How can sexual addiction be a real addiction?

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

To answer this question, we have to look at the problem of addiction in general. What makes any behavior an addiction? When do you cross the line from behavior that could be considered a bad habit into addiction territory? For example, how many beers a night make you an alcoholic? How much chocolate do you have to consume to be labeled a chocoholic? How many affairs does one have to have in order to say that this person is a sex addict?

Sorry, folks, but there is no magic number when it comes to addiction. Addictionologists have generally agreed that for a behavior to be labeled an addiction, the following elements must be present:

  1. Can’t stop despite negative consequences.
  2. Presence of a mood-altered state
  3. Strong element of denial.
  4. Behavior is chronic and escalating because of tolerance.
  5. Occurrence of withdrawal symptoms.

Let’s look at each of these elements in turn and see how compulsive sexual behavior fits these 5 descriptors:

1. Can’t stop despite negative consequences.

Let’s say that a guy drinks a six-pack of beer one night. Is he an alcoholic? Maybe. Let’s say that he drinks these six-packs every night for a week. Is he an alcoholic? Maybe. Let’s say that he then gets arrested for driving under the influence, goes to court and has his license suspended, after which he is so upset that he goes out drinking to feel better and has a wreck driving home. This guy is definitely moving into addiction territory at this point. He had to go out and do the very same behavior to feel better that brought him some negative consequences in the first place.

Sexual addiction works the same way. It’s not the number of affairs or prostitutes that defines the sexual addict. It’s what happens after there are consequences. Let’s take the case of a man who is married, loves his wife, and wants to stay married. But he starts going to strip bars and eventually ends up spending most of his paycheck for lap dances, leaving him with no money to buy his kid a birthday present. The next week he’s feeling so guilty that the only thing that takes his mind off his problems is to go back to the strip bar. Or to go to a massage parlor. More guilt leads to more secret sexual behavior until there is the development of an ongoing secret life.

I know of a case where a young man was arrested five times for exposing himself in mall parking lots. He got off with probation until the sixth time, when the judge was fed up and said that if he got arrested again for exhibitionism, he would have to go to jail. This guy was so nervous and fearful walking out of the courthouse that he actually exposed himself on the way to his car in the courthouse parking lot. There you have addiction in action.

2. Presence of a mood-altered state.

Cocaine makes the user feel powerful and alert. Alcohol relaxes many people. Why do people engage in addictive behaviors? It’s simple. They want to change their mood. They want to feel better, at least in the short run. So they drink. Or shoot up. Or go to massage parlors. In the old days, it was thought that you had to take a substance in order to be an addict, e.g., a cocaine addict is addicted to cocaine. But a cocaine addict isn’t really addicted to cocaine, but rather to the feeling that comes with cocaine, in other words, the power surge, mind in overdrive, feeling like you can take on the world, willing to take risks in the name of adventure, with perhaps a heightened sexual drive. (Which, by the way, often dissipates as the user does more and more cocaine.)

Many sex addicts don’t need drugs in order to go into a profound sexual trance, often using specific rituals to deepen the effect. Fantasy and pornography usually play a large role in the development of the trance state. Addicts report feeling like their brains have been taken over, as if they are in the control of someone else, like a Jekyll & Hyde situation. I know a gay man who felt the need to cruise around the park for hours looking for just the right person to have anonymous sex with, sometimes not even having sex but going home exhausted. Sex addicts who also use alcohol, marijuana or other drugs to deepen their sexual trance state report that they often relapse in chemical dependency treatment if their sexual trance urges are ignored.

There is a psychiatric problem known as obsessive-compulsive disorder. It involves doing rituals over and over in a driven way. Think of Jack Nicholson in As Good As It Gets. This is not addiction because there is no high. In the movie Jack washed his hands over and over but was still a grouch. Some therapists try to treat sexual addiction as belonging in this category. But the sex addict is after a high; he wants that trance state.

3. A strong element of denial.

Look at the letters in DENIAL. They could be said to stand for Don’t Even kNow I Am Lying. It is said that in this country alcoholism is the most untreated treatable disease. And the reason that most alcoholics don’t get better is that they refuse to admit that they have this disease. So they don’t go for help. You aren’t going to recover from cancer if you don’t first admit that you have it. Then you have to take chemo or whatever else the doctor says is most effective.

Sex addicts, also, have a million excuses for their compulsive behavior: We Italians have a high sex drive; what my husband doesn’t know won’t hurt him; all gays have anonymous sex, no big deal; it’s only a hand job at the massage parlor, so what can it hurt? The only way to come out of denial is to have consequences that actually mean something, such as the loss of a job or important relationship. Family members can find ways to set up interventions, as has been done historically with other addicts.

4. The behavior is chronic and escalating.

Sex addicts, like other addicts, are not just going through a phase. Rarely does addictive behavior just go away on its own. Instead, the addict has to find new ways to get high because of the phenomenon of tolerance. The lap dance at the strip bar isn’t enough because you don’t get to touch the woman, so then it’s off to the massage parlor. Perhaps that person only does hand massage, so then there may be an escalation to intercourse with call girls. Then regular intercourse becomes boring and S&M painful scenarios may emerge.

Or, say a person starts off exposing himself once a month from the bedroom window as a teenager, for a lark. A pornography collection is built, fantasy life increases, and the next thing you know the exposing behavior is escalating out of the house, so that the person is risking car accidents by driving while masturbating, several times a week or even daily. Sexual addiction often starts in childhood, which is why it often includes strongly ingrained ritualistic patterns of behavior that are very hard to break, especially without professional help.

5. Occurrence of withdrawal symptoms.

Everybody knows that alcoholics can go into withdrawal and have, for example, delirium tremors (DT’s), if they are in advanced stages of alcoholism and stop drinking suddenly. But do sex addicts have withdrawal symptoms? Dr. Patrick Carnes, author of Don’t Call It Love and other books on sexual addiction, conducted research on hundreds of sex addicts and found that when they enter treatment they often have many of the same withdrawal symptoms that alcohol and drug addicts have. I used to work in a hospital setting, and when we had sex addicts stop their rituals in a “cold turkey” fashion through the use of celibacy contracts, they often reported sleepless nights, intrusive dreams, a high level of waking anxiety, irritability, and emotional liability (roller coaster feelings). They often had sexual “using dreams,” much the same way that drug users do when they first enter treatment.

In summary then, it is clear that compulsive sexual behavior does have all these elements that make up an addictive disorder. The good news is that recovery from sexual addiction can be successful, especially if the addict follows some of the tried and true methods of addiction recovery, such as going to appropriate 12-Step meetings, seeing a therapist, entering a treatment program or considering a halfway house.

