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Attachment, Shame, and Childhood Sexual Abuse and the Acquisition of Sexual Addiction

ProQuest Dissertations and Theses, 2011
Dissertation
Author: Ginger A Gunn
Abstract:
The primary purpose of this study was to investigate the influence of attachment, shame, and childhood sexual abuse (CSA) on the development of sexual addiction. This study proposed three hypotheses: (a) anxious and avoidant adult attachment would predict sexual addiction; (b) shame would mediate the relationship between attachment and sexual addiction; and (c) CSA would moderate pathways between attachment and sexual addiction. Survey and contact information was presented to men and women age 18 and older at local 12 Step sexual addiction groups, emailed to local therapists who facilitate sexual addiction groups, presented at a local conference focused on sexual addiction recovery, and featured as an advertisement in local newspapers. Participants completed surveys primarily online via Survey Monkey, and paper surveys were available upon request. Data was collected from 91 participants with 51 men, 39 women, and 1 transgender individual. A path analysis was completed using the bootstrapping sampling method to test the direct effects of attachment on sexual addiction and the indirect effects of shame. Avoidant attachment had a significant direct effect on sexual addiction, β = .23, p = .004; the relationship was not mediated by shame. The path from anxious attachment to sexual addiction, the total effect, was significant, β = .30, p = .002. The indirect effect of shame for the pathway between anxious attachment and sexual addiction was significant, β = .22, p = .004. Shame partially mediated the relationship between anxious attachment and sexual addiction. Anxious attachment, avoidant attachment, and shame accounted for 30% of the variance in sexual addiction. A hierarchical regression analysis was done to investigate the moderating effect of CSA on the relationship between attachment and sexual addiction. CSA did not moderate the pathway between anxious or avoidant attachment and sexual addiction. However, CSA predicted sexual addiction. Avoidant attachment led to the development of sexual addiction. Individuals with anxious attachment developed a shameful self due to invalidating caregiving. Shame resulted in the use of sex as a means to regulate emotions and experience pleasure, which led to sexual addiction. This study further clarifies the symptoms and contributing factors for sexual addiction.

Table of Contents

Table of Contents ............................................................................................................... iv List of Figures .................................................................................................................... vi List of Tables .................................................................................................................... vii List of Appendices ........................................................................................................... viii Abstract .............................................................................................................................. ix A. Chapter I: Introduction and Literature Review ............................................................ 11

1. Introduction ............................................................................................................... 14 2. Literature Review ...................................................................................................... 14 2.1. Sexual Addiction ................................................................................................ 14 2.1.1. Defining Sexual Addiction ......................................................................... 14 2.1.2. Symptoms of Sexual Addiction .................................................................. 20 2.1.3. Summary of Sexual Addiction .................................................................... 24 2.2. Attachment Theory ............................................................................................. 25 2.2.1. Affect Regulation ........................................................................................ 29 2.2.2. Adult Attachment ........................................................................................ 31 2.2.3. Adult Romantic Attachment ....................................................................... 33 2.2.4. Attachment and Sexual Addiction .............................................................. 36 2.2.5. Summary of Attachment ............................................................................. 39 2.3. Shame Theory ..................................................................................................... 41 2.3.1. Distinguishing Shame ................................................................................. 41 2.3.2. Affective Shame.......................................................................................... 43 2.3.3. Shame, Caregiving, and Addiction ............................................................. 44 2.3.4. Shame and Attachment Styles .................................................................... 46 2.3.5. Outcomes of Shame .................................................................................... 47 2.3.6. Shame, Attachment, and Sexual Addiction ................................................ 49 2.3.7. Summary of Shame ..................................................................................... 52 2.4. Childhood Sexual Abuse .................................................................................... 53 2.4.1. Identifying CSA .......................................................................................... 53 2.4.2. Factors Contributing to Occurrence and Severity ....................................... 55 2.4.3. Attributions of CSA .................................................................................... 57 2.4.4. Outcomes of CSA ....................................................................................... 59 2.4.5. Attachment and CSA .................................................................................. 63 2.4.6. Hypersexuality ............................................................................................ 65 2.4.7. CSA and Sexual Addiction ......................................................................... 68 2.4.8. Summary of CSA ........................................................................................ 69 2.5. Summary of literature review ............................................................................. 72 3. Hypotheses ................................................................................................................ 73

