In many ways, it would appear that breaking up is similar to falling in love. I know what you are thinking, and you are right – it’s not quite the same thing. However, in terms of the physiological effects that it has on your mind, psyche, and body, it would appear to have quite a significant effect as it can potentially turn your world upside down.

Breakups can throw our worlds into a chaos, similar to falling in love, I would suggest. Dr. Helen Fisher wrote a book called Why We Love, and in her book, she discussed the chemical changes that actually take place in the human brain and body when one ‘falls in love,’ which she surmised was similar to being on cocaine. In the early stages of, what she describes as lust and romantic love, the brain goes through a series of changes, which can be best described as exciting, but chaotic. The third stage is the attachment phase, or long-term love, which is basically biology’s way of allowing couples to raise children together; not as chaotic, and not as exciting, but with deep trust and love. In breakups, we experience a similar chaos, though perhaps not quite as exciting, and sometimes perhaps downright tumultuous. Now, most of us hope that we won’t have to get to this stage of “breaking up,” but sometimes it’s actually bound to happen and is in fact a blessing, perhaps in disguise, as it will undoubtedly force us to grow and heal. Like ripping a band-aid off, breakups do allow for new cell growth, if given the proper time and patience.

Breakups are not only a chaotic time, but are also a vulnerable time for most. The early stages of breakup periods, if not dealt with consciously, with allowance for grieving, and sadness, can lead to a slew of other problems. Many people turn to other sources for solace in the early stages of a breakup: alcohol, drugs, food, one-night stands, dating, and sex, to name a few. Some people do this, but not all. Some people turn inwards, decide to eat healthy, exercise, spend some quality time alone, and balance it with friends, work and family. Others may jump head first into some other relationship, without a break from their current life, and start over anew. The point is that jumping head first into something new, whether it be a new relationship, or even just work, or random one-night stands, though they may feel good in the moment, during this time of new vulnerability can lead to bigger and greater problems down the road.

Let’s talk about sex for just a brief moment. After a long-term relationship, some people may find that their sexual drives are at an all time high. People respond to this increase in arousal in several different ways. Finding another long-term partner to focus your affections on is one way, and finding a series of anonymous or one-night stand hook-ups might be yet another way. Either way may be fine for you; however, it is very important to take care, as jumping head first into either of these options could halt the healing process, and in many cases adds on a whole other series or problems to the fold. Sex addiction is amongst those possibilities. Addictions often develop as a result of anxieties which require soothing. Acting out sexually could, in the moment, alleviate one’s anxiety, but in the long run can turn into an escape from dealing with one’s problems in the present, which could eventually turn into an addiction.

The main thing to remember during a breakup is what to not do. Avoid jumping into something new right away, and avoid patterns that alleviate pain, temporarily. Do allow yourself to sit and feel the pain, as difficult as that may seem. Allow yourself to be alone, to sit alone. Give yourself time to think, breathe and exist in your own pain. Pain and suffering are a part of life. Avoiding the inevitable strips us of growth, as it doesn’t allow us to utilize our own coping skills, which in the end are akin to survival. Develop those survival skills now, not later. In addition, allowing our own healing to occur now can prevent a slew of maladies later on. Sometimes a breakup can seem like the end of the world, and it’s hard to hear these words, but trust me when I say time heals all wounds.

Related Articles:
Phases of Healing
3 Things You Can Do in Overcoming Sex Addiction
Why Does Mr. Wrong Feel Like Mr. Right?

I’m struck by the fact that people with addiction issues, when confronted with the destructive effects of their behaviors, often find it harder to stop. This is especially true, in my clinical experience, when it comes to compulsive sexual behavior, aka sex addiction. Why is that?

Therapy clients who struggle with drinking or substance abuse tend on the whole to accept – eventually, and with my ongoing support – that they do have a problem with drinking or using, and that these behaviors are an obstacle to happier living. Once “the cat is out of the bag”, they usually attempt to reduce or quit using, over time, or else quit therapy altogether.

Those struggling with compulsive sexual behaviors, however, may remain ambivalent for years, while remaining in therapy –  aware of their dependence on these behaviors and the destructive effects of same, while wrestling with whether or not they want to stop. It’s a matter of two steps forward, two steps back, over and over again, with no change in sight.

Additionally, it is often reported to me that there appear to be more people in Alcoholics Anonymous with long-term sobriety compared to those in Sex Addicts Anonymous or Sex and Love Addicts Anonymous or other 12-step programs for healthier sexuality. Those with long-term sexual sobriety – or “abstinence” – tend to be fewer in number. Again – how come?