(If you copy this article for others, please copy the following author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

Sexual Anorexia: The Flip Side of Sexual Addiction

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

Sexual addiction occurs when a man (or woman) becomes so obsessed with certain sexual rituals or behaviors that he can’t even stop after serious consequences, such as job loss, divorce, disease, or constant shame attacks. In early recovery, a period of celibacy is often prescribed in order to break the destructive patterns. But what happens after that? Often celibacy turns out to feel safer than the risky business of trying to have healthy sex with someone you love but with whom you might feel guilty or ashamed. Sexual anorexia then sets in—with the partner feeling even more rejected than before.

A loss of sexual desire in sex addicts can also occur as a side effect from antidepressants, or because of physical problems from prostate cancer to menopause. Often the partner of a sex addict (or other addict) is shut down, partly because of valid trust issues, such as worrying: “Is he going to give me a sexually transmitted disease?” I have also noticed, in 10 years of working with sex addicts and their families, that there is a very high percentage of male sex addicts who marry women who were sexually abused as children, often creating sexual anorexia as a kind of coping skill to ward off the possibility of any future sexual abuse. This person may feel drawn to marry a sex addict from many of the same impulses that lead children of alcoholics to marry alcoholics themselves.

This topic of sexual anorexia is explored further in this selection of questions and answers culled from the last four years of Sharon O’Hara’s column on “Love & Sex” appearing monthly in Steps For Recovery newspaper. Perhaps one of these problems may match your own.

Q. After being a year sober, I met this real sweetheart of a guy in AA. We got married after a 6-month courtship and I thought that everything was finally going my way for once. Only problem is, we’ve been married for a year and a half now, and I don’t want to have sex much anymore. Before getting sober, I used to do sexual stuff with men I didn’t even like much, just to keep them around. Now that I’m sober I remember what I did and the whole idea of sex brings back these flashbacks. I don’t really want to lose my husband, but when he pressures me for sex, I just want to have a drink. What should I do?

A. Now is the time to give yourself the gift of some personal shame-reduction therapy. Going to 12-Step groups can help keep you sober, and there are some great Women Only groups where you can talk more freely about sexual issues in recovery. You know that drinking won’t really solve your sexual problem—drinking will just add another problem to your existing list. Your current sexual anorexia sounds like a post-traumatic stress type of reaction. Shutting down sexually is a fairly common way of handling sexual shame and guilt.

You also might want to see a therapist about how to talk to your husband more effectively. If he’s a recovering person himself, it’s likely that he has a few hang-ups himself in the sexual arena. Try to remember that you are both in this recovery thing together. Sometimes guys forget that a marriage license is not a mating license, to be hauled out every time one person wants to have sex and the other doesn’t. Sex needs to be consensual even when you are married. A good therapist can help you both to regain intimacy with some sexual trust exercises. Reading Wendy Maltz’s book The Sexual Healing Journey might be a good way to get started. Or look into Patrick Carnes’ book Sexual Anorexia. Good luck to you both.

Q. I’m on Zoloft because I used to be angry and depressed all the time, and being sober from alcohol didn’t exactly improve my mood. I thought that my wife was going to divorce me because I was such a jerk when I was drinking, but once I got sober I was a really angry guy, and I thought she was going to divorce me because of that. Zoloft helped even out my moods but now I can’t keep an erection half the time, and now I’m afraid my wife is going to divorce me because of that. Have any advice?

A. Yes, it’s true that one of the side effects of Zoloft and Prozac is a tendency for some people to experience less sexual desire or an inability to achieve orgasm. You might want to talk to your psychiatrist about this problem because there are some new antidepressant drugs on the market that may not have these side effects. Or perhaps your doctor could adjust your dose of Zoloft so that these symptoms were minimal. Viagra is another option, if you are able to use it responsibly. Another suggestion is for you and your wife to discuss opening up your sexual repertoire to include more activities that are not necessarily centered around penile-vaginal intercourse. After all, the largest sex organ in your body is your brain. You might want to use it more imaginatively. This could be an opportunity for you and your wife to explore a variety of ways to pleasure one another, including holding, kissing, stroking, massaging, talking, and being close. Not every sexual encounter has to end in orgasm in order to be enjoyable. You could try some of the exercises in books on Tantric Sex, which often describe how the male orgasm is enhanced after a period of voluntary orgasmic discipline.

Q. My wife is having some pre-menopausal symptoms—she’s 48 and I’m 52—and now she’s fearful all the time that her sexual desirability is on the wane. She used to really enjoy sex, but now all she talks about is being a dried up prune for the rest of her life. It’s gotten so that I’m afraid that I am married to a woman who will truly be a dried up prune for the rest of my life. What can I say to her?

A. Probably the best thing you can tell her is that old standby: “I love you.” Menopause can last from two to ten years. The good news is that some women report this time as a period of renewal, of finding inner empowerment, of discovering who they really are and how their priorities might change. Some women actually report an increase in sexual desire. Others report a number of symptoms such as dryness, mood swings, night sweats, headaches, and weight gain. There are a number of ways for your wife to minimize her symptoms, from estrogen and/or testosterone replacement therapy to acupuncture, but she may need the help of a menopause specialist. The North American Menopause Society has a list of doctors who specialize in helping women make it through the “change” with a minimum of problems.

Quite frankly, menopause also forces women—and the men who love them—to face their own mortality fears. This is a time when couples often can re-prioritize their lives, find more time to enjoy one another or explore new options. Your wife doesn’t have to be “a dried-up prune” for the rest of her life. It might help if she, and you, started by reading one of several very good books on the market about menopause, such as Lonnie Barbach’s The Pause, or Gail Sheehy’s Menopause, the Silent Passage.

Q. My wife was sexually abused as a child by her uncle, and she kept it a secret for a long time. I’ve tried to be understanding, although first I wanted to go out and kill the guy. We’ve been living together for 3 years, but I didn’t know about this abuse until six months ago. We’re both going to Adult Children of Alcoholics meetings, and it’s helping a lot in terms of handling anger and resentment. However, my wife is having a lot of sexual problems. We’re only having sex about once a month these days. When I first met her I thought that I had found my sexually ideal woman. She’s beautiful, and she used to be willing to do anything in bed. Now she says that she was putting on an act to please me. The weird thing is that she likes to use vibrators, by herself, lying face down on a bed. I found her that way once, and I became upset that she would prefer to masturbate rather than have sex with me.