Sexual Addiction v

B. Chapter II: Method ....................................................................................................... 77 1. Participants ................................................................................................................ 77 2. Measures.................................................................................................................... 77 2.1. Experiences in Close Relationships Questionnaire-Revised .............................. 77 2.1. Sexual Addiction Screening Test-Revised ......................................................... 79 2.2. Experiences of Shame Scale ............................................................................... 81 2.4. Unwanted Childhood Sexual Experiences Questionnaire .................................. 83 2.5. Demographic Questionnaire ............................................................................... 85 3. Procedure ................................................................................................................... 85 3.1. Data and Participant Safety ................................................................................ 86 3.2. Statistical Model ................................................................................................. 87 3.3. Data Managment ................................................................................................. 87 C. Chapter III: Results ...................................................................................................... 88 1. Data Screening ....................................................................................................... 88 2. Sample Demographics ........................................................................................... 90 3. Measure Correlations ............................................................................................. 91 4. Test of Hypotheses ................................................................................................ 92 D. Chapter IV: Discusssion............................................................................................... 99 1. Interpretation ............................................................................................................. 99 2. Discussion of Hypotheses ......................................................................................... 99 2.1. Attachment, Shame, and Sexual Addiction ........................................................ 99 2.1. Attachment, CSA, and Sexual Addiciton ......................................................... 102 3. Implications ............................................................................................................ 105 3.1. Implications for Practice ................................................................................... 105 3.2. Implications for Research ................................................................................. 105 4. Limitations .............................................................................................................. 108 5. Conclusions ............................................................................................................. 109 E. References .................................................................................................................. 111 F. Appendices ................................................................................................................. 126

Sexual Addiction vi

List of Figures Figure 1. Hypotheses Represented by Model Paths.......................................................... 76 Figure 2. Path Analysis: Hypothesized Model ................................................................. 97 Figure 3. Path Analysis: First Step of Model Trimming .................................................. 97 Figure 4. Final Trimmed Model for Mediating Effect of Shame ..................................... 98

Sexual Addiction vii

List of Tables Table 1. Assessing Univariate Normality of Continuous Variables ................................. 89 Table 2. Means, Standard Deviations, and Standard Errors ............................................. 89 Table 3. Sample Demographics ........................................................................................ 91 Table 4. Measure Correlations .......................................................................................... 92 Table 5. Boostrap Results for Mediation Model ............................................................... 96

Sexual Addiction viii

List of Appendices Appendix A. IRB Application ........................................................................................ 126 Appendix B. Informed Consent Form ............................................................................ 134 Appendix C. Debriefing Form ........................................................................................ 137 Appendix D. Recruitment Forms .................................................................................... 140 D.1. Verbal Recruitment Script ....................................................................................141 D.2. Email Script for Clinicians ...................................................................................141 D.3. Newspaper Ad Script ............................................................................................141 D.4. Business Card ......................................................................................................141 Appendix E. Assessment Instruments............................................................................. 142 E.1. Experiences in Close Relationships-Revised ........................................................143 E.2. Sexual Addiction Screening Test-Revised ...........................................................148 E.3. The Experience of Shame Scale ...........................................................................151 E.4. The Unwanted Childhood Sexual Experience Questionnaire ...............................154 E.5. Demographic Questionnaire .................................................................................156 Appendix F. Personal communication with B. Green .................................................... 157 Appendix G. Personal communication with B. Andrews .............................................. 160