I know there is a lot of controversy in the mental health field about whether sexual compulsivity is truly an “addiction.” It is not my intent here to address that complex question. Suffice it to say that the suffering of those who can’t stop, in the face of heartbreaking damage and loss, is staggering to behold. If one of the key criteria for an addiction is an inability to stop in spite of negative consequences, then compulsive sexual behavior more than qualifies as an addiction.

So, if one assumes we are in fact dealing with two actual addictions, we are still left with the aforementioned disparity between drug/alcohol vs. sexual sobriety. Is it because one can live without drugs or alcohol, but cannot “remove” sexuality from one’s being? We are, organically speaking, sexual creatures, and the goal of treating sexual addiction is not to remove one’s sexuality but to create healthier, more intimate and less self-destructive behaviors.

I suspect that, because we are dealing with sex after all, the issue goes even deeper. Sexual desires and fantasies often emanate from the very core and are difficult to interpret. Heterosexual men with compulsive sexual issues, for instance, may desire sex with other men while staying married to a woman; some pursue sex with transvestite prostitutes, in ways that put themselves at legal and medical risk. I know of high-functioning women who are compelled to conduct serial affairs, virtual or real, with men whose only apparent goal is to sexually “use” them in sadistic or degrading ways. These are people who have little to gain, it would seem, and everything to lose.

Another complication is that sexuality is a relational activity. It always implies another person, either real or fantasized. One can use heroin or drink alone, as many do. But it always “takes two to tango”, even if one of those people is a fantasy or “virtual” person. Even when one uses online pornography, for instance, another person is “present”, at least onscreen.

Close readings of sexual fantasies and compulsive behaviors can be revealing of one’s buried self-concepts and unexpressed needs; an S&M fantasy may represent a way of coping with an overbearing or shame-inducing caregiver, by sexualizing the pain and staying in control of the fantasy/scenario (even if one is the “M”). Those struggling with scenarios of dominance over others may be trying to compensate for intolerably low self-worth, an attempt to control chaotic emotions leftover from a traumatic upbringing.

My experience with straight men who compulsively watch porn often reveals a desire for a woman who can offer everything but demand nothing, and disappear when the encounter is over, before she decides he’s “too much” for her, or “gross,” or perverted, etc.  It’s a sort of mini-relationship, easily controlled by someone who usually has a desire for and deep fear of intimacy, who gets his needs met quickly and then signs off.

It’s almost as if these fantasies provide a window into the psyche, revealing unmet needs.   Like the need to feel in control, to express repressed desires, to sexualize (i.e. numb or self-medicate) hurtful or shameful feelings or other emotions that are unconscious or too difficult to articulate.

These are feelings and needs that cannot be expressed in their actual relationships – usually because they are perceived as “disgusting” or “too much” for their partner.  Of course, their partner very often has her own “stuff” and tends to be closed off, angry, controlling, etc.  It’s an extremely painful dynamic that I see with many of my male clients – straight and gay – who struggle with sexual compulsivity.

Why would a man, or anyone really, seek an “emotionally unavailable” partner? Because we tend to gravitate toward the familiar, even if what is familiar is dissatisfying or even abusive.

Very often the person chooses an emotionally closed off, or overly aggressive (or withdrawn) partner because, in reality, the alternative is too scary. It may sound strange, but what’s even scarier than not finding love – especially in cases of a traumatized upbringing, which includes just about everyone I work with – is actually finding it! Why is that? Because love can be lost or taken away, leaving the person abandoned and traumatized (again) – even more painful than being mistreated or ignored. In the latter case, at least you know someone is there.

Thus the person suffering from core interpersonal trauma – the result of a faulty caregiver, another human being – who ends up sexualizing their needs via the behaviors described above, hovers between a desperate yearning for and deep aversion to intimate connection. The sort of “mini-relationship” described above is often a substitute. It satisfies…for a while. One connects, finds relief via sex and affection (what’s actually virtual feels real at the moment) – then detaches before becoming too invested or emotionally “at risk” for abandonment.

That emotional risk, believe it or not, is usually more frightening than the prospect of the legal or health risks that accompany these behaviors. Abuse and emotional distance is familiar, even if painful, while the possibility of genuine love is new and terrifying.

Thus the compulsive behaviors are a temporary solution to the very real and shameful problem of a confusing inability to connect with others.  I say “shameful” because very often the feeling is something like, “I’m an idiot because I don’t know how to stop.  Why do I do such disgusting things.  What a piece of garbage I truly am.”  (Even if the person is outwardly successful, wealthy, etc.  As they say in recovery, it’s always an inside job.)

One of my clients once said in my office, with a smile on his face, “I have no love in my life.  I’d only ruin it if I did”.  This was a successful, married attorney with a compulsion to see prostitutes.

