May 14, 2025 • 60 mins
Welcome to Episode 1 of Mental Health Rewritten!
In our season-opening episode, we confront one of the most misunderstood and stigmatized topics in mental health: sex addiction.
Through the story of Daniel — a man whose professional success masks a deep internal struggle — we explore how compulsive sexual behavior impacts relationships, careers, and personal identity.
Along the way, we challenge misconceptions about sex addiction, examine its clinical roots, and highlight the hidden pain it causes across gender lines and around the world.
Featuring clinical insights from Havi Kang, Dr. Justin Dodson, and Dr. Alexandra Katehakis, alongside research from Mayo Clinic and YouGov, we uncover:
What defines sex addiction and compulsive sexual behavior
Why shame and secrecy make healing harder
How societal stigma silences both men and women
The global scope of this often-taboo disorder
Rooted in research from the DSM-5 and ICD-11, and grounded in real-world stories, Mental Health Rewritten opens conversations where silence once reigned.
Tune in to hear how Daniel’s journey toward healing begins — and how, together, we can start to rewrite the narrative about addiction, identity, and hope.
Listen now and subscribe for upcoming episodes exploring suicide, racial trauma, and more. Reminder: Mental health challenges are as real — and as serious — as physical ones.
If you or someone you know needs help, please reach out to a mental health professional.
Mental Health Rewritten, created by the OWLS Education Company, in collaboration with The Ummah Collective Group, is hosted, written, and produced by Dominic Lawson.
Executive Producers: Kenda Lawson and Dr. Whitney Howzell
Cover Art: Alexandria Eddings of Art Life Connections
Some music was provided by DJ Krate Digga of The Mighty Sound Champz Crew
Referenced & Supporting Sources
Does Society Have a Sex Addiction Problem?
Mayo Clinic
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Mental health rewritten is forinformational purposes only and is not a
substitute for medical advice,diagnosis, or treatment,
please consult a mentalhealth professional for care.
This podcast may include sensitive topics.
Listener discretion isadvised. Business trips,
they were routine. Routine,another city, another deal,
(00:22):
but this trip feels well different.
Daniel doesn't know why. He just knowshe can't keep pretending because see,
this trip isn't a negotiation,
a presentation or anotherdeal to close. No,
this is something else.Something he has fought,
(00:43):
denied,
hidden from himself and everyone he loves.
His wife's words, haunt him.
Get help or never come back.
He looks at the house one last timefeeling the weight of his actions
await. No amount of businessdeals could ever lighten.
And when you ask abehavioral health clinician,
(01:06):
Daniel's story is not an uncommon one.
What once might've been novel orfun or hot and exciting starts to
become deeply burdensome because itgrates on people's integrity and their
conscience,
and they have to look at their partnerand their kids every day and lie and know
that they're not who they say they are.
Daniel has left his home foryears under the guise of success,
(01:29):
ambition, and responsibility. And on thesurface, he has done everything right,
A rising star in the company, aman on the brink of the C-suite,
but now he sits on the curb in frontof his house in his gated community
facing a truth.
He can't negotiate his way out ofhaving to explain to two young,
(01:51):
innocent faces, faces why daddyhas to be gone for a while,
a long while, but even underthe mountain of shame and guilt,
he feels Daniel holds onto a single shred of hope,
a reminder that sometimes we canheal the things we once broke.
(02:11):
Sometimes we get a secondchance to rewrite our
narrative.
Change begins with understandingand understanding begins
with reflection.
My name is Dominic Lawson andwelcome to Mental Health Rewritten.
(02:32):
In this episode ofMental Health Rewritten,
we uncovered the complexities of sexaddiction, compulsive sexual behavior,
exploring the impact on relationships,
the hurdles and treatment and thesocietal and cultural lenses that shape
our understanding.
Join us as we rewrite theconversation around sex addiction.
(03:00):
I had a conversation about the formationof this podcast with a clinician,
and I told them we were going to startwith sex addiction, and she was like,
wow, Dominic, you're really goingoff the deep end to begin, huh? Well,
I guess so. Sex is fundamentallya natural and pleasurable thing,
and it's simply part of the humanexperience. In every culture,
(03:23):
in every generation. Itconnects us, drives intimacy,
and honestly just feels good.
But just like anythingelse that brings pleasure,
there can be a complexity to it.
For some sex can betangled with pain, secrecy,
or even compulsion. What startsoff as something natural can shift
(03:44):
sometimes slowly,
sometimes all at once intosomething that feels out of control
or even harmful.
But let's go back to the complexity ofthe matter because let's say you may
actually suffer from sex addictionand you live in the United States,
it may prove difficult forsomeone to even believe you.
(04:07):
A u gov study in 2018 sharedthat 52% of adults believe
that the disorder wasreal. That is a good thing.
However, this next part is not23% believe that it was not real,
and another 25% were unsure.That part is alarming.
(04:27):
When you add in the studies from theMayo Clinic that suggests between six and
8% of US adults could beclassified as addicted to sex,
we could be talking aboutupwards of 24 million Americans
and many health professionals fear thatit may be increasing due to the rise of
apps devoted to hooking up or casual sex,
(04:48):
more sexual topics being discussedon the internet and social media,
not to mention pornography,
and that is such a big topic that we'regoing to take that on in episode two.
And then there is the perceptionthat it is a male-centered issue.
And while it may be more common in men,
women are also affected andthey often find a harder time
(05:12):
finding a treatmentsolution due to that stigma,
often not as visible in self-help groups.
And this isn't just a problem inthe United States, it's global.
Take Rebecca Barker from the uk,
she told the BBC in2018 that at its worse,
she was having sex five times a day and it
(05:35):
still wasn't enough.
She said her partner lovedthe attention at first,
but over time even he became overwhelmed.
Thereby highlighting that even whenthe addicted partner is being faithful,
the disorder can still be problematicfor relationships in other ways.
If you want to read moreabout Rebecca's story,
(05:57):
the link to that BBC articleis there in the show notes.
Rebecca's story isn't uniqueto the UK around the world. Sex
addiction and the compulsions thatdrive it are shaped by more than just
personal experiences.It's culture, religion,
and societal norms that influence notonly how compulsive sexual behavior
(06:18):
is understood,
but how it's treated or even ignored.
Because let's say you live in a regionof the world where religion plays a
dominant role. Think MiddleEast or parts of Latin America.
Compulsive sexual behavior isoften framed as a spiritual crisis
(06:39):
rather than a psychological one.
Religious leaders frequently serve asthe first line of intervention guiding
individuals through prayer, fasting,
or counseling before mental healthprofessionals or even consulted.
This approach offerscomfort to some, but others.
It delays treatment orprevents it altogether.
(07:03):
The fear of being judged as morallyweak can keep individuals suffering in
silence.
But what about societies where sexualhealth is approached with openness?
Let's say Scandinaviaand the Netherlands here,
sex addiction is rarely seen throughthe lens of morality. Instead,
the focus is on harm reductionand healthy boundaries,
(07:26):
but not abstinence. Thecontrast is striking.
While some cultures seek torestrict sexual behavior,
others focus on rebalancing it.
The result is that treatment models canlook radically different depending on
where you are and whatyour society values.
(07:46):
In East Asia,
technology and isolation play adifferent role in places like Japan
and South Korea.
Compulsive sexual behavior is oftentied to digital addiction and social
withdrawal.
It's less about hypersexuality in thephysical world and more about escaping
into a virtual one.
(08:07):
This rise in digital compulsionhighlights how technological and societal
shifts can shape theexpression of sexual addiction.
It's not just about sex, it'sabout connection, loneliness,
and the need for intimacy and anincreasingly disconnected world.
So across cultures, one truth emerges.
(08:29):
Compulsive sexual behavior reflectsmore than just individual struggles.
It mirrors how societies definesex, morality, and identity.
And while the approaches may differ,
the underlying need forunderstanding for connection remains
universal. This I admit,
(08:50):
is a lot to take in. It'sa very complex topic,
but lucky for us,
I have a very decent contact list ofexperts that are well versed on these
matters. Allow me tointroduce you to one. Now.
One of the things is that people don'tquite understand what sex addiction is,
especially when they hear that term. Ithink they have a lot of misconceptions,
(09:11):
a lot of misunderstanding.
This is my really good friend, Javi Kangpsychotherapist and trauma life coach.
She also works at iap. She divesdeeper into this very complex topic.
But nowadays the ICDcalled it compulsive sexual
behavior disorder.
You are probably curious whyyou heard that sound just now.
(09:33):
I'll explain in a whileafter Javi finishes.
So now that our field is shiftinginto that language using compulsive
sexual behavior disorderversus sex addiction, however,
there's still an underlying addictivecomponent here when it comes to sex
addiction. And so whenwe think about addiction,
there's those usual criteria thatwe're looking for when it comes to sex
(09:55):
addiction. We're looking for thoseexact same criteria, loss of control,
preoccupation, withdrawalescalation, negative consequences,
all of those things thatwe would typically look for in an addictive process.
We're also looking for in sex addiction.
If those things are notpresent for that client,
then maybe we're not workingwith a sex addiction.
(10:16):
Maybe we're just working withsomeone who has a higher sex drive,
someone who has different interests.
Negative consequences. It's a themethat echoes throughout history.
We've seen how unchecked sexualcompulsions have destroyed public figures
from Hollywood moguls to CEOs. Daniel,
who we will check in with latermay not be on magazine covers,
(10:40):
but his struggle is the same.
And when we think aboutcompulsive sexual behavior,
we often only imagineit as a modern issue.
But allow me to take you backto 1812 where Dr. Benjamin Rush
regarded in 1965 by the AmericanPsychiatric Association as the
father of American psychiatryis examining a morbid
(11:04):
state of sexual appetite. In his book,
diseases of the Mind Rushrecognized the profound
personal and societal impacts ofunregulated sexual desires long before
modern psychology coinedterms like hypersexuality.