Sexual Addiction ix

Ginger A. Gunn 350 words

Abstract

The primary purpose of this study was to investigate the influence of attachment, shame, and childhood sexual abuse (CSA) on the development of sexual addiction. This study proposed three hypotheses: (a) anxious and avoidant adult attachment would predict sexual addiction; (b) shame would mediate the relationship between attachment and sexual addiction; and (c) CSA would moderate pathways between attachment and sexual addiction. Survey and contact information was presented to men and women age 18 and older at local 12 Step sexual addiction groups, emailed to local therapists who facilitate sexual addiction groups, presented at a local conference focused on sexual addiction recovery, and featured as an advertisement in local newspapers. Participants completed surveys primarily online via Survey Monkey, and paper surveys were available upon request. Data was collected from 91 participants with 51 men, 39 women, and 1 transgender individual. A path analysis was completed using the bootstrapping sampling method to test the direct effects of attachment on sexual addiction and the indirect effects of shame. Avoidant attachment had a significant direct effect on sexual addiction, β = .23, p = .004; the relationship was not mediated by shame. The path from anxious attachment to sexual addiction, the total effect, was significant, β = .30, p = .002. The indirect effect of shame for the pathway between anxious attachment and sexual addiction was significant, β = .22, p = .004. Shame partially mediated the relationship between anxious attachment and sexual addiction. Anxious attachment, avoidant attachment, and shame accounted for 30% of the variance in sexual addiction. A hierarchical regression analysis was done to investigate the moderating effect of CSA on the relationship between

Sexual Addiction x

attachment and sexual addiction. CSA did not moderate the pathway between anxious or avoidant attachment and sexual addiction. However, CSA predicted sexual addiction. Avoidant attachment led to the development of sexual addiction. Individuals with anxious attachment developed a shameful self due to invalidating caregiving. Shame resulted in the use of sex as a means to regulate emotions and experience pleasure, which led to sexual addiction. This study further clarifies the symptoms and contributing factors for sexual addiction.

Sexual Addiction 11

Chapter I

Introduction

Within the current study, I will seek to confirm or disconfirm the theorized relationship between attachment dimensions and the development of sexual addiction. In addition, I will investigate the mediating effect of shame developed within childhood and the moderating effect of childhood sexual abuse (CSA) on the hypothesized predictive relationship between attachment and sexual addiction. Sexual addiction, much like other addictions, often takes control of an individual’s life, creating emotional pain and severely disrupting occupations, families, and relationships. The following is an example of the disruption that occurs for the sexual addict. I started having lover after lover. It was getting too complicated at times. I started discovering male prostitutes. When the male prostitutes weren’t around, I went to girlie shows, and I bought the gals. The pattern was the same: one was not enough. I’d need two guys at a time. These people would call my house. My last lover I figured cost me about $30,000…I was spending hours a day pursuing lust objects, either going to the pornos, picking people up, trying to get my wife in bed or masturbating. (Carnes, 1989, pp. 16-17) Thus, sexual addiction can severely strain an individual’s financial means and interpersonal relationships. Sexual addiction is defined as excessive sexual behaviors that increase in frequency and novelty over time, increase risk for disease, and interfere with occupational or relational venues (Keane, 2004). Problems associated with sexual addiction include the following: health risks related to unprotected sex with multiple unknown partners, economic loss due to difficulty with employment (being fired for use

Sexual Addiction 12

of internet porn at work), legal problems resulting from sexual behaviors (soliciting prostitutes), emotional and psychological turmoil, and the negative impact on the partner and the relationship between partners (Reid & Woolley, 2006). The purpose of this study is to further understand the valence of contributing factors for the development of sexual addiction. Attachment styles developed in early attachment relationships have been theorized as salient contributing factors (Leedes, 2001) and limited research has supported this relationship (Zapf, Greiner, & Carroll 2008). Shame has been identified as a key component in the sexual addiction cycle (Carnes, 1989), but little is known about the effects of characterlogical shame in relation to addictive sexual behaviors. Many male sexual addicts have experienced childhood sexual abuse (CSA), but little research has been done to test for the effects of CSA on the development of sexual addiction. The development of shame and the occurrence of CSA fall under the umbrella of attachment. Both significantly effect and reflect attachment quality. Consequently, the purpose of my project is to extend the theory of attachment by investigating the role of CSA and shame in the development of a sexual addiction. Attachment is defined as the pattern of interpersonal bond(s) built from childhood through adulthood with caregivers and significant others and has traditionally been identified as secure, anxious, or avoidant. However, within the current study, attachment will be discussed dimensionally (Fraley, Waller, & Brennan, 2000). Individuals will respond to items that address both avoidant and anxious attachment qualities. Multiple theories have sought to explain why and how sexual addiction develops within individuals. Childhood attachment deficits have been identified as a factor that may contribute to the development of sexual addiction (Butler & Seedall, 2006; Leedes,

