Sanctuary for the Abused

Monday, August 27, 2018

Sexual Anorexia



...and A Small Town Private Practice
by Michael Zahab

The following is a conversation between Michael Zahab, a public relations manager at recovery facility, and the husband-wife team of Paul Hartman, M.S., Marriage & Family Therapist, and Ginnie Hartman, M.A., L.P.C. The Hartmans have worked together in private practice since 1991 at the Healing Center in Spring Lake, Michigan. Paul and Ginnie began their counseling careers in 1981 and 1985, respectively. They recently completed training with Patrick Carnes, Ph.D., for the treatment of sexual anorexia.

Michael Zahab (MZ): Please tell me about your professional background and your current practice.

Paul Hartman (PH): I'm a Marriage and Family Therapist in private practice, specializing in addiction issues. In many years of working with recovering alcoholics, I've tried to help those people who are physically dry move on to a higher level of recovery by dealing with family of origin issues as well as doing Twelve Step recovery work. Despite seeing much progress in my clients, I've continued to feel that something was missing in my work.

I've discovered in the last couple years that the issue I've seldom, if ever, addressed is sex addiction. So, after training with Pat Carnes, I began to do groups that specifically focused on this area. Most participants have been people who were already in recovery from another addiction-long-term recovery for some-but all were still having relationship problems and experiencing pain in their life. Once I began to address sex addition issues, once I made it the primary thrust of therapy, I began to see a tremendously positive response among some of my clients. I'm very excited about the outcomes I continue to see.

Ginnie Hartman (GH): My work for many years has focused primarily on individual families that have been affected by addiction. I have done a lot of group work on family of origin issues and have seen remarkable progress. After my training with Patrick Carnes, however, I began to look for and talk about sexual anorexia-and I have been amazed by the number of people-women, primarily-who struggle with this problem. I've long believed that when substance addiction is present in a relationship, sexual function is usually distorted. But I never understood the dynamics involved until I worked with Pat [Carnes]. I am so excited as I watch the participants in women's groups that have been together for quite a while bloom as they discover and explore their sexuality for the first time.

MZ: Do you believe that this is a new problem, or is it something that we've simply overlooked for many years?

PH: Awareness has been building for some years, beginning for us with the model Claudia Black developed in the early 1980's when she published, It Will Never Happen To Me. We've also had Pia Mellody's work to draw from. I was familiar with Pat Carnes' work through his books, but it wasn't until training with him that I set up groups explicitly focused on treating sex addiction.

This is an important point. Previously I put all my clients together in groups; I didn't differentiate. Generally, the clients in such groups became, after several months, became good friends. They felt safe enough with one another to disclose family secrets, but what they didn't do was talk about sexual issues. No matter how safe the environment, these issues never seemed to come out mixed groups.

My first (sex addiction) group was composed of men who had at least two of years of recovery and had done a lot of group work. When they came together in a sex addiction group, experiences came out that they had never before talked about. It's been the missing treatment piece for these men.

Frankly, I'm coming to believe more and more that the so-called primary addictions aren't truly primary addictions. I'm seeing more and more men for whom the primary addiction is sex addiction. The other addictions are secondary to sex addiction.

MZ: Spring Lake, Michigan, is not a large community. Has it been difficult to pull together enough people to conduct groups which address sex addiction?

P.H.: When I came back from the training, I wondered about this same question. As soon as word got out around the community that I was doing this, however, people were calling and asking to get in the group. Now I have two groups running concurrently, and could easily do one every night of the week if I had the time.

MZ: Ginny, what was your experience coming away from the training? Are you finding a similar situation among the women with whom you work?

GH: Although I've always treated some sexual dysfunction, I'm now just much more aware of the problem. After evaluating my clients more carefully, I realized that those who were in a relationship with an addict had invariably shut down sexually in some way and disowned their sexuality. Several women, when first approached about sexual anorexia, responded with such comments as, "I'm not sexual, and I could care less if I ever have sex again. I'm fine without it. I don't feel anything is missing." Other were being sexual with their partner, but only for their partner, not for themselves.

Each of these women had done family of origin work, a lot of recovery work, and were in a Twelve Step program. I had to really help them understand that they would not be fully recovered until they could embrace their sensual and sexual being. After announcing the group and suggesting Pat Carnes' book, Sexual Anorexia, I had a group of ten before I knew it. As word spread in the recovering community, I had another group of ten-and now I have people on a waiting list.

MZ: Do the women in group meet the criteria for sexual anorexia more than the criteria for any of the other sexual disorders?

