The Emergence of Feminine Sexual intercourse Dependancy: Knowing Gender Differences

Clinical Care Consultants Arlington Heights, IL 60004 Unlike alcohol or drug addiction, there is still no formal diagnosis for sex addiction. To make matters worse, female sex and love addiction is similarly not recognized as a bona fide addiction disorder. However, most addiction specialists agree that it has risen to "epidemic" proportions (R. Weiss, 2011).The term "sex addiction" was coined by Patrick Carnes. Carnes first used the term in his 1983 seminal book on the topic: "Out of the Shadows: Understanding Sexual Addiction." Carnes is largely responsible for popularizing the study and treatment of sex addiction, as well as establishing a valid and commonly used diagnosis. Because most statistics are based on sex addicts who seek treatment, statistical representation of this disorder is considered to be low. Women are less likely than a man to seek help for her problem sexual behavior for a variety of reasons - mostly related to shame. (Weiss 2011). Research and treatment fields have directed little attention to women's struggle with this addiction. Other than an early treatment by Charlotte Kasl (author of Women, Sex, and Addiction: A Search for Love and Power) and some writings by Carol Ross and Jennifer Schneider, sex addiction in women has been largely ignored (Feree, 2001).

According to Carnes, 3% of the total U.S. population is female sex addicts. In other words, of all American sex addicts, 37.5% are female. Carnes' research also indicates that approximately 20% of those seeking help are female. This statistic is consistent with similar statistics regarding females seeking alcohol treatment (Carnes, 1983). According to Robert Weiss (2011), an international sexual addiction expert, author, educator and founder of the Sexual Recovery Institute, 8 to 12% of those seeking sexual addiction treatment are women. Statistical support for the prevalence of sex addiction is starting to build. According to Dr. Patrick Carnes, a nationally known speaker and expert on sex addiction issues and recovery, estimates that 5-8% of Americans are sex addicts. The National Council on Sexual Addiction and Compulsivity estimates that between 6-8% of Americans are addicted to sex. Mary Ann Miller, a psychologist who founded the Chicago chapter of Sexual Addicts Anonymous (SAA), estimates that up to 6% of Americans are (sex) addicts. Robert Weiss, another well-known expert and founder of the Sexual Recovery Institute, guesses that 3-5% of the U.S. population suffers  free adult videos from sexual addiction. The Mayo Clinic estimates that 3-6% of adults in the United States are sex addicts. "Many others (Coleman, 1995; Goodman, 1993, 1998; Irons & Schneider, 1999; Kafka & Hennon, 1999; Money, 1986; Orford, 1978; Schneider, 1991; Schneider & Irons, 1996) have described problematic hypersexuality and, as Goodman (1992) observed, there is general agreement that the pattern of behavior exists..." (Finlayson,Seal & Martin 2001). Therefore, the estimated number of sex addicts in the U.S. is between 9,200,000 (3%) and 24,500,000 (8%) individuals. Sex addiction is not just a modern problem. "It has existed at all times in human history. Sexual excess and debauchery have been described and catalogued from antiquity. Nymphomania, a term derived from the Greek, has been used in the past to describe female sexual excess. Don Juanism, after Don Juan...has denoted male hypersexuality." (Finlayson, Seal, & Martin 2001). "(in 1886) Krafft-Ebbing...described a case of abnormally increased sexual appetite, "to such an extent that permeates all his thoughts and feelings, allowing no other aims in life, tumultuously, and in a rut-like fashion demanding gratification and resolving itself into an impulsive, insatiable succession of sexual enjoyments. This pathological sexuality is a dreadful scourge for its victim, for he is in constant danger of violating the laws of the state and of morality, of losing his honor, his freedom, and even his life." (Finlayson, Seal, & Martin 2001). Our societal gender bias significantly affects the accurate statistical representation of female sex addiction. A society that regards male hyper-sexuality in positive terms has created a shameful backdrop and societal prejudice for women. Hypersexual men are commonly considered "virile" or "studs," whereas hypersexual women are considered "sluts," "whores" or "nymphomaniacs." These unfair and egregiously incorrect conceptions of sex hyper-sexuality and addiction have marginalized and minimized the seriousness of female sex addiction. Gender bias is also found in addiction-related research. In most addiction studies, females are underreported; underdiagnosed