Sexual Addiction 13

2001). Children who are not provided a validating environment may be unable to develop self-nurturing skills, affect regulation, and self-governance that is necessary to maintain healthy romantic relationships within adulthood (Goodman, 1993; Swartz & Southern, 1999). This lack of validation has been theorized to result in the development of internalized shame (Kohut, 1977). Shame can be defined as a sense of self-hate that reflects bodily shame, behavioral shame, and characterological shame. Shame has long been identified as a factor in the development of addictions (Levin, 1987). Addiction can be viewed as an archaic fixation resulting from caregiving behaviors that fail to validate the child in key developmental periods. The child is unable to internalize his or her caregiving self-object and continues to seek out other self-objects in his or her substance of choice (sex, drugs, alcohol, or food) to maintain a somewhat stable self-structure and gain some measure of physical pleasure without the burden of seeking out and maintaining intimacy with others, which requires social skills not developed within childhood (Levin, 1971). The occurrence of childhood sexual abuse (CSA) is a significant disruption to the developing attachment process. CSA can be defined as the presence of sexual behavior, as in an invitation to act sexually, exhibitionism, fondling, masturbation, oral sex, attempted intercourse, or completed intercourse, perpetrated by an adult five years older than a child of 16 years or younger (Rind, Tromovitch, & Bauserman, 1998). Childhood sexual abuse has been associated with a variety of maladaptive behaviors, such as hypersexuality (Browning, 2002) and revictimization (Merrill, Guimond, Thomsen, & Milner, 2003). CSA can be understood as a severe disruption of attachment development in which the child must be hypervigilant against the perpetrator, who is often a family

Sexual Addiction 14

member, and the child continues to have difficulty trusting other adults. Children may then be unable to trust the perpetrator and remain vigilant when around other attachment figures for fear of being abused again. Literature Review First, in the current section I will provide differing views on the label given to the occurrence of excessive, risky sexual behaviors. Second, a rationale for the decision to label excessive, risky sexual behaviors as sexual addiction will be provided. Third, prior literature will be presented that address sexual behaviors and the process of sexual addiction. Lastly, a summary will review this information and indicate the need for further understanding regarding the role of attachment in the development of sexual addiction. Defining Sexual Addiction Currently, the label for excessive, risky sexual behavior is under dispute. Within this section, I will present various ways that prominent researchers have labeled excessive, risky, sexual behavior and the rationale behind my decision to identify excessive, risky sexual behavior as sexual addiction. Coleman, Miner, Ohlerking, and Raymond (2001) identified compulsive sexual behavior (CSB) as a disorder in which individuals are consumed by sexually arousing fantasies and urges. These urges may be identified as intrusive, driven, and repetitive. Individuals with CSB (a) experience a lack impulse control, (b) often have social or legal problems, (c) incur disruption in interpersonal and occupational functioning, and (d) incur health risks. According to Coleman, CSB behaviors can be divided into two types: paraphilic and non-paraphilic. Paraphilias are non-normative behaviors that involve

Sexual Addiction 15

recurrent and distressing fantasies involving (a) nonhuman objects, (b) suffering of others or one’s partner, and (c) non-consenting children (American Psychiatric Association, 2000). These behaviors include exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, and sexual sadism. Non-paraphilic sexual behavior may be normative sexual behavior that is engaged in an excessive and compulsive manner: sex with multiple partners, excessive sex with a single partner, and excessive use of online sexual material (Coleman et al., 2001). While the Diagnostic and Statistical Manual of Mental Disorders IV TR (APA, 2000) does not list sexual addiction as a diagnosis, the heading Sexual Disorder Not Otherwise Specified, 302.9, states that occurrence of a sexual disorder may be shown as “distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used” (p. 582). According to Coleman, this diagnosis best fits the description of compulsive sexual behaviors. Kafka (2007) claimed that nonparaphilic hypersexuality disorders are disinhibited manifestations of normal human sexual arousal and desires. The behaviors are not necessarily recognized as socially deviant and share the same clinical characteristics as many of the paraphilic disorders. This label, unlike compulsivity or addiction, is not bound to specific explanatory models, actions, or behaviors. Bancroft and Vukainovic (2004) have sought to investigate the anxiety reducing effects of excessive, risky sexual behaviors. For some individuals, concurrent feelings of anxiety or depression result in heightened sexual satisfaction compared to those without anxiety. Therefore, some individuals may act out sexually in obsessive-compulsive patterns in order to reduce anxiety and painful affect. Three factors play a significant role