A. Many women who were sexually abused as children have struggles with their sexuality as adults. Interestingly, it may be a myth that such women are unable to enjoy sex. However, it is true that they may feel guilty about enjoying sex. Your wife needs to know that you love her for more than her beautiful body, because sexual abuse teaches a woman that her body is the only thing she has that is worth something. Some women are truly afraid of their sexual potential, because they are afraid that enjoying sex as an adult may mean that they deserved the abuse they got as a child. Most sexual abuse survivors report feeling more empowered after therapy with a trauma specialist, or by joining something like an incest survivor’s group. And the two of you together might want to find some safe ways to talk about your sexual future, perhaps by finding a couples therapist who has had experience with sexual abuse issues.

Q. I don’t know which is worse: what my husband was like before he joined Sex Addicts Anonymous, or what my husband has been like since he joined SAA. Before was when he was getting hand jobs from prostitutes in massage parlors. I can’t believe how much money he spent on that!! Then he joined SAA and stopped seeing the prostitutes. But he also stopped having sex with me. At first I was so mad at him that I didn’t care if I never had sex with him again, and I began thinking seriously of divorce.

But I have two little boys and my husband was so remorseful—after he got caught—that I decided to see if we could still make the marriage work. I did some research on SAA and found out that many recovering people go on a celibacy contract for 30 days or even 90 days, but it’s been 4 months now. He tells me he loves me, but he just isn’t ready. Last night he finally told me that he’s afraid that if he has sex with me, then he’ll start wanting to have sex with prostitutes, so it’s better to shut down altogether. I don’t think that this is a great solution for saving a marriage. What do you think?

A. You’re right: no sex at all is not a great solution for saving a marriage, especially if one of the partners is unhappy with that solution. Your husband is afraid. He obviously cares about you, and he’s afraid that if he were to slip and see a prostitute that you might leave him. I think it may be time for the two of you to see a marital therapist who can help the two of you to come up with a plan for healthy sex. For example, for many couples in recovery, it is important to start out slowly. Some couples go out on dates, for example, and they get to know each other through courtship rituals that do not in the beginning involve the genitals. Then they move to hugging, kissing, holding and so on. Most people put lots of energy into career goals or investment strategies but never take the time to plan for intimacy. Remember that your husband has an intimacy disorder, not just a prostitute problem.

Q. When we first got married, my wife and I couldn’t seem to get enough of each other. We made love almost every night. Then we had some rough times due to my drinking, and we started to grow apart. She spent a lot of time at her job, and finally she gave me an ultimatum—to stop drinking or she’d leave me. I went into rehab, and I haven’t had a drink in a year. The problem is, our sex life just isn’t what it used to be. She’s still busy at her job, and I’m going to a lot of meetings. We’re both tired all the time, and it seems like we pass each other like ships in the night. How can I rekindle romance?

A. I once saw a book that had a great title: “How to Fall in Love With the Person You Already Live With.” I don’t remember exactly what was in the book, but the general idea was to start back at the beginning, with the courtship stage. In other words, suggest to your wife that you have an “intimacy date” that doesn’t include genital sex. Take her out for dinner, buy her flowers, say something complimentary, such as how you appreciate that she stayed with you through rehab. Come home and cuddle, rub her feet, and ask her opinion on something. Listen. Don’t give advice. Hold her when you go to sleep.

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

Gay, Straight, or Somewhere In-Between?

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

Despite the fact that the American Psychiatric Association stopped labeling homosexuals as having some sort of mental disorder 30 years ago, there are many people who still believe that to be gay is, by definition, an indication of pathology. Since my specialty is working with sex addicts and their family members, most of the gay men I’ve seen have been struggling with some sort of compulsive sexual problem. However, this doesn’t mean that all gay men are sex addicts. Many gay men are just looking for someone to love, like human beings everywhere.
It is also true that if you help a gay man to recover from being compulsively promiscuous, he is not likely to turn straight, even if he himself is convinced that to do so would solve his “acting out” problem. Many of these self-loathing gay men get married in the hopes of finding a woman who will “cure” them, a situation that most often leads to an ongoing pattern of a shame-based double life. However, I have discovered over the last nine years of struggling to understand intimacy disorders, that when it comes to questions of sexual identity, human beings are capable of immense variation

This topic of “gay, straight, or somewhere in-between” is explored further in this selection of questions and answers culled from the last four years of Sharon O’Hara’s column on “Love & Sex” appearing monthly in Steps For Recovery newspaper. Perhaps one of these problems may match your own.

Q. I’m 24, and I moved to L.A. from Tennessee right out of college. When I first moved here I went a little nuts sexually, having anonymous sex in adult bookstores and in public bathrooms. I felt so ashamed of my sexuality back home, and there’s so much freedom here. Maybe there’s too much freedom, because a few months ago I tested positive for HIV. My problem is that I don’t know what to tell my parents, if anything. They don’t even know that I’m gay. Meanwhile, they want to come to L.A. for Christmas. My live-in lover, who has AIDS, says that I have to tell them at Christmas or he’s going to move out. I feel coerced on all sides. The only good news is that I’ve stopped acting out sexually since I started to attend Sexual Compulsives Anonymous meetings. Sign me: Anonymously Gay.

A. First of all, A.G., congratulations on attending SCA and taking a major step towards sexual recovery. Whenever you have major decisions facing you, it is usually a good idea to first do some research among people struggling with similar decisions. If you haven’t contacted them already, it would probably be a good idea to call the folks at Aids Project Los Angeles. They can steer you to support groups for people with HIV, as well as other community resources.

You need to give yourself time to explore a variety of issues associated with “coming out” as well as living with HIV. Now is the time to find a therapist to help you to sort through your priorities. Don’t let your lover push you into making disclosures before you’ve had a chance to process your own feelings. Perhaps you can ask your parents to put off their visit for a few months, and meanwhile embark on a journey of self-discovery.

Q. I’m a 45-year-old married man, and I’ve been reading your column for months, yet I’ve never seen anyone write in with my problem. I’m not gay, but occasionally I find myself having oral sex with men in “gay” bathrooms, certain places I discovered in a local park. I’m always on the receiving end, and I don’t want to get involved with men in any kind of romantic way, so I don’t think I’m gay. It all started when I was about 14 and this older boy introduced me to oral sex. I didn’t think of it as “real sex,” but my orgasm was very intense.

Later on, I got married and had a couple of kids. My wife was not interested in oral sex of any kind, and I didn’t push the issue. Two years ago I had an affair with a woman I met at work, and my wife found out and threatened to divorce me. I broke off the affair, but this woman liked to perform oral sex, and now I can’t stop fantasizing about it. Then I found out about these “gay” bathrooms in the park, and I started going there because I get the release and there’s no romance involved. So I don’t feel like I’m being unfaithful to my wife like with the affair. And I don’t see how I could get HIV as there is no anal sex. My only problem is, I seem to be going more and more often. And I gave my phone number to one of the guys in the park, and now he’s invited me to his house. I haven’t gone yet, but every time I get into an argument with my wife I find myself looking at the telephone. What should I do? Mr. Double-Life

A. Tell the truth and tell it faster. To somebody, preferably to a counselor who specializes in treating compulsive sexual behavior. At the very minimum it would be a good idea to attend Sex Addicts Anonymous (SAA) or Sexaholics Anonymous (SA) meetings, where you may find out that there are other people struggling with the same or similar sexual problems.