and overlooked (S. O'Hara). For example, the American Medical Association recognized male alcoholism as a disease in 1956; but it was not until the late 1980s that significant findings regarding female alcoholism was represented in research studies. Sexual addiction in women rarely receives the same research and popular media attention received by men, so it continues to be underreported and minimized. Moreover, media and news coverage seems to cover female and male sex addiction differently. Female sex addicts are often portrayed as manipulative, power hungry, sex crazed and shameless individuals. On the popular VH1 reality series, "Sex Rehab with Dr. Drew (Pinsky)," female sex addicts are mostly porn stars. On the other hand, media reports on male sex addicts include powerful celebrities whose sex drive has led them astray (Tiger Woods, Michael Douglas and David Duchovny). At the end of the day, men seem to remain famous, while the "famous" female sex addicts' careers crumble and end in shame and disrespect. There seems to be a mistaken assumption that sexual addiction is a "one size fits all" disorder. This could not be further from the truth. Female addiction is often misunderstood, incorrectly diagnosed and inappropriately and ineffectively treated. Although female and male addiction share many similarities, female addiction is distinctly different. In actuality, sex addiction tends to parallel our society's gender stereotypes. For example, men tend to prefer face-to-face anonymous contact and are more aggressive and dominant. They typically favor sexually explicit chat, cyber-porn and interactive sexual play - virtual and in person. They gravitate toward the voyeuristic forms of sexual behavior, i.e., chronic masturbation, Internet pornography, strip clubs and the use of real-time videos (webcams). The goal for most male sex addicts is to seek sexual stimulation - not the sexually stimulating relationship. To the male addict, the euphoric "fix" is in the act, not the relationship. Another gender difference in sex addiction is found in the relational boundaries of the acting out behavior. Men tend to maintain distinct and clear emotional boundaries with the "object" of their compulsive and lustful desires - not as often seeking a romantic or personal experience. They seek sexual opportunities that come from discreet, anonymous and disconnected "hookups." To the typical male sex addict, the relationship is the vehicle by which his lustful obsessions and compulsions are satiated. If there is a "relationship," it is often fantasy based - lasting just long enough to satisfy his out-of-control pursuit of sexual contact. For the typical sexually addicted male, at the conclusion of the sexual act - usually at orgasm - he becomes disconnected, disinterested and even repelled by the object of his lust. It is important to note that females can also look like stereotypical male sex addicts, as males can also look like stereotypical female sex addicts. Female Sex Addiction Myths Female sex addiction has been largely underrepresented because of misunderstandings and the subsequent development of myths. Such myths or commonly-held erroneous beliefs have contributed to the ignorance, fear, shame and consequent silence concerning female sex addiction (Ferree 2011). Myth One: Females Cannot Be Sex Addicts. Within the addiction treatment field, it is a well-known fact that women, like men, can be addicted to sex. However, the general public believes that sexual compulsivity is mostly a male phenomenon. The belief that women do not struggle with sexual compulsivity comes from societal prejudices, double standards and ignorance rooted deeply in the American culture. A female "sex" addict, like her male counterpart, is addicted to uncontrollable compulsive sexual behavior. Even with the similarities, women tend to use sex for power, control and attention. "They score high on measures of fantasy sex, seductive role sex, trading sex and pain exchange." (S. O'Hara) Prior to the mid 1950's, women who had sex outside of marriage were subjected to harsh and unfair judgment. Female sexuality outside of marriage, especially masturbation, was viewed as the closest thing to moral bankruptcy. It was with the 1953 Kinsey study, "Sexual Behavior in the Human Female," that normative data regarding female sexuality was made available to the public at large. The Kinsey Reports played a significant role in changing the public perception of female sexuality. Fifty-eight years later, women with aberrant sexual behavior, such as sex addiction, are still viewed through the lens of hypocrisy and condemnation. That which was acceptable for men was considered "ugly" and "perverted" for women. A myopic society that scorns, rejects