Sexual Addiction 16

in sexually compulsive symptoms: (a) impaired affect regulation, (b) lack of behavioral inhibition, and (c) a dysfunctional motivational reward system (Goodman, 1993). Individuals may be unable to regulate their internal emotional states and seek external sexual acts, which produce pleasure and provide escape from internal emotions. Torres and Gore-Felton (2007) suggest that loneliness and marginalization create feelings of anxiety. Individuals who experience marginalization, such as homosexuals, have lowered psychological functioning and increased feelings of loneliness. Compulsive sexual behavior is driven by the need to reduce anxiety rather than by sexual desire. Sex is a solution that is effective in the short term and is reinforced as a coping strategy to reduce anxiety. Alcohol and substance abuse are other strategies used to reduce emotional pain stemming from loneliness. There is an ongoing debate as to whether risky sexual behavior should be identified as an addiction or a disorder associated with compulsivity, similar to OCD. While Coleman makes a case for risky sexual behavior as CSB, there appears to be some significant differences between CSB and OCD. Unlike compulsions that occur within OCD, risky sexual behavior involves the experience of pleasure from repetitive sexual acts. The physiological effects of sexual acts are comparative to the physiological effects of drugs, and oftentimes when drugs are not readily available, addicts substitute sex for their drugs of choice (Carnes, Murray, & Charpenter, 2005). The DSM-IV TR description of Obsessive Compulsive Disorder (OCD) includes reduction of anxiety and notes that the individual gains no pleasure from the compulsive act: The essential features of Obsessive-Compulsive Disorder are recurrent obsessions or compulsions that are severe enough to be time consuming (i.e., they take more

Sexual Addiction 17

than 1 hour a day) or cause marked distress or significant impairment. At some point during the course of the disorder, the person has recognized that the obsessions or compulsions are excessive or unreasonable…. Compulsions are repetitive behaviors (e.g., hand washing, ordering, checking) or mental acts (e.g. praying, counting, repeating words silently) the goal of which is to prevent or reduce anxiety or distress, not to provide pleasure or gratification. (APA, 2000, pp. 457) While sexual acts result in reductions of anxiety and depression, they also result in pleasure in the early stages of the syndrome. This pleasure is evidenced by physiological effects within the dopaminergic and andrenergic systems in the brain (Keane, 2004). In addition, sexual paraphilics respond to serotonergic and noradrenergic antidepressants much like depressed persons do, while OCD typically responds to serotenergic drugs alone (Goodman, 2001). When sexually addicted OCD individuals were treated for their OCD behaviors, sexually addictive behaviors did not improve. The relationship between an individual and his or her substance of choice is rigid and intense (Keane, 2004). Substances of choice are often identified as psychoactive drugs, but can also include unyielding, ritualized behaviors such as gambling or sexual acts. When individuals seek to satiate their desire for gratification, they experience three neurochemical responses: arousal, satiation, and fantasy or preoccupation with the object or substance that resulted in pleasure. With the state of arousal comes an increase in the neurotransmitters dopamine and norepinephrine. Satiation results in increased gamma- aminobutryic acid, and fantasy results in an increase in serotonin. Just as mood-altering substances can result in these central nervous system responses, mood-altering behaviors