He believed such urges couldlead to moral and physical decay.
(11:26):
In chapter 18, rush includednot just his reflections,
but also personal letters hereceived from distressed patients or
their loved ones. Onesuch letter detailed,
the anguish of a young mantormented by uncontrollable desires.
My dear sir, I write to youin confidence and great shame,
(11:48):
my son,
A bright and hopeful youthnow wastes under the burden of
desires.
He cannot quell his pursuitsonce innocent have turned toward
ruin. I fear for his health and spirit,
is there no cure for this afflictionthat robs him of his vigor?
And standing.
(12:09):
Rush's acknowledgement of such lettersreveals the universal and enduring
nature of this struggle.
The behaviors rush described arestrikingly similar to those that are
diagnosed and treated today.
It also signals how deeplyingrained and timeless this issue is
because while the namesand faces may change,
(12:32):
the patterns often remain the same.
And while Daniel May not wear Tricohats and travel via horseback,
his situation looks verysimilar. Which leads me to the,
you heard earlier when TAVI said.
Compulsive sexual behavior disorder.
(12:53):
Mental health rewrittenis an educational podcast.
I'm pretty sure you got that gist fromthe history lesson we just gave you.
But after all,
we are an education company and muchof the content you will hear on this
podcast is guided by the Diagnosticand Statistical Manual of Mental
Disorders or the DSM,
which is in its fifth edition and theInternational Classification of Diseases
(13:16):
or the ICD, which is in its 11th edition.
For a full explanationof what those things are,
be sure to check out ourexplainer trailer on our RSS feed.
But when you hear that sound,that means someone on the show,
more than likely a mentalhealth professional has mentioned something that we
want to provide a full anddetailed definition of,
(13:37):
and that is usually a disorderof sorts from the ICD 11 or
DSM five.
This is there to combat the sometimesharmful and misinformation that you often
see on social media and the internet.We will share the definition and
sometimes maybe even create a fictionalscenario to help further explain.
(13:58):
So let's get to the first one.
Compulsive sexual behaviordisorder in the ICD 11,
it is classified underimpulse control disorder.
This disorder is characterized by apersistent pattern of failure to control
intense,
repetitive sexual impulses orurges leading to repetitive sexual
(14:18):
behaviors.
The individual may engage in thesebehaviors despite negative consequences
or derive little satisfaction from them.
The diagnosis requires that thesymptoms persist for an extended period,
typically at least six monthsand cause significant distress or
impairment in personal, family, social,
(14:40):
or important areas of functioning.
It was added to the 11thedition of the ICD in 2018 and
effective for globaluse in January of 2022.
But there is something interesting here.
The ICD 11 and the DSMfive often work in tandem,
but neither compulsive sexualbehavior disorder or sex addiction is
(15:02):
in the DSM five. Why is that? Luckily,
I know just who to ask what say you Javi.
The DSM is still kind of figuring itout, right? They're still working on it.
They're still trying to see if itfits into the addiction section.
So I think there's definitelymovement towards that.
The ICD was able to make it fit into thecompulsive nature of the diagnosis of
(15:24):
this that comes with this too. Andso it was able to show up in the ICD,
which I think is greatbecause again, as clinicians,
we can put more of a solid diagnosison it and be able to continue to treat
whether it is a sex addiction, ifthere's that addictive process.
But compulsive sexual behaviordisorder is very encompassing in
(15:46):
that sense.
It could really encompass anyone whois maybe acting out sexually with
others or even if it's justmore of a virtual presence.
What Javi touches on is a critical shiftin how we understand and experience
compulsive sexual behavior.Today. The internet,
social media and mobile technologyhave made sexual content interactions
(16:07):
more accessible than ever before,
blurring the line between healthyexploration and compulsive use.
And this accessibility changesnot just the how, but the who.
The landscape of sex addiction isevolving from what we once saw as the
classic sex addict is somethingmore insidious and hidden,
(16:29):
existing quietly behind screens.
A big part of that now iswithout proper protections,
a much younger demographicnow has access to this type
of content.
Javi breaks it down evenfurther explaining how this divide between the classic
and contemporary sex addictplays out in practice.
(16:49):
So the classic sex addict is like thetypical sex addict that you might think
about who would get in their carand go down the road to go do some
cruising behavior to pick up a prostitutemight go to a massage parlor and pay
for that massage or the happy ending.
They might be the ones that went toBlockbuster to go rent those DVDs to go
purchase magazines, right?
(17:10):
So there was a lot more physicalbehaviors involved in that.
There's a lot more that was requiredfor them to get there fixed. Nowadays,
the contemporary sex addict, they don'thave to get up and leave anywhere.
They could be at home andstill be engaging in this compulsive sexual behavior,
virtually on their phone, on their laptop.
Video games also have now theycould meet a lot of people that way.
(17:33):
So there's this big shift that's happeningin that sense too. Another component
that might be different between aclassic sex addict and a contemporary sex
addict is the trauma piece.
A classic sex addict mayhave a lot more trauma,
can origin trauma as well,that fuels their behavior.
Whereas a contemporary sex addict,
(17:56):
they may not have that level of trauma.
It's not like they're reenacting somesexual trauma that they have been in,
but purely because it's accessibility,
because they can justlog on. And nowadays too,
I feel kids at a younger age are gettingaccess to sex or at least understanding
what it is at a much younger age thanmaybe you and I when we were younger.
(18:19):
It took us way to high school or collegeto really understand what sex is or
even see a porno or anything like that.
So nowadays they're like 9, 10, 8.
It's changing their brains in that sense,
and they're having more accessto it at their fingertips.
Before we continue, I want to goback to something Javi said before.
The DSM is still kind of figuring itout, right? They're still working on it.
(18:42):
They're still trying to see if itfits into the addiction section.
That's the thing about sex. Italready carries so much stigma.
Sprinkle in the fact that there are manythat are divided in the clinical world,
and you can understand quickly whyit is a tricky topic to tackle.
But that's exactly why we created mentalhealth rewritten and started with the
(19:04):
track focusing on sex becauseif we're being honest,
call it whatever you want. Sex addiction,compulsive sexual behavior disorder.
Either way,
you can easily see why it's one of thosetopics people would rather not touch.
What Javi describes is part of a largerconversation happening across the mental
(19:25):
health community, which means therehas to be dissenting opinions,
and I think it would be irresponsiblefor me just to present only one side of
this conversation. Again, the ICD elevens,
recognition of compulsive sexual behaviormarked an important step forward,
but not everyone agrees.
Here are some statements from variousbehavioral health professionals featured
(19:48):
in Psychology Today,
including the first one from Dr.Dale Reger from the DSM five task
force. Just to clarify, becauselegal just handed me a note,
while these are directquotes from clinicians,
the voices you'll hear are AI generatedrecreations and not the actual
clinicians. Let's hearwhat Dr. Rieger had to say.
(20:10):
There was concern that the evidence forsexual addiction as a distinct disorder
was insufficient. While somebehaviors align with addiction models,
we felt more research was needed toavoid pathologizing normal sexual urges.
The.
Hesitation highlights deeper concerns.
The line between hypersexuality anda high libido isn't always clear.
If we're not careful,
(20:30):
diagnosing sex addiction can feel morelike a moral judgment than a clinical
one.
As you can see, this debate isn'tjust cultural, it's clinical.
There is ongoing debate over whethercompulsive sexual behavior is best treated
through addiction frameworks or if itreflects deeper emotional and neurological
issues rooted in trauma.
The lack of consensus doesn'tjust affect diagnosis.
(20:53):
It shapes how treatment unfolds.For clients like Daniel,
this debate isn't academic.
It's important because it shapes howpeople like him receive care and whether
their struggles are met witheither compassion or skepticism.
And for many,
just finding a name for what they're goingthrough can be the first step towards
(21:14):
healing. But this isn't the first timemental health professionals have debated
sexuality. In the 1940s and fifties,
Alfred Kinsey's groundbreaking researchon human sexual behavior shook the
foundations of what we thought. Weknew his work was controversial,
but it paved the way for many of theconversations we are having today.
(21:37):
These differing opinions highlightthe challenge facing researchers and
clinicians alike. And as Javi points out,
even those working toexpand our understanding of compulsive sexual behavior,
face significant hurdles,
not least of which is the lack oflong-term studies and the individuals
willing to participate in the research.
(21:58):
There's a lot of research that's beingdone right now too with the addictive
process when it comes to sex to porn,
and I think there's just not a lotof research backing it just yet.
So I think that's part of what the paneland the folks working for the DSM is
trying to get more research,trying to get more information.
There's not enough people who caneven say, Hey, I'm a sex addict,
(22:21):
do research on me.
So it's that lack of consensusor lack of having people to even
do the research on.
And there's just insufficientempirical evidence at this point.
But there's a lot of hopes outthere who are doing that currently.
There's lots of testing that's beingdone, lots of studies being done,
(22:43):
so there's movement on it. But aswith anything that goes into the DSM,
it takes time.
As Javi mentioned,
the lack of evidence and consensus hasmade it challenging for the DSM to fully
integrate sex addiction intohis diagnostic framework.
And maybe if there were more research,fewer people would ask this question,
what's the difference between ahigh sex drive and sex addiction?
(23:07):
It's a valid question, but before weunpack it, let's check in with Daniel.
See, he's made it pastan excruciating day. One,
a day spent filling out forms that ledto a late night of staring up at the
ceiling, wondering how he even got here.
He didn't even unpack hissuitcase, but here we are,
(23:28):
day 13, things are still uneasy,
but he's starting to settle in.Daniel was in a group session,
hands fidgeting, eyesdarting to the floor,
surrounded by a circle ofstrangers almost two weeks in.