and unfairly judges female sex addiction (while being more tolerant with men) places roadblocks for support, education and counseling/treatment. A fear of being disparaged, blamed, shunned and, ultimately, isolated by their loved ones prevents many women from feeling safe enough to seek help. It is no wonder that women sex addicts maintain their silence and secrecy about their addiction. Myth Two: Female Sex Addicts Are Only Addicted to Relationships or Love - Not Sex. Even though most female sex addicts are "relationship" or "love" addicts, many others are addicted to sex, masturbate compulsively, use pornography, engage in a variety of Internet sexual activities, have affairs with multiple partners, engage in anonymous sex or phone sex and are exhibitionists. According to Kelly McDaniel, licensed professional counselor and author of "Ready to Heal: Women Facing Love, Sex and Relationship Addiction," therapists have recently seen more women with (sex addiction)...in connection with Internet porn, which has become a "gender-neutral" addiction. "Before, female sex addicts generally tended to have affairs or become sex workers." Most female addicts avoid the term "sex addiction" because it carries negative connotations of sexual perversion, nymphomania and promiscuity. When given a choice, women prefer the romantic and nurturing connotations of "love" or "relationship" addiction. The "sex addiction" label is resisted because women are often not motivated by the pursuit of sex only - but instead by a deep and insatiable desire for love, acceptance, affection and affirmation. Naturally, female sex addicts prefer a term that represents their femininity. Myth Three: Women Who Are Sex Addicts Know About Their Problem. Rarely do women identify themselves as sex addicts. Similarly, when a sexually addicted female seeks mental health services, it is likely that the clinician will misdiagnose her. It is common for untrained clinicians to only diagnose a comorbid (co-occurring) mental health problem, while completely missing the sex addiction diagnosis. As a result of a scarcity of research, training and effective screening protocols, the female sex addict who is in denial of her problem is likely to interface with professionals who share her ignorance and denial systems. If sex is the core addiction, it may be hidden beneath a more obvious and less shameful concurrent addiction. Having more than one addiction, women are prone to only seek professional help for the addiction that is more obvious and socially acceptable. Shame, embarrassment and fear of consequences, i.e., divorce or social alienation, may push the sex addiction - the primary or core addiction - to the addict's unconscious. Simply, sex addiction is easier to deny than another addiction such as alcohol or drugs. Myth Four: Consequences Are the Same for Females and Males. Although female sex addicts experience the same consequences as men, a societal sexual double standard also creates more painful and harsher consequences. Additionally, women are more prone to suffer health concerns such as unwanted pregnancies or sexually-transmitted diseases. Because of the power and strength differential of men and women, women face a higher probability of physical harm such as rape or aggravated battery. Women suffer unique and agonizing consequences because they often feel responsible for the shame, embarrassment and punishing social judgment that their male partner and children endure. A Sexual Double Standard Our culture/media encourages women to be sexually provocative and available, while holding them in contempt if they cross the boundary of society-determined rules concerning sexual decency. Male sex addicts are afforded greater tolerance and freedom than females. "The belief that women and men are held to different standards of sexual conduct is pervasive in contemporary American society. According to the sexual double standard, men are rewarded and praised for heterosexual sexual contacts, whereas women are derogated and stigmatized for similar behaviors." (Kreager & Staff, 2009) Sexual double standards date back to earliest recorded history. Biblical archeologists and religion historians point to frequent sexist and misogynist references in religious documents and art. These scholars believe that references to sexism in religious texts were at least partially influenced by patriarchal, tribal, violent and intolerant societies. The sexual double standard also can be traced back to the 13th century during the crusades when a knight required his lady to wear a chastity belt to ensure her sexual fidelity. As hard as it may be to believe, this punishing and humiliating device is still in use today; in 2004, the USA Today reported