GH: It seems so. The typical woman who has been in relationship with an addict has totally disowned her sexuality. She's decided she doesn't want or need sex any longer. This represents a shift to an extreme; these women have not had a lifetime of sexual anorexia. There are, of course, women who have been shut down sexually most of their lives, but that doesn't seem to be the norm among those I've seen.

MZ: Do the couples or individuals with whom you've worked have sexual or relationship issues, but no other apparent dysfunction?

PH: We occasionally see people like this, but, they're not our typical couple client. Generally speaking, our typical couple is in their late 30's or 40's and has been in Twelve Step recovery for six, seven, or eight years. The husband is an alcoholic with seven to eight years of sobriety and he's been active in A.A. During this time, his spouse has been working a good Alanon program.

When they come to us, we hear such stories as: "We're doing everything the program tells us to do. We're working the Steps; we've got a sponsor; we're not into our addiction, but our relationship is terrible and we're thinking of getting a divorce." After a deeper assessment of such couples, we quickly get into the issue of sexual satisfaction and dissatisfaction-and there it is.

MZ: Among the dysfunctional behaviors, are the Internet and pornography a factor? Tell me about this.

PH: I'd put this right on the top of the list. I continue to be amazed each week as people come in and disclosing the ways they use sexually explicit materials on the Internet for arousal and masturbation and how they go to chat rooms and how they then go out to meet people from the chat rooms. That's got to be one of the top issues we deal with in our marital therapy work. This is something that, two years ago, I never asked about. Now, I ask routinely.

GH: I can't tell you how many women who have come into therapy saying, "My marriage is falling to pieces, I don't know what's happened, my husband is up all night on the computer, on the Internet." They have no idea what's going on. As a therapist, you simply have to be aware of this problem.

MZ: How has the training affected your clinical approach and work?

GH: Understanding the anorexia cycle (preoccupation, distance strategies, sexual aversion, despair) has been so important for us and for our clients. It's so much easier to identify how sexual addiction has affected individuals and their intimate relationships. Previously, I recognized that some kind of cycle was in place, but I didn't have a term for it. The term "sexual anorexia" fit perfectly. Clients understand it, too. They know immediately what we're talking about. Consequently, it's much easier to then help clients see how that cycle had interrupted their own sexual maturity and growth. It's made all the difference.

PH: Our work in addictions has long had this basic premise: all current dysfunction is tied in to dysfunction in the family of origin-and that dysfunction often took the form of child abuse. One way people survive that kind of experience is to shut down emotionally. The focus of our work has been to help people access those repressed feelings and express them, and the result has been healing.

In contrast, whether it's Ginnie's sexual anorexia group or my sex addiction group, we focus explicitly on the sexual issues and the thoughts, feelings and behaviors that accompany them.

The other difference is that every week, the group is focused on something that is explicitly sexual. We really follow the outline we received at the training, starting with denial and going right through that outline, you have a subject and it just builds-it just provides the program.

We have a large population of clients who have been extensive family of origin work, so not all are starting from square one-but some are. Initially, I was concerned abut how I could take two divergent groups and treat them together. I decided to deal with child abuse early in the process. That piece of it was repetitious for some, but they didn't object. And those who hadn't dealt with these issues found it very revealing and helpful.

MZ: How did you implement what you learned in the training?

GH: I began evaluating my clients to discover those who had sexual disorder issues, and gave those who did some of the literature to read. I also checked with clients who had finished family of origin work and suggested they do some reading on the topic, too. Many more than I expected called back immediately asking to be in the group.

PH: It hasn't worked that well for me on the sex addiction side. I typically recommend Out Of The Shadows or Don't Call It Love. For a person who is in denial of their sex addiction, my experience is that those books don't do a lot to bring them out of denial. When reading about the behaviors that Patrick describes, many men focus on what they don't do.

One-on-one therapy, however, has help enormously. Through it, these men begin to understand that if they're spending an inordinate amount of time fantasizing about sex and/or objectifying women-regardless of what acting out behaviors they have-this alone is enough to make the diagnosis of sex addiction.

I also stress that such a diagnosis is important, not to put a label on them, but to help us know how to help. Some of these guys have been all over the mental health community looking for help, but haven't gotten it. They've been treated for anxiety disorders, depression, obsessive-compulsion disorder, you name it. Many of them have been on medications, especially the SRI's (seratonin reuptake inhibitors) with some improvement. But after all the treatment and all the Twelve Step experiences, they're still coming back saying, "Is that all there is?"