And today it looks like forfirst time, he's going to speak.
(23:48):
I know this feeling. Maybe you do too.
It's almost like the first day ofschool except for obvious reasons.
The stakes feel much higher,
that tightness in your chest whenit's finally your turn to speak,
and you're not even sure ifyour voice will come out.
So when Daniel says.
I don't really know what to say.
(24:09):
It feels like he's balancing on theedge of something unsure to take a step
forward,
but someone across him nods and somehowthat nod carries more weight than
words.
None of us did. At first. Juststart with what brought you here?
My wife, she told me not tocome back unless I got help.
I've lied to her for years.I've lied to everyone.
(24:32):
I don't even know how to stop.
The room goes quiet,
but it's not awkward is thekind of silence that feels safe,
the kind that lets you just breathe.
You're in the right place, man.
Here. And Danny opened up like that.
It's a reminder of how much courageit takes to face these parts of
(24:52):
ourselves. His storyreflects something universal,
the need to be seen, theneed to feel understood,
and that need, it doesn't alwaysshow up the way you expect.
That's where the line between healthydesire and compulsion starts to
blur.
(25:13):
So let's talk about it and bring in anew perspective to this conversation.
So think about.
It like this. It's a drug, right?
So when you think aboutpeople that drink a lot,
they're going to require more and morealcohol to get buzzed or to get drunk
when you're thinking aboutsex. If I don't get it,
then it becomes a crisis.
(25:33):
This is Dr. Justin Dotson.
He's worked with countless menstruggling to understand this difference,
and he's here to break down howhypersexuality takes root and why for
many the real unmet need drivingit isn't even about sex at
all.
And that's what leads to infidelity,
because now we're so convinced thatwe're not going to get caught and we're
(25:55):
risking health and trust and all thosethings in order to get a need met at
that time. So what that moment is,
it becomes sneaking around inorder to get your need met.
So you value having your need met overthe care and concern of other people.
And a lot of people come to treatmentbecause someone in their life says, Hey,
this is a problem.
(26:16):
That's what the difference betweenhypersexuality and high sex drive,
because a high sex drive doesn'ttypically ruin the relationships.
It's being unfaithful becauseyou've become hypersexual.
Sneaking around isn't something thatcomes from high sex drive that comes
from hypersexuality because now it's anaddiction because you compulsively need
(26:37):
to seek out sex and habit inorder to satisfy yourself once.
Maybe it was once a week, andthen the more and more we do it,
the more and more peoplerequire of it, right?
So you're never satisfied.
That's the difference betweenhigh sex drive and hypersexuality,
where you're just seeing that you can'tget enough and you need more and more in
(26:57):
order to satisfy that unmet need.
But that unmet need is typically belongingand connection and something else
that was missing in an earlier pointin life. But somewhere along the line,
you learn that this sexual component iswhat alleviated and what made you feel
better. And a lot of men do it in private.
That's what makes it acceptable tothem because you do it in private,
(27:17):
but then when other people in yourlife are witnessing it or noticing it,
or it's taking away from your sexualactivity with your partner or it's leading
to infidelity, then that's when, oh man,
I got to do something about this. I haveto change it or else I'm risking losing
this person. And the reality is whenmen come into my office, I tell them,
you're not going to stop doing this today.
(27:38):
You're not going to do this even thoughwe had a great session and we uncovered
some things, you still have tounlearn to not use this thing.
You still have to replace something. AndI've seen men where they can stop it.
And then once they open that door,
it's Pandora's box again because theyhaven't learned how to truly execute
and replace the behavior.
And sometimes it just depends on theresources that man and the motivation
(28:03):
in order to undo thelearning. But it's possible.
It's easier to catch it earlier on versus20 years of doing something the same
way all the time. And therenot being a true consequence.
Healing from hypersexuality starts withrecognition. As Dr. Dotson explains,
the line between high sex drive andcompulsive behavior becomes clear when
(28:24):
trust goes away and secrecygrows and relationships suffer.
But awareness alone isn'tenough. Change takes time.
And unlearning old habitsrequires new, healthier ones.
That's why Dr. Dotson guidesmen through key questions,
because honest reflectionreveals the door.
(28:45):
To healing. So these are some questionsthat I'd want men to ask themselves.
Do you feel like you need sex constantly?Are you constantly thinking about it?
Is it hurting your relationship?
So even if you're onlydoing it with your partner,
are you bending the boundaries of yourpartner or are you treating them in
a way that makes them feelsexualized or not good?
(29:06):
You go behind your partner'sback to watch porn.
Are you exhibiting behavior that wouldmake them feel bad? A lot of people say,
even though I'm only sleeping with you,
some partners say watchingpornography is cheating.
That's a whole notherconversation. But some people do.
Do you feel guilty after having sexor seeking sex from other people
or watching pornography? Doyou lie about the behavior?
(29:30):
Do you ever find that you are satisfied?
Do you disregard any negative consequencesof you constantly trying to have sex
with your partner or even steppingout? And do you ever feel satisfied?
Answering those questions are going tobe the first step in figuring out if
someone has a high sex drive or.
Hypersexuality.
(29:50):
What Dr. Dotson just describedgives us a window into the complex,
often blurry line between highsex drive and hypersexuality.
These questions aren't just diagnostic.
They tap into the lived experience ofindividuals struggling to discern whether
their behaviors are part of ahealthy sexual expression or
(30:12):
indicative of something more disruptive.
And that's where professionals likeDr. Alexandra Kaha has come in.
She's the founder of the Center ofHealthy Sex in Los Angeles, California.
She's the voice you heard at the topof the show when we first introduced
Daniel.
Her insight offers how cliniciansdevelop frameworks for addressing sexual
(30:33):
health over the long term.
I started this center insomewhere around the mid two
thousands because when Iwent to graduate school,
I was really interested in human sexualityand the question of what makes for a
long-term erotic relationshipand a monogamous committed
relationship over time, because Ididn't have a role model for that.
(30:56):
My parents divorced when I was27 after 30 years of marriage,
and 50% of the population divorced.So that was really my question.
And I sort of stumbled along thisthing called sexual addiction.
And at the time, pat Carns,
I just installed the sexual disordersunit here in LA at Del Lamo Hospital,
and there were just a handfulof people treating the problem.
(31:18):
And I had the good fortune of gettingan internship and starting to treat this
thing called sex addiction. And initially,
Dr. Kern's model was acognitive behavioral model where you just look at your
thoughts and stop your behaviorsand then you're good to go. And
after working in that modelfor about eight years,
(31:38):
I started to think about what wasmissing was a road towards sexual health,
which of course was what a lot ofhis critics had said from the get go.
But he was only one man tryingto figure out one problem.
And so I started to look at the questionof what is healthy sexuality for people
who are in recovery from sexaddiction? And so with that,
(31:58):
just following mypassion and my interests,
I started to expand and hadsome interns working for me,
and then together collaborativelywith my husband, Douglas Evans,
we built Center for Healthy Sex so thatwe could have intense intensive programs
and groups and offer a full host ofservices for people struggling with this
problem.
(32:19):
One thing I know about recoveryis that it's rarely linear.
Dr. Kakis work has shown thatmany clients carry unresolved
trauma from childhood,
often manifesting as compulsivesexual behaviors in adulthood.
Research indicates that approximately70% of individuals with sexual
addiction report histories ofearly life trauma or neglect
(32:43):
according to the College of Educationat the University of Georgia.
This led me to wanting to know moreabout the link between trauma and the
disorder that led to Dr.Kada Hawke's book and 2016.
In addition to that, how does shemeasure the impact of her work?
Well, that's tricky to measure. I'msure I've seen thousands of people.
(33:06):
Some will tell you I helped themenormously or save their lives,
and others might say it wasokay, or I didn't get what I,
so I don't know how to measure that.
But I do know that I feelincredibly grateful and
honored to have had afront row seat to many,
many men and women's healingprocess when it comes to this
(33:29):
problem.
And so many people whose sexualitywas tampered with as a child,
whether it was shamedor physically abused,
become sexually addicted and compulsivebecause they don't know how else to
regulate their nervoussystems. And in 2016,
I published a book called SexAddiction as Affect Dysregulation,
(33:50):
which is a deep dive intothe underlying science,
the neuroscience of whatmakes human beings human,
and what happens when we don'tget the appropriate nurturing that
we need from infancy forward.
And how that is the beginning of themaking of all types of addicts that when a
child is not gettingsoothing, comfort, connection,
(34:15):
regulation of their nervous system,
they start to look for otherthings to do that for them,
whether it's video games or internetpornography or eating or not eating,
starving themselves. And then of course,
later in life as teenagers andyoung adults, drugs, alcohol,
you name it.
Dr. Kakis journey illustratesunderstanding sexual addiction and
(34:37):
compulsive behavior often begins atthe intersection of personal experience
and clinical insight.The search for answers,
whether for a client or oneself,
reveals how deeply intertwinedthese behaviors are with our
emotional histories.
Sexual addiction rarelyexists in isolation.
(34:58):
It reverberates through relationshipsand not just intimate ones creating
distance, mistrust,
and pain even when recovery begins.
Rebuilding those fracturedconnections presents its own set of
challenges.
This begins a new chapterin this conversation,
one that shifts from thepersonal experience of addiction to its ripple effects
(35:22):
on relationships, family, andthe very fabric of intimacy.
And it can be summed up ina fairly new clinical term
as we explore the ripple effectsof addiction on relationships.
One term emerges repeatedly, betrayal,
(35:43):
trauma at its core,
betrayal trauma refers to the deeppsychological distress that occurs when
someone we rely on for safety andemotional connection violates our
trust in the context of sexualaddiction or compulsive sexual behavior.
Partners often experiencethis as a profound rupture,
a shattering of the sense of securitythat forms the foundation of intimacy.