Mr. Double-Life, you appear to be quite good at rationalizing your behavior, but there are several major flaws in your line of thinking. Number one: You can get HIV from unprotected oral sex. Yes, it’s less likely than participating in anal sex, but there’s still a risk. That means that you’re putting not only your own life on the line, you’re also putting your unsuspecting wife’s life on the line, too, as I don’t imagine that you’re using condoms with your wife. Number two: You may feel that having anonymous sex with men is less a threat to your marriage than having an affair with a woman, but your wife might feel differently. For many women, infidelity is infidelity, whether it’s due to prostitutes, lovers, or same-sex partners.

The main thing is, you’re leading a double life, which usually means that you may have a true intimacy disorder. Lastly, you are risking being arrested by a vice cop and having your reputation (and marriage) put in jeopardy. I know several men who have been arrested by vice cops who hang out in public bathrooms for the purpose of arresting people such as you. The fact that your behavior is escalating (giving out your phone number) is especially indicative that you are crossing over into addiction territory. This is not about being gay or straight, it is about living outside your own sense of integrity. You need more help, my friend, or it is likely that your consequences will get much worse.

Q. I’m a recovering alcoholic, 34 years old, and I happen to be a gay man who is in a committed relationship with a 25-year-old man. Last week I found out that he has been going to adult bookstores every couple of weeks, where he has been having sex with strange men. Of course, he—I’ll call him Mike—insists that it isn’t real sex because it’s mostly manual and oral, but I’m devastated. Mike says that because he’s only 25 he has a greater sex drive than me, that he doesn’t have any emotional feelings for these men, and that he didn’t want me to feel bad because I don’t want to have sex as often as he does. So of course now I feel even worse, that I drove him to have sex with strangers because I don’t have as high a sex drive as he does. He says that after doing these sexual things with strangers that he then feels more emotionally close to me. How can this be so? This isn’t the first time that this has happened to me, but I thought that this time it would be different with Mike. I’m beginning to think that all men are pigs when it comes to sex. Faithful and Gay

A. Dear Faithful: Usually I hear this “all men are pigs” comment from women, so it’s bizarrely refreshing to hear it from a man. But of course it isn’t true—if it were, you’d be one too, and it doesn’t seem to me that you’ve done anything pig-like yourself. Your friend Mike may or may not be a sex addict, but he sure has the sex addict rationalizations down pat. It is one of the most painful things for the partners of sex addicts that they not only have to deal with the very real problems of loss, betrayal, and possible sexual infections, but they, the partners, also are often blamed for causing the problematic behavior. This is true across the board, for both gay and straight couples. This is a projection of guilt by the sex addict and you shouldn’t fall for it.

It is possible that Mike feels more emotionally close to you after having anonymous sex with somebody else simply because at that moment he’s feeling needy and you’re there. Plus, because he may be feeling guilty, he may be willing to put effort into pleasing you in some way. However, it doesn’t really matter what the rationalization is, the truth is that the person who is unfaithful in a committed relationship is a liar, living out of his/her integrity. This Mike fellow just wants to have his cake and eat it too, and he wants to blame you for giving him an appetite to sneak a piece from another person’s plate.

Your basic problem is that you are very vulnerable to blaming yourself for this situation. Now is the time to go to S-Anon, or Al-Anon, or Adult Children of Alcoholics, any of the partner-type 12-Step meetings. You need supportive people around you as you sort out what it is that you are responsible for and what it is that you are not responsible for when it comes to Mike.

Let yourself grieve the loss of the vision you had of your relationship, so that you can deal with the reality of the one you have. It is likely that your lover Mike has a history of compulsive sexual behavior that pre-dates you. It is highly unlikely that you caused this situation. If Mike is willing to go to Sexual Compulsives Anonymous, great. Then you might eventually go to Recovering Couples Anonymous. There are lots of places where you—and he—can go for help. But right now you’re the one who is suffering the most, and you need help to let go of this misplaced sense of responsibility.

Q. I have an unusual problem. My boyfriend “Tom” told me that he used to be gay, but now he’s not. Everyone I’ve talked to about this situation is sure that Tom will “revert to being a homosexual” because once you’ve had sex with a man you’re evidently branded forever. I’m not a young girl—I’m 43. And Tom is 41. Tom had a sexual relationship with a man I’ll call Bill who was a composer when they were both in college. Tom even says that he thinks that he loved the way Bill played the piano as much as anything. In fact, Tom didn’t like the sex part very much. Tom stopped sleeping with Bill after 3 years and has only been with women since then. Actually he’s only been with one woman in the last 10 years since Tom is the monogamous type—one of the things I like about him. Do you think that Tom is going to revert to being gay? Or can I trust him to “stay straight” like he says he will? Confused but Hopeful

A. Dear Confused: If you’re looking for sexual guarantees, you’re going to have to look elsewhere than at human beings. The more I work with people who have love and sex problems, the more I’m convinced that human beings are pretty complicated when it comes to matters of the heart. It is true that there are a number of men whose sexual orientation is primarily homosexual, but because of societal consequences connected to coming out of the closet, they end up married to women but have secret liaisons with men. It doesn’t sound as if Tom is in this category, but I’m not sure how well you know Tom.

On the other hand, there are certainly a number of men who had homosexual encounters of one kind or another when young who go on to have successful heterosexual relationships. Very few people are 100 percent gay or straight anyway. The standard thinking is that a person’s primary orientation is linked to which sex he or she fantasizes about, or, to put it another way, with whom can he/she fall in love? I think that you need to take things slowly with Tom. Perhaps you could both benefit from some couples therapy as you explore your respective relationships to your own sexuality. One good sign is that Tom appears to be talking openly to you about his past. Keep on talking. Secrecy and shame are the real relationship killers.

(If you copy this article for others, please copy the following author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

Cybersex in the Recovery Community

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both Beverly Hills and San Pedro.

