Dr. Robert Weiss LCSW, CSAT

Sexual Trauma: The Basics

When victims of early-life sexual trauma enter treatment, they typically present with multiple, compounded, and complex clinical challenges. Consider the case of Jason, a 25-year-old man:

Jason grew up the only son of two alcoholics. His father sexually abused him from a very young age, and his mother abused him verbally, emotionally, and sometimes physically. With both parents, the abuse grew worse when they drank. Now, as an adult, Jason is struggling to hold on to a job, to maintain his friendships, and to control his sexual behavior. He says that every night after work he logs on to half a dozen or so “adult friend-finder apps” and chats with people seeking sex. More often than not, he has sex with at least two or three different people, and sometimes more. As soon as one person leaves his apartment, he’s online looking for the next one. Often, he is awake and sexually acting out until three or four in the morning, which leaves him both tired and unproductive the next day at work – an issue that may soon get him fired.

Deeply ashamed of his behavior, Jason nevertheless continues to engage in it, stating in therapy that it’s the only thing that makes him feel alive. At this point, he’s convinced that he’s nuts.

While intellectually capable far beyond his current situation, emotionally he is fragile and depressive. He has no way of knowing or understanding that his compulsive adult sexual responses to any form of emotional discomfort are in fact learned coping mechanisms that are relatively normal (or at least expected) given the degree and nature of the complex trauma he experienced in childhood. Therefore, he simply sees himself as bad, unworthy of love, and hopelessly broken.

Unsurprisingly, in the early stages of treatment Jason did not see a connection between his childhood abuse and his adult-life behavioral problems. This non-comprehension is both normal and understandable, as the obvious response to trauma is a desire to not think about it or re-live it. As a result, adults like Jason with a history of early-life trauma, especially sexual trauma, typically are depressed and anxious and cope with their trauma by pushing it away. Sometimes they do this by “numbing out” with addictive substances or addictive behaviors (compulsive sex, in Jason’s case); other times they do this by alienating others and engaging in various forms of self-destructive activity. All without any understanding of their motivations.

Due to this lack of understanding and association, many sexually traumatized men whose issues manifest later in life think of themselves and their symptoms as crazy, as we see with Jason. These men simply don’t understand that their upbringing was lacking and left them without a positive sense of self or needed life-skills, and that their problematic behaviors are an adaptive response to what they experienced. As a result, they develop negative and shamed views of themselves, becoming highly self-critical and blaming themselves for events and circumstances over which they had little or no control. In other words, the beliefs they developed as children about the cause and reasons for their abuse – and often what they were told by those who abused them – create a deeply ingrained shamed self and a negative self-concept, which in turn feeds a wide variety of later-life psychological issues.

Sadly, research findings corroborate that traumatized children are more likely than traumatized adults to develop trauma-related disorders like PTSD, depression, anxiety, dissociative disorders, externalizing and internalizing behavior, substance and behavioral addictions, and the like. This is especially true when no relief or support is available and the abuse is perpetrated by someone in close relationship to the child, constituting a betrayal trauma. Research also suggests that the more times a child is traumatized, the greater the likelihood of adverse reactions later in life. In fact, young people with four or more significant traumatic experiences prior to age 18 are:

• 1.8 times as likely to smoke cigarettes
• 1.9 times as likely to become obese
• 2.4 times as likely to experience ongoing anxiety
• 2.5 times as likely to experience panic reactions
• 3.6 times as likely to be depressed
• 3.6 times as likely to qualify as promiscuous
• 6.6 times as likely to engage in early-life sexual intercourse
• 7.2 times as likely to become alcoholic
• 11.1 times as likely to become intravenous drug users

In other words, there is an undeniable link between early-life complex developmental trauma and numerous adult-life psychological issues – including substance abuse and behavioral addictions (such as sexual addiction).