(36:08):
Dr. Jennifer Ed, whopioneered the concept,
describes betrayal trauma as uniquebecause it's not just the act of the
betrayal that causes harm,but the relational dynamic,
the fact that the betrayal comes fromsomewhat integral to our emotional
wellbeing.
This can lead to symptoms similarto post-traumatic stress disorder or
(36:29):
PTSD,
but with the added complexity ofnavigating ongoing relationships with
the person responsible for the harm.
Dr. Kaki explains this experience bestthrough the lens of someone who has
sat with countless clientsfacing this very crisis.
It's a really important topic andrelatively new when we think about
(36:53):
trauma. But imagine that you areliving in an idyllic marriage,
whether it's heterosexual,homosexual, doesn't matter,
and you have a life that you'repretty perfect, you're grateful,
you're both employed, youhave two beautiful children.
You work in the community. Maybeyou're even involved in your church,
(37:14):
and you find out that the person that youhave been in love with and trusted all
this time is not the personyou thought they were. In fact,
not only they are lying like youdidn't just catch them in a lie,
but you start to learn that forthe 25, 30 years of your marriage,
they've never ever been faithful to you.
And that they've had multiplesexual partners, not just one,
(37:36):
but 2050 sex workers, strip clubs,
affair partners, spending thousands,
sometimes as much as a milliondollars on this affair,
partner or partners over time.
And so what happens withpeople typically women,
is the reality.
It's like a massive internalearthquake where what they
(38:00):
thought was solid groundis no longer solid ground.
And they don't know who to trust.
They can't trust themselves because oneof the refrains is How come I didn't see
this? Why didn't I know this? Andalso, how could he do this to me?
And everybody thought hewas so nice and so perfect,
and we were the perfect family.
(38:21):
So the partner's reality gets unbelievably
jolted like an earthquake.
Like I needed it, needed it. Youneeded sex workers and affairs.
You needed to betray me, our children,our community. Was I not enough for you?
It wasn't about you. It wasnever about you not being enough.
It sure feels like it was about.
(38:46):
The emotional devastation.
Dr. Kada Ock is describes ismost certainly a real one.
Research indicates that approximately16% of married individuals in the US
have admitted to infidelity atsome point in their marriage.
But perhaps the most surprisingthing is that healing is
(39:06):
possible. See, despitethe initial devastation,
studies show that around 60to 75% of couples affected
by infidelity choose to stay togetherand work through the betrayal.
And is this concept of betrayaltrauma is actually how I met Dr. Kakis
in the first place for the LosAngeles screening of the movie,
(39:29):
accidentally Brave in it,
Maddie Corman tells the powerful storyof her experiencing betrayal trauma
in a very high profile way.
It was to the point that they hadto uproot their family and move.
Dr. Kajaki shares how far reachy itcan be and the delicate balancing act
many partners face.
(39:49):
And what's painful about it too,
for approximately 70 to 80%of these couples will work it
out and work through it. So it'svery difficult. For example,
if it were me to badmouth my partner andtell all my friends and family that he
cheated what he did and how muchmoney he stole. And then later,
three months later, sixmonths later saying,
(40:10):
we're getting back together and thosepeople and hear what they heard,
it's very difficult to repairrelationships. So again,
many women won't tell anybody becausethey don't know what they want to do. Yet.
The secrecy, the shame,
and the uncertainty leave manypartners feeling isolated,
unsure whether to speak out orprotect their relationship in silence.
(40:35):
But as painful as the betrayal is,
the question of what constitutesbetrayal is just as complex for
some infidelity is clearcut. That makes sense.
A physical affair or a hiddendouble life for others,
the boundaries blur iswatching pornography,
a breach of trust is flirting.
(40:56):
Or is it the emotional distancethat grows between two people?
In the quiet moments between intimacy,
Dr. Dodson unpacks how couplesdefine infidelity in different ways
and why understanding each other'sboundaries can be the key to preventing
future ruptures.
Well, it depends on expectations.
So I've heard conversationsand I've seen people that say,
(41:19):
if you flirt with somebody else,
you're cheating if you watchpornography or you're cheating, right?
So if there's any entity orthing or person that takes your attention off of me,
that is cheating.
And it depends on how this couple defineswhat that is for the relationship.
But oftentimes you do have onepartner saying, this is my boundary,
these are my lines. And if you crossthem, that means you are being unfaithful.
(41:41):
Oftentimes, there's one person in therelationship that doesn't see it the same.
And let's just use for thisinstance the man, right?
So whether it's a same sexcouple or heterosexual couple,
sometimes there is a persontypically the man that says,
that's not cheating if we do these things.
But I think that conversation reallygoes into what did that person's,
(42:02):
the other partner's expectations of ahealthy relationship? A lot of people want
their partner to be obsessed withthem so much in a healthy way because
that in their mind givesthem security and safety.
So that's what people arereally seeking, right?
So if you break that downand you slice it out,
people are really seekingsafety, security, connection,
(42:25):
and anything or person or thingthat breaks your connectedness,
to me, that removes this healingsafe is a form of cheating to them.
Sometimes that is accurate,sometimes it's not.
And so I think that's a fine linethat you get to flesh out in therapy,
you get to flesh out inconversations and multiple exercises.
(42:46):
There are a lot of tools that you can useto just have deeper conversations with
people. But I do think that it's reallyimportant to have these boundary setting
conversations in terms of learningwhat your partner's boundaries are,
learning what their expectationsof a healthy relationship,
learning what their examples were.
Because a lot of times when peoplecome into the room and I say, well,
(43:06):
how did you learn healthy sexual behavior?
How did you learn to havesex for the first time?
A lot of it came from either what wasan example of an unhealthy relationship
or pornography because then you hadcouples or somebody in the relationship
learning how to havesex through pornography.
Dr. Dotson's insight into boundariesreveal the delicate dance couples perform
(43:29):
each person defining what feels likebetrayal based on their personal
experiences, fears, and past wounds.
But as Dr. Dotson continues,
he highlights how these seeminglysmall fractures can evolve into deeper
disconnection. It'snot just about the act,
it's about what the actrepresents in the relationship.
(43:49):
The partner left feelingunwanted, unseen, or insecure,
isn't just reacting to the present moment.
Often they're responding to a longhistory of experiences that shaped their
understanding of trust andintimacy. That's what people want.
People want to be wanted.
So even going back to the exampleof the woman that says, well,
(44:11):
if you talk to her, you'recheating. She doesn't,
something in her life says that'swrong, because at some point,
maybe a man doing that was thestart of her being cheated on,
or that is speaking to an insecurityor that is a threat to some
degree. And even if the manor someone else is saying, oh,
(44:32):
you're blowing this out of proportion,
we have to get to what is threateningabout that to this person.
And then you can getto the bottom of that,
the more you can flesh that out and reallyunderstand what they're really saying
behind that anger.
And for Daniel, thatprocess is still unfolding.
(44:55):
The work he's doing doesn't just livewithin therapy rooms or 12 step meetings.
And that brings us to a pivotalday in Daniel's journey.
The weight of healingrests not just on him,
but on the fragile threads of trust.
He's hoping to rebuildwith his wife because now
it's day 40 family day,
(45:18):
their meeting reminds us that healingisn't just a personal journey,
it's relational,
and the road to rebuilding trustbegins one fragile step at a time.
Daniel stands near the entrance ashis wife steps inside, arms crossed,
they haven't seen each other inover a month. She scans the room,
(45:38):
eyes landing on him. Hey, his wife nods,
but doesn't move closer. Daniel noticesher wedding ring still on her hand,
and it gives them hope, however fragile,
they sit outside beneaththe shade of an oak tree.
The kids couldn't make it.It's too hard for them.
They don't understand why you're gone.
(45:59):
I know I'm trying. She stillstudies him for a moment,
searching for signs ofthe man she married.
I want to believe you.
Daniel looks down at his hands.
I want that too.
As we step into the nextphase of this discussion,
(46:21):
Javi walks us through thetreatment landscape where denial,
trauma and addiction intersect,
and how clinicians navigate the complexterrain of recovery from 12 step
programs to holistic healing.
There's a good percentage of folks whoare coming to treatment because they got
caught by their partner, and nowtheir is making the ultimatum,
(46:42):
we need to work on this, or we'redone kind of a thing. For those folks,
it could be a bit moreof a challenge, right?
Because they might be more in denial.
So that might be the firsttreatment approach is really helping them understand,
is this a problem for you? Andwhere does this trace back for you?
Is there some trauma that'sbeing reenacted here,
or is it simply this addictiveprocess that you're engaging in?
(47:02):
Then we also have to assess if there'sany other addictions happening too.
Is there alcohol of drug abuse?
Workaholism is a really common onethat goes along with sex addiction,
substance abuse as well. For women,
oftentimes they have a lot ofexpectations when it comes to sex. A
lot of their expectationsare to a certain standard,
(47:23):
and so when that gets challenged,
they have their own internal distressthat comes up that leads them and
guides them to getting the help thatthey need. So they might be more willing,
more open to seek treatmenton their own, but also,
there's a good percentage of women whohave been in multiple affairs and they
also got caught and are coming totreatment for that same reason. But yeah,
(47:45):
the first pieces would be workingthrough any denial, and then from there,
really moving them into 12 step recovery.
A big piece of addiction isconnecting with others, being honest,
having accountability.
So being part of a 12 step groupwill be able to provide those things.
Group therapy is anotherreally good treatment approach for sex addicts or those
(48:07):
who have impulsivesexual behavior disorder,
group therapy family ifthey're in a relationship,
family or couples marriage therapy. Andthen just holistic approaches as well.
Yoga, exercise, meditation.
Another big piece for me too isworking on growing their sense of self.
As Harvey emphasizes.
