A Brief Screen for Sex Addiction

Amy Sohler, MPA, MA, LMHC, CDP, MHP, CSAT c, EMDR
Counselor, Gentle Path at The Meadows

Although it may be clinically hard to diagnose, sex addiction may affect up to three to seven percent of the population. Unfortunately, there is more of a stigma attached to sexually “acting out” than there is with the symptoms of other addictions. Many clinicians don’t have a well-defined criterion to diagnose the condition. Complicating matters even further is that sex addiction is often maintained and protected by a shield of dishonesty.

On a brighter note, we now have a reliable tool called PATHOS to use for diagnostic purposes. Based on research published in the American Society of Addiction Medicine by long-time sex researcher Dr. Patrick Carnes, PATHOS is a brief screening that takes only a few minutes to complete. PATHOS has a high reliability and validity, which was revealed in several studies that “support the use of PATHOS as a screening instrument to detect potential sexual addiction in clinical settings.”

As with all addictions, early intervention and assessment are critical to the recovery process. As a quick screener, PATHOS can be used by counselors, pastors, and doctors, along with other medical providers, as a quick and accurate assessment of potential problems with sex addiction.

The below six key questions can be used as a first assessment to help determine if a more in-depth assessment is necessary. If there is a positive (yes) response to three or more questions, a referral to a Certified Sex Addiction Therapist (CSAT) would potentially be the next step.

1. Preoccupation — Do you often find yourself preoccupied with sexual thoughts?
Sex addicts obsess about sex in ways most people do not. Everything becomes filtered through an erotic lens and in an effort to keep up the stimulation, the patient will find it difficult to focus on important social, occupational and family obligations. The ways preoccupation shows up may include:

• Fantasizing: Similar to daydreaming, but constant and sexual in nature
• Objectification: Sexualizing others
• Euphoric recall: Continued rumination about previous sexual encounters
• Shame: Hiding some of your sexual behavior from others?

2. Feelings of shame and fear often are at the core of sex addiction.
These feelings stem from beliefs of being unworthy and unlovable. Sexual behavior and habits are often hidden and kept secret. Shame and fear may show up as:

• Compartmentalizing secret parts of sexuality so no one else knows
• Anxiety-related disorders
• Hidden parts of life and elaborate ways to keep sexual behavior hidden
• Inability to be honest

3. Therapy — Have you ever sought therapy for a sexual behavior you did not like?
Although sex addicts have a history of seeking help for their problems, they either do not find knowledgeable help or leave therapy before they can get better. How this plays out is:

• The sex addict does not see a professional skilled and trained in sex addiction treatment such as a Certified Sex Addiction Therapist (CSAT).
• Sex addiction and the dishonesty around the behaviors are not disclosed as a core issue, so progress cannot be made.
• As a dopaminergic disorder of the brain, abstinence is required to calm the hedonic set point down so that therapy can be effective; therapists untrained in sex addiction do not address this.

4. Hurt Others — Has anyone been hurt emotionally because of your sexual behavior?
Infidelity, secrets, and betrayal are frequent allies of sex addiction. Often there are a number of people who have been harmed or will be harmed in the process. Hurting others includes:

• Emotional wreckage with partners, family members, friends and in the workplace
• Leaking out of incomplete parts and pieces of the sexual behavior, called a “staggered disclosure,” without therapeutic support from a trained sex addiction therapist, which further traumatizes others
• Emotional distancing by the sex addict from their loved ones

5. Out of Control — Do you feel controlled by your sexual desire?
Many sex addicts find they are engaging in behaviors which they do more or for longer periods of time than they intended. The escalation of the addiction is seen through:

• Tolerance: the same activities no longer supply the same pleasure, so new and more extreme behaviors emerge.
• A majority of the addict’s inner and outer life is devoted to fantasy, euphoric recall and acting out behaviors and behaviors that support the increased time needed for the addiction.
• Important obligations start not being met, affecting work, family, and friends. A house of cards of dishonesty may be holding up the addicts increasing secrets.

6. Sad — When you have sex, do you feel depressed afterward?
Sex addicts feel despair about their sexual activities. Often they report not even enjoying the sex when it is happening. Depression is common. Depression can be seen in”

• Increased hopelessness
• Increased negativity
• Lack of ability to feel pleasure over small things in life

Today, there are professional societies dedicated to sex addiction; a dedicated medical journal; significant research published in a wide variety of journals; and other clinically oriented journals. Furthermore, many facilities, such as The Meadows and Gentle Path at The Meadows, offer treatment and there is even a nationwide network of Certified Sex Addiction Therapists. You can access professional resources at the International Institute for Trauma and Addiction Professionals at http://www.sexhelp.com.

Contact Gentle Path at The Meadows Today

Every journey begins with a single step. Through an array of time-tested modalities, we’ll give you and your loved ones the tools to develop healthy relationships. These tools will remain with you for the rest of your life. We want to see you and your loved ones prosper and thrive. Visit our website here or call the Gentle Path at The Meadows Intake Team at 855-333-6076.