MZ: As a member of the group progresses, what indications or changes do you see?

PH: These male sex addicts have been carrying an enormous level of shame. I believe now that more shame is associated with sex addiction than any other dysfunction. Because of the shame, there's an extra need for secrecy. In treatment, we work to reduce their level of shame, and that alone has an enormous impact on their lines. As their shame decreases, their self-esteem increases. They start to believe, often for the first time in their lives, that they are valuable people. To me that's been the biggest change that I've seen emerge from this group. These men are beginning to really love themselves. They seem themselves as worthwhile, good men. It's so powerful.

GH: I think one of the changes I see is people rediscovering their passion for life. When you shut down any part of your being-particularly your sexuality-you just lose some of the passion and vitality for life. I see life back in their eyes, color in their face. I see a lot of physical changes in female clients. They move differently, they are able to wear feminine clothes again, and they report learning once again to enjoy touching and being touched.

PH: Ginny and I have seen similarities in progress and healing in both our male and female clients, but we have see one significant difference: the progress women make seems to be quite steady and straight ahead. The men in my group, however, initially made good progress breaking through denial. They could identify their dysfunctional sexual behaviors, and, I believe, genuinely wanted recovery. Yet week after week they came to group talking about slipping-going back to their dysfunctional sexual behaviors. I think what Patrick has learned about this in his research is that it's very typical in the first year recovery from sex addiction.

MZ: How is the support community where you practice?

PH: That was another concern I had. We have a very strong A.A. recovery community, but other Twelve Step programs are not widely available. There were no S.A. groups in our area, which meant clients had to drive 45 minutes to less than ideal groups. I'd advise therapists who try this approach to encourage your own clients to start a Twelve Step group-which is what we did. Attendance is typically twelve to sixteen people, and they've just recently expanded to an additional evening night. Both are well-established and well-attended. GH: All of the women I see are in Twelve Step groups, too. Two or three women have sought help for more family of origin issues. And when they finish this group (sexual anorexia) they too will probably go into one of our family of origin groups.

MZ: How critical is to have members of the family of origin geographically close with regard to progress with therapy and recovery?

GH: We have found, since we use experiential and psycho-drama techniques, that it isn't necessary for the family to be physically available.

PH: I agree. Today's treatment techniques enable people to heal whether or not they have direct access to family. A typical dysfunctional response is to cut off relationships-from parents, from siblings, from adult children. I think as long as those severed relationships continue, a certain amount of woundedness lives on inside the person. After they learn how to set boundaries, clients can go back and sustain family relationships-even with a member who has not been through recovery-most, but not all, of the time.

http://www.sexhelp.com/sa_small_town_practice.cfm

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Sunday, July 01, 2018

Coping with Sexual Anorexia and Aversion



Coping with Sexual Anorexia and Aversion

by Rob Jackson, MS, LPC, LMHC, NCC

Note: Given the brevity of the article, it is not possible to cover all the facets of this disorder. Anyone suspecting he or she has this condition is strongly encouraged to speak with a professional counselor.

A review of the long-term effects of childhood sexual abuse (CSA) is sobering. Research has identified numerous detrimental effects:
The apparent common denominator in these conditions is the profound injury done to one’s ability to trust and attach to another human being.

While it is generally recognized that abused males have a more difficult recovery from CSA, I find there are two conditions that are more prevalent among female survivors. These conditions are sexual anorexia and sexual aversion disorder.

Sexual Anorexia
You may be more familiar with the type of anorexia that occurs when a person, usually a young woman, obsesses over how to avoid food. Over time, this condition can lead to numerous health concerns – and can even be fatal, as shown by the 1983 death of singer Karen Carpenter. This condition has a parallel known as sexual anorexia.

Sexual anorexia occurs when a person – again, most often a woman – fails to possess a healthy, sexual desire. This person will most likely be unaware of the hidden drivers that compel her behaviors. These victims can be in otherwise loving marriages, but have no interest in expressing any type of sexuality. They will often fail to initiate sexual contact, but usually report that once sex is underway, they are able to enjoy the exchange.

The impact of sexual anorexia on marriage can be profound. This condition can force an unhealthy celibacy onto the spouse, or worse, help lead the spouse to a false sense of entitlement to pornography, masturbation, or extramarital sexual involvement. These behaviors, in turn, further erode intimacy in the relationship and can facilitate a destructive cycle that threatens the marriage.