It took me a few moments to realize the smile was an awkward attempt to conceal shame, not any sort of bemusement. That smile was one of the saddest things I’ve ever seen.

What I want to stress here is the pain that needs soothing is, in part, not the result of an unrequited hunger for love, nor a fear of finding it, but rather an impossible non-reconciliation between the two.

Here are two opposing, powerful forces at work, with radically different agendas – one to connect, the other to protect.  Without help, this internal conflict results in unmanageable emotional turmoil and frustration. The cycle never ends, until the person says “enough,” and seeks help.

I’ll talk next time about how therapy can, when effective, provide a slow but steady path towards healthier intimacy and a chance to escape the suffocating shame and loneliness that so many of my clients describe as a slow-moving poison — leading them to behaviors they so desperately want to stop, but can’t.

Related Articles:
Super-sizing Sex
The Good and Bad Sides of Porn
Three Ways to Avoid Sex Addiction Relapse

The most common question I get in my work and sometimes from my friends is “Am I an alcoholic?” This is usually followed by “Does this mean I have to go into rehab?” or “Will I ever be able to have a drink again?”

I believe that treatment for addiction should be individualized to take into effect each person’s individual needs, complexity, and readiness to change. Every case is different. Sometimes the answer is undeniably complicated. I was trained to apply systematic screening and assessment in order to determine if alcohol abuse vs. dependence is present based on Diagnostic and Statistical Manual of Mental Disorders criteria and make treatment recommendations based on the American Society of Addiction Medicine placement criteria.

But sometimes I encounter cases of addiction that do not fit anywhere. After the tragic death of Amy Winehouse, there was a lot of speculation online—even by professionals in the addiction field—as to who was to blame. There was actually one article I read that seemed to imply that if she had been able to drink in moderation maybe she would still be alive. I honestly cannot comment on that either way.

Understanding the Harm-Reduction Model

I will say the harm-reduction model of treating addictions is not popular among people who advocate for abstinence as the only acceptable treatment outcome and people who support the 12-step program approach. Having worked at a methadone clinic for years and witnessed powerful positive change, I am not a big fan of one-size-fits-all treatment approaches, nor am I into labeling.

I have found one view on addictions very helpful for people who do not seem to fit the traditional medical model of addiction: the Stanton Peele approach. Here’s a summary of his view on addiction:

“Addiction is not unusual, although it can grow to overwhelming and life-defeating dimensions. It is not essentially a medical problem, but a problem of life. It occurs for people who learn drug use or other destructive patterns as a way of gaining satisfaction in the absence of more functional ways of dealing with the world. Therefore, maturity, improved coping skills, and better self-management and self-regard all contribute to overcoming and preventing addiction. Addiction is a way of coping with life, of artificially attaining feelings and rewards people feel they cannot achieve in any other way.” —Stanton Peele

[fat_widget_addiction_right]Of course, I think harm-reduction does not work for everyone. In fact, it can be detrimental to one’s recovery. But that’s a subject for another article. One area I find Peele’s theory to be applicable is in explaining how addiction and intimate relationships are so closely interconnected.

Jim always ends at the bar drinking after a fight with his wife. Anna’s drinking always gets out of control after a break up. John had experimented with pain pills on and off in college but did not get addicted to them until after the devastating loss of his long-time lover and best friend. Travis’s sex addiction gets worse after feeling rejected by a love interest.

In the words of one of the people in my therapy sessions, “I was lost before I found love. I was on a path of self-destruction with drugs, alcohol, and women; but with my wife I have found what I was always missing. I have been clean and sober since. Now I’m high on life.”

Addiction As a Way to Respond to Unsafe Relationships

By unsafe, I don’t mean physically violent—although that is the most obvious case. Unsafe means threatening to the ego as much as threatening to the body. What I’m talking about here is emotional safety. When we feel loved, accepted, nourished, protected, and part of someone else, we feel safe. That safety is often threatened when we feel unloved, not cared for, betrayed, lied to, yelled at, abandoned, neglected, rejected, and violated.

To understand where we are going, we have to understand where we came from.

Safety and the Primitive Brain

Let’s start with the evolution of the brain. In the base of our brain, we have the reptilian brain. We share this part of the brain with animals including alligators and lizards. The reptilian brain takes care of those things we don’t usually think about: heartbeat, digestion, and breathing. It also is concerned with survival, and if it’s dangerous, it will help us respond in one of five basic ways: fight, flight, freeze/play dead, submit, or hide. I also view these as the five basic survival skills of couples. Couples may fight, flee (leave), play dead (stare right through their partner), submit (OK, whatever you want, just stop the nagging!), or hide (go to another room).