Working through denial is one of themost crucial and challenging steps in
(48:30):
treating compulsivesexual behaviors. In fact,
studies show that denial canmanifest in various forms,
minimizing harm, refusing responsibility,
or rejecting the needfor treatment altogether,
hindering acknowledgementand delaying recovery.
And that's according to the WashingtonState Sex Offender Policy Board.
(48:51):
But once denial starts to lift thereal work of unpacking patterns,
exploring identity andconfronting shame begins now,
we shift to Dr. Kakis, who now leadsus deeper into the heart of recovery,
unveiling the frameworks, tools,
and therapeutic modelsthat shape lasting change.
Javi laid the foundation,
(49:12):
but Dr. Kakis picks up where the workbegins to unravel something unexpected,
yet profoundly human grief. Honestly,
that's not something I was expectingwhen I was researching this episode,
but when you take a step back,
it kind of makes sense becausein the process of healing,
there's often a reckoning,not just with the addiction,
(49:33):
but with the time relationships,
the pieces of self thatwere lost along the way.
And the model that I use is what Icall a top down, bottom up model,
meaning we start with the cognitivebehavioral aspect of it using Patrick
Kane's task model.
And that model is in a book he wrotecalled Basing the Shadow. It's a workbook.
(49:55):
It's a terrific workbook forpeople to get started with.
So it's really lookingat all the secrets, lies,
excuses and problems people have,
and looking at their cycle of addictionand looking at what kind of sex
addict they are becausethere are 12 types.
Now, if you're working with acertified sex addiction therapist,
(50:17):
there are several instruments thatpeople take self-report measures to look
at what kind of sex addict they are, whatkind of activities they've been up to.
So we really kind of unearth the wholething, all the secrets and the lies.
And by unearthing it all,
it starts to reduce the amount ofshame the person has around their
behaviors because shame silences us.And so when people start to talk about
(50:42):
this problem, they startto feel better faster,
and they start to come out ofdenial by telling themself,
it wasn't that bad or Ididn't do it that much.
Because when you really start to writeall this stuff down and see that it's
been decades of your life,
you start to see howpervasive a problem it was.
And with that comes grief and loss.
(51:02):
People really have togrieve the loss of time,
the loss of relationships,how they hurt other people,
and also were hurtingthemselves all along the way.
So that's really in a nutshell,
the first layer of treatment.
And with that goes attending 12step meetings for the fellowship so
(51:24):
that people can be in groups with otherpeople who have experienced the same
thing historically,
whether it's in their childhoodstories or their acting out stories,
their repeated cheating,
the marriages they've gone through andstart to see that they're not alone,
and that the people that they're withare good people. They're people just like
them. They just had a bad startto life and have done bad things.
(51:47):
And then after that periodof time, which can take six,
eight months a year,
then I start to work in a deeper waywith people in what's called more
psychodynamic psychotherapy of reallylooking at the childhood trauma
hurts,
helping people to feel in their bodiestoday what they couldn't feel then
(52:07):
because it was so dangerous. Andthat process is a process of,
you could call it reparentingreclamation of the self,
but from a neural perspective,
these are circuits thathave become uncoupled,
and people feel it because theyreport feeling dead at the core or
chronically depressed or highly anxious.
(52:31):
And it's the recoupling of these circuitsgoing back and getting that child and
bringing them back into the present momentthat starts to help people feel more
neurally integrated.And when they're more neurally integrated,
they'll tell you that theyhave had a spiritual awakening,
that they feel lighter, free, or happier,
that the promises of alcoholicsanonymous start to come true.
(52:54):
But this is a good threeto five year process,
which sounds long,
but when you think about how long ittakes somebody to get into therapy and get
help, sometimes they're in theirforties. It's really not that long,
and you're going to be threeto five years older anyway.
So do you want to be three to five yearshealthier or in a deeper hole than you
are right now?
(53:16):
What Dr. Kaha is reveals,
he strikes at the core of whatlong-term healing truly demands.
It's not just stopping. The behavior isabout reclaiming the parts of yourself.
The addiction buried. The processis slow and often painful,
but it opens up the door to somethingdeeper, connection, integration,
(53:37):
and sometimes redemption.
Sex addiction hides in plainsight, woven into jokes, TV dramas,
and celebrity scandals. In our culture,
the line between desire anddisorder, blurs, pop culture,
(54:00):
sometimes normalizes, indulgence,
often dismissing compulsive sexualbehavior as a high sex drive.
This can leave those strugglingfeeling misunderstood or invalidated,
and that can be very dangerous.Javi takes it from here,
unpacking how these cultural messagesshape and sometimes distort our
(54:22):
understanding of sex addiction.
I think, again,
our current culture isyou can watch any movie,
there's going to be some type of a sexscene in there, right? And I think too,
just in culture, evenwhat's going on right now,
there's a lot of highprofile folks who are getting
arrested, who are facing jail time,who have huge allegations against them.
(54:45):
And absolutely there's that misconception.
They think it's just having lots of sex,
having a high sex drive or hypersexuality.
And so there is a lot of misconception,
and my suggestion would be at leastdo a bit of research or listen to
these kinds of podcasts tokind of figure out, okay,
what do they mean when they say that?
(55:06):
It's almost thrown out there as a joke.
Javi highlights how cultural perceptionsoften downplay or distort the reality
of sex addiction.
This disconnect between societalunderstanding and clinical truth
creates a barrier that those whomight otherwise seek help are trapped
between shame and the fearof not being taken seriously,
(55:29):
which is why we wanted toend with Dr. Alexandra Kaki.
Stepping in again to remind us thecondition is officially recognized as.
Compulsive sexual behavior disorder.
And why that language we use matters.
The InternationalClassification of Diseases book,
it's called the ICD,it's in the 11th issue,
(55:51):
is put out by the WorldHealth Organization in the World Health Organization in
2021 or 22 recognizedcompulsive sexual behavior
disorder.
And I think colloquiallyand in the zeitgeist,
we call it sex addiction.
So it's important for people listeningto know there is a bonafide diagnosis for
(56:11):
it now,
but we still all call it sex addictionbecause it's easier. It's a shorthand.
Everybody knows what it is.
Sex addiction is real,
not just a buzzword or moral failing.
It has a name and a place in the ICD 11.
Once again,
this official recognition doesn'tjust validate the experience of those
(56:35):
struggling.
It opens the door to morecompassionate structured paths
toward healing.
But recovery isn't just aboutdefinitions of clinical terms.
It's about the quiet personal victories,
the conversations thatwere once too hard to have,
and the apologies that felt impossible,
(56:55):
and the relationships that beginto heal and repair peace by
piece. And for Daniel,
that work has carried him to this moment,
day 60 graduation day.
But this isn't the end.It's a beginning one.
He doesn't have to face alone. Ashe walks out on the overcast sky,
(57:20):
Daniel steps out of the facility walkingtowards his wife as she waits in the
parking lot. And as he walks towards her,
he glances back at the building.
A few of the men from hisgroup wave from the entrance,
he lifts his hand and return,
and his wife welcomes him in.
Ready.
(57:41):
I think. So he climbs in resting hishand over hers on the gear shift.
I know there's still a long way to go.
His wife squeezes his hand.
We'll.
Get there.
And as they pull away,
Daniel watches the facilitydisappear in the rear view mirror,
but this time he's not runningaway from it for the first time,
(58:04):
he's driving towards something better.
Next time on mental health rewritten,
we shift the focus from sex addictionto pornography. In this episode,
we explore the fine line betweenconsumption and compulsion and the often
overlooked realities behind thescenes of the adult film industry.
(58:27):
We'll hear from the clinicians weheard from today that treat pornography
addiction,
but we will also hear from someonewho's lived on the other side of the
camera.
So it was during thepandemic in 2020, actually,
specifically October of 2020,
I found myself struggling financially.
I found myself battling homelessness,
(58:49):
and I needed a way to makemoney. I kind of had just said,
what else do I have to lose?
Tune in next time as we confrontthe myths, hear the stories,
and rewrite the conversation aroundPornography and mental health.
Mental health rewritten created bythe Owls Education Company, is hosted,
(59:11):
written, and producedby me. Dominic Lawson,
executive producer Kendall Lawson.
Cover Art was created by AlexandriaIngs of Art Life Connections.
Sources to create this episodeare included in the show notes.
Be sure to review and subscribe to theMental Health Rewritten podcast on Apple
Podcast, Spotify, or whereveryou like to listen to podcast,
(59:35):
and also let people knowabout the podcast. We would appreciate that very much.
Five star ratings are always helpful.
You can also watch snippets of some ofthe conversations that didn't make the
episode on Instagram,on our Instagram page,
mental Health rewritten podcast,
and in the form of YouTube shorts onour Education Company YouTube page.
(59:57):
For a full transcript of thisepisode and other resources,
go to www.mentalhealthrewritten.com.
There you can read our blog,
leave us a review or leave a voicemailwhere you can ask a question or let us
know what you think about the showwhere we may play in a later episode.
Thank you so much for listening tothe Mental Health Rewritten Podcast,
(01:00:17):
where prioritizing mentalhealth is not optional.
Take care of yourself.
Mental health rewritten is forinformational purposes only and is not a
substitute for medical advice,diagnosis, or treatment,
please consult a mentalhealth professional for care.
This podcast may include sensitive topics.
Listener discretion isadvised. Business trips,
they were routine. Routine,another city, another deal,
(00:22):
but this trip feels well different.
Daniel doesn't know why. He just knowshe can't keep pretending because see,
this trip isn't a negotiation,
a presentation or anotherdeal to close. No,
this is something else.Something he has fought,
(00:43):
denied,
hidden from himself and everyone he loves.
His wife's words, haunt him.
Get help or never come back.
He looks at the house one last timefeeling the weight of his actions
await. No amount of businessdeals could ever lighten.