Sexual Addiction 18

(gambling or participating in high-risk sexual activities) can result in elevated neurotransmitters as well. Many who report sexually addictive behaviors also report lifetime problems with alcohol abuse or dependence, and compulsive sexual behavior has been shown to trigger drug use such as cocaine, crack cocaine, and inhalants (Black, Kehrberg, Flumerfelt & Schlosser, 1997; Schneider & Irons, 2001; Kalichman & Cain, 2004). Eating disorders, caffeine use, and smoking are also common co-morbid behaviors (Sprenkle, 1987). Historically, addiction to substances has been identified with the criteria of tolerance and withdrawal (Schneider & Irons, 2001), which parallels the physiological effects of psychoactive drugs. The DSM-IV TR defines dependence as “a maladaptive pattern of substance use, leading to clinically significant impairment or distress” (APA, 2000, p. 197). According to Schneider and Irons, sexual addicts often report feelings of tolerance and an increased need for sexual acts (increased hours on the internet, more bizarre or riskier sexual acts), and feelings of withdrawal (dysphoria, anxiety, and difficulty concentrating). Carnes (1989) has identified 10 behavioral signs indicating criteria for a diagnosis of sexual addiction, including: (a) a pattern of out-of-control sexual behavior, (b) severe consequences due to sexual behavior, (c) the inability to stop despite adverse consequences, (d) a persistent dispute of self-destructive or high risk behavior, (e) ongoing desire or effort to limit sexual behavior, (f) sexual obsession and fantasy as a primary coping strategy, (g) increasing amounts of sexual experience because the current level of activity is no longer sufficient, (h) severe mood changes around sexual activity, (i) inordinate amounts of time spent in obtaining sex, being sexual, or

Sexual Addiction 19

recovering from a sexual experience, (j) neglect of important social, occupational, or recreational activities because of sexual behavior. (pp. 12-27) Sprenkle (1987) suggested that sexual addicts progress through the following four stages within their sexual addictions: (a) preoccupation, a trance-like mood in which the individual is engrossed in sexual thoughts; (b) ritualization, a routine the individual has developed leading up to behavior; (c) compulsive sexual behavior, an act the individual is unable to control; and (d) despair, feelings of powerlessness and hopelessness. According to Schneider (2004) if an individual experiences the following: (a) loss of control, (b) continuation of the act despite negative consequences, and (c) obsession and preoccupation, his or her behavior can be identified as an addiction. The terms addiction and compulsion have multiple meanings even in the sex research literature (Carnes, 1996). Throughout the five areas of research that seek to explain and treat sexual addiction (sexual medicine, addiction medicine, trauma medicine, psychiatry, and criminal justice), there are common themes. These themes include intense arousal with pleasure and satiation and the presence of anxiety reduction. Individuals are preoccupied with fantasies, are obsessive, and often dissociate and deprive themselves, which may include an aversion to the sex act. Sexual behaviors are evidenced by neurochemical processes and reflect internal chemistry and the presence of excessive or depriving sexual behaviors that may interact with other excessive or depriving behaviors such as eating or substance abuse. Historically, sexual addiction has been identified as hypersexuality or an impulse control disorder (Kafka, 2007). In the past, the DSM II (APA, 1968) recognized sexual deviations as personality disorders but made specific mention of nonparaphilic

Sexual Addiction 20

hypersexuality. Don Juanism and nymphomania were identified as psychosexual disorders NOS within the DSM-III (APA, 1981). The DSM-III-R gives an example of a Sexual Disorder NOS as the following: “distress about a pattern of repeated sexual conquests or other forms of nonparaphilic sexual addiction, involving a succession of people who exist only as things to be used” (APA, 1987, p. 296). Currently, the DSM-IV- TR (APA, 2000) does not use the term sexual addiction, but makes reference to the use of another human as a sexual object repetitively. This study considers excessive, risky, sexual behavior as a sexual addiction evidenced by (a) the initial pleasure of the sexual act, (b) tolerance, evidenced by the increased frequency and amount of sexual acts, (c) the presence of withdrawal, (d) and the inability to abstain from excessive, risky, sexual behaviors despite various negative consequences. Symptoms of Sexual Addiction. Sexual addiction is a broad term that can refer to many addictive sexual behaviors. The current section will review studies that provide information regarding various sexual behaviors, the frequency of the sexual behaviors, and demographics for the typical sexual addict. Schneider (2004) identified seven behavioral manifestations of sexual addiction: (a) fantasy sex, an obsessive sexual fantasy life characterized by neglecting responsibilities to engage in fantasy and/or prepare for the next sexual episode; (b) seductive role sex, in which conquest is necessary for arousal and decreases rapidly after initial contact, and arousal can be increased with greater risk and or an increase in partners; (c) voyueristic sex (visual arousal), requiring the use of visual material to venture into a trancelike state often accompanied by

