Treatment is not “one size fits all”

Focused on presenting the idea that treatment should be relevant to the specific symptoms of the diagnosis, Dr. James Cantor shared his experience working with individuals living with sex addiction and hypersexuality at the latest Grand Rounds.

“Whether we call it hypersexuality or sex addiction, it doesn’t matter.  What’s important is to determine what we do about it.  To do that, we have to agree on what ‘IT’ is and this is usually a sexual behavior that a person wants to be suppressed,” shares Dr. Cantor.

To arrive at a better understanding of hypersexuality and the distinctions in this behaviour, the cases referred to a sexual behaviours clinic were examined.   The results show that the cases of hypersexuality are greatly increasing in number over the past ten years and that 80-90 percent of these cases are medical referrals.

“We should challenge the idea that ‘no matter what the sexual problem is, the causes and treatment are the same’,” says Dr. Cantor.  “In treating sex addiction, there are often controversial and contradictory ideologies among the public and mental health professionals,” adds Dr. Cantor who feels that the key to determining the best treatment options come from listening more to what the patients says.

“When we started listening we recognized that there were similarities and distinctions among the patients who are living with sex addiction.”

The first group called Paraphilic Hypersexuality tends to be engaged in novelty seeking behaviour and is more likely to have a criminal history, mostly with prostitutes.  They have more frequent substance abuse problems and a greater number of sexual partners.  They also tend to have a later onset of puberty and loss of virginity as well as a greater probability of being attracted to she males. 

Another group, the Avoidant Masturbators is more likely to report anxiety problems and use masturbation to avoid other issues.  They spend an inordinate amount of time masturbating, viewing pornography or forgoing major live activities.  They tend to have conventional sexual interests, higher education, less alcohol use and more frequent sexual dysfunction problems such as delayed ejaculation.

Those who were identified as Chronic Adulterers are the ones most discussed in media but are only about 10-15 percent of those being referred. They are more likely to have a mood disorder such as depression and are also more likely to report sexual dysfunction, such as premature ejaculation. While those in the category of Sexual Guilt usually self identify as sex addicts and are usually from a religious or restrictive environment.  Another group, the Designated Patient is usually referred by their partner following the discovery of infidelity, a paraphilic interest or breaking a zero tolerance ban on masturbation.

“The potential treatments and interventions will differ depending on the category of hypersexuality,” says Dr. Cantor indicating why it’s important to listen to the patients.

He highlights some of the treatment options as follows:
For the Paraphilic Hypersexuality there would be accommodation made, while for Avoidant Masturbation, the issue was not the masturbation itself.  “If you address the other issues, the ones they are trying to avoid, the sexual behaviour changes,” says Dr. Cantor.

For chronic adultery and the Designated Patient, the treatment may be couples' counseling, while for  sexual guilt it's Psychoeducation.

Dr. Cantor agrees that there is still room for research on sex addiction and that this can lead to a number of opportunities for treatment modalities. “This act of listening to the patients and looking for patterns is important in recovery”.