Dissociation and Sexual Addiction/Compulsivity: A Contextual Approach to Conceptualization and Treatment

The possible relationship of dissociation to sexual addiction/compulsivity (SAC) among childhood sexual abuse (CSA) survivors is explored. In applying a treatment procedure based on functional behavioral analysis to CSA survivors exhibiting SAC it was frequently observed that SAC patterns of behavior were not sexually gratifying, but that clients had been previously unaware of this. These clients often had poor recall of even recent instances of SAC and described a subjective sense of being in a daze, truncated awareness, and absence of a sense of agency during SAC episodes. Repeated detailed description of recent incidents of SAC in session helped clients become less dissociative when subsequently participating in SAC behaviors and gradually reduced the appeal of engaging in them. On the basis of these observations it is argued that recognition of the dissociative quality of SAC behavior in CSA survivors is essential to adequately understanding it, and that targeting the dissociative elements of SAC in treatment is crucial to disrupting it. It is also proposed that in this clinical population SAC can reflect the dissociative disconnectedness represented by re-enactment of CSA experiences, failure to integrate emotional intimacy with sexuality due to insecure or disorganized attachment, association of sexual activity with soothing and validation rather than sexual arousal, or a combination of these factors