Sexual addiction and eating disorders:

1. Sexual addiction and eating disorders: AN EXPLORATION OF ADDICTION INTERACTION IN THE COUPLE DYAD Jayme Koerselman, MA, CSAT, NZAC (Provisional) Lecturer – School of Counselling Laidlaw College

2. Addictions defined - Sex • Controversial term especially in the area of sex and eating • “Out of control behavior” (Carnes, 1992, 2001) • Both binging and restricting – “Sexual Anorexia” (Carnes, 1997; Nelson, 2003) • Sexual compulsivity (Quadland, 1985) or impulsivity (Barth & Kinder, 1987) • Sexologists have been more reluctant to accept this terminology instead using the DSM IV terminology hypersexuality and hyposexuality (Kaplan, 1995)

3. Addictions defined - Eating • “Vandereycken (1990) cautions against bulimia being a form of addiction in spite of the similarities to other addiction as he states this is mainly based on analogy only and clinicians (and patients!) wanting to reassure each other of a known entity. He goes on to say it’s important to look at what is similar but also what is dissimilar between eating disorders and addiction. • Addiction model of eating disorders see Handbook of Addiction Disorders (Coombs, 2004)

4. Addictions defined • For the purpose of our discussion addiction is defined as: • Loss of control of behavior • Behavior continues in spite of significant consequences • Preoccupation with the behavior or preparation of it • Distress, anxiety, irritability if unable to engage in the behavior (Carnes, 2001: Goodman, 1993, 1998) • The cycle of destructive thoughts and behavior that affect mind, body, and relationships

5. Self/Couple concept & beliefs Restriction/ Compensatory Preoccupation Physical and emotional consequences Life consequences/ Unmanageability Ritualization Acting out

6. How this became an interest • Clinical observation • Case examples • Common Characteristics • Addiction parallels and interaction (Carnes, 2005; Petrucelli & Stuart, 2001; Orford, 2001; Huebner, 1993) • Carnes (2005) describes “the understanding of excessive behaviors as addictive disorders that share similar features, causes, and even cures. As part of that clarification we are proposing a model that integrates the addictions and proposes that the addictions have metapatterns that are important and discernable clinically” (p. 87).

7. How this became an interest • Professional studies/Literature Reviews • Attachment styles • Addiction characteristics • Neurobiological aspects • Studies of differentiation – Bowen, Winnicott, Sullivan, Schnarch, Bowlby • Relational anthropology

8. Common Characteristics • Process addictions (Power, 2005) • “Series of events repeated in the course of acting out self-destructive patterns” (Glass, 2011). • Addictive cycle • Problem of desire – “Appetites” (Knapp, 2003) “In short, the things we once needed in order to survive—food, shelter, intimate partnerships—have become the things we want in order to feel sated. But satiety is itself a tricky subject, in large part because our culture—visual, commercially rapacious, oriented toward quick fixes and immediate gratification—both fuels and defines the wish for it at almost every turn, on almost every front.”

9. Common Characteristics - Problem of Desire • “They [women] value their independence and find it difficult to bond with another person. They are afraid of their dependency needs, of becoming vulnerable in a love relationship. In this age, it is easy to turn to something impersonal, non-demanding and seemingly free from conflict—something like food, the new lover. Food as a lover is always there. It accepts them unconditionally they do not have to pencil it into their appointment books or worry about herpes or AIDS. But just as a lover can bring them satisfaction and unhappiness simultaneously, so, too, can food bring emotional upheaval—the dilemma we have mentioned: to eat is to be thin and happy or fat and sad.” (Meadow, 1992) • “Not wanting to want and wanting to be wanted” - (Schnarch, 1991)

10. Common Characteristics • Relational disorders • Bulimics in particular tend to show a high self-consciousness and inability to enjoy sex yet have a prevalence to be hypersexual (Schembri & Evans, 2008; Rodríguez et al., 2007; Pinheiro, et al., 2009) which suggests that they may use sexual activity as a means of relational security and approval (Culbert & Klump, 2005). • Similarly, sex addicts often objectify and avoid any meaningful intimacy in sexual encounters. • “Other-centered validation” (Schnarch, 1991)