And when you ask abehavioral health clinician,
(01:06):
Daniel's story is not an uncommon one.
What once might've been novel orfun or hot and exciting starts to
become deeply burdensome because itgrates on people's integrity and their
conscience,
and they have to look at their partnerand their kids every day and lie and know
that they're not who they say they are.
Daniel has left his home foryears under the guise of success,
(01:29):
ambition, and responsibility. And on thesurface, he has done everything right,
A rising star in the company, aman on the brink of the C-suite,
but now he sits on the curb in frontof his house in his gated community
facing a truth.
He can't negotiate his way out ofhaving to explain to two young,
(01:51):
innocent faces, faces why daddyhas to be gone for a while,
a long while, but even underthe mountain of shame and guilt,
he feels Daniel holds onto a single shred of hope,
a reminder that sometimes we canheal the things we once broke.
(02:11):
Sometimes we get a secondchance to rewrite our
narrative.
Change begins with understandingand understanding begins
with reflection.
My name is Dominic Lawson andwelcome to Mental Health Rewritten.
(02:32):
In this episode ofMental Health Rewritten,
we uncovered the complexities of sexaddiction, compulsive sexual behavior,
exploring the impact on relationships,
the hurdles and treatment and thesocietal and cultural lenses that shape
our understanding.
Join us as we rewrite theconversation around sex addiction.
(03:00):
I had a conversation about the formationof this podcast with a clinician,
and I told them we were going to startwith sex addiction, and she was like,
wow, Dominic, you're really goingoff the deep end to begin, huh? Well,
I guess so. Sex is fundamentallya natural and pleasurable thing,
and it's simply part of the humanexperience. In every culture,
(03:23):
in every generation. Itconnects us, drives intimacy,
and honestly just feels good.
But just like anythingelse that brings pleasure,
there can be a complexity to it.
For some sex can betangled with pain, secrecy,
or even compulsion. What startsoff as something natural can shift
(03:44):
sometimes slowly,
sometimes all at once intosomething that feels out of control
or even harmful.
But let's go back to the complexity ofthe matter because let's say you may
actually suffer from sex addictionand you live in the United States,
it may prove difficult forsomeone to even believe you.
(04:07):
A u gov study in 2018 sharedthat 52% of adults believe
that the disorder wasreal. That is a good thing.
However, this next part is not23% believe that it was not real,
and another 25% were unsure.That part is alarming.
(04:27):
When you add in the studies from theMayo Clinic that suggests between six and
8% of US adults could beclassified as addicted to sex,
we could be talking aboutupwards of 24 million Americans
and many health professionals fear thatit may be increasing due to the rise of
apps devoted to hooking up or casual sex,
(04:48):
more sexual topics being discussedon the internet and social media,
not to mention pornography,
and that is such a big topic that we'regoing to take that on in episode two.
And then there is the perceptionthat it is a male-centered issue.
And while it may be more common in men,
women are also affected andthey often find a harder time
(05:12):
finding a treatmentsolution due to that stigma,
often not as visible in self-help groups.
And this isn't just a problem inthe United States, it's global.
Take Rebecca Barker from the uk,
she told the BBC in2018 that at its worse,
she was having sex five times a day and it
(05:35):
still wasn't enough.
She said her partner lovedthe attention at first,
but over time even he became overwhelmed.
Thereby highlighting that even whenthe addicted partner is being faithful,
the disorder can still be problematicfor relationships in other ways.
If you want to read moreabout Rebecca's story,
(05:57):
the link to that BBC articleis there in the show notes.
Rebecca's story isn't uniqueto the UK around the world. Sex
addiction and the compulsions thatdrive it are shaped by more than just
personal experiences.It's culture, religion,
and societal norms that influence notonly how compulsive sexual behavior
(06:18):
is understood,
but how it's treated or even ignored.
Because let's say you live in a regionof the world where religion plays a
dominant role. Think MiddleEast or parts of Latin America.
Compulsive sexual behavior isoften framed as a spiritual crisis
(06:39):
rather than a psychological one.
Religious leaders frequently serve asthe first line of intervention guiding
individuals through prayer, fasting,
or counseling before mental healthprofessionals or even consulted.
This approach offerscomfort to some, but others.
It delays treatment orprevents it altogether.
(07:03):
The fear of being judged as morallyweak can keep individuals suffering in
silence.
But what about societies where sexualhealth is approached with openness?
Let's say Scandinaviaand the Netherlands here,
sex addiction is rarely seen throughthe lens of morality. Instead,
the focus is on harm reductionand healthy boundaries,
(07:26):
but not abstinence. Thecontrast is striking.
While some cultures seek torestrict sexual behavior,
others focus on rebalancing it.
The result is that treatment models canlook radically different depending on
where you are and whatyour society values.
(07:46):
In East Asia,
technology and isolation play adifferent role in places like Japan
and South Korea.
Compulsive sexual behavior is oftentied to digital addiction and social
withdrawal.
It's less about hypersexuality in thephysical world and more about escaping
into a virtual one.
(08:07):
This rise in digital compulsionhighlights how technological and societal
shifts can shape theexpression of sexual addiction.
It's not just about sex, it'sabout connection, loneliness,
and the need for intimacy and anincreasingly disconnected world.
So across cultures, one truth emerges.
(08:29):
Compulsive sexual behavior reflectsmore than just individual struggles.
It mirrors how societies definesex, morality, and identity.
And while the approaches may differ,
the underlying need forunderstanding for connection remains
universal. This I admit,
(08:50):
is a lot to take in. It'sa very complex topic,
but lucky for us,
I have a very decent contact list ofexperts that are well versed on these
matters. Allow me tointroduce you to one. Now.
One of the things is that people don'tquite understand what sex addiction is,
especially when they hear that term. Ithink they have a lot of misconceptions,
(09:11):
a lot of misunderstanding.
This is my really good friend, Javi Kangpsychotherapist and trauma life coach.
She also works at iap. She divesdeeper into this very complex topic.
But nowadays the ICDcalled it compulsive sexual
behavior disorder.
You are probably curious whyyou heard that sound just now.
(09:33):
I'll explain in a whileafter Javi finishes.
So now that our field is shiftinginto that language using compulsive
sexual behavior disorderversus sex addiction, however,
there's still an underlying addictivecomponent here when it comes to sex
addiction. And so whenwe think about addiction,
there's those usual criteria thatwe're looking for when it comes to sex
(09:55):
addiction. We're looking for thoseexact same criteria, loss of control,
preoccupation, withdrawalescalation, negative consequences,
all of those things thatwe would typically look for in an addictive process.
We're also looking for in sex addiction.
If those things are notpresent for that client,
then maybe we're not workingwith a sex addiction.
(10:16):
Maybe we're just working withsomeone who has a higher sex drive,
someone who has different interests.
Negative consequences. It's a themethat echoes throughout history.
We've seen how unchecked sexualcompulsions have destroyed public figures
from Hollywood moguls to CEOs. Daniel,
who we will check in with latermay not be on magazine covers,
(10:40):
but his struggle is the same.
And when we think aboutcompulsive sexual behavior,
we often only imagineit as a modern issue.
But allow me to take you backto 1812 where Dr. Benjamin Rush
regarded in 1965 by the AmericanPsychiatric Association as the
father of American psychiatryis examining a morbid
(11:04):
state of sexual appetite. In his book,
diseases of the Mind Rushrecognized the profound
personal and societal impacts ofunregulated sexual desires long before
modern psychology coinedterms like hypersexuality.
He believed such urges couldlead to moral and physical decay.
(11:26):
In chapter 18, rush includednot just his reflections,
but also personal letters hereceived from distressed patients or
their loved ones. Onesuch letter detailed,
the anguish of a young mantormented by uncontrollable desires.
My dear sir, I write to youin confidence and great shame,
(11:48):
my son,
A bright and hopeful youthnow wastes under the burden of
desires.
He cannot quell his pursuitsonce innocent have turned toward
ruin. I fear for his health and spirit,
is there no cure for this afflictionthat robs him of his vigor?
And standing.
(12:09):
Rush's acknowledgement of such lettersreveals the universal and enduring
nature of this struggle.
The behaviors rush described arestrikingly similar to those that are
diagnosed and treated today.
It also signals how deeplyingrained and timeless this issue is
because while the namesand faces may change,
(12:32):
the patterns often remain the same.
And while Daniel May not wear Tricohats and travel via horseback,
his situation looks verysimilar. Which leads me to the,
you heard earlier when TAVI said.
Compulsive sexual behavior disorder.
(12:53):
Mental health rewrittenis an educational podcast.
I'm pretty sure you got that gist fromthe history lesson we just gave you.
But after all,
we are an education company and muchof the content you will hear on this
podcast is guided by the Diagnosticand Statistical Manual of Mental
Disorders or the DSM,
which is in its fifth edition and theInternational Classification of Diseases
(13:16):
or the ICD, which is in its 11th edition.
For a full explanationof what those things are,
be sure to check out ourexplainer trailer on our RSS feed.
But when you hear that sound,that means someone on the show,
more than likely a mentalhealth professional has mentioned something that we
want to provide a full anddetailed definition of,
(13:37):
and that is usually a disorderof sorts from the ICD 11 or
DSM five.
This is there to combat the sometimesharmful and misinformation that you often
see on social media and the internet.We will share the definition and
sometimes maybe even create a fictionalscenario to help further explain.
(13:58):
So let's get to the first one.
Compulsive sexual behaviordisorder in the ICD 11,
it is classified underimpulse control disorder.
This disorder is characterized by apersistent pattern of failure to control
intense,
repetitive sexual impulses orurges leading to repetitive sexual
(14:18):
behaviors.
The individual may engage in thesebehaviors despite negative consequences
or derive little satisfaction from them.