Sexual Addiction 21

masturbation; (d) exhibitionistic sex, arousal resulting from attention or shock by viewer; (e) anonymous sex involving no seduction but including one-night sexual encounters with strangers in restrooms, beaches, bars, etc.; (f) paying for sex, in which arousal is heightened by payment for sex and over time sex and payment become connected; and (g) trading, selling or bartering sex for power. The addict gains control over others by using sex as blackmail. (pp. 204-05) Among college men who reported cruising for sex on campus, fifty percent reported at least one sexual encounter in a campus restroom, locker room, or sauna within the 90 days prior to enrollment in the study (Reece & Dodge, 2004). Men reported sexual acts focused primarily on genitalia, solo masturbation, mutual masturbation, and oral interaction. Men who reported using sexual toys within the last 90 days had higher sexual addiction scores compared to those who had not. Many men reported that they had no fear of getting an STI or HIV. Many sexual addicts first use online pornography and progress, either to new or different forms of pornography or to differing types of sexual behaviors with other individuals. About one-third of online cybersex respondents reported 1 to 10 hours per week spent online downloading material, and a little less than 1/3 spent 11 to 30 hours online (Cooper, Scherer, Boies & Gordon, 1999). Among Swedish respondents, addicts who spent 15 hours on the internet stated they had engaged in the following behaviors: looking for a sexual partner, replying to sex ads, chatting with people who had the same sexual interests, buying sex products, and contacting prostitutes (Daneback, Ross, & Mansson, 2006). After beginning the use of online pornography, sexual addicts may

Sexual Addiction 22

report an increase in reading pornographic magazines and an increased use of adult magazines. Dew, Brubaker, and Hays (2006) found that among 508 heterosexually married men who reported using the Internet for sexual purposes, nearly half reported their sexual orientation as bisexual, 31% as heterosexual, and 21% as homosexual. Those who reported a greater number of sexual activities resulting from online communication were significantly more likely to be between ages of 35 and 54, label themselves bisexual or homosexual, live in suburban areas, and earn greater than 80,000 dollars yearly. The use of unprotected oral (giver), vaginal (inserter), and anal (receptor) sex were the strongest predictors of the total number of sexual partners in the last year. Online sexual material is easily accessible and affordable and facilitates the development of sexual addiction. Individuals may spend large amounts of time viewing pornography online that they might not view otherwise. As they continue to view pornography, they often view for a greater number of hours and seek out new forms of pornography. Daneback et al. (2006) found that up to 74% of sexual addicts were men. Cooper et al. (1999) found that among 9,177 who chose to complete an online survey regarding their online sexual pursuits and propensity for risky sexual acts, a majority were male respondents with a mean age of 34.96 and standard deviation of 11.62 years. Only 14 percent were women, with a mean age of 32.60 years and standard deviation of 10.24 years. A majority of the participants reported being heterosexual, 7% reported being gay or lesbian, and 7% reported being bisexual. According to Gana, Trouillet, Martin, and Toffart, (2001) men are more likely to achieve boredom and engage in solitary sexual behaviors, such as masturbating and

Sexual Addiction 23

viewing pornographic materials. In a study conducted by Dodge, Reece, Cole, and Sandfort (2004), male college students were shown to have participated in a higher number of sexually compulsive behaviors than college women. In addition, women reported being in exclusive sexual relationships more often than men. Heterosexual men reported significantly more involvement in nonexclusive sexual encounters than women. Among bisexual and homosexual men and women, Kelly, Bimbi, Nanin, Izienicki, and Parsons (2009) found that gay and bisexual men were higher in self-reports of sexually addictive behaviors than lesbian and bisexual women. Individuals high in sexual compulsivity were more likely to drink alcohol or use drugs and were more likely to engage in sado-masochistic behaviors, exhibitionism, and sex with urine. Schneider (2000) conducted a qualitative study to investigate differences among men’s and women’s use of cybersex. A majority of men used pornography online, while only 1 out of 10 women utilized pornography. A majority of men reported an extensive history of compulsive masturbation and use of pornography. Women preferred using chat rooms to meet possible real-life sexual partners, under the pretext that sexual acts occurred in a relationship and were more meaningful. A few women reported favoring pornographic images. One woman reported, “There are women out there like myself who are aroused visually like men and have some characteristics that more closely follow that typical male sex addiction” (Schneider, 2000, p. 262). Prior studies have focused on male sexual addicts. However, sexual addiction occurs among both men and women. It appears that men are more likely to engage in solitary sexual acts, while women seek interpersonal ways of acting out sexually.

