The Institute for Research and Treatment of Addictive Disorders

1. The Institute for Research and Treatment of Addictive Disorders Presents:

2. The Correlation of Childhood Trauma and Women with Sexual Addiction Erin Cotten, MSW, CSW and Jessica Omer, MSWI

3. Introduction • Criteria for Sexual Addiction • Myths of Woman and Sexual Addiction • Define Trauma and its Effects • Motivation for Woman struggling with Sex Addiction • Special Considerations in a Clinical Setting • Treatment

5. Sexual Addiction • Recurrent failure (pattern) to resist impulses to engage in acts of sex. • Frequently engaging in those behaviors to a greater extent or over a longer period of time than intended. • Persistent desire or unsuccessful efforts to stop, reduce, or control those behaviors. • Inordinate amount of time spent in obtaining sex, being sexual, or recovering from sexual experience. • Continuation of the behavior despite knowledge of having a persistent or recurrent social, academic, financial, psychological, or physical problem that is caused or exacerbated by the behavior. • Need to increase the intensity, frequency, number, or risk of behaviors to achieve the desired effect. (Carnes)

6. Misconceptions about women and sexual addiction: • Sexual addiction is a man’s problem and that women do not struggle with it. • Women don’t need or want sex. • Women can control themselves sexually and men cannot control themselves sexually. • Women are chaste and responsible for appropriate sexual interaction with their partner. • Female Sex Addicts are only relationship and love addicts.

7. Definition of Trauma • Trauma: An experience that produces sudden change and leaves a long-lasting effect. • The Greek origin means “wound” • Trauma is subjective, one thing that is traumatic to one person, may not be traumatic to another person. • There is a common link between sexual addiction and trauma, particularly sexual abuse.

8. Statistics of Childhood Sexual Abuse • Estimates of the prevalence of childhood sexual abuse range from 15%-33% in the general female population and from 35% to 75% in female clinical samples. (Polusny & Follette, 1995; Rind, Tromovitch, & Bauserman, 1998) • CSA occurs across all socioeconomic and ethnic groups (Polusny & Follette, 1995; Rind, Tromovitch, & Bauserman, 1998) • Girls are at about 2.5 to 3 times higher risk than boys (Polusny & Follette, 1995; Rind, Tromovitch, & Bauserman, 1998) • Risk for CSA rises with age (Polusny & Follette, 1995; Rind, Tromovitch, & Bauserman, 1998)

9. Link between Abuse (Trauma) and Sexual Addiction • “There is substantial evidence that abuse occurring in childhood affects adult sexual behavior. Childhood abuse has been independently associated not only with later abuse by a partner but also with sexual risk behaviors” (Morrill et al, 2001, p. 171)

10. Link between Abuse (Trauma) and Sexual Addiction • History of sexual abuse increases in adulthood the likelihood of having multiple sexual partners by 30% and of engaging in prostitution by 45% (Cunningham et al, 1994) • “A study of 491 college women found that those reporting childhood sexual abuse had more negative attitudes toward sex were less assertive about birth control and refusing sex” (Johnsen & Harlow, 1996).

11. Link between Abuse (Trauma) and Sexual Addiction • A study of 4014 9th -12th graders, sexually abused females had more lifetime sexual partners and pregnancies (Raj, Silverman, & Amaro, 2000) • “In women, sexual assault in adulthood has been associated with more sexual partners, unprotected sex involving drugs, teen pregnancy, and STIs” (Zierler et al, 1991)

12. Effects of Childhood Trauma • Attachment Problems • Emotion Dysregulation • Guilt and Shame • Personality Disorders • Addiction • Self Worth Problems

13. Basic Assumptions of Cognitive Neural Restructuring Therapy • All behaviors and emotional processes both healthy and unhealthy are a result of neural pathways that have been developed within the brain. • Trauma occurs when an individual is thrust into a state of disequilibrium and is striving to regain homeostasis without sufficient innate resources. • Addictions are a result of the brain having been altered as a result of some traumatic process. (Cognitive-Neural Restructuring Therapy for the Treatment of Sexually Compulsive Disorders Handbook)

14. Traumatic Sexualization • “Process in which a child's sexuality, including both sexual feelings and sexual attitudes, is shaped in a developmentally inappropriate and interpersonally dysfunctional fashion as a result of sexual abuse.” (Finkelhor and Browne,1985)

15. Traumatic Sexualization • Women who have experienced CSA may acquire inaccurate or harmful ideas about their sexuality and about intimate relationships in general through the process of modeling, reinforcement, and punishment by the abuser (Lemieux, 2008, p. 127).