On the other hand, if the reptilian brain is safe, we will do one of five things: play, nurture, mate, work, and be creative. Remember when you first met your partner? How you played, nurtured each other, and had more sex? Do you remember being more creative and productive at work?  As animals evolved, a second part of the brain developed called the mammalian brain. This brain developed when animals began to live in groups and take care of their young. This is the part of the brain where feelings are stored. That’s why most animals experience some feelings and live in groups.

Several million years ago, a third part of the brain developed: the cerebral cortex. In humans, this part of the brain is five times bigger than the other two parts combined and is where all logical processes happen: speech, writing, logic thinking, math, etc. The three parts of the brain work together simultaneously. If a tiger is coming at you, your logical brain says, “That’s a tiger,” your mammalian brain says “I feel scared,” and your reptilian brain says “Run!” or “Freeze!”

But in relationships, it is often hard to articulate or identify who or what the “tiger” actually is. We know something is not right, and we are left analyzing the behaviors we can clearly see but can rarely understand. How is it, for instance, that when Jim and Linda fight, he ends up getting drunk at the bar even though he knows that is not going to help the situation at home but only confirm Linda’s insults?

Sometimes fighting, fleeing, or hiding involves addictive behaviors—particularly sexual behaviors, but also gaming, internet addiction, and alcoholism. Often past experiences with these behaviors make a person more susceptible to restarting (if they have stopped) or increasing the frequency of these behaviors. This explains why people engage in addictive behaviors even against their logical thinking. It appears that the primitive reptile brain has taken over the cerebral cortex. This is why people logically know it doesn’t make sense to engage in behaviors that often make the already troubled relationship even worse. They are “thinking” with their primitive reptile brain, which often means they are not actually thinking at all.

Sometimes we are not simply chasing a drink or a drug. Sometimes using is a maladaptive way of coping with unsafe relationships. In this case, treatment should focus on the relationship and reestablishing safety more than on changing addictive behaviors themselves. I have found that establishing safety and learning to evoke mental images of safe places/mental states is crucial in learning to calm oneself and coping with highly stressful situations, which in return helps the addictive behavior dissipate.

In my opinion, this should also be the main focus of relapse prevention in more traditional addiction treatment.

References:

1. Clifford, R. (n.d.). From Reptiles to Humans: A Three Brain Odyssey. Retrieved from http://www.starchiefpress.com/articles/article42.html
2. Luquet, W. (2007). Short-term couples therapy the Imago model in action (2nd ed.). New York: Routledge.
3. Peele, S. (1990, March 14). Cures depend on attitudes, not programs. Retrieved from http://lifeprocessprogram.com/lp-blog/library/cures-depend-on-attitudes-not-programs/

I want to start off by saying that pornography in and of itself is not a ‘bad’ thing. We have preconceived notions about porn being something bad. Men feel guilty about it. Women feel threatened by it. I want to talk a little bit about why porn is good, and why porn is bad. At the core, I believe that everything in moderation is the best format to follow. And a little bit of porn should be fine, as long as it’s not interfering with your sex life, social life, finances, job, relationship, family, responsibilities and so on. (Read: Most mental health professionals will in fact determine whether or not something is considered an addiction, or if someone is addicted based on the aforementioned variables of responsibilities. If something is being affected, such as any or all of job, relationship, family, money, chances are the individual has a problem or addiction, and will likely be treated as such by the mental health professional.)

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So, with that said, we are long overdue to begin to wonder how the internet’s biggest industry Porn, which continues to infiltrate our relationships, our sex lives, our bedrooms, not to mention the lives of teenagers who have the highest porn viewing statistics, and so much more continues to thrive, when it seems to have so many negative connotations? How can 63 million viewers be so wrong*? As a sex educator, I feel that a lot of it has to do with our attitudes about sex. Naturally, when we don’t feel comfortable talking about something, that we already feel we know so little about, and ill-equipped to talk about, read: yes, I am talking about Sex, its presence, in a highly graphic manner is going to intrigue us. Hence we are enticed to watch such movies and videos. But on the flipside, the messages we were sent growing up about masturbation, sex and nudity, and the silence we were fed when it came to anal sex, girl-on-girl or man-on-man sex, group sex or orgies, and sodomy may also lead to anxiety about what we see, which can lead to the on the better end, aforementioned feelings of guilt, and full blown addictions on the worst-case-scenario end. (more…)

I was very young when I knew I wanted to be a therapist. I became particularly interested in depression and how people deal with traumatic events. Never in a million years did I think I would be an addiction expert. After my graduate studies I took an internship at a substance abuse outpatient center. This was purely by chance and because they had a good reputation for offering really good supervision. During my internship it quickly became clear to me that my graduate program in mental health had left me ill prepared to work with substance abuse issues. I kept screening for mental health symptoms because that’s what I knew and we tend to go where we feel comfortable.