that a 40-year old British woman set off a security alarm because of her steel chastity belt. This woman said her husband had forced her to wear the device to prevent an extramarital affair while on vacation in Greece. Yet another historical reference of sexual double standard is illustrated in Nathanial Hawthorne's classic novel, "The Scarlet Letter," which was written in 1850. The main character, Hester Prynne, was placed in prison with her infant daughter for conceiving a child through an adulterous affair. Hester struggled to redeem herself in a society that was harshly judgmental and punishing to females who defied the sexual mores of her time. Hawthorne's "The Scarlet Letter" has become a symbol of modern society's harmful, harsh and punishing sexual double standard. Fifty-eight years after the publishing of the "The Scarlet Letter," Sigmund Freud further perpetuated the myth of sexual inequality in his 1908 article "On the Sexual Theories of Children," in which he introduced the concept of "penis envy." According to Freud, the defining moment of gender and sexual identity for a woman occurs when she realizes that she doesn't have a penis. Freud believed that girls wished they were born with penises instead of vaginas. Critics of Freud's work argue that he was a patriarch, anti-feminist and misogynistic. One could argue that Freud was merely a product of the sexually repressed Victorian society in which he lived. Even today, the double standard continues to be inexorably entwined in our culture - so much so now that women themselves are guilty of discriminating against their own gender. A significant percentage of women judge highly sexually experienced women more negatively than men (Milhausen and Herold, 1999). It is still commonplace for women's sexual histories to be used against them in workplace harassment cases or in cases of sexual assault (Valenti, 2009). The double standard creates a dangerous backdrop for women who are considering getting help for their sexual addiction. Concurrent Addictions Especially with sex addiction, addictive disorders tend to coexist or fit together (Carnes, 1983). Concurrent addictions, which are multiple addictions that are simultaneous expressed and/or ritually connected, are quite common for female addicts. Examples include smoking marijuana before going online, drinking alcohol before an Internet date to lower inhibitions and taking stimulants in order to surf the net all night. Concurrent addictions, like alcoholism, may have been started to hide or numb the pain or shame caused by out-of-control sexual compulsions. Alcohol, especially, lowers inhibitions and alleviates anxiety - making the sexual acting out more "pleasurable" and "easier." Rarely does a sex addict have just one addiction (Carnes, 1983). Carnes' research on sexual addictions revealed that 83% of sex addicts reported multiple addictions: � Chemical dependencies - 42% � Eating disorders - 38% � Compulsive overworking - 28% � Compulsive spending - 26% � Compulsive gambling - 5% Four Categories of Female Sex Addiction (Feree, 2001) Female sex addicts may be categorized (in order of prevalence) into four groups: Relationship Addict, Pornography or Cybersex Addict, Stereotypical Sex Addict and Sexual Anorexic. Category One: The Female Love or Relationship Addict Female love addicts compulsively seek total immersion in a relationship - real or imagined. The "lust" for an intoxicating relationship becomes a dramatic obsession that may be stronger and more compelling than the overwhelming desire for sex. Love addiction creates an illusion of power, control and even dominance. Love addicts compulsively seek exciting, exhilarating and mood-altering relationships, which by definition are unstable. They practice serial monogamy: seeking multiple relationships, which begin with intense passion but end relatively quickly. These unhealthy relationships become the organizing principle of the love addict's life. According to a renowned expert on love addiction, Pia Mellody, it is dependent on, enmeshed with and compulsively focused on taking care of another person (1992). Like any addiction, the drug or process, in this case the relationship, persists despite the addict having no control over it and suffering obvious negative effects. Female love addicts are habitually preoccupied with romance, intrigue or fantasy. They are driven by an insatiable desire for a romantic "fix," which requires a steady stream of new and exciting short-term romantic monogamous relationships. They rely on their exhibitionistic and seductive "powers" to "feed" their addiction. They are entranced by the intoxicating "high" initiated at the point when they meet their love object. Beginning with hope, excitement