“Sexual compulsions and paraphilia related disorders (PRDs) are complex psychiatric disorders; therefore, exact causes are not known, although there are many theories. Whether they represent an addiction, obsessive-compulsive disorder, impulse control disorder, or a pattern of hypersexualism is still a matter of controversy. Some have argued that since these disorders represent an ongoing pattern of uncontrolled sexual behaviour, they should be viewed as an addiction because like substance abuse, these consist of a pathological relationship with a mood-altering experience. Others have argued against this idea, instead describing paraphilias and PDRs as symptoms of an underlying obsessive-compulsive disorder (OCD).” – M. Williams, PhD brainphysics.com

Through research and study, I have written a simple overview of sexual behaviours and suggested treatments.

Sexual Addictions

People who have addictions, also called “appetitive compulsions”, or “extreme appetitive urges” are compelled to satisfy a “need” – these refer to gambling, food, alcohol and drug addiction and some forms of sexual activity. However, while appetitive-compulsives tend to be lured to the things they crave, they also want to stop.

A person who has a sexual addiction notices his or her behaviour is destructive, yet cannot control the urges regardless of painful loss and emotional consequences. Whilst the person experiences gratification in the activity itself it’s important to note that distress, shame and guilt override this type of momentary “pleasure”. A person’s sexual addiction is often to escape emotional pain, maybe about loss, abuse, recent traumatic event; or something else.

Treatments of choice: The 12-Step ProgrammesAddiction Counselling

The 12-step programmes attempt to support people who wish to discuss their personal addiction and behavioural concerns. Developed in 1935 by Bill Wilson and Dr Bob Smith, the programme was originally intended for those who were experiencing alcohol addiction; and it now addresses and treats other addictions, including smoking, drug addiction, compulsive gambling, plus sex and porn addiction.

Addiction counsellors are active listeners who help the sufferer identify the behaviours associated with this condition and addresses emotional needs and how these are affected, which can lead to full recovery.

Sexual Obsessions

Sexual obsessions are biologically driven into a person’s mind without their will. What usually follows are corresponding compulsions to counter the obsession. For example, a person who has a paedophile obsession generally has a strong urge to check for signs that will prove or disprove whether they are capable of molesting a child; or they will suffer doubts and will ruminate about whether they have already committed such an act.

Yet, they desperately want to stop checking because they know how harmful their obsession is. Most people who have an obsessional problem have insight into their symptoms and understands how the disorder works, but due to the relentless doubts that go with this condition the person fears an underlying threat – the threat that they mistakenly believe marks their true values or morals. As a result, they find it difficult to resist anxiety relieving compulsions.

Unlike a person who gains some form of temporary relief through giving into addictive behaviours, and this being a consequence of acute anxiety or stress-related issues (“I do it because of my anxiety”), for a person who has OCD the only goal from checking is momentary relief (“I do it to relieve my anxiety caused by the obsession”).

Treatments of choice: In-person or online cognitive behavioural therapy programmes with exposure response prevention, SSRI medication, mindfulness, or inpatient treatment.

Cognitive Behavioural Therapy (CBT) with exposure response prevention (ERP) is the combined gold standard treatment for the obsessive compulsive disorder. Cognitive therapy acts as the foundation for facing obsessions and the exposure therapy focuses on strategies designed to help a person resist compulsions and reach recovery, or at least reduced symptoms. A selective serotonin reuptake inhibitor (SSRI) is often also prescribed for people who have moderate-severe symptoms. In extreme cases, a patient would be admitted for inpatient treatment at a specialised hospital that treats OCD.

Paedophilia

This is not a paedophile obsession (POCD) or an addiction. However, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is a mental condition termed “paedophilic disorder”. Literally, paedophilia means an attraction for children (Arthur S. Reber). Yet, the term needs to be dealt with carefully, as paedophilia differs from actual child abuse. As noted, a paedophilic disorder is a psychiatric disorder; therefore, as the term is used, “that attraction is always sexual in its connotations and the meaning of the term is restricted to the sexual feelings of an adult for a child. It only becomes a paraphilia when it results in actual sexual activity and the child is pre-pubic.” (Reber) 

Treatments of choice: The Dunkelfeld Project

The Dunkelfeld Project allows people access to professional mental health treatment and attempts to prevent or change deviant behaviour.

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