Substance abuse counselors on the other hand are often undertrained in mental illness and tend to ignore or dismiss signs of it, thinking once the drugs are out of someone’s life they will get back to normal functioning. And when they don’t they blame the clients “for resisting happiness” or being “chronic complainers”.  We fail to recognize that sometimes, even after drugs and alcohol are long gone, people struggle with what could have been there all along: mental illness. (more…)

Many of the partners or loved ones (POLOs) of those struggling with addiction often seem reluctant to get help for themselves. I’m not sure why that is, but I’m hoping this article provides some answers.

These beleaguered folks are often fixated on the behavior of the loved one who struggles with drugs or alcohol (or other compulsions). Of course, it’s hard not to fixate on rampantly destructive behaviors. It often seems as though families where addiction is present are always struggling to either avoid or deal with addiction’s collateral damage (financial, emotional, professional, etc). I’m coming to the conclusion that because the behaviors surrounding addiction are so darkly magnetic, a constant pull on the family’s attention, it may be hard to understand why focusing on oneself is important. (more…)

Have you ever found yourself in a shopping mall, searching, with a slightly pounding heart, for something? Something to wear tonight, tomorrow, or for that next important meeting, or perhaps it’s something yet to be thought of, but you know you must need something, or at least you feel like you need something. Maybe you just want something new, what is the difference, right? You are just going to get it and then whatever is really going on will go away, maybe it’s not even that something tragic or problematic is happening, but your mind and emotional system has been wired so that you go shopping, and when you get a new object that will, in turn, whether you acknowledge this or not, assist you in getting rid of something, or help you “deal” with your feelings.

People who have found compulsive shopping to be an avenue of distraction use compulsive spending as an emotional regulation system. Compulsive spending is the thread or the glue that holds the emotional regulation system together when a person would typically “fall apart” or fragment.

Take the Compulsive Spending Quiz

If the scenario listed in the first paragraph sounds familiar, you may want to consider whether you tend toward compulsive buying. To do so, answer each of the following questions with “almost always,” “once in a while,” “infrequently,” or “not at all”:

1. Do you buy things you want even if you know at that moment you do not have the money to pay for it?
2. Is it difficult for you to save money?
3. When you have some extra cash that you could save, do you think instead of other things you would like to buy?
4. Do you cheer yourself up or give yourself a reward by going shopping?
5. Does more than a third of your income go to pay credit card bills, not including rent or a mortgage payment?
6. Have you had to move credit lines because you typically don’t have the money to pay off your credit line?
7. Do you pay the minimum balance on your credit card most of the time?
8. Are you inclined to keep buying more of your favorite things—clothes, makeup, CDs, books, computer software, electronic gadgets—even though you do not have a specific need for them?
9. When and if you have to say no to yourself or control yourself from buying something you really want, do you feel intensely deprived, angry, or upset?

If you answered “always” and “once in a while” to at least four of these questions, you may have overspending tendencies. The last question is a particularly potent indicator of a serious problem; if you answered “always” or “once in a while” to question number 9, compulsive spending/shopping should be considered a real concern.

What’s Really Going On?

At the core of many compulsions and addictions lays the untouched, guarded emotional life. A person suffering from a hunger disease such as compulsive spending experiences anxiety because he or she wants something but cannot allow themselves to really know what it is. This knowing would perhaps be too painful to tolerate and hence the compulsion to spend becomes the method of soothing, a frantic race to kill off the thoughts, and acquiring objects of desire with a “magical” credit card, makes the soothing process easy. Then, once the objects are consumed or purchased, a sense of relief surfaces simultaneously along with negative thoughts toward the self for doing something so “stupid.” A repetitious cycle is created because the acquisition provides transient satisfaction, not long-term satiation, and it fuels the compulsion to buy increasingly. The wanting and anticipation of getting the new purse, shoes, or race car contains the most pleasure and is done repeatedly.

In fact, some people buy the same thing over and over, knowingly or not. For example, perhaps a person buys 20 pieces of the same fruit at each grocery store visit whether or not he or she needs them, because the purchase creates a feeling of safety, soothing, and containment over anxiety.

Compulsive spending becomes increasingly severe over time, just like other forms of addiction. Credit cards are maxed out and new cards are obtained until the damage is so severe that serious debt is what leads a person to seek some form of assistance or at least hit rock bottom, and then, get help or start the cycle once again. It is important to understand that the “habit” is not an intellectual problem, but an emotional problem, in the sense that the emotional regulatory system has gone awry and spending is what keeps the system held together.