and a huge desire, these relationships usually devolve into disinterest; disillusionment and conflict. The euphoric "fix" escalates and then maintains until the relationship does not deliver the drug-like euphoria anymore. Like with other addicts, female love addicts try, but never succeed in satisfying their insatiable and compulsive need of romantic euphoria - their drug of choice. Signs of Love or Romance Addiction: � Thinking you are in love despite just meeting ("love at first sight") � Valuing the time spent with love object over time and attention needed for self � Relationships create feelings of safety, happiness and optimism � Mistaking sexual or romantic intensity for healthy love � Constantly "on the prowl" for a romantic partner � Short, intense and conflict-based relationships � Pattern of failed relationships � Using sex, seduction and intrigue to "hook" or hold onto a partner � Using romantic intensity to hide, cover or "medicate" emotional pain, conflict or problems � Pattern of "dating" abusers, narcissists and addicts (emotionally unavailable, distant and harmful) � Flirting and/or having an affair while in a relationship � Pattern of broken promises to stop the behavior/addiction  � Sacrificing time with friends or family to act out � Avoiding relationships to control the addiction Unlike sex addicts, love addicts tend to act out within a relationship. Often, they are unable to avoid or let go of toxic relationships, even if they are unhappy, depressed, lonely, neglected or in danger. Typically, love addicts are disinterested in the sexual aspect of the romance, including orgasm. The "pull" and the power of the "love" in love addiction almost always exceeds the addict's sexual desires. It is not unusual for the female addict to report apathy or even dislike of sexual activity, including orgasm. Love addicts tend to use sex to manage their feelings or to control their partner - the co-addict. To the love addict, the sexual experience is a means to the end. According to the Love Addiction Anonymous (LAA) website, "unlike sex addicts, love addicts crave an emotional connection and will avoid, at any cost, separation, anxiety and loneliness." Many female love and relationship addicts report that they are addicted to the intoxicating, intense and all-consuming feelings experienced in the attraction phase of a relationship. This "rush" is described in Dorothy Tennov's 1979 book, "Love and Limerence: the Experience of Being in Love." Tennov coined the term "limerence," which she described as an involuntary state of mind that results from a romantic attraction to another person, combined with an overwhelming, obsessive need to have one's feelings reciprocated. Symptoms of Limerence (Tennov, 1979): � Intrusive thinking about the limerent object ('LO') � Acute longing for reciprocation � Mood fluctuations based on LO's actions � Can only feel it with one person at a time � All-consuming obsession that the LO will relieve the pain � Preoccupation (fear) with rejection � Incapacitating and uncomfortable shyness in the beginning � Intensification through adversity � An aching `heart' (in the chest) when there are doubts � Buoyancy ("walking on air") with reciprocation � Intense obsessions demotivate the person from other responsibilities (friends, family, work) � Emphasis is placed on positive attributes of the LO, while ignoring the negative Category Two: The Female Cybersex Addict Cybersex is virtual sex where sexually explicit material is viewed or exchanged to evoke a sexual response. The cybersex addicts act out their sexual compulsions through the use of and involvement with the Internet. Cybersex requires vivid, visceral and sexually evocative sexual stimuli. Female cybersex addicts typically do not meet in person, but in "virtual" places, i.e., email, chat rooms, with video cams, prolonged email interactions and role-playing activities. While creating a safer experience, anonymity often enhances the sexual excitement for the female cybersex addict. Cybersex addicts usually act out together in "virtual" places through masturbatory activities. Female cybersex addicts are more prone to have phone contact or seek relationships through their activities (Schneider, 2011). Cybersex Addiction Activities � Viewing and masturbating to Internet pornography (photos or videos) � Live webcam sexual interaction � Sexual membership sites (Swingers, BDSM, etc.) � Membership in cyber affair sites (AshleyMadison.com) � Seeking sex through personal sex ads (Craigslist or Backpages) � Participating on sex-related chat sites � Adult dating sites (Adult Friend Finder) � Cell phone hook-up applications � GPS hook-up applications (Grindr) Category Three: The Female Sex Addict Female sex addicts