Sexual Aversion Disorder
Of the two disorders, Sexual Aversion Disorder is the one that carries official diagnostic criteria from the American Psychological Association. In terms of symptoms, this disorder is more severe.

An individual who suffers from a more active form of Sexual Aversion Disorder, finds sex to be repulsive, without exception. According to the DSM IV, “The essential feature of Sexual Aversion Disorder is the aversion to and active avoidance of genital sexual contact with a sexual partner.”1 Some individuals’ aversion extends to all sexual behaviors, including kissing and touching. A person’s reaction “may range from moderate anxiety to and lack of pleasure to extreme psychological distress.”2


This disorder can injure the patient’s spouse at a deep level. The passive indifference of sexual anorexia is one thing, but the active repulsion of sexual aversion is quite another. The spouse may begin to wonder if maybe he/she is sickening to their spouse, rather than just the act of sex.


Closing Thoughts
It’s important to note that not every survivor of CSA will suffer sexual dysfunction, and not everyone who suffers anorexia or aversion has been sexually abused. Nevertheless, these conditions strongly correlate with CSA and can continue to injure the survivor as well as his or her spouse or future mate.

The husbands or wives of these individuals will need to be patient and understanding. In most cases when this kind of problem affects a couple’s marriage, there was a time when the conflicted spouse was forced into unhealthy sexual experiences as a child, or even as an adult in an abusive relationship. The marriage can be a safe place where old wounds are healed as husband and wife yield themselves to each other in the safety of their marital commitment.

Although this is only a brief overview of these conditions, if this seems to fit you or someone you love, it is worth talking to a professional. Any unresolved trauma has the potential to lead to further injury or addictions. There is hope for recovery. This healing starts when a person suffering anorexia or aversion takes “ownership” of this condition. He or she will acknowledge that this condition can only further injure the marriage – and both spouses - if left untreated. Seeking whatever resources are needed is part of this healthy ownership of the problem. Compassion for each other and respect for the marriage can motivate both spouses to do whatever it takes to restore the pleasure and joy of marital sexuality.

Copyright © 2004 Rob Jackson. All rights reserved. International copyright secured.

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Wednesday, April 18, 2018

SEXUAL ANOREXIA


They suffer silently, consumed by a dread of sexual pleasure and filled with fear and sexual self-doubt. They feel profoundly at odds with a culture that tirelessly promotes sex but is strangely unconscious about sexuality. It is not inhibited sexual desire they are experiencing, although often they possess a naiveté, an innocence, or even a prejudice against sex. It is not sexual dysfunction, although their suffering often wears the mask of physical problems that affect sex. It is not about being cold and unresponsive although that certainly is a way in which they protect themselves against the hurt. It is not about religious belief, although religious sexual oppression may have been a place to hide. It is not about guilt and shame, although those feelings are powerfully experienced. Nor is it about sexual betrayal or risk or rejection, although those are common themes. It is simply the emptiness of profound deprivation, a silent suffering called sexual anorexia.

Sexual anorexia is an obsessive state in which the physical, mental, and emotional task of avoiding sex dominates one's life. Like self-starvation with food or compulsive dieting or hoarding with money, deprivation with sex can make one feel powerful and defended against all hurts. As with any other altered state of consciousness, such as those brought on by chemical use, compulsive gambling or eating, or any other addiction process, the preoccupation with the avoidance of sex can seem to obliterate one's life problems. The obsession can then become a way to cope with all stress and all life difficulties. Yet, as with other addictions and compulsions, the costs are great. In this case, sex becomes a furtive enemy to be continually kept at bay, even at the price of annihilating a part of oneself.

The word anorexia comes from the Greek word orexis,meaning appetite. An-orexis, then, means the denial of appetite. When referring to food appetite, anorexia means the obsessive state of food avoidance that translates into self-starvation. Weight concerns and fear of fat transform into a hatred of food and a hatred of the body because the body demands the nurturance of food. food anorexics perceive bodily cravings for sustenance as a failure of self-discipline. The refusal to eat also becomes a way for food anorexics to reassert power against others, particularly those who may be perceived as trying to control the anorexic, trying in some manner to prevent the anorexic from being his or her "true" self. Ironically, many food anorexics are driven by a powerful need to meet unreal cultural standards about the attractiveness of being thin. A terror of sexual rejection rules their thoughts and behaviors and is a primary force behind this striving for thinness. The irony here is that sexual anorexics share precisely the same terror.