11. Common Characteristics – Relational disorders • Attachment styles • Perceive families as rigid and disengaged (Waller, Slade, & Calam, 1990; Carnes, 1992) • Both individuals struggling with sex addiction and eating disorders have been linked to an insecure attachment – specifically highly anxious and highly avoidant (Koskina & Giovazolias, 2010; Zachrisson & Skårderud, 2010; Zapf, Greiner, & Carroll, 2008; Carnes, 2011)

12. Common Characteristics • Brain effects • Reward circuitry of the brain – (Blum et al., 2012) • Drugs of abuse, sex, and food all activate the dopaminergic mesolimbic reward system of the brain • Similarly evidence showing that mate selection and “falling in love” was linked to dopaminergic reward and motivation pathways in the brain • “Reward Deficiency Syndrome” • Motivational circuit activation – (Rodriguez et al., 2007)

13. Common Characteristics • Social influences • Advertising increase and messages contained • Desire is evoked and answered through the product – often which has a sexual component contained in the advertisement • Idealized/sexualized imagery • APA – sexualization of girls task force (Hatch, 2011) • Recent European legislation for digital retouching • Sexualization of food • There is an aspect of something “wrong/naughty” about eating (at least certain foods) and sex (Knapp, 2003; Meadow, 1992)

15. Common Characteristics - Social Influences • Obsession over beauty, bodies, and sex • 11.7 million cosmetic surgical and non-surgical procedures in the U.S. In 2007, an increase of 500% in past decade (91% of these are women). $13.2 billion was spent and the most frequent nonsurgical procedures were botox injections while liposuction was the most frequent surgical. (The American Society for Aesthetic Surgery) • $7 billion spent on cosmetic products in the U.S. (YMCA – Beauty at any cost) • $46.3 billion spent on weight loss products in the U.S. (Marketdata) • $97.06 billion spent world wide (top 16 tracked) on pornography in 2006 (http://internet-filter-review.toptenreviews.com/internet-pornography-statistics.html) • In 2010, The Nielsen Company estimated 28% of people who used a work computer to access the internet visited an adult site. (Heussner & Jaffe, 2010)

18. Common Characteristics • Restricting/binging • Carnes (1997) documents that 72% of sex addicts described their behavior as binge/purge • Both contain obsession/preoccupation • “Separate lives” • The question of abstinence • Developing a healthy relationship with food and sexuality

19. Dyadic interaction • Mate selection • Restricting/Binging within the dyad • One partner’s behavior can directly fuel the other’s • Hidden or separate lives (and often attachment style) creates distance which reinforces the isolation of addiction

21. Clinical Case examples • “Tom and Sue” • The “Fat Suit” • Acting out and the somatic embodiment of meaning • “Jeff and Lisa” • “Married with separate lives” • “Brad and Megan” • Boundaries - “to be close you have to be compliant”

22. Treatment implications • Relational Diagnosis (Kaslow, 1996, 2006) • How do the presenting problems help stabilize the couple? • How do the presenting problems regulate closeness and distance within a couple? • What perhaps is the presenting problem communicating nonverbally within the marriage?

23. Treatment implications • Broaden treatment strategies • Interpersonal/Relational Therapy • Managing relational anxiety • Bowen’s triangulation model • Differentiation as “the process by which a person manages individuality and togetherness in a relationship” (Schnarch, 1991, 2009) • Siegel’s (1999, 2007) neural integration, mindfulness and the “river of well-being” that runs between chaos and rigidity

24. Treatment implications • “System” interaction awareness • Family/Couple sessions (Bird, 2006) • Addiction interaction awareness • Break the cycle individually AND in the dyad • RCA – couples 12 step

25. To love is to be alone, at least initially and momentarily, since it is unilateral and not dependent on response from the loved one. And since the fear of being separated makes us concerned with the response of the other, and so keeps us from loving, the very fear of aloneness and separation oddly enough results in our awful aloneness and deadly separation. (Malone & Malone, 1987, pp. 1011)

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