You have two
00:37:43.720beautiful children. You work in the community. Maybe you're even involved in your church. And
00:37:49.780you find out that the person that you have been in love with and trusted all this time is not the
00:37:54.540person you thought they were. In fact, not only are they lying, like you didn't just catch them
00:37:59.660in a lie, but you start to learn that for the 25, 30 years of your marriage, they've
00:38:04.380never, ever been faithful to you, and that they've had multiple sexual partners, not
00:38:10.220just one, but 20, 50 sex workers, strip clubs, affair partners, spending thousands, sometimes
00:38:18.180as much as a million dollars on this affair partner or partners over time.
00:38:23.360And so what happens with people, typically women, is the reality, it's like a massive internal earthquake where what they thought was solid ground is no longer solid ground.
00:38:39.060And they don't know who to trust. They can't trust themselves because one of the refrains is, how come I didn't see this? Why didn't I know this? And also, how could he do this to me?0.63
00:38:50.800and everybody thought he was so nice and so perfect,
00:42:13.180And if you cross them, that means you are being unfaithful.
00:42:16.300Oftentimes there's one person in the relationship that doesn't see it the same.
00:42:20.720And let's just use for this instance, the man, right?
00:42:24.460So whether it's a same-sex couple or heterosexual couple, sometimes there is a person, typically the man that says, that's not cheating if we do these things.
00:42:33.140But I think that conversation really goes into what are that person's, the other partner's expectations of a healthy relationship.
00:42:40.300A lot of people want their partner to be obsessed with them so much in a healthy way because that, in their mind, gives them security and safety.
00:42:50.760So that's what people are really seeking, right?
00:42:53.120So if you break that down and you slice it out, people are really seeking safety, security, connection.
00:43:00.160And anything or person or thing that breaks your connectedness to me that removes this healing safe is a form of cheating to them.
00:46:52.820As we step into the next phase of this discussion,
00:46:56.400Javi walks us through the treatment landscape.
00:46:58.720where denial, trauma, and addiction intersect and how clinicians navigate the complex terrain
00:47:04.740of recovery from 12-step programs to holistic healing. There's a good percentage of folks
00:47:11.240who are coming to treatment because they got caught by their partner and now their partner
00:47:15.840is making the ultimatum, we need to work on this or we're done kind of a thing. For those folks,
00:47:21.660it could be a bit more of a challenge, right? Because they might be more in denial.
00:47:24.420So that might be the first treatment approach is really helping them understand,
00:47:27.800Is this a problem for you? And where does this come, where does this trace back for you? Is there some trauma that's being reenacted here? Or is it simply this addictive process that you're engaging in?
00:47:37.420And then we also have to assess if there's any other addictions happening too.
00:47:40.680Is there an alpha corvina, drug abuse, workaholism is a really common one that goes along with
00:47:45.640sex addiction, substance abuse as well.0.94
00:47:48.160For women, oftentimes they have a lot of expectations when it comes to sex.
00:47:54.860A lot of their expectations are to a certain standard.0.51
00:47:58.040And so when that gets challenged, they have their own internal distress that comes up
00:48:03.860that leads them and guides them to getting the help that they need.
00:48:07.420So, they might be more willing, more open to seek treatment on their own, but also there's a good percentage of women who have been in multiple affairs and they also got caught and are coming to treatment for that same reason.
00:48:19.860But yeah, the first pieces would be kind of working through any denial.
00:48:24.880And then from there, really moving them into 12-step recovery.
00:48:28.540A big piece of addiction is connecting with others, being honest, having accountability.
00:48:34.520So being part of a 12-step group will be able to provide those things.
00:48:38.180Group therapy is another really good treatment approach for sex addicts or those who have
00:48:46.060If they're in a relationship, family or couples, marriage therapy.
00:48:49.860And then just holistic approaches as well, yoga, exercise, meditation.
00:48:55.200Another big piece for me, too, is like working on growing their sense of self.
00:48:59.040As Hawley emphasizes, working through denial is one of the most crucial and challenging steps in treating compulsive sexual behaviors.
00:49:07.660In fact, studies show that denial can manifest in various forms, minimizing harm, refusing responsibility, or rejecting the need for treatment altogether,
00:49:17.840hindering acknowledgement and delaying recovery and that's according to the
00:49:23.120Washington State sex offender policy board but once denial starts to lift the
00:49:28.400real work of unpacking patterns exploring identity and confronting shame
00:49:33.140begins now we shift to Dr. Katahakis who now leads us deeper into the heart of
00:49:39.200recovery unveiling the frameworks tools and therapeutic models that shape
00:49:44.240lasting change. Javi laid the foundation, but Dr. Katahakis picks up where the work begins to
00:49:56.920I was expecting when I was researching this episode. But when you take a step back, it kind
00:50:01.940of makes sense. Because in the process of healing, there's often a reckoning, not just with the
00:50:07.580addiction, but with the time relationships, the pieces of self that were lost along the way.
00:50:13.100The model that I use is what I call a top-down, bottom-up model, meaning we start with the cognitive behavioral aspect of it, using Patrick Karn's task model.