Specialists in sexual medicine have long noted the close parallels between food disorders and sexual disorders. Many professionals have observed how food anorexia and sexual anorexia share common characteristics. In both cases, the sufferers starve themselves in the midst of plenty. Both types of anorexia feature the essential loss of self, the same distortions of thought, and the agonizing struggle for control over the self and others. Both share the same extreme self-hatred and sense of profound alienation. But while the food anorexic is obsessed with the self-denial of physical nourishment, the sexual anorexic focuses his or her anxiety on sex. As a result, the sexual anorexic will typically experience the following (not all, only a couple need be present):

Sexual anorexics can be men as well as women. Their personal histories often include sexual exploitation or some form of severely traumatic sexual rejection-or both. Experiences of childhood sexual abuse are common with sexual anorexics, often accompanied by other forms of childhood abuse and neglect. As a result of these traumas, they may tend to carry dark secrets and maintain seemingly insane loyalties that have never been disclosed. In fact, sexual anorexics are for the most part not conscious of the hidden dynamics driving them. Although obsessed with sexual avoidance, they are nonetheless also prone to sexual binging, occasional periods of extreme sexual promiscuity, or "acting out in much the way that bulimics will binge with compulsive overeating and then purge by self-induced vomiting. Sexual anorexics may also compensate with other extreme behaviors such as chemical or behavioral addictions, codependency, or deprivation behaviors like dieting, hoarding, saving, cleaning, or various phobic responses. The families of sexual anorexics may also present extreme patterns of behavior and thought. Finally, the sexual anorexic is likely to have been deeply influenced by a cultural, social, or religious group that views sex negatively and supports sexual oppression and repression.

Sexual anorexia, therefore, can wear many masks. Consider the sexual trauma victim who takes care of her pain by compulsively overeating. People focus on her obesity, not noticing the hidden anorexic agenda of avoiding being desirable to anyone. Or think of the alcoholic who has never been sexual except when drinking. The prospect of being sexual while sober is so intimidating that a broader "abstinence" is embraced. For most sexual anorexics, however, a complex array of extremes exists. When a person's appetites are excessive we use words like addiction or compulsion. But excesses are often accompanied by extreme deprivations for which we use terms like anorexia or obsession. In fact, these seemingly mutually exclusive states can exist simultaneously within a person and within a family. Consider the case of a sexually addicted alcoholic heterosexual male. The further his drinking and sexual behavior get out of control, the harder and more compulsively his wife works (the more she behaves hyper responsibly), and the more she shuts down sexually (anorexia). These disorders are not occurring in isolation. But the end result is that the problem of sexual anorexia is not likely to get addressed because it lacks the clarity and drama of the drinking, the sexual acting out, and the workaholism.

People minimize the problem of sexual anorexia. After all, whoever died of a lack of sex? Yet, as we see in this book, the physical and psychological consequences of sexual anorexia are severe, and the problem is central to understanding the entire mosaic of extreme behaviors.

This book focuses on the suffering of the sexual anorexic. Sexual anorexia is as destructive as the illnesses that often accompany it, and behind which it often hides, such as alcoholism, drug addiction, sexual addiction, and compulsive eating. It resides in emotion so raw that most sufferers would wish to keep it buried forever were it not so painful to live this way. Sexual anorexia feeds on betrayal, violence, and rejection. It gathers strength from a culture that makes sexual satisfaction both an unreachable goal and a nonnegotiable demand. Our media focus almost exclusively on sensational sexual problems such as rape, child abuse, sexual harassment, or extramarital affairs. When people have problems being sexual, we are likely to interpret the difficulty as a need for a new technique or a matter of misinformation. For those who suffer from sexual anorexia, technique and information are not remotely enough. Help comes only through an intentional, planned effort to break the bonds of obsession that keep anorexics stuck.

This book is intended as a guide to support that effort. The early chapters help the reader understand sexual anorexia: how it starts, and how it gathers such strength. The last twelve chapters present a clinically tested and proven plan for achieving a healthy sexuality. This program has worked for many, many people. It is safe. It is practical. It works if the sufferer follows the guidelines and has the appropriate outside support. It will not be easy because the obsession was created in the first place by intimate violations and shattered trust. Yet step by step, healing can be effected so that the sufferer can learn to trust the self as well as others.

The plan is designed to involve a network of external support made up of partners, therapists, close friends, clergy, and so on. The book will explain the importance of having these "fair witnesses" along on the journey to health and freedom. Breaking the isolation is essential to dismantling the dysfunctional beliefs and loyalties that keep people in pain.

from: SEXUAL ANOREXIA by Dr. Patrick Carnes

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