Addiction to cybersex is a very popular topic these days. In a recent survey of over 9000 Internet users reported in the Journal of Sexual Addiction & Compulsivity (vol.7, 2000), fully 17% admitted that their online sexual behavior had gone out of control. Sex is the most researched topic on the Internet, due to what is referred to by Dr. Alan Cooper as the “Triple-A engine” of sexual compulsivity: anonymity, accessibility, and affordability. Never before in the history of the world has so much sexual material been available so quickly to so many people as currently exists on the Internet. Pornography used to mean an occasional Playboy under the mattress—now the average teen can see thousands of sexual images in the time it used to take to read a magazine.

What do these facts mean to the 12-Step recovery community? Let’s face it: if you are an addict when it comes to alcohol or drugs, it’s likely that your sexual life is also vulnerable to addictive patterns. Newly recovering addicts are especially prone to cross-addiction, and if your job or hobby involves major use of a computer, it’s awfully tempting to put that resentful partner/spouse out of your mind while indulging in a downloaded sexual fantasy.

Recently I talked to a couple about their cybersex history (I’ll call them Steve and Anne). Steve was rightly proud of his three years of sobriety after kicking a heroin habit of 10 years duration. Anne and Steve wanted to save their marriage, but Steve was about to lose his job selling computer software due to being caught at work downloading fetish images from a sexual site. Meanwhile Anne, originally very righteous in her views on pornography, later admitted that she had gone to chat rooms herself in order to have stimulating sexual conversations with strangers. Over several weeks of therapy this couple managed to institute new boundaries through a combination of self-censorship (loading special software on the computer that blocks out sexual material), practicing communication exercises, healthy sex homework, and attending some Recovering Couples Anonymous meetings.

If you or someone you know is experiencing problems with cybersex compulsivity, perhaps you will find more information of interest in the following questions and answers culled from my past columns on “Love & Sex” in the Steps For Recovery newspaper:

Q. I’m a recovering from methamphetamine abuse, and recently I decided to start going to Sex Addicts Anonymous meetings because since I got sober from drugs, I can’t seem to stop masturbating. Lately I’ve been staying up at night, smoking a couple of packs of cigarettes, looking at various sex sites on the Internet. I’ve even got my favorite ones “bookmarked” so I can return to them at the click of a mouse. Sometimes I masturbate past the point of pleasure. It’s like I have to wear myself out or something.

I have a girlfriend, sort of, but she’s always upset with me for one thing or another, and it’s so much easier to masturbate than to deal with her. The last time I went over to see her, I thought we were going to have sex, but she got a recovery phone call from a friend of hers, and I ended up falling asleep waiting for her to get off the phone. So in the middle of the night I woke up, then went home and did my little ritual in order to go back to sleep. I don’t even know if I have a problem or not—I guess it’s hard to take this masturbation thing seriously, since the consequences are nowhere near as severe as they were when I was on drugs.

A. There is a controversy about the role of masturbation in sexual recovery circles. The folks at SA (Sexaholics Anonymous) and SRA (Sexual Recovery Anonymous) take the position that if you identify yourself as a sex addict, then you are fooling yourself if you think that you can masturbate successfully. What they mean by “successfully” is when you masturbate as a self-nurturing activity, without compromising your intimate relationships, and unaccompanied by degrading sexual fantasies. SA/SRA members take the stand that sex addicts need to abstain from masturbation altogether and instead seek for sexual expression within marriage or a committed relationship.

SAA (Sex Addicts Anonymous, SCA (Sexual Compulsives Anonymous), and SLAA (Sex and Love Anonymous) all take the position that abstention from masturbation is a personal decision. However, most of these latter group members would also agree that abstaining from masturbation is a good idea in early recovery (in order to break self-destructive patterns).

In your case, you yourself began going to SAA meetings because you thought you had a problem with masturbation. That says something right there. It sounds like you are using masturbation as your primary coping skill whenever you have a falling-out with your girlfriend. It would be wise for you to try to create some alternative coping skills, with the help of an SAA sponsor and appropriate therapist. You’re right that compulsive masturbation may not have the same intense consequences as methamphetamine abuse, but you may lose out on being able to sustain any kind of intimate relationship if the only woman you’ll let into your heart is made up of pixels on a screen.

Q. I’m a recovering alcoholic—two years sober—and I just found out that my wife is hooked on computer sex. I thought that she was just working late, but she’s really hooked by those “chat rooms” and romance e-mail that amounts to sending sex letters to strangers. All of this came crashing down last month when she admitted that she actually met one of these guys in a restaurant—he’d flown to L.A. from Maine or someplace. She told me that she didn’t have sex with the guy, because he wasn’t so intriguing in person as he was on the computer, and I guess she felt guilty so she confessed. I was really angry, and then she confronted me about how she had stood by me when I was drinking really bad. She thinks it’s time for me to be understanding about her problem, but I just want to wring her neck. I keep imagining her with these guys and I just see red. Then I feel guilty because she did stand by me when I went to treatment. Should I stick with her or what?

A. The shoe is definitely on the other foot. Many addicts feel just as confused as you do when their partners start engaging in some kind of addictive behavior. Of course, there are some differences. Alcoholics most often bring consequences on themselves. They ruin their health, their job performance, or their reputation. But sex addicts who act out with other sex partners are potentially putting their spouses’ lives at risk. After all, we are living in the age of AIDS. And even if you don’t get a life-threatening disease, there are all kinds of other nasty sexually transmitted diseases floating around, such as herpes, chlamydia, and venereal warts.

In other words, it’s generally easier to be an Al-Anon support person than it is to be an S-Anon support person. Al-Anon says things like: “Just take care of yourself, lead your own life, and let the alcoholic have consequences.” Unfortunately, the spouse of a sex addict may have his/her life on the line. The health consequences that your wife may end up paying could be transferred to you.

However, in your case, it sounds like your wife confessed because she may want some help in order to stop her compulsive behavior. If she’s willing to go to treatment or to attend one of the sexual recovery groups (SAA, SA, SLAA or SRA), then your relationship has a chance of being repaired. I don’t suggest that you make an impulsive decision about the future of your relationship. You might want to check out S-Anon, COSA or CODA and discover what codependent recovery is all about—it may even strengthen your chemical recovery.

Q. My husband has this pornography problem. Well, I think it’s a pornography problem, but he thinks it’s just a hobby. Tom assures me that he’s faithful to me, never had an affair, never saw any prostitutes, so why should I complain? Problem is, he’s so computer-obsessed that he doesn’t even want to have sex with me very often, about every 3 months or so. Meanwhile, practically every night Tom is downloading pictures from the Internet, and he has a stack of porno magazines in the garage.

Our son is 12 and I’m afraid that he’s going to pick up these same bad habits, or maybe do something worse. I’ve already found Penthouse magazines under my son’s mattress. Can you tell me a way that I can get my husband Tom to stop being such a bad role model for my son with this porno stuff? Tom gave up cigarettes last year when he saw our son smoking, but he’s turned a deaf ear to my complaints about the computer.