In his book, Hunger Diseases, Raymond Bettegay defines hunger diseases as the emotional problems a person has based on a lack of self-esteem, so much so that they are driven to possess and consume people and or things in an addictive manner. However, no matter how much they get, it does not feel like enough. The hunger is insatiable. It is thought that these problems derive from childhood when the child’s hunger for closeness, warmth, and stimuli were either inadequately met or inordinately gratified, triggering a recurrent experience of insatiable hunger—a hole or emptiness that must be filled with a constant supply of something. Compulsive spending, too, develops to create homeostasis in an emotional world that seems scary, unstable, and uncertain. The process provides sustenance and recovery requires an intentional transition, just like transitioning a baby from a bottle or from nursing. Recovery requires being attentive to needs, feeling emotions, rather than suppressing them, and responding with insight and care.

Neurobiology and Addiction

Currently, research and clinical experience both indicate that there is no addiction center in the brain and no specific circuits strictly for an addictive purpose. However, the brain systems involved in addiction are among the key organizers and motivators of human emotional life and behavior, which is why addiction has a powerful hold over people. In the book In the Realm of Hungry Ghosts, Gabor Mate designates the three major networks of the brain involved in addictive processes: the opioid apparatus, the brains natural narcotic—the dopamine system, the manager of incentive motivation functions—and the self-regulation system.

The less effective an opioid system is to provide love, pleasure, and pain relief, the more driven a person will be to seek joy or relief through compulsions perceived as rewarding, such as spending money for a new dress or makeup. The dopamine system is triggered during the origination and development of addictive behaviors, such as compulsive spending. The dopamine system is the main strengthener of compulsive spending behavioral patterns because desire, wanting, and craving are all incentive feelings managed by dopamine, while opioids are more responsible for the pleasure-rewards aspect of compulsive spending. Both the opioid circuits and dopamine pathways are important components of the emotional part of the brain. Emotions exist for a very basic purpose, according to Mate, to initiate and maintain activities necessary for survival. So, in essence, they regulate two drives that are essential to human beings: attachment and aversion.

The self-regulation system, technically known as the orbitofrontal cortex (OFC), regulates how a person processes and reacts to emotions. In compulsive spenders, the OFC emotionally overvalues an object of desire or the act of spending, making it the main concern for the compulsive shopper, and sadly, the only concern. The OFC also undervalues other objectives, like making rent, providing for oneself and family members. By becoming triggered even at the thought of a new purse or sunglasses, the OFC encourages craving and neglects its job of impulse control (Mate, 2010).

References:

1. Battegay, Raymond, MD. (1997). Hunger Diseases. New York: Jason Aronson, Inc.
2. Mate, Gabor, MD. (2010). In the Realm of Hungry Ghosts: Close Encounters with Addiction. Berkeley, CA: North Atlantic Books

When is not enough sex too little by far?

When we talk about sex addiction, most of us think of someone who is unable to stop engaging in sexual activity. And most of us can understand that too much sex can be dangerous, due to the potential for acquiring sexually transmitted diseases, losing a committed l relationship, or experiencing a decline in health. But no one ever died from lack of sex, right? Surprisingly, addiction can be described as too much or too little—excess or deprivation.

Sexual deprivation, also known as sexual anorexia, has severe physical and psychological consequences, and many people come to me looking for help in tackling and unraveling this serious problem. By the way, a significant percentage of the people I work with by phone are struggling with sexual anorexia. Often, these people feel more ashamed and embarrassed than those with a more traditional form of sex addiction. Before you think you don’t know anyone like that, remember that they will probably keep their secret, feeling deeply out of sync with a culture that constantly promotes sex but is sadly unconscious about sexuality.

Perhaps you suffer quietly with sexual anorexia, consumed by dread of sexual pleasure yet filled with fears and sexual self-doubts. If so, you may find Dr. Patrick Carnes’ excellent book, Sexual Anorexia helpful. He explains what sexual anorexics are not, “It is not inhibited sexual desire they are experiencing, although often they possess a naïveté, an innocence, or even a prejudice against sex. It is not about being cold and unresponsive although that certainly is a way in which they protect themselves against the hurt.”