The diagnosis requires that thesymptoms persist for an extended period,
typically at least six monthsand cause significant distress or
impairment in personal, family, social,
(14:40):
or important areas of functioning.
It was added to the 11thedition of the ICD in 2018 and
effective for globaluse in January of 2022.
But there is something interesting here.
The ICD 11 and the DSMfive often work in tandem,
but neither compulsive sexualbehavior disorder or sex addiction is
(15:02):
in the DSM five. Why is that? Luckily,
I know just who to ask what say you Javi.
The DSM is still kind of figuring itout, right? They're still working on it.
They're still trying to see if itfits into the addiction section.
So I think there's definitelymovement towards that.
The ICD was able to make it fit into thecompulsive nature of the diagnosis of
(15:24):
this that comes with this too. Andso it was able to show up in the ICD,
which I think is greatbecause again, as clinicians,
we can put more of a solid diagnosison it and be able to continue to treat
whether it is a sex addiction, ifthere's that addictive process.
But compulsive sexual behaviordisorder is very encompassing in
(15:46):
that sense.
It could really encompass anyone whois maybe acting out sexually with
others or even if it's justmore of a virtual presence.
What Javi touches on is a critical shiftin how we understand and experience
compulsive sexual behavior.Today. The internet,
social media and mobile technologyhave made sexual content interactions
(16:07):
more accessible than ever before,
blurring the line between healthyexploration and compulsive use.
And this accessibility changesnot just the how, but the who.
The landscape of sex addiction isevolving from what we once saw as the
classic sex addict is somethingmore insidious and hidden,
(16:29):
existing quietly behind screens.
A big part of that now iswithout proper protections,
a much younger demographicnow has access to this type
of content.
Javi breaks it down evenfurther explaining how this divide between the classic
and contemporary sex addictplays out in practice.
(16:49):
So the classic sex addict is like thetypical sex addict that you might think
about who would get in their carand go down the road to go do some
cruising behavior to pick up a prostitutemight go to a massage parlor and pay
for that massage or the happy ending.
They might be the ones that went toBlockbuster to go rent those DVDs to go
purchase magazines, right?
(17:10):
So there was a lot more physicalbehaviors involved in that.
There's a lot more that was requiredfor them to get there fixed. Nowadays,
the contemporary sex addict, they don'thave to get up and leave anywhere.
They could be at home andstill be engaging in this compulsive sexual behavior,
virtually on their phone, on their laptop.
Video games also have now theycould meet a lot of people that way.
(17:33):
So there's this big shift that's happeningin that sense too. Another component
that might be different between aclassic sex addict and a contemporary sex
addict is the trauma piece.
A classic sex addict mayhave a lot more trauma,
can origin trauma as well,that fuels their behavior.
Whereas a contemporary sex addict,
(17:56):
they may not have that level of trauma.
It's not like they're reenacting somesexual trauma that they have been in,
but purely because it's accessibility,
because they can justlog on. And nowadays too,
I feel kids at a younger age are gettingaccess to sex or at least understanding
what it is at a much younger age thanmaybe you and I when we were younger.
(18:19):
It took us way to high school or collegeto really understand what sex is or
even see a porno or anything like that.
So nowadays they're like 9, 10, 8.
It's changing their brains in that sense,
and they're having more accessto it at their fingertips.
Before we continue, I want to goback to something Javi said before.
The DSM is still kind of figuring itout, right? They're still working on it.
(18:42):
They're still trying to see if itfits into the addiction section.
That's the thing about sex. Italready carries so much stigma.
Sprinkle in the fact that there are manythat are divided in the clinical world,
and you can understand quickly whyit is a tricky topic to tackle.
But that's exactly why we created mentalhealth rewritten and started with the
(19:04):
track focusing on sex becauseif we're being honest,
call it whatever you want. Sex addiction,compulsive sexual behavior disorder.
Either way,
you can easily see why it's one of thosetopics people would rather not touch.
What Javi describes is part of a largerconversation happening across the mental
(19:25):
health community, which means therehas to be dissenting opinions,
and I think it would be irresponsiblefor me just to present only one side of
this conversation. Again, the ICD elevens,
recognition of compulsive sexual behaviormarked an important step forward,
but not everyone agrees.
Here are some statements from variousbehavioral health professionals featured
(19:48):
in Psychology Today,
including the first one from Dr.Dale Reger from the DSM five task
force. Just to clarify, becauselegal just handed me a note,
while these are directquotes from clinicians,
the voices you'll hear are AI generatedrecreations and not the actual
clinicians. Let's hearwhat Dr. Rieger had to say.
(20:10):
There was concern that the evidence forsexual addiction as a distinct disorder
was insufficient. While somebehaviors align with addiction models,
we felt more research was needed toavoid pathologizing normal sexual urges.
The.
Hesitation highlights deeper concerns.
The line between hypersexuality anda high libido isn't always clear.
If we're not careful,
(20:30):
diagnosing sex addiction can feel morelike a moral judgment than a clinical
one.
As you can see, this debate isn'tjust cultural, it's clinical.
There is ongoing debate over whethercompulsive sexual behavior is best treated
through addiction frameworks or if itreflects deeper emotional and neurological
issues rooted in trauma.
The lack of consensus doesn'tjust affect diagnosis.
(20:53):
It shapes how treatment unfolds.For clients like Daniel,
this debate isn't academic.
It's important because it shapes howpeople like him receive care and whether
their struggles are met witheither compassion or skepticism.
And for many,
just finding a name for what they're goingthrough can be the first step towards
(21:14):
healing. But this isn't the first timemental health professionals have debated
sexuality. In the 1940s and fifties,
Alfred Kinsey's groundbreaking researchon human sexual behavior shook the
foundations of what we thought. Weknew his work was controversial,
but it paved the way for many of theconversations we are having today.
(21:37):
These differing opinions highlightthe challenge facing researchers and
clinicians alike. And as Javi points out,
even those working toexpand our understanding of compulsive sexual behavior,
face significant hurdles,
not least of which is the lack oflong-term studies and the individuals
willing to participate in the research.
(21:58):
There's a lot of research that's beingdone right now too with the addictive
process when it comes to sex to porn,
and I think there's just not a lotof research backing it just yet.
So I think that's part of what the paneland the folks working for the DSM is
trying to get more research,trying to get more information.
There's not enough people who caneven say, Hey, I'm a sex addict,
(22:21):
do research on me.
So it's that lack of consensusor lack of having people to even
do the research on.
And there's just insufficientempirical evidence at this point.
But there's a lot of hopes outthere who are doing that currently.
There's lots of testing that's beingdone, lots of studies being done,
(22:43):
so there's movement on it. But aswith anything that goes into the DSM,
it takes time.
As Javi mentioned,
the lack of evidence and consensus hasmade it challenging for the DSM to fully
integrate sex addiction intohis diagnostic framework.
And maybe if there were more research,fewer people would ask this question,
what's the difference between ahigh sex drive and sex addiction?
(23:07):
It's a valid question, but before weunpack it, let's check in with Daniel.
See, he's made it pastan excruciating day. One,
a day spent filling out forms that ledto a late night of staring up at the
ceiling, wondering how he even got here.
He didn't even unpack hissuitcase, but here we are,
(23:28):
day 13, things are still uneasy,
but he's starting to settle in.Daniel was in a group session,
hands fidgeting, eyesdarting to the floor,
surrounded by a circle ofstrangers almost two weeks in.
And today it looks like forfirst time, he's going to speak.
(23:48):
I know this feeling. Maybe you do too.
It's almost like the first day ofschool except for obvious reasons.
The stakes feel much higher,
that tightness in your chest whenit's finally your turn to speak,
and you're not even sure ifyour voice will come out.
So when Daniel says.
I don't really know what to say.
(24:09):
It feels like he's balancing on theedge of something unsure to take a step
forward,
but someone across him nods and somehowthat nod carries more weight than
words.
None of us did. At first. Juststart with what brought you here?
My wife, she told me not tocome back unless I got help.
I've lied to her for years.I've lied to everyone.
(24:32):
I don't even know how to stop.
The room goes quiet,
but it's not awkward is thekind of silence that feels safe,
the kind that lets you just breathe.
You're in the right place, man.
Here. And Danny opened up like that.
It's a reminder of how much courageit takes to face these parts of
(24:52):
ourselves. His storyreflects something universal,
the need to be seen, theneed to feel understood,
and that need, it doesn't alwaysshow up the way you expect.
That's where the line between healthydesire and compulsion starts to
blur.
(25:13):
So let's talk about it and bring in anew perspective to this conversation.
So think about.
It like this. It's a drug, right?
So when you think aboutpeople that drink a lot,
they're going to require more and morealcohol to get buzzed or to get drunk
when you're thinking aboutsex. If I don't get it,
then it becomes a crisis.
(25:33):
This is Dr. Justin Dotson.
He's worked with countless menstruggling to understand this difference,
and he's here to break down howhypersexuality takes root and why for
many the real unmet need drivingit isn't even about sex at
all.
And that's what leads to infidelity,
because now we're so convinced thatwe're not going to get caught and we're
(25:55):
risking health and trust and all thosethings in order to get a need met at
that time. So what that moment is,
it becomes sneaking around inorder to get your need met.
So you value having your need met overthe care and concern of other people.
And a lot of people come to treatmentbecause someone in their life says, Hey,
this is a problem.
(26:16):
That's what the difference betweenhypersexuality and high sex drive,
because a high sex drive doesn'ttypically ruin the relationships.
It's being unfaithful becauseyou've become hypersexual.
Sneaking around isn't something thatcomes from high sex drive that comes
from hypersexuality because now it's anaddiction because you compulsively need
(26:37):
to seek out sex and habit inorder to satisfy yourself once.
Maybe it was once a week, andthen the more and more we do it,
the more and more peoplerequire of it, right?
