SUMMARY :
The National Council
on Sexual Addiction and Compulsivity also defines sexual addiction (and by extension,
Cybersex Addiction) in an analogous manner
to physiologic addiction to common
substances of abuse. These points have been incorporated as treatment considerations
for those patients reported in this paper.
The fundamental purposes of this
paper are
1) to report on the clinical experience with patients determined
to be suffering from Cybersex Addiction, 2) to bring attention
to this relatively
new phenomenon, and
3) to encourage earlier diagnosis and treatment interventions.
Reported
is the clinical experience with
15 consecutive patients who were diagnosed
with Cybersex Addiction. The cohort consisted of males whose average age was 39.
Nearly all were college graduates. All were married. The average number of hours
spent weekly on the Internet at sexually oriented sites was self-estimated at
23.8. (The initial underestimated range was from 7 to 70 hours per week.)
No
patient’s acting out was exclusive to Cybersex : other forms of acting out
included, among others, prostitution, phone sex, affairs, nude modeling studios,
excessive use of pornography, and compulsive masturbation. The average length
of treatment for completed cases was 23 months with the range being 15 to 36 months.
The average amount of time in treatment for active cases was 15.2 months.
Diagnostically,
in addition to a DSM-IV diagnosis of Sexual Disorder, Not Otherwise Specified
(302.9), all were diagnosed with Obsessive-Compulsive Disorder (300.3) and/or
a Depressive Disorder (Depression, Not Otherwise Specified (311) ; Major Depressive
Disorder (296.2 or 296.3). All patients suffered from characteristics of a personality
disorder including antisocial, avoidant, dependent, histrionic, obsessive-compulsive,
and narcissistic traits.
Treatment includes : 1) Individual Psychotherapy
(Cognitive Behavioral Therapy), 2) Group Psychotherapy, Support Groups (such as
Sex Addicts Anonymous), 3) Offering of Conjoint Psychotherapy, 4) psychopharmacologic
Intervention with Selective Serotonin Reuptake Inhibitors, Buproprion, Mirtazapine,
Venlafaxin, and Atypical
Anti-psychotic Neuroleptics (Quetiapine, Risperidone).
The
principal goal was a reduction of the target symptoms of the obsessive-compulsive
sexual acting out and depressive symptoms.
The initial results show that 6
of the 15 patients completed treatment. All of these patients discontinued all
forms of sexual acting out. Of the remaining 9 patients, one patient discontinued
all Cybersex involvement but on occasion consorted with a prostitute. One patient
discontinued all Cybersex involvement but on occasion engaged in an affair. One
parient had a dramatic reduction in Cybersex Addiction, meaning that he visited
Cybersex sites less than one time in a six week period. All treated patients showed
improvement as measured by reduction in frequency of sexual acting out.
Discussion
includes the caution that while medication facilitated clinical progress, the
utilization of medication carries the risk of giving patients a false sense of
security and thereby fostering the ever-present element of denial. It was noted
that once the compulsivity was ameliorated, the underlying sexual psychopathology
became more evident and help define the agenda for psychotherapeutic intervention.
In 12 of the 15 patients (80 %) there was very clear evidence of intimacy failure.
Compulsive lying in patients with Cybersex Addiction is to be expected as integral
to the self-denial found in all cases of Cybersex Addiction and must be dealt
with in therapy. Clinically, patients do better when they share their difficulties
with treatment and their struggles for recovery with their partner. Those patients
who initially refuse to share with their partners will likely prolong treatment.
Though not found in this specific cohort, in the experience of the authors, Cybersex
Addicts commonly suffer from co-morbid alcoholism.
Limitations in this
preliminary study include :
1) the size of the cohort, 2) the fact that Cybersex
Addiction was not an exclusive form of sexual acting out, 3) the patients’estimates
of time spent at Internet sexual sites were underestimates, 4) that it was impossible
to calculate the degree of denial and distortion of the history initially given,
5) the amount of success was largely via self-report, although spouses were asked
for corroborative information, 6) that fact that all patients accepted medication
may identify a different population than those who don’t accept medication,
and 7) that there was no longitudinal followup dealing with the therapy for the
underlying sexual dysfunction which spawned Cybersex Addiction.
Recommendations
include :
1) Screen all patients presenting with sexual dysfunction
for
Cybersex Addiction ; 2) Be aware that Cybersex Addiction usually co-exists with
other forms of sexual acting out ; 3) Be aware that patients presenting with psychosexual
developmental arrest or regression may also suffer from CyberSex Addiction ; 4)
Education about Cybersex Addiction should be considered for patients presenting
with early warning signs of Cybersex Addiction which includes (among others) dysphoria
association with increasing, private time spent with the computer ;
5) Treatment
must be multimodal and should encompass 1) Individual Psychotherapy,
2) Group
Psychotherapy, 3) Couples Therapy, 4) A 12 Step Self-Help Program such as Sex
Addicts Anonymous, and 5) Trial with Selective Serotonin Reuptake Inhibitors,
and/or Mirtazapine, and/or Venlafaxin, and when indicated, augmentation with Atypical
Anti-psychotic medications.