Exploring Female Sex and Love Addicts: Survey Results and Implications

1. Closing the GapResults from the Women’s Sexuality Survey on Female Sex and Love Addicts M. Deborah Corley, PhD Sante Center for Healing www.santecenter.com deb@santecenter.com 1-800-258-4250 David L. Delmonico, PhD Duquesne University www.internetbehavior.com delmonico@duq.edu 412-396-4032

2. Objectives • Review results of Women’s Sexual Survey differences between Non-FSLA & FSLA • Frequencies of Interest • Research Questions & Resulting Subscales • Hypersexual disorder/FSLA • Impact of Internet-Cybersex • Risk factors/Consequences of ACE • Health Issues/In Harm’s Way • Shame/Need for Affirmation • Clinical implications/red flags • Next steps in research – who will step up

3. FSLA / Women’s Sexuality Survey • Project in collaboration with Duquesne University, Sante Center for Healing, and Society for the Advancement of Sexual Health (SASH) • Women’s Summit Group (14 women considered experts in treatment of FSLA) developed 144 questions related to history, symptoms, acting out behaviors, consequences • Survey on surveymonkey.com for 9 months • Over 500 valid responses (230 self-identified non-addicts, 261 FSLA (95 SA, 166 Love/Relationship Addicts, 32 no selection)

4. FLSA Women’s Sexuality Survey 1 • Non-FSLA Grp (n=230) • Average age 35 • Range 18-70 • 33% made >60K • 24% had BA or above • 93% heterosexual • 63% com. Relationship • Average 10.8 years • 56% had no children • Mean – 1.04 children • 12% TX for sex problm • 9% TX cybersex problm • FSLA Group (n=261) • Average age 33 • Range 18-73 • 23% made >60K • 16% had BA or above • 90% heterosexual • 55% com. Relationship • Average 7.2 years • 55% had no children • Mean – 1.02 children • 40% TX for sex problm • 22% TX cybersex problm

5. Research Questions • Did the women who identified themselves as female sex and love addicts also meet criteria as outlined in other instruments (HBI, Kalichman SCS, W-SAST)? • Were there differences on those scales for those who identified self as sex addict compared to those who ID self as love and relationship addict? • What if any was the impact of cybersex activity? • Were there factors that might highlight risk for FSLA? (Adverse Childhood Experiences)

6. Research Questions 2 • Were there similar consequences for ACE in our groups? • What type of health consequences were present for FSLA and were they different than the non-addicts? • Did the addict groups put self “In Harm’s Way” more frequently than the non-addict group? • Did the addict groups have more guilt/shame or have a greater need for affirmation than non-addicts?

7. FLSA Women’s Sexuality Survey 2 • Non-FSLA Group • 23% feel bad abt sexual behaviors • 32% feel degraded • 10% can’t control sex desire • 30% withdrawal sympt • 21% compromised values • 17% made failed effort to stop behavior • 11% interferes with family life /responsibilities • FSLA Group • 67% feel bad abt sexual behaviors • 70% feel degraded • 49% can’t control sex desire • 71% withdrawal sympt • 67% compromised values • 62% made failed efforts to stop behavior • 45% interferes with family life /responsibilities

8. Measures • Hypersexual Behavior Inventory (Reid, et al, 2011) • 19 item scale using 5-point Likert scale • Three factor model measuring control, consequences, and coping associated with sexual thoughts, feelings and behaviors. Reliability using Cronback’s alpha co-efficient (Control a = .94, coping a = .90, consequences a = .87) • W-SAST (Carnes, et. al., 2010) • 25 item questionnaire, true/false response • Three factors measuring pre-occupation/loss of control, relationship disturbance, affect disturbance. Reliability scores a = .84 • Sexual Compulsivity Scale (Kalichman, et al., 1994) • 10 item scales using 4-point Likert type scale endorsing sexual thoughts, feelings and behaviors. Relability scores from a = .86 - .87.

9. Subscale comparisons • Hypersexual Behavior Subscale (mirrored items in HBI associated with control, coping, consequences) • Three subscales assessing control (19 items, a = .89), coping (15 items, a = .87), and consequences (19 items, a = .85) associated with sexual thoughts, feelings, and behaviors. • W-SAST (Carnes, et. al., 2010) • Same 25 item questionnaire, true/false response • Three factors measuring pre-occupation/loss of control, relationship disturbance, affect disturbance. Reliability scores a = .84 • Sexual Compulsivity Scale (Kalichman, et al., 1994) • 8 items mirroring the SCS 10 item scales but with true/false response

10. * p<.001 a = .89

11. * p<.001 a = .85

12. * p<.001 a = .87

14. Cybersex (Corley & Hook, 2011, in press) • 13.7% of sample identified self as having cybersex problems • Participants spent average of 2.48 hr. per wk in cybersex behavior (SD=5.52); 23.8 hr. per wk in general use of computer (SD=19.59). FSA spent significantly more time in cybersex behavior than did FLRA and both addicted groups more than non-addicts. Only small difference in ratio of cyber to general use found. • The cybersex group spent significantly more time in cybersex behavior than all other groups, experienced more depression associated with their sexual behavior, more withdrawal symptoms, & scored higher on hypersexual behavior subscales.