can fit the stereotypical "male" pattern of sexual addiction. This is an addiction driven by a lustful and compulsive preoccupation with a sexual activity. Sex addicts typically engage in chronic masturbation, with or without pornography, and have anonymous sex with individuals who they either met online or "picked up" in a bar or other public place. To the female sex addict, the relationship is less important than the thrill of the sexual experience. While female sex addicts are less voyeuristic, they are more exhibitionistic. Typically, they are exotic dancers or strippers, prostitutes or women who sell sex or trade it for something desired. Female sex addiction occurs with the same 11 behavioral forms of sexual addiction that Patrick Carnes outlined in his breakthrough book on sex addiction, "Out of the Shadows." It should be noted that despite the commonalities, there are clear gender differences and gender behavior preferences. 1. Fantasy Sex - Sexually charged fantasies, relationships and situations 2. Seductive Role Sex- Seduction of partners 3. Anonymous Sex - High-risk sex with unknown persons 4. Paying for Sex - Purchasing of sexual services 5. Trading for Sex - Selling or bartering sex for power 6. Voyeuristic Sex - Visual arousal 7. Exhibitionistic Sex - Attracting attention to the body or sexual parts of the body 8. Intrusive Sex - Boundary violations without discovery 9. Pain Exchange - Being humiliated or hurt as a part of the sexual arousal 10. Object Sex - Masturbating with objects 11. Exploitive Sex - Exploitation of the vulnerable Category Four: Sexual Anorexia The term "sexual anorexia" has been used to describe sexual aversion disorder (DSM code 302.79), a state in which the patient has a profound disgust and horror at anything sexual in themselves and others (P. Carnes, 1998). The title of Carnes' 1997 book, "Sexual Anorexia: Overcoming Sexual Self-Hatred," describes the sex or love addict's psychological motivation for this disorder - contempt and self-hatred - often for their sex or love addiction. Sexual anorexia is the inverse of sexual addiction. Sexually anorexic women are as compulsive with their aversion to sex as sex addicts are trying to have sexual experiences. Sexual anorexics suppress or repress their sexually addictive compulsions by denying their own sexuality, avoiding all sexual encounters, rebuking others for any and all sexual interest and/or vehemently condemning others for their sexual proclivities or desires. Sexual anorexia includes a binge/purge cycle, during which a woman may uncontrollably sexually act out for an extended period of time, and which may be followed by a sexual shutdown - avoiding all forms of sexual expression and activity. Symptoms of Sexual Anorexia (Carnes, 1993): � Persistent fear of intimacy, sexual contact, sexual pleasure, sexually transmitted diseases, etc. � Preoccupation, to the point of obsession, with sexual matters, including the sexuality, sexual intentions and sexual behaviors of others, and their own sexual inadequacy. � Negative, rigid or judgmental attitudes about sex, body appearance and sexual activity. � Shame and self-loathing over sexual experiences. � Self-destructive behavior in order to avoid, limit or stop sex. Conclusion The treatment of sex addiction as a gender neutral problem has created unnecessary roadblocks to females seeking services for sex and love addiction. Although there are distinct gender differences with sex and love addiction, the problem is clearly universal. Until the popular media represents female sexual addiction in a more socially acceptable and less derogatory manner, women will be "shamed" out of seeking the much needed help, support and services. The mental health and addiction fields also need to overcome its own limitations regarding unsubstantiated and unsupported beliefs regarding women and sex and love addiction. Until our society's gender blindness, sexist beliefs and double standards are corrected, scores of female sex and love addicts will be deprived of timely, effective and compassionate addiction services. It is time that all mental health and addiction practitioners open their hearts, minds and offices to female sex and love addicts. Bibliography Carnes, P. (1983) "Out of the Shadows: Understanding Sexual Addiction," Minneapolis: CompCare. Carnes P. (1991) "Don't Call It Love: Recovery from Sexual Addiction," Bantam Books. Carnes, P. (1998) "The Case for Sexual Anorexia: An Interim Report on 144 Patients with Sexual Disorders," Sexual Addiction and Compulsivity, Volume 5. Issue 4, 1998. Carnes, P. (2005) "Kaplan & Sadock's Comprehensive Textbook of Psychiatry," Vol. 1, Lippincott Williams and Wilkins. 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