Sexual Addiction: The Basics

Before further discussing the link between early-life sexual trauma and later life sexual addiction, it is important to understand the basics of sexual addiction. For the most part, sex addiction looks a lot like any other addiction – the only significant difference being the addict’s “drug of choice.” In fact, the primary diagnostic criteria for sexual addiction closely mirror the criteria for every other addiction:

• Ongoing obsession/preoccupation
• Loss of control (typically evidence by failed attempts to quit or cut back and/or an inability to stop the behavior pattern once started)
• Continuation with the behavior pattern despite directly related negative life consequences

Thus, sex addicts engage in repetitive patterns of compulsive sexual fantasy and activity, and they continue to do so even as their clearly out of control behaviors (to an external observer) create significant problems in their lives – relationship issues, trouble at work or in school, physical risk, declining physical and emotional health, financial turmoil, legal concerns, mood disorders, and more.

Can a Behavior (Like Sex) Really Be Addictive?

At present, there is a general cultural consensus regarding addiction to substances. Less understood is the concept of behavioral addictions. Much of this confusion stems from the fact that behavioral addictions sometimes involve activities that are (for most people, most of the time) healthy and even life affirming. For instance, eating and sex, two of the more commonly diagnosed behavioral addictions, are necessary to human existence, as they contribute to survival of both the individual and the species. In fact, these activities are so inherently necessary that the human brain is preprogrammed to experience them as pleasurable.

This experience of pleasure is evoked primarily by the release of the neurotransmitter dopamine into the nucleus accumbens, sometimes referred to as the “rewards center” of the brain. The nucleus accumbens connects, via neural pathways, to other areas of the brain, including the hippocampus (memory), the ventral striatum (processing rewards), the dorsal anterior cingulate (anticipating rewards), the amygdala (the alarm center, processing the significance of events and emotions), and the prefrontal cortex (decision making, judgment). Via these pathways, the nucleus accumbens communicates to other parts of the brain the pleasurable sensations associated with being sexual (or eating). In this way, humans remember the pleasure they’ve experienced related to life-sustaining activities and thus are internally prompted to engage in the same or similar behaviors in the future.

Unfortunately, people with early-life trauma issues can learn to use and abuse the brain’s dopaminergic response as a means of coping with or dissociating from stress and emotional pain. For these individuals, the pleasurable dopamine response evoked by sexual fantasy and activity (or other highly pleasurable and therefore potentially addictive behaviors) is used to tolerate or escape from stress, anxiety, depression, and the emotional discomfort wrought by unresolved early-life trauma. In other words, people who struggle with behavioral addictions engage in their problematic patterns of behavior not to have a good time, but to emotionally escape (to control what they are feeling). These are the exact same reasons that alcoholics drink and drug addicts get high.

To further understand the similarities between substance addictions and behavioral addictions, it may help to consider the cocaine addict who, cash in hand, has found a source for the drugs he so desperately desires. In the moment, with little conscious thought, he will leave work early without informing his boss, hop in the car, and race to his dealer’s house – all the while experiencing a sense of emotional euphoria and a tunnel-like focus on obtaining and using his drug of choice. Isn’t he high already? After all, his thinking is impaired (he’s making bad decisions), his heart is racing, his hands are clammy, and he feels compelled to purchase and use the drugs no matter the consequences. And the closer he gets to using, the harder his heart pounds, the more he perspires, and the more distorted and misinformed his thinking becomes. Put simply, this addict gets high on the anticipatory fantasy and euphoric recall his thoughts produce long before he ingests the drug itself.

Sexual addiction operates on the same “anticipatory high” principle. In fact, sex addicts find as much (if not more) pleasure and emotional escape in sexual fantasies and the pursuit of sex as in the sex act itself. Sex addicts sometimes refer to this elevated, fantasy-driven state of neurochemical excitement as being in “the bubble” or “the trance.” In this state of fantasy-driven dopaminergic mood elevation, they will literally lose touch with reality for hours or even days at a time – high on the idea of sex, with little or no actual physical contact. Thus, for both substance addicts and behavioral addicts, the fantasies and actions that lead up to using/acting out are every bit as compelling and desirable as the actual drug or behavior. The pairing of intense fantasy and ritual produces a highly desired form of neurochemical arousal, which serves as a distraction from intolerable (to the addict) emotional discomfort.

References

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