15. Cybersex 2 (Corley & Hook, 2011, in press) • 53% of sample exposed to pornography as a child • Participants who experienced childhood sexual abuse or who were exposed to pornography were more likely to report cybersex behavior. • Exposure to pornography as a child was stronger predictor of hypersexual behavior than sexual abuse as a child. • 79% of cybersex group reported frequently visiting porn website and chat rooms compared with 20% of the addict/non-cybersex group and 6% of the non-addicts. • 58% of cyber group reported relying on abusive pornography or fantasies to feel aroused, compared with 16% of addict/no cyber, & 10% of non-addicts

16. Hypersexuality in Women (other studies) • N=2450 / 18-60 yrs of age /Sweden • IC M=5.1, SD=5.4 (men M=5.5, SD=6.2) • Mast. M=1.6, SD=3.3) (men M=4.9, SD=6.9) • Hypersexual women similar to men • Early on set of intercourse; impersonal sex • Relationship instability • Diverse sexual experiences/same sex partners • Paraphilic interests • STD infections • Smoking; Alcohol & other drug abuse • General dissatisfaction with psychological health and life in general • Women – sexually abused as children Langstrom & Hansom (2006), Archives of Sexual Behavior, 35(1), 37-52

17. Risks identified other places • Carnes et al, 2010 • Relationship disturbances – relationship problems as result of sexual behavior; associated with seeking help • Affect disturbances included periods of depression, anxiety, feeling degraded or shame • Associated features factor, childhood abuse, engaging in S&M, sexual problems of parents, sex with minors • CDC – Adverse Childhood Experiences • ACE = psychological, physical, sexual abuse; household dysfunction (i.e. living with addicted or substance abusing member of household, mental illness, mother treated violently, criminal behavior • Consequences – the more ACEs have, the more risk for smoking, substance abuse, depression, suicide attempts, depression, > 50 lifetime sexual partners, STD, IBS, cancer, stroke, other health risks

18. Risks identified other places 2 • CDC – Adverse Childhood Experiences • ACE = psychological, physical, sexual abuse; household dysfunction (i.e. living with addicted or substance abusing member of household, mental illness, mother treated violently, criminal behavior

19. FLSA Women’s Sexuality Survey 3 • Non-FSLA Group • 43% child sex abuse • 25% adult sex abuse • 41% exposed to porn as child • FSLA Group • 54% child sex abuse • 36% adult sex abuse • 63% exposed to porn as child

20. Risks identified other places 2 • CDC – Adverse Childhood Experiences • Consequences – the more ACEs have, the more risk for smoking, substance abuse, depression, suicide attempts, depression, > 50 lifetime sexual partners, STD, IBS, cancer, stroke, other health risks, living with violent partner

21. FLSA Women’s Sexuality Survey 4 • FSLA Group • 25% got pg from SA • 18% terminated SA pg • 7% fertility problems • 33% got STD • 10.3% attempted suicide • 42% used alcohol/drugs during sexual behavior • 71% stayed in relationship after became abusive • Non-FSLA Group • 13% got pg from SA • 10% terminated SA pg • 2% fertility problems • 14% got STD • 3.1% attempted suicide • 23% used alcohol/drugs during sexual behavior • 43 % stayed in relationship after abuse

22. Medical Subscale Sex & Love Addicts = no difference SLRA = different from normals Medical Subscale (a = .54) (4 items)

23. In Harm’s Way Sex & Love Addicts = no difference SLRA = different from normals In Harm’s Way (a = .92) (29 items)

24. Guilt / Shame All groups p<.001 Guilt/Shame (a = .90) (37 items)

25. Affirmation Sex & Love Addicts = no difference SLRA = different from normals Need for Affirmation (a = .84) (16 items)

26. Boundary Violations among Women

27. Sex with a minor? *Pearson Chi-Square p<.01

28. Sex with a subordinate? *Pearson Chi-Square p<.001

29. Clinical Implications • Women Sex, Love & Relationship Addicts Exist • Some aspects seem differentiated between women identifying as sex addicts versus love addict • Some aspects seem the same • Sex Addicts More Difficulties • Cybersex is worthy of a second look in women and its contribution to sexual problems • Placing oneself in the way of harmy is worthy of clinical evaluation – relationship to trauma? • Suicide assessment for women SLRA is a must • Women can and do violate others’ boundaries

30. Where to now with research • Utilizing Women’s Sexuality Survey • ACE lens • Prevention - In Harm’s Way

31. What women seek in therapy • A more negotiated therapeutic relationship • When asking about abuse think about ACE questionnaires • Think more globally and ask more questions about what the process means for all aspects of their lives (family, work, self) – Level of Burden • Need to be encouraged to “find their voice” in therapy. Careful attending and listening to their decisions, choices, and experiences is essential • Tend to focus on the relationship and not the treatment tasks; find ways to use the relationship to increase motivation to change through secure attachment with you as therapist • Help them identify authentic self, good enough mother, reliable friend

32. Assessment Tools • Hypersexual Behavior Inventory (RReid@mednet.ucla.edu) Women’s Sex Addiction Screening Test (w-SAST) (Carnes – http://www.sexhelp.com) • Internet Sex Screening Test (delmonico@duq.edu) • Kalichman Sexual Compulsivity Scale (Kalichman & Rompe, 1995) • Washton/Sealy Questions for Multiple Addiction (JOHN SEALY@aol.com) • CDC ACE (www.cdc.gov/ace)

33. Defining Hypersexual Behavior Disorder • Over a period of 6 months, recurrent & intense sexual fantasies, urges, or sexual behaviors (SFUBs) in association with 3 or more of the following 5 criteria: • Time consumed by SFUBs interferes with other important non-sexual goals, activities and obligations • Repetitively engaging in SFUBs in response to dysphoric mood states • Or in response to stressful life events • Unsuccessful efforts to control or reduce these SFUBs • Disregarding the risk for physical or emotional harm to self or others

34. Defining Hypersexual Behavior Disorder 2 • Significant personal distress or impairment in social, occupational or other important areas of functioning associated with these SFUBs • These SFUBs are not due to physiological effect of an exogenous substance (drug of choice or medication) • Specific if: • Masturbation • Pornography • Sexual Behavior with Consenting Adults • Cybersex • Telephone sex • Strip Clubs • Other