A. Being curious about Penthouse-type magazines is fairly normal behavior for 12-year-olds. Sometimes overreacting to finding such magazines can be more traumatic to the child than the pornography itself. It’s important not to shame children but to use such situations as opportunities to talk about healthy sexuality that is age-appropriate.

On the other hand, it does sound as if you and your husband have an intimacy problem. Tom appears to like interacting with pornography more than he likes interacting sexually with you. This behavior may indicate a true compulsion that predates your relationship, or it may be indicative of some other problem in your marriage. I don’t know how you relate to your own sexuality. The best way that you can teach your child about sex is to demonstrate a loving and affectionate relationship with your husband.

I would definitely suggest couples therapy, and if your husband won’t go, find a therapist for yourself.. You may eventually have to issue an ultimatum to your husband—either the cybersex goes or you do—but before you get to that stage, you might also want to check out S-Anon, which is a support group for spouses where there are problematic sexual issues.

(If you copy this article for others, please copy the following author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

Handling Sexual Infidelity: Should You Tell Your Partner?

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

One of the trickiest ethical dilemmas in 12-Step recovery is the problem of sexual disclosure. Should a woman who had affairs while she was drinking or using drugs own up to her spouse about the infidelity once she has gotten sober? What about the married man who compulsively sees prostitutes and sometimes “forgets” to wear a condom? Should he assume that because he has a negative HIV test that he’s off the hook? When do you tell, and how much? These are the questions that are debated endlessly in 12-Step meetings and telephone calls.

It’s interesting to take a historical look at how the founders of AA handled this question. In the AA Big Book, much emphasis is laid on the importance of honesty: “Rarely have we seen a person fail who has the capacity to be honest,” it says right at the beginning of Chapter Four entitled “How It Works.” However, when it comes to the question of making amends, the founders emphasized caution, suggesting in Step Nine that it is a good idea to make direct amends “except when do to so would injure themselves or others.” This sentence has generally been interpreted to mean that, since it would injure the wife to find out about her husband’s affairs, it would therefore be better not to tell her.

Founder Bill W. writes on page 81: “If we are sure our wife does not know, should we tell her? Not always, we think.” The basic idea here is that the alcoholic should tell the truth about infidelities to his sponsor and to God, then pray for forgiveness and the willingness to change his ways. The justification for this lapse in AA’s otherwise strong advocacy of total honesty is that sexual disclosure might cause the wife to end the marriage, potentially compromise another person, or perhaps cause the alcoholic to risk relapse.

However, as Dr. Jennifer Schneider points out in her 1998 article “Surviving Disclosure of Infidelity,” published in the Journal of Sexual Addiction & Compulsivity, it is likely that AA founder Bill W’s inconsistency on the question of honesty may well have derived from his own personal struggles with sexual addiction, which was not a recognized disorder at the time. She quotes Nan Robertson, author of Getting Better: Inside Alcoholics Anonymous (1988), as follows:

“Particularly during his sober decades in AA in the forties, fifties, and sixties, Bill Wilson was a compulsive womanizer. His flirtations and his adulterous behavior filled him with guilt, but he continued to stray off the reservation. His last and most serious love affair . . . began when he was in his sixties. She was important to him until the end of his life, and was remembered in a financial agreement with AA. (p. 36)”

This last mistress, Helen W., actually received 1.5% of the royalties from the Big Book after Bill’s death. As for Bill’s wife, Lois, “she never mentioned his philandering,” writes Robertson in this history of AA’s founders. Dr. Schneider then makes the point that perhaps it would be wise to consider that the recommendations of the AA Big Book concerning sexual infidelity may be best understood as a reflection of Bill W’s denial process as concerns his own sexual addiction, “rather than as a reasoned recommendation of a group of recovering people (p. 213).”

Although the Big Book has many brilliant insights for helping alcoholics and addicts to stay sober, its author may not be the best guide for sexual recovery. The influence of the Big Book is also felt in the White Book of SA called Sexaholics Anonymous, and in SAA’s similar book, Hope and Recovery. Both books caution sex addicts not to disclose to their partners/spouses too quickly or too much, and to talk to their group members first.

In all of this, it is very interesting that until recently, nobody asked the partners what it was that they wanted. Since the 12-Step book writers were predominantly male and the partners predominantly female, whatever the addiction, it turns out that the men were deciding what was best for their female partners without actually consulting them. Dr. Jennifer Schneider surveyed 82 couples in various stages of sexual recovery in 1998. She discovered that the partners of sex addicts overwhelmingly wanted: 1) to be themselves in charge of how much was going to be disclosed, and 2) to have their feelings of violation and distrust validated by both the addict and any therapist they might be seeing as a couple.

As a result of this research, Dr. Schneider strongly recommends that disclosure be “guided by the spouse’s desire to know,” rather than by the addict’s desire to minimize. She went on to note that, although 60 percent of the partners threatened to leave upon the first disclosure of infidelity, 76 percent of those who threatened to leave never did so or even separated temporarily.

For a further discussion on this topic of infidelity, you might want to peruse some of these “Q & A on Love & Sex” dilemmas, culled from past issues of Sharon O’Hara’s column in the Steps For Recovery newspaper:

Q. I’m a 39-year-old recovering alcoholic, sober 5 years. I’ve been married 10 years, and I have an 8-year-old son. Last year I had an affair with a woman at work, whom I’ll call Fay. She was married, too. A couple of lunches turned into a torrid 8-month relationship of stolen afternoons. I fantasized about Fay all the time. I never seriously thought I’d leave my wife for her, but I just couldn’t break it off. I felt guilty but the forbidden element was so compelling. Finally Fay moved to another state, and we called it quits. I haven’t even talked to her in months.

Here’s my problem: My wife found some bills for a motel I used to see Fay last year. I denied her accusations of infidelity, but she keeps asking, saying that she can handle the truth, that she’s more upset by my lying than she would be if I admitted to an affair. Meanwhile, my sponsor says that the 8th and 9th Step on making amends suggests that I shouldn’t tell my wife, because the truth would hurt her. What do you think?

A. I think that you want an easy way out, and there is no easy way out. Yes, the amends steps in AA have often been interpreted as “it’s better to keep sexual secrets if the truth would hurt your spouse.” And if you had had an affair years ago that she didn’t know about I might be inclined to suggest that you leave the sleeping dog in peace.

However, you have a wife who has caught you with evidence, and now you have to keep lying, and it appears to be eating you. This is actually good news. It means that you hurt because you are out of integrity with yourself. Perhaps you are a fellow who doesn’t really like lying to someone you love.