16. Characteristics of Traumatic Sexualization • Children who experience traumatic sexualization are likely to emerge from their abusive experiences with distorted sexual cognitions, attitudes, emotions, and behaviors (Lemieux, 2008, p. 127). • More severe CSA is likely to result in greater traumatic sexualization and have a greater impact on women's sexual functioning. (Finkelhor and Browne, 1985)

17. Sexual Template • Values and beliefs are shaped by Family, Culture, and Primary Support. • Blueprint of sexual likes/dislikes that is developed and shaped by our early sexual experiences. • These early experiences shape values, beliefs, and expectations around sexuality.

18. Clinical Manifestation • Patterns of sexual addiction with women: • High volume of sexual partners • Pornography and Masturbation • Cybersex • Relationship Addict • Binge/Starve Pattern • Sexual avoidance/ Sexual Anorexia • Period of sexual binging and period of sexual anorexia.

19. Clinical Manifestation • Sexual Revictimization • “maltreatment on more than one occasion by different perpetrators in later dating relationships” (Gagne’, et al, 2004, p. 1156). • “First…victimization can act as a risk factor for subsequent similar experiences with an increased probability of the victim being caught in a destructive life trajectory” (Gagne’, et al, 2004, p. 1156) • Similar to Freud’s defense mechanism “undoing”.

20. Motivation • Power and Control • : “I love the feeling I get when men want me. Several guys will usually hit on me and I can pick the one I want. Men do it all the time, why can’t I? (Feree, 2001, p. 293-294) • Determined not to be hurt or victimized they become the one in control and with the power.

21. Motivation • Loneliness • “Loneliness can be as compelling as a motivator as the need for power… please somebody love me, is the cry of her heart. And sex is the only substitute she knows for love” (Ferre, 2001 p. 296) • Escape from feelings of worthlessness and shame.

22. Motivation • Creating intimacy or closeness with another person. • “Internet communication fosters pseudo-intimacy… the Internet short circuits most components of human courtship, such as noticing, attraction, touching, creating intimacy, and commitment. Allows for an immediate connection with another person, which provides the rocket fuel for females’ participation in Internet sex” (Schneider) • Closeness with no real risk because she may not know how to connect in any other way.

23. Motivation • Charlotte Kasl study: “ • 90 women survivors of childhood abuse and met criteria for sexual addiction • The participants “used their sexuality as a primary source of power and reported an intense desire to escape from the feeling of worthlessness and shame”. • They wanted to bond to someone but they did not know how…sexually compulsive/addictive behavior is motivated by pain, fear, loneliness, and desperation… • These women believe that if others knew what they were really like they would be rejected, so they find ways to turn away potential friends or loving partners” (Roller, 2007, p. 488)

24. Special Considerations • 1. Safety • 2. Toxic Shame • 3. Perfectionism • 4. Women and Christian Community • 5. Cultural Beliefs • 6. Social Isolation

25. Special Considerations in a Clinical Setting • 1. Safety • “In general women’s sexual behavior is more relational…and female’s acting out is more likely to involved another person at some level” (Feree, p. 290, 2001). • Cybersex: • Women are over-represented in the percent of people engaging in cybersex and chat rooms. • Women are more likely to have their take their online sexual activities turn into real life encounters (Schneider) • Discuss safety issues

26. Special Considerations in a Clinical Setting • 2. Toxic Shame • CSA survivors frequently internalize feelings of “badness, shame, or guilt” as they recognize the inappropriateness of their experiences. (Finkelhor and Browne, 1985) • “Shame is the intensely painful feeling or experience of believing we are flawed and therefore unworthy of acceptance and belonging” (Brown, 2007, p. 5) • Shame causes: • Fear • Blame • Disconnection • Overwhelming feeling of wanting to escape

27. Special Considerations in a Clinical Setting • 3. Perfectionism • “If I am perfect and other people see that, maybe I am not such a bad person” • Set Unrealistic Expectations • Who we should be • What we should be • How we should be • Willing to put a lot on the line to protect our image of perfection • Unfulfilling • “I want to be perceived as… I don’t want to be perceived as…”

28. Special Considerations in a Clinical Setting • 4. Women and the Christian Community • Adulterous Woman • Double Standard • Women are keepers of Chastity • Addiction is seen as a moral failure. • Repentance is needed rather than treatment. • Struggle is seen as insufficient willpower. • The expectation of living a higher moral standard keeps them from asking for help.