He continues, describing a number of other reasons that people contact sex therapists, “It is not about religious belief, although religious sexual oppression may have been a place to hide. It is not about guilt and shame, although those feelings are powerfully experienced.” Nor, I might add, is it about sexual betrayal or rejection, though these are themes I hear quite often. It is simply the emptiness of profound deprivation, the silent suffering known as sexual anorexia.[fat_widget_sex_left]

The word anorexia comes from the Greek word orexis, meaning appetite. Thus an-orexis translates as ‘denial of appetite.’ And most of us associate it with the obsessive avoidance of food, or self-starvation. The steadfast refusal to eat can become a way for food anorexics to assert a kind of power over others, especially those they feel are trying to control them in some way. Many food anorexics are driven by a powerful need to achieve a Barbie-doll figure. The terror of sexual rejection is the primary force behind this striving for impossible thinness. Sexual anorexics often share these same fears and distortion of thought. Dr. Carnes notes that in both cases, the sufferers starve themselves in the midst of plenty. That’s been true in my experience too—the majority of sexual anorexics that I’ve worked with have had partners or spouses who were more than willing to engage sexually.

There are striking parallels between food anorexia and sexual anorexia: the essential loss of self, the same thought distortions, the same extreme self-hatred and isolation. Both types struggle for some kind of control over themselves and others, usually the people closest to them. Food anorexics will sometimes become “bulimic,” bingeing with compulsive overeating, and then purging by self-induced vomiting. In a similar fashion sexual anorexics often “act out” with periods of sexual promiscuity or exaggerated frequency. One woman I worked with reported that she only approached her boyfriend for sex twice per year, but when she did she demanded nonstop intercourse or would masturbate to the point that she bled.

Sexual anorexics can be men or women, heterosexual or homosexual. Many have histories of childhood abuse and neglect, sexual and otherwise, what one person I worked with called “my dark secrets.” At some point, they experienced profound loss of trust, causing their “wires to cross,” or their sexual arousal template to be affected. The more frightened you are, the stronger your need to maintain some semblance of control.

Since most sexual anorexics are unaware of the hidden trauma driving them, I’ve found therapy can be very helpful. One man I worked with expressed amazement that “there’s actually a name for this horrible suffering.”

The final alcoholic family role I’d like to discuss in the context of recovery is the lost child. This is the child who stays under the radar, invisible, quietly decamping to his/her room, disappearing behind a stack of empty booze bottles or cloud of marijuana smoke. To paraphrase D.W. Winnicott, for a child it is normal to hide, but a tragedy not to be found.

What happens when a lost child gets clean and sober? To understand this, we have to look at what happened to make this child “lost” to begin with. This child, in a way, becomes, almost literally, a skeleton in the family’s closet. The child’s disappearance serves the dysfunction of the family in that this child will never divulge the family’s skeletons. There are many “elephants in the room” in such families; sometimes untreated addiction, other times abuse or neglect. The family’s collective shame must be hidden; the lost child serves as a kind of metaphor for what is repressed. When a child like this stays lost, he learns that his needs don’t matter, and so the adaptive hiding strategy becomes a way of life, later to be soothed and narcotized by the powder, needle, or bottle (as well as a series of codependent relationships).

The ambivalence this child struggles with in new-found sobriety arises from the advantages and disadvantages of the lost role. On the one hand, this person has protected his/herself from the vortex or volatility of the chaotic family dynamic. He/She has not had to enter into the fray and risk attack, injury, or humiliation. Invisibility becomes the best form of defense.

On the other hand, he/she lives with a kind of emotional anorexia and is a prime target for a host of destructive behaviors: self-harm (cutting, burning), eating disorders, sexual compulsivity, codependence, addiction, and so forth. This child wants to be heard, needs to be heard—but is terrified of being heard. Being heard means facing the feelings beneath the cloak of invisibility, and risking the judgment and/or abandonment of the family members who rely on him/her to stay quiet. Such a person carries heavy feelings of shame, guilt, rage, isolation, and a longing for (and terror of) human connection.

The question of whether the family can be helpful or destructive, as the child gets sober, hinges, not so much on the degree of the family’s past dysfunction, but on their current willingness to get honest and authentic. This family support, of course, is preferable to the lost child, more so than accusations of the child being bad by forcing them to look at long-hidden family secrets.

The family may consciously yearn for his/her sobriety while unconsciously defending against their own shame and guilt. I once knew the father of a l0st daughter, newly sober (my client); he was often enraged at her for a variety of puzzling reasons, until I discovered that he himself was an alcoholic who was terrified of having to face his own problems. His words said “get healthy” but his behavior said “let’s keep things as they were.”

It only takes one relatively balanced member of the immediate family who is willing to align with this newly sober lost person, and live in honesty rather than deceit, to bolster the addict’s support system. Having just one family member on board who loves and accepts the addict, who is not overly threatened by his/her recovery, can bolster a sense of hope. This actual relationship can shed light on the addict’s (usually futile) attempts—prior to sobriety—to find surrogates for lost family members.