00:50:24.980And that model is in a book he wrote called Facing the Shadow.
00:50:28.900It's a workbook. It's a terrific workbook for people to get started with.
00:50:32.520So it's really looking at all the secrets, lies, excuses and problems people have and looking at their cycle of addiction and looking at what kind of sex addict they are, because there are 12 types now.
00:50:48.820If you're working with a certified sex addiction therapist, there are several instruments that people take, self-report measures to look at what kind of sex addict they are, what kind of activities they've been up to.
00:51:00.860So we really kind of unearth the whole thing, all the secrets and the lies.
00:51:06.420And by unearthing it all, it starts to reduce the amount of shame the person has around their behaviors because shame silences us.
00:51:15.500And so when people start to talk about this problem, they start to feel better faster.
00:51:20.240And they start to come out of denial by telling themselves it wasn't that bad or I didn't do it that much.
00:51:26.120Because when you really start to write all this stuff down and see that it's been decades of your life, you start to see how pervasive a problem it was.
00:51:37.720People really have to grieve the loss of time, the loss of relationships, how they hurt other people, and also were hurting themselves all along the way.
00:51:48.920So that's really, in a nutshell, the first layer of treatment.
00:51:53.900And with that goes attending 12-step meetings for the fellowship so that people can be in groups with other people who have experienced the same thing historically, whether it's in their childhood stories, their acting out stories, their repeated cheating, the marriages they've gone through, and start to see that they're not alone and that the people that they're with are good people.
00:52:17.820They just had a bad start to life and have done bad things.
00:52:22.020And then after that period of time, which can take six, eight months a year, then I start to work in a deeper way with people in what's called more psychodynamic psychotherapy of really looking at the childhood trauma hurts, helping people to feel in their bodies today what they couldn't feel then because it was so dangerous.
00:52:43.840and that process is a process of you could call it reparenting reclamation of the self
00:52:51.200but from a neural perspective these are circuits that have become uncoupled and people feel it
00:52:58.900because they report feeling dead at the core or chronically depressed or highly anxious
00:53:05.080and it's the recoupling of these circuits going back and getting that child and bringing them
00:53:10.640back into the present moment, that starts to help people feel more neurally integrated.
00:53:16.660And when they're more neurally integrated, they'll tell you that they have had a spiritual
00:53:20.380awakening, that they feel lighter, freer, happier, that the promises of Alcoholics Anonymous
00:53:28.520But this is a good three to five year process, which sounds long, but when you think about
00:53:34.580how long it takes somebody to get into therapy and get help, sometimes they're in their
00:53:38.78040s, it's really not that long. And you're going to be three to five years older anyway.
00:53:43.820So do you want to be three to five years healthier or in a deeper hole than you are right now?
00:53:50.740What Dr. Katahakis reveals here strikes at the core of what long-term healing truly demands.
00:53:57.440It's not just stopping the behavior. It's about reclaiming the parts of yourself,
00:54:02.160the addiction buried. The process is slow and often painful, but it opens up the door to something
00:54:09.020deeper, connection, integration, and sometimes, redemption.
00:54:23.320Sex addiction hides in plain sight, woven into jokes, TV dramas, and celebrity scandals.
00:54:29.720In our culture, the line between desire and disorder blurs.
00:54:35.080Pop culture sometimes normalizes indulgence, often dismissing compulsive sexual behavior as a high sex drive.
00:54:43.080This can leave those struggling feeling misunderstood or invalidated, and that can be very dangerous.
00:54:50.640Javi takes it from here, unpacking how these cultural messages shape and sometimes distort our understanding of sex addiction.
00:54:59.720I think, again, our current culture is you can watch any movie, there's going to be some type of a sex scene in there, right?
00:55:07.520And I think, too, just in pop culture, even what's going on right now, there's a lot of high-profile folks who are getting arrested, who are facing jail time, who have huge allegations against them.
00:55:20.460And absolutely, there's that misconception.
00:55:23.080They think it's just having lots of sex, having a high sex drive or hypersexuality.
00:55:27.460sexuality. And so there is a lot of misconception. And my suggestion would be do a bit of research,
00:55:35.420right? Or listen to these kinds of podcasts to kind of figure out, okay, what do they mean when
00:55:39.600they say that? Right? It's almost thrown out there as a joke. Javi highlights how cultural
00:55:45.360perceptions often downplay or distort the reality of sex addiction. This disconnect between societal
00:55:51.460understanding and clinical truth creates a barrier that those who might otherwise seek
00:55:57.280help are trapped between shame and the fear of not being taken seriously. Which is why we wanted
00:56:04.760to end with Dr. Alexandra Katahakis stepping in again to remind us the condition is officially0.80
00:56:10.920recognized as compulsive sexual behavior disorder and why that language we use matters. The
00:56:18.400International Classification of Diseases book, it's called the ICD, it's in the 11th issue,
00:56:25.540is put out by the World Health Organization.
00:56:28.320And the World Health Organization in 2021 or 22
00:56:31.920recognized compulsive sexual behavior disorder.
00:56:36.120And I think, you know, colloquially and in the zeitgeist,