If you tell your wife about the affair, however, I would like to predict that she is unlikely to take this news as calmly as you might think from your description of your wife’s words (“I can handle the truth”).

I’d like to know some more about the entire situation. Is this the only affair you’ve had? Or is there a pattern here? Do you have other secret sexual behaviors? If so, you might have a true sex addiction problem, and in that case, secrecy usually escalates the obsessive thinking. Many sex addicts in recovery have discovered that telling the truth to their spouses (often with the help of a therapist) meant that they could finally make headway in re-establishing trust. So you have a dilemma. Yes, your wife might leave you if you tell her the truth. But your relationship might stay sour if you don’t tell, because on some level you both know you’re lying.

Q. I’m a 45-year-old man, and I’ve been in recovery from cocaine and marijuana for about 10 years. I’ve been married for 18 years and I have 3 children who mean the world to me. Before I got sober I had a couple of short affairs with women who got high with me. I never told my wife because I got a sponsor who said that the 9th Step in CA means that you don’t make amends by hurting someone. He said that if I told my wife about the affairs it would be dumping on her. I was kind of relieved, to tell the truth. And for the last 9 years I’ve been faithful—I guess I was really grateful that she stuck by me. Then last year I started flirting with one of my wife’s coworkers. It was just one of those crazy things that happened. I was sure it would be over in a couple of weeks but now it’s been going on for 10 months. I keep telling myself to stop seeing this coworker on the sly but I can’t seem to stop. I’m thinking of telling my wife, because then maybe it’ll make me stop. I don’t want to get divorced. What do you think?

A. I think you’re risking a number of important relationships right now. Your marriage, the respect of your children, your wife’s relationship with her coworker, just to name a few. If you want to stop having this affair you might consider doing one or more of the following, before you talk to your wife: 1) Get a therapist who specializes in problems of sexual compulsivity. 2) Go to SAA, SA, and/or SLAA meetings. Get a sex recovery sponsor from one of these meetings. It’s not enough just to show up and talk. You’ve got to walk the walk. Don’t get a CA sponsor for your sexual/romantic problems—talk to someone who has had to face his own sexual recovery issues. 3) Check out a treatment center, either outpatient or inpatient. 4) Read Patrick Carne’s book Out of the Shadows—there is a revised edition that is still one of the best introductions to understanding sexual addiction.

Don’t turn your wife into your personal sheriff. It’s not fair to her and you’ll resent her for it. Eventually you may need to get honest with your wife, but you really need to do a lot of work on yourself first.

Q. Last year I slept with my girlfriend’s husband. It was stupid. They’d had a fight, and Tommy wanted comforting, and I was lonely, and you probably have heard all these kinds of excuses before. Anyway, it was only the one time. The problem is, I haven’t told my girlfriend Karen about this incident, but it’s eating away at me. I don’t know what to do. Tommy keeps giving me these looks when Karen isn’t looking, like now we have this little secret. To tell the truth, I didn’t even like having sex with him, and now I feel creepy when he gives me a goodbye hug or something. I just don’t want to lose my friendship with Karen because I was so stupid. Should I tell her?

A. If you want to tell Karen simply to unload your own guilt, this seems to me to be adding insult to injury. You are right to acknowledge that this little “incident” has affected your friendship in a profound way, because the truth is that you now have a secret with the husband that you’re keeping from the wife, your friend. And you may just have to live with how that feels, because behavior does have consequences.

I don’t know if you are in a 12-Step program, but the Ninth Step says that you make direct amends to a person you’ve harmed unless doing so would injure them or others. I think your best bet is to stay clear of Tommy and see this episode as a major learning experience. Talk to a therapist about safe ways to accept appropriate responsibility. If this kind of thing has been a pattern in your life, you may want to check out Sex and Love Addicts Anonymous for further help. You can use this mistake to grow, or to beat yourself up until the next millennium. Remember, it is possible to be imperfect and worthwhile, both at the same time. But you can only really grow if you’re willing to learn from your mistakes.

(If you copy this article for others, please copy the following author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at

Sober Dating Plan

From Guest Therapist Linda Hatch, Psy D.


The following are some Ground Rules for recovering sex addicts who are about to start dating after a period of sexual abstinence.

 Check for appropriateness of potential dates


“I will not date anyone I met through any inner or middle circle activity”.

“I will not date anyone I met through an online ad that is suspect”.

“I will not date anyone I met when they were dating a friend of mine”.

“I will not date anyone who is more that a few years different from me in age”.

“I will not date anyone where there is a significant power differential”.

What are your rules for how you will avoid obviously inappropriate people?





Who are your trusted advisors and how often will you check in with them?


“I will check in with (names of friends in recovery who have experience in sober dating.)”

“I will have my sponsor meet the person or at least check in with sponsor or trusted persons before and after seeing potential date.”

Names of trusted advisors and plan for feedback:




General Rules Once You Have Started Dating

 Personalize these rules with notes that apply to you as dating progresses:

“I will ask that the person share their relationship history openly and honestly and will look for problematic patterns”.


“I will not continue dating someone who is dating someone else or has recently ended a relationship that may not be completely resolved.


 “I will do a ‘red-light, yellow-light, green-light’ exercise with any dating partner i.e. 3 lists of attributes specifying positive (green) questionable (yellow) and deal-breaker (red) things I have discovered as I get to know the person.  I will add to the lists as I go along and share it with my therapist, sponsor or other trusted advisor”.



“I will be particularly alert to whether the person has the capacity to give intimacy, affection and commitment.”


“I will be particularly alert as to whether the person is interested in relating in a serious way vs. being just seductive.  I will ask pointed questions about what the person is looking for and be vigilant for vague answers”.


“I will be vigilant about whether I am distorting my view of a person or relationship so as to pursue a sexual obsession”.


“I will check in often as to whether the relationship is becoming addictive in any way for me including whether I am kidding myself about what I feel for them”.


Ground Rules for When to Have Sex

How long will you date before agreeing to have sex?


“I will not have sex until I have had a chance to assess the person’s character and my own motives”.

“I will not have sex until I have gone on 6 dates”.

“I will not have sex until I have dated the person for 4 months”.

“I will not have sex unless we are ­­­___ (committed, engaged, married)”.

List your rules for when you will have sex 1.______________________________________________________________________



What are your bottom line issues?


“I will not have sex with anyone I could not commit to”.

“I will not have cyber sex, sexting etc.”

“I will not expect to bring my acting-out fantasies into the relationship in any way”

“I will not have sex with a sex addict who is not in good recovery”.

List your rules surrounding sex in recovery:






How Are Female Sex Addicts Different From Males?

