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Sexual Compulsion and Trauma
There is currently no consensus on the nature or definition of sexual compulsion, or indeed whether it should exist as a legitimate psychiatric diagnosis. Most sources characterize sexual compulsion as a compulsive or addiction disorder, with the primary pathological characteristic being an inability to control one's thoughts, urges, or behaviors of a sexual nature. Individuals who experience these issues may spend an inordinate amount of time thinking about, seeking, or having sexual encounters and often are severely impaired in their ability to retain marriages, careers, and interpersonal relationships. This entry discusses views on sexual compulsion, the role of trauma, and treatment options.
Compulsions are repetitive behaviors (such as checking or hand washing) or mental acts (such as recitation of a phrase or counting) that are performed in an effort to reduce or prevent anxiety or stress. Taken from this point of view, individuals with sexual compulsion may be reckless in their behavior and may place themselves in dangerous situations when seeking sex, feeling that their only hope of decreasing their mounting anxiety is to engage in sexual activity.
Alternatively, addictions are characterized by both physiological (tolerance, or a need for increasing amounts of the addictive substance or behavior; withdrawal, or a period of extreme discomfort and often acute illness following termination of the addictive substance or behavior) and psychological (persistent desire to decrease or control use of the substance or behavior; neglect of important roles such as work and family) characteristics. From an addiction point of view, sexual addiction is considered in much the same light as a substance addiction, where a behavior is continued despite negative consequences associated with use of the substance (or engagement in the behavior).
Still others believe that sexual compulsion or addiction is simply a by-product of cultural, social, and other influences and, as such, should not constitute a discrete psychiatric diagnosis. Regardless of point of view, most professional sexologists use diagnostic criteria based either on American Psychiatric Association or World Health Organization definitions of addiction to identify and treat those exhibiting the appropriate diagnostic criteria.
Research on Sexual Compulsion and Trauma
A great deal of research has suggested that trauma, often of a sexual nature, can serve as a risk factor for substance addiction; it is also believed that childhood sexual trauma may be a risk factor for sexual addiction in adulthood. Further, it has been suggested that a history of trauma may be associated with increased risk of relapse among those in treatment or recovery for addiction. Research and establishment of risk factors for addiction of any kind are confounded, however, by issues such as culture (e.g., some cultures view sex as necessary solely for procreation, whereas others are more accepting of sexual activity purely for enjoyment) and differential diagnoses (e.g., individuals who are said to be sex addicts are also often diagnosed with a substance use disorder, impulse control disorder, eating disorder, or some other psychiatric condition). As a result, the identification of trauma as an accepted risk factor for sexual addiction is tentative at best.
The relationship between a history of trauma and obsessive-compulsive symptoms is even less well established. Some research has suggested that childhood trauma (sexual abuse, emotional abuse, physical neglect) may be associated with obsessive-compulsive symptoms; however, these studies are relatively recent and are often confounded by the same issues experienced in addiction research, particularly differential diagnosis. Studies of individuals with obsessive-compulsive disorders frequently include participants with other psychiatric disorders such as social anxiety disorder, depression, or generalized anxiety disorders. Very little research has been conducted that attempts to identify specific risk factors for sexual compulsivity. As such, the direct relationship between trauma and compulsivity has yet to be firmly established, particularly where sexual compulsivity is concerned.
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