Sexual Addiction 24

Summary of Sexual Addiction An overview of literature has been provided regarding labels used to identify sexual addiction, and the various sexual behaviors reported by sexual addicts. Coleman et al. (2001) identified compulsive sexual behavior (CSB) as a disorder in which individuals engage in excessive sexual acts such as sex with multiple partners, excessive sex with a partner, and excessive use of online sexual material. Goodman (1993) identified that individuals with sexually compulsive symptoms lack the ability to regulate internal emotional states, and sexual acts produce pleasure and escape from internal emotions. Torres and Gore-Felton (2007) found that individuals who experience marginalization, such as homosexuals, often experience feelings of loneliness, and use sex to reduce anxiety rather than gain sexual gratification. However, the DSM-IV TR (APA, 2000) identified compulsions as repetitive behaviors that do not result in pleasure or gratification, while many sexual addicts report experiencing sexual pleasure at the onset of their sexual addiction. Keane (2004) found that sexual addicts experience pleasure evidenced within the dopaminergic and andrenergic systems. Goodman (2001) found that sexual paraphilias respond to serotonergic and noradrenergic antidepressants similarly to depression, while OCD behaviors respond to just serotenergic drugs. Schneider and Irons (2001) found that many sexual addicts experience feelings of tolerance with an increased need for sexual acts and feelings of withdrawal. Both are identified as criteria for dependence in the current DSM- IV TR (2000). In addition, many who report sexually addictive behaviors report a lifetime use of drug and alcohol, suggesting that sexually addictive acts can trigger or be used to substitute for alcohol or drugs (Schneider & Irons, 2001). Thus, the label of sexual

Full document contains 162 pages
Abstract: The primary purpose of this study was to investigate the influence of attachment, shame, and childhood sexual abuse (CSA) on the development of sexual addiction. This study proposed three hypotheses: (a) anxious and avoidant adult attachment would predict sexual addiction; (b) shame would mediate the relationship between attachment and sexual addiction; and (c) CSA would moderate pathways between attachment and sexual addiction. Survey and contact information was presented to men and women age 18 and older at local 12 Step sexual addiction groups, emailed to local therapists who facilitate sexual addiction groups, presented at a local conference focused on sexual addiction recovery, and featured as an advertisement in local newspapers. Participants completed surveys primarily online via Survey Monkey, and paper surveys were available upon request. Data was collected from 91 participants with 51 men, 39 women, and 1 transgender individual. A path analysis was completed using the bootstrapping sampling method to test the direct effects of attachment on sexual addiction and the indirect effects of shame. Avoidant attachment had a significant direct effect on sexual addiction, β = .23, p = .004; the relationship was not mediated by shame. The path from anxious attachment to sexual addiction, the total effect, was significant, β = .30, p = .002. The indirect effect of shame for the pathway between anxious attachment and sexual addiction was significant, β = .22, p = .004. Shame partially mediated the relationship between anxious attachment and sexual addiction. Anxious attachment, avoidant attachment, and shame accounted for 30% of the variance in sexual addiction. A hierarchical regression analysis was done to investigate the moderating effect of CSA on the relationship between attachment and sexual addiction. CSA did not moderate the pathway between anxious or avoidant attachment and sexual addiction. However, CSA predicted sexual addiction. Avoidant attachment led to the development of sexual addiction. Individuals with anxious attachment developed a shameful self due to invalidating caregiving. Shame resulted in the use of sex as a means to regulate emotions and experience pleasure, which led to sexual addiction. This study further clarifies the symptoms and contributing factors for sexual addiction.