Sharon O’Hara is the former Clinical Director of the Sexual Recovery Institute and sees private clients for individual, group, and couple therapy both in Beverly Hills and San Pedro.

Historically speaking, women have always been overlooked or underrepresented in addiction studies, whether the compulsive behavior studied had to do with alcohol, drugs, gambling, or sexual acting out. It has been 60 years since the founding of AA, 50 years since the American Medical Association recognized alcoholism as a disease, and yet it was not until the late 1980s that significant findings regarding very powerful gender differences in the development of alcoholism surfaced in research studies for other diseases, such as heart disease or AIDS, where women have also been underrepresented as research subjects.

In his pioneering research that focused mainly on male sex addicts, Patrick Carnes described in Out of the Shadows how early victimization experiences led to the formation of negative core beliefs (e.g. I am unworthy, I will always be abandoned, sex is my most important need). Highly charged early erotic experiences, often dangerous and/or abusive, coupled with powerful shaming messages, led to a preoccupation with sexualizing all feeling states. In other words sex-addicts-in-the-making, at an early age, learned to block out all painful feelings of inadequacy or loneliness through sexual fantasy, rituals, and an escalation of self-destructive sexual behaviors.

In later research discussed in his book Don’t Call It Love, Patrick Carnes discovered that in general male sex addicts tend to objectify their partners and seem to prefer sexual behavior that involves relatively little emotional involvement. This leads male sex addicts to engage primarily in such activities as voyeuristic sex, buying prostitutes, having anonymous sex, and engaging in exploitative sex. This may be seen as a logical extension of the way that men in our culture are raised to view women and sex.

As the dozens of pop psychology books on male-female relationships can attest, there is no end to the lament that men in our culture have difficulty with bonding and intimacy issues. We live in a culture that prizes competition and autonomy, particularly for men: getting ahead, going for the gold, becoming an individual, gaining mastery of feelings, making sexual notches on one’s belt. Taken to the extreme, these values can easily lead to extreme isolation, objectification of sex partners, an inability to express feelings, and a strong sense of entitlement at the expense of others—all fertile breeding ground for addictive behaviors. (I’ve been wanting to diagnose this phenomenon as “Independency syndrome,” meaning putting too much emphasis on being independent.)

Women sex addicts, on the other hand, tend to use sex for power, for control, and for attention. They score high on measures of fantasy sex, seductive role sex, trading sex, and pain exchange. Unlike the men, female sex addicts do not seem to be following an intensified trend already existing in the general culture. In fact, by acting out sexually, these women seem to be reacting against culturally prescribed norms.

Author Charlotte Kasl has noted that women in our culture are primarily trained to be sexual codependents. In her book, Women, Sex, and Addiction: A Search For Love and Power, she defined such codependency as letting one’s body be used in order to hold onto a relationship, whether or not a woman really wants to have sex. In general, sex addicts tend to use (manipulate) relationships in order to have sex, whereas sexual codependents use (manipulate) sex in order to keep relationships. Neither group has a clue as to true intimacy.

Codependency has become an overused term, tending to brand all helping impulses as pathological. In her ground-breaking work on normal female development, In a Different Voice, Carol Gilligan describes how women create a sense of identity through relationships, through the development of an “ego-in-context-of-relating”. Male developmental theorists from Freud to Erikson have emphasized the need for human beings to become autonomous, basing these models on themselves and then projecting them onto women.

Gilligan points out that normal female development involves an early need for intimacy skills, with autonomy becoming an issue when women are older, perhaps in their 30s or 40s. Men, on the other hand, are encouraged to find their autonomous identities first and then to explore intimacy skills.

This may explain why, so often, we see the phenomenon of women going back to school after the kids are grown to “find themselves,” at just about the point when their husbands may be wanting to get closer, wanting to “settle down.” The point here is that a woman’s need to understand herself in the context of relationship is not by definition pathological. It is only when these normal developmental needs are distorted (usually through early abuse experiences), that desperate, compulsive, and obsessive behavior emerges, culminating in various women-who-love-too-much scenarios.

Sex addiction in women cannot truly be understood without being constantly aware of the interrelationship of addiction and codependency. Often it appears in my outpatient practice that some women sex addicts are actually trying to “fix” their codependency (a self-perceived sense of weakness and vulnerability) by taking the initiative to act out sexually “like a man.” Consider the following examples:

* Kate, a 25-year-old woman, married, with a 3-year-old daughter. She had been incested for 12 years by her father, which she had difficulty seeing as abuse, because “he didn’t use force.” This woman was so hyper-eroticized as a child that she sexualized all relationships, male and female. Her sexual acting out behavior had shifted from replaying abusive scenarios with men (hitchhiking, seeking out dangerous sexual situations) to a compulsive use of female prostitutes. Her primary sexual motive was to be in control, and buying women made her feel powerful.

It became clear that this was less a question of sexual orientation than it was a need for sexual dominance in order to handle fears and other painful feelings. And in Kate’s mind, buying sexual favors from women was not as “immoral” as having illicit affairs with men. She did not want to become too dependent on her husband’s affections because of a deep fear of abandonment, but she paradoxically craved intimacy. In other words, Kate became a sex addict in order to hold off her fear of becoming too sexually codependent, which was what her father had trained her to be.

* Marie, a 42-year-old entrepreneur, divorced, no children. Marie came into treatment saying, “every day I want to turn a trick.” She, too, had been sexually abused as a child, and had tried to gain internal mastery of her feelings by becoming a call girl and madam, where she felt more in charge. Even though she had stopped practicing prostitution 7 years ago, Marie could not stop compulsively masturbating to the point of injuring her genitals, and she fantasized about turning tricks constantly. This sexual self-abuse was not her only coping mechanism; she was also a binge-purge bulimic.

* Lila, a 34-year-old woman, married, with two adopted daughters. Lila came into treatment after attending a Family Week for her husband, who was a sex addict who cruised young men in public parks. He was very homophobic and wanted Lila to “cure him” of his attraction to men. He also hoped to “cure her” of her attraction to women, even though he had known throughout their 12-year marriage that she had always been primarily oriented towards lesbianism. After Lila stopped focusing on her husband’s acting out behavior as the cause of all their problems, she realized that she felt equally out of control about her own sexuality, and that she needed treatment for herself.

Many women have found the fellowship of Sex and Love Addicts Anonymous helpful in reducing the shameful feelings that surround the problem of compulsive sexual behavior, which is the first step towards stopping this behavior.

(If you copy this article to share with others, please copy this author bio as well):

Sharon O’Hara, MFT, CSAT, has offices in the Beverly Hills and Torrance/San Pedro area, specializing in treating sex addicts and their partners. She can be reached via email at