Compulsive Sexual Behavior   Sexual Addictions

Compulsive Sexual Behavior Sexual Addictions PowerPoint PPT Presentation

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Case Vignette. Recently, I had a personal conversation with a large regional hospital HR director in the metro Atlanta area that was intriguing. He told me that the most common reason now for employee termination at his hospital was due to repeated actions of employees using the hospital internet s

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Compulsive Sexual Behavior Sexual Addictions

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1. Compulsive Sexual Behavior & Sexual Addictions Michol Polson, Ph.D. UTHSC Department of Family Medicine

2. Case Vignette Recently, I had a personal conversation with a large regional hospital HR director in the metro Atlanta area that was intriguing. He told me that the most common reason now for employee termination at his hospital was due to repeated actions of employees using the hospital internet system to access pornography. This hospital terminated employees at the third attempt. He stated that he could not grasp why these employees would continue to surf the internet for pornography when they knew the hospital had flagged them and was monitoring their internet traffic.

3. What is Going on with These People?

7. Compulsive Behavior Loss of ability to choose to stop or continue a behavior Continuation of such behaviors MAY result in: Arrest Divorce Loss of health Loss of employment Loss of freedom Behavior could be considered as “out of control”

8. If I start, I will not be able to stop

9. What is Sexual Addiction?

10. 1. Loss of Control Persistent desire to stop/control behaviors Unsuccessful efforts to stop/control behaviors 2. Continuation despite adverse consequences 3. Obsession/Preoccupation: loss of time, productivity Obtaining Using Recovering

11. Difference Between Sexual Addiction and Compulsive Behavior? Nonaddicted persons Ability to stop behaviors Pull back Reestablish control Opportunistic acting out, not in conflict with self

12. Compulsive sexual behavior Adverse consequences Continuation of sexual behaviors Compulsive acting out, great deal of internal conflict

14. Internet Sex 70% of porn traffic between 9am-5pm US porno revenue exceeds 6 billion currently (3rd) 12-17 year olds largest consumers of internet porn Average first time contact is 11 years of age Gender: 60-70% males 30-40% females 70% of compulsive addicts use internet only or combine usage

15. “Cybersex is the crack cocaine of sexual addiction” Rapid escalation of amount and variety Internet provides: access affordability anonymity

16. Etiology of Sexual Addiction Anyone, BUT: More from families multiple addictions rigid, disengaged families Psychological trauma common Propensity for high-risk behavior Onset due triggered around high stress events Trouble with accountability, authority Little confidence in relationships or intimacy

17. Prevalence Epidemiological estimates vary Inconsistent criteria for defining sexual compulsive behaviors Lack of funding Lack of committed researchers Most information comes from clinical treatment programs specialized in sexual addictions Best estimates are approximately 5% of general population Higher than pathological gambling, bipolar, schizophrenia

18. Demographics 3: 1 ratio of men to women Younger and older persons in cybersex 65% of sex addicts run the risk of contracting STDs 79% have lost work productivity 70% severe marital or relationship due to behavior 65% report sleep disorder due to shame, fear, despair Vehicle accidents and sexual acting out for addicts 19% men, 21% women OBGYNs, ER good for genital trauma referrals

19. Clinical Presentation Not candid about behavior Conceal severity, escalation factor When the patient does seek help: evidence of a long-term problematic sexual behavior other addictions often co-exist or may present first may involve abuse of power Clinical presentation centers on loss of control adverse life events as consequence

20. Clinical data accumulates over time Serial affairs, STDs, spouse provides information Sexual incident + evidence of other compulsive behaviors ALC, excessive work, compulsive eating, gambling Behavior involves abuse of power Especially trust relationships, community VIPs Unexplained problems + sexual problems Family, work absences Large sums of money disappear

21. Assessment What is the physician’s role in assessment? No screen- refer out? Screen- refer out? Screen-history-refer out? Screen-history-refer out-follow-up?

22. Screening vs. HPI Assessment

23. Sexual Addiction Screening Test 25 items Self administered Discriminates effectively between sex-addicts, non sex addicts Cutoff score is 13 96.5% of sex addicts classified correctly May refer patients to to take the SAST or physician may provide

24. Differential Impulse control disorders Bipolar mood disorder PTSD Substance induced disorders Dissociative disorders OCD Gender identity disorder Dementia or other cognitive disorders Personality disorders

25. Role of the Primary Care Physician Most trusted relationship in healthcare If relationship warm and supportive, Pt will often disclose Provide complete physical Assess, treat comorbidities Major depressive episode Sleep disorder Irritability Difficulty concentrating

26. Treatment Factors Addiction oriented primary therapist 3-5 years involvement 1st 2 years most intensive 12 Step sex addiction group to prevent relapse 12 Step for other co-morbid addictions Work the program, not just attend Find sponsor, step work, service Early family involvement Spiritual support Exercise, nutrition, healthy lifestyle

27. Psychotropic Medication Treat for Mood, Anxiety Disorders “Start low, go slow” may NOT work in most cases Need to target as more treatment resistant: Major depressive illness Anxiety disorders GAD Panic OCD PTSD

29. Psychotherapy Factors Multi-disciplinary approach crucial! Inpatient vs. outpatient? Is 12 step sexual addiction group enough? Other modalities? Individual psychotherapy Family therapy Couples therapy

30. Referral: Where to Send Patients? Metro Memphis/West Tennessee Addiction inpatient facilities for substance abuse Out-of-state inpatient for sexual addiction Addiction out-patient therapy: All licensed therapists some training Certified substance addictions specialists TennCare/HMO provider lists Only 5 CSATs in metro area: 3 certified 2 in training

31. Physician Follow-Up Periodic drug screen if co-morbidity Dialogue about recovery between Pt and Physician Specific to sexual addiction recovery: To what are you addicted (defines sobriety) About what are you fantasizing? How are you handling HALT in your life? Hungry Angry Lonely Tired

32. The End

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