Of course, the addict’s partner or family members often cannot or will not accept their loved one’s condition and desire to change, and are threatened by the prospect of recovery. They may defend this terror by insisting on seeing addiction as a moral failing or weakness. Still, the addict has a chance of success, as always, though the recovery work proves more formidable: this is a case that requires immediate support-building, as the lost person begins speaking the truth and breaking the bonds of repression. Like all addicts, he/she will require the support of a sober community, therapy, and intensive recovery work. Being rewarded with love, acceptance and higher self-esteem is often strong inspiration.

It is still amazing to me how threatened alcoholic family members become as their loved one becomes healthier; as order is threatening to chaos, health is threatening to the ideology of sickness, which casts a black pall over everything and fosters a sense of futility. Thankfully, recovery can lift the black veil of these (mis)perceptions, when the addict is truly ready to surrender and begin the slow, sometimes grueling, but always worthy, path towards wellness. This can happen without the aid and support of loved ones, but recovery comes easier when family, too, is willing to change.

In part I of this series, Family Ties: Support for Family Members with Alcoholism, I discussed what happens when members of alcoholic families, who are alcoholic themselves, get sober. The members of these families tend to fall into certain behavioral patterns, or roles, which classically include: the hero, the scapegoat (or identified patient), the mascot, the lost child, and the caretaker. I want to further explore the patterns I have observed in my clinical experience working with individuals and their families, both in my private practice and in a 30-day residential treatment program.

What’s interesting to observe is how the entire family dynamic changes once their loved one gets sober. I never cease to wonder at how a person’s stabilization in treatment often leads to an increase in their family’s anxiety. Thus, as soon as the person completes detox and starts showing signs of improvement, the parent or sibling or spouse of the person will call the staff in a more anxious state than ever. This, of course, is a sign that the family’s homeostasis is changing, which is terrifying to a dysfunctional system (which tends to reject change)—another reminder that, to paraphrase James Masterson, people often come to therapy or treatment to feel better, not necessarily to get better (Masterson & Lieberman, 2004).

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What happens when a family mascot enters the treatment process for alcoholism or addiction? The mascot is someone who lessens family anxiety by providing distraction and deflection, often via humor and comic relief. Here is the “class clown” who can break tension by cracking wise at precisely the right time.

Keep in mind that family members may play more than one role simultaneously; for instance, I once worked with an individual who was a recovering alcoholic—and a stand-up comedian. Quite a good one, in fact. Fortunately, he was able to provide insight and painful emotional truth, along with the laughs. The good news with such a person is that humor is often a filter for truth, so if he/she can step out of the spotlight and get in touch with the pain of addiction, without deflecting it with humor—or to enhance rather than distract from truth—then recovery can begin.

The problem is when the person tries to re-enter the family system. Family members are inevitably going to find themselves unsettled, antsy, perhaps even critical of the clown who sheds the mask. Very often you will hear people say of a recovering mascot, “She used to be so funny, now she’s kind of boring” or “He’s so serious now that he’s sober, what happened to the exciting guy I used to know?” What often happens when a mascot (or any such family member) gets sober, is that the other members (or even close friends and co-workers, etc) are now left with an absence of deflection, or distraction, which creates a void—filled, inevitably, with each persons’ unexamined problems. Now the sibling, parent, or spouse of the mascot no longer has the luxury of distraction, and that anxiety must be contained and processed by a system that is inherently uncomfortable with owning or processing anxiety healthily.

Thus, the mascot may be left with feelings of guilt, shame, self-criticism—the usual feelings that come with early sobriety—magnified by a dysfunctional family system which gives lip service to sobriety but, in fact, isn’t exactly sure how to deal with it. This person may feel they are causing the anxiety in a family, when it’s been there all along: in subterranean form. This speaks, again, to the importance of viewing alcoholism as a family disease in which each person is required to look at his/her “stuff” without passing the buck any longer (i.e. shaming/blaming, etc). For each member, this process will at first feel very uncomfortable. But getting better does not guarantee feeling better, at least in the beginning. Paradoxically, the constant laughter and tension-breaking shenanigans of the mascot, within an actively-addicted family system, has drowned the pain that must now be dealt with head on, if the system is to truly have a shot at health.

Sadly, this did not happen with the sober comedian I mentioned earlier. With sobriety came anger on the part of his spouse, much of which was justified, given the destructive way he behaved in his addiction. However, she refused to acknowledge the fresh start his sobriety provided, declined to get help via al-anon or counseling; in turn, he blamed her for his feelings of guilt, shame, and (eventually) rage. Neither took responsibility, or found healthy support, and word has it that he is now drinking and using with abandon while his wife is hurt, angry, and seeking divorce.

References:

1) Masterson, J. & Lieberman, A. (2004). A Therapist’s Guide To The Personality Disorders. Phoenix, AZ: Zeig, Tucker & Theisen.