29. Special Considerations in a Clinical Setting • 5. Cultural Expectations • Woman should be a certain way. • Media gives messages that any part of a woman’s body can and should be changed or altered. • Messages like be ready for sex at all times but don’t be promiscuous. • Men are penalized more severely and more often for sex crimes than woman but the outrage of woman committing such crimes is greater.

30. Special Considerations in a Clinical Setting • 6. Social Isolation • Invisibility • Women do not see themselves reflected back in the culture and feel a sense of disconnection and powerlessness. • “While cultural beliefs tend to support male addict’s obsession, they contribute to the shame of women addicts who measure themselves by the same social standards. They add to their shame when they feel they must the “only” woman who acts this way-and it is that sense of uniqueness which is central to the secret world of an addict. Their loneliness represents the special burdens our culture places on women.” (Carnes, 2001, 163)

31. Treatment • Cognitive Neural Restructuring Therapy • Autobiography • Self Soothing • Sexual Template • Understand Brain Chemistry • Cycle Work • Neurofeedback and Scripting • Biofeedback • Emotion Self Regulation • Shame work/Work through Trauma • Forgiveness

32. Treatment • Attachment • Look at Patterns in relationships • Revictimization • Focus on alternative healthy attachments • Safety net • Challenge Beliefs of Toxic Shame • Speak Shame • Courage: Tell your story with your whole heart • Empathy • “I am enough” • Authenticity

33. Conclusion • Women struggle with sexual addiction just as men do. • Trauma is a precursor for sexual addiction. • Women experience intense shame from their addiction due to societal and cultural messages. • Healing is possible with proper intervention and shame reduction.

34. Bibliography • Brown, B. (2007). I Thought It was Just Me (but it isn’t) Telling the Truth about Perfectionism, Inadequacy, and Power. New York, NY. Gotham Publishing. • Carnes, P. (2001). Out of the shadows: understanding sexual addiction (3rd ed.). Center City, MN: Hazelden Information & Edu. • Cunningham, R., Stiffmann, A., Dore, P., & Earls, P. (1994). The association of physical and sexual abuse with HIV risk behaviors in adolescence and young adulthood; implications for public health. Child Abuse & Neglect, 18(3), 233-245. • Ferree, M. (2001). Females and Sex Addiction: Myths and Diagnostic Implications. Sexual Addiction and Compulsivity, 8, 287-300. • Ferree, M. (2002). Sexual Addiction and Co-Addiction Experiences Among Women of Faith. Sexual Addiction & Compulsivity, 9, 285-292. • Ferree, M. (2003). Women and the web: cybersex activity and implications. Sexual and Relationship Therapy, 18(3), 385-393. • Gagne, M., Lavoie, F., & Hebert, M. (2005). Victimization during childhood and revictimization in dating relationships in adolescent girls. Child Abuse & Neglect, 29, 1155-1172. • Johnsen, L., & Harlow, L. (1996). Childhood sexual abuse linked with adult substance use, victimization AIDS risk. AIDS Education and Prevention, 8, 44-57.

35. Bibliography • Kasl, C. S. (1989). Women, sex, and addiction: a search for love and power. New York: Ticknor & Fields. • Lemieux, Suzanne, and E. Sandra Byers. "The Sexual Well Being of Women Who have Experienced Child Sexual Abuse." Psychology of Women Quarterly 32 (2008): 126-144. Print. • Morrill, A., Kasten, L., Urato, M., & Larson, M. J. (2001). Abuse, addiction, and depression as pathways to sexual risk in women and men with history of substance abuse. Journal of Substance Abuse, 13, 169-184. • Opitz, D. M., Tsytsarev, S. V., & Froh, J. (2009). Women's Sexual Addiction and Family Dynamics, Depression, and Substance Abuse. Sexual Addiction and Compulsivity, 16, 324-340. • Raj, A., Silverman, J., & Amaro, H. (2000). The relationship between sexual abuse and sexual risk among high school students: finding from the 1997 Massachusetts Youth Risk Behavior Survey. Maternal and Child Health, 4, 125-134. • Roller, C. G. (2007). Sexually Compulsive/Addictive Behaviors in Women: A Women's Healthcare Issue. Journal of Midwifery and Women's Health, 52(5), 486-491. • Schneider, J. (2000). A Qualitative Study of Cybersex Participants: Gender Differences, Recovery Issues, and Implications for Therapists. Sexual Addiction & Compulsivity, 7, 249-248. • Zierler, S., Feingold, L., Laufer, D., Velentgas, P., Kantrowitz-Gordonm, I., & Mayer, K. (1991). Adult survivors of childhood sexual abuse and subsequent risk of HIV infection.. American Journal of Public Health, 81, 572-575.