So you're never satisfied.
That's the difference betweenhigh sex drive and hypersexuality,
where you're just seeing that you can'tget enough and you need more and more in
(26:57):
order to satisfy that unmet need.
But that unmet need is typically belongingand connection and something else
that was missing in an earlier pointin life. But somewhere along the line,
you learn that this sexual component iswhat alleviated and what made you feel
better. And a lot of men do it in private.
That's what makes it acceptable tothem because you do it in private,
(27:17):
but then when other people in yourlife are witnessing it or noticing it,
or it's taking away from your sexualactivity with your partner or it's leading
to infidelity, then that's when, oh man,
I got to do something about this. I haveto change it or else I'm risking losing
this person. And the reality is whenmen come into my office, I tell them,
you're not going to stop doing this today.
(27:38):
You're not going to do this even thoughwe had a great session and we uncovered
some things, you still have tounlearn to not use this thing.
You still have to replace something. AndI've seen men where they can stop it.
And then once they open that door,
it's Pandora's box again because theyhaven't learned how to truly execute
and replace the behavior.
And sometimes it just depends on theresources that man and the motivation
(28:03):
in order to undo thelearning. But it's possible.
It's easier to catch it earlier on versus20 years of doing something the same
way all the time. And therenot being a true consequence.
Healing from hypersexuality starts withrecognition. As Dr. Dotson explains,
the line between high sex drive andcompulsive behavior becomes clear when
(28:24):
trust goes away and secrecygrows and relationships suffer.
But awareness alone isn'tenough. Change takes time.
And unlearning old habitsrequires new, healthier ones.
That's why Dr. Dotson guidesmen through key questions,
because honest reflectionreveals the door.
(28:45):
To healing. So these are some questionsthat I'd want men to ask themselves.
Do you feel like you need sex constantly?Are you constantly thinking about it?
Is it hurting your relationship?
So even if you're onlydoing it with your partner,
are you bending the boundaries of yourpartner or are you treating them in
a way that makes them feelsexualized or not good?
(29:06):
You go behind your partner'sback to watch porn.
Are you exhibiting behavior that wouldmake them feel bad? A lot of people say,
even though I'm only sleeping with you,
some partners say watchingpornography is cheating.
That's a whole notherconversation. But some people do.
Do you feel guilty after having sexor seeking sex from other people
or watching pornography? Doyou lie about the behavior?
(29:30):
Do you ever find that you are satisfied?
Do you disregard any negative consequencesof you constantly trying to have sex
with your partner or even steppingout? And do you ever feel satisfied?
Answering those questions are going tobe the first step in figuring out if
someone has a high sex drive or.
Hypersexuality.
(29:50):
What Dr. Dotson just describedgives us a window into the complex,
often blurry line between highsex drive and hypersexuality.
These questions aren't just diagnostic.
They tap into the lived experience ofindividuals struggling to discern whether
their behaviors are part of ahealthy sexual expression or
(30:12):
indicative of something more disruptive.
And that's where professionals likeDr. Alexandra Kaha has come in.
She's the founder of the Center ofHealthy Sex in Los Angeles, California.
She's the voice you heard at the topof the show when we first introduced
Daniel.
Her insight offers how cliniciansdevelop frameworks for addressing sexual
(30:33):
health over the long term.
I started this center insomewhere around the mid two
thousands because when Iwent to graduate school,
I was really interested in human sexualityand the question of what makes for a
long-term erotic relationshipand a monogamous committed
relationship over time, because Ididn't have a role model for that.
(30:56):
My parents divorced when I was27 after 30 years of marriage,
and 50% of the population divorced.So that was really my question.
And I sort of stumbled along thisthing called sexual addiction.
And at the time, pat Carns,
I just installed the sexual disordersunit here in LA at Del Lamo Hospital,
and there were just a handfulof people treating the problem.
(31:18):
And I had the good fortune of gettingan internship and starting to treat this
thing called sex addiction. And initially,
Dr. Kern's model was acognitive behavioral model where you just look at your
thoughts and stop your behaviorsand then you're good to go. And
after working in that modelfor about eight years,
(31:38):
I started to think about what wasmissing was a road towards sexual health,
which of course was what a lot ofhis critics had said from the get go.
But he was only one man tryingto figure out one problem.
And so I started to look at the questionof what is healthy sexuality for people
who are in recovery from sexaddiction? And so with that,
(31:58):
just following mypassion and my interests,
I started to expand and hadsome interns working for me,
and then together collaborativelywith my husband, Douglas Evans,
we built Center for Healthy Sex so thatwe could have intense intensive programs
and groups and offer a full host ofservices for people struggling with this
problem.
(32:19):
One thing I know about recoveryis that it's rarely linear.
Dr. Kakis work has shown thatmany clients carry unresolved
trauma from childhood,
often manifesting as compulsivesexual behaviors in adulthood.
Research indicates that approximately70% of individuals with sexual
addiction report histories ofearly life trauma or neglect
(32:43):
according to the College of Educationat the University of Georgia.
This led me to wanting to know moreabout the link between trauma and the
disorder that led to Dr.Kada Hawke's book and 2016.
In addition to that, how does shemeasure the impact of her work?
Well, that's tricky to measure. I'msure I've seen thousands of people.
(33:06):
Some will tell you I helped themenormously or save their lives,
and others might say it wasokay, or I didn't get what I,
so I don't know how to measure that.
But I do know that I feelincredibly grateful and
honored to have had afront row seat to many,
many men and women's healingprocess when it comes to this
(33:29):
problem.
And so many people whose sexualitywas tampered with as a child,
whether it was shamedor physically abused,
become sexually addicted and compulsivebecause they don't know how else to
regulate their nervoussystems. And in 2016,
I published a book called SexAddiction as Affect Dysregulation,
(33:50):
which is a deep dive intothe underlying science,
the neuroscience of whatmakes human beings human,
and what happens when we don'tget the appropriate nurturing that
we need from infancy forward.
And how that is the beginning of themaking of all types of addicts that when a
child is not gettingsoothing, comfort, connection,
(34:15):
regulation of their nervous system,
they start to look for otherthings to do that for them,
whether it's video games or internetpornography or eating or not eating,
starving themselves. And then of course,
later in life as teenagers andyoung adults, drugs, alcohol,
you name it.
Dr. Kakis journey illustratesunderstanding sexual addiction and
(34:37):
compulsive behavior often begins atthe intersection of personal experience
and clinical insight.The search for answers,
whether for a client or oneself,
reveals how deeply intertwinedthese behaviors are with our
emotional histories.
Sexual addiction rarelyexists in isolation.
(34:58):
It reverberates through relationshipsand not just intimate ones creating
distance, mistrust,
and pain even when recovery begins.
Rebuilding those fracturedconnections presents its own set of
challenges.
This begins a new chapterin this conversation,
one that shifts from thepersonal experience of addiction to its ripple effects
(35:22):
on relationships, family, andthe very fabric of intimacy.
And it can be summed up ina fairly new clinical term
as we explore the ripple effectsof addiction on relationships.
One term emerges repeatedly, betrayal,
(35:43):
trauma at its core,
betrayal trauma refers to the deeppsychological distress that occurs when
someone we rely on for safety andemotional connection violates our
trust in the context of sexualaddiction or compulsive sexual behavior.
Partners often experiencethis as a profound rupture,
a shattering of the sense of securitythat forms the foundation of intimacy.
(36:08):
Dr. Jennifer Ed, whopioneered the concept,
describes betrayal trauma as uniquebecause it's not just the act of the
betrayal that causes harm,but the relational dynamic,
the fact that the betrayal comes fromsomewhat integral to our emotional
wellbeing.
This can lead to symptoms similarto post-traumatic stress disorder or
(36:29):
PTSD,
but with the added complexity ofnavigating ongoing relationships with
the person responsible for the harm.
Dr. Kaki explains this experience bestthrough the lens of someone who has
sat with countless clientsfacing this very crisis.
It's a really important topic andrelatively new when we think about
(36:53):
trauma. But imagine that you areliving in an idyllic marriage,
whether it's heterosexual,homosexual, doesn't matter,
and you have a life that you'repretty perfect, you're grateful,
you're both employed, youhave two beautiful children.
You work in the community. Maybeyou're even involved in your church,
(37:14):
and you find out that the person that youhave been in love with and trusted all
this time is not the personyou thought they were. In fact,
not only they are lying like youdidn't just catch them in a lie,
but you start to learn that forthe 25, 30 years of your marriage,
they've never ever been faithful to you.
And that they've had multiplesexual partners, not just one,
(37:36):
but 2050 sex workers, strip clubs,
affair partners, spending thousands,
sometimes as much as a milliondollars on this affair,
partner or partners over time.
And so what happens withpeople typically women,
is the reality.
It's like a massive internalearthquake where what they
(38:00):
thought was solid groundis no longer solid ground.
And they don't know who to trust.
They can't trust themselves because oneof the refrains is How come I didn't see
this? Why didn't I know this? Andalso, how could he do this to me?
And everybody thought hewas so nice and so perfect,
and we were the perfect family.
(38:21):
So the partner's reality gets unbelievably
jolted like an earthquake.
Like I needed it, needed it. Youneeded sex workers and affairs.
You needed to betray me, our children,our community. Was I not enough for you?
It wasn't about you. It wasnever about you not being enough.
It sure feels like it was about.
(38:46):
The emotional devastation.
Dr. Kada Ock is describes ismost certainly a real one.
Research indicates that approximately16% of married individuals in the US
have admitted to infidelity atsome point in their marriage.
But perhaps the most surprisingthing is that healing is
(39:06):
possible. See, despitethe initial devastation,
studies show that around 60to 75% of couples affected
by infidelity choose to stay togetherand work through the betrayal.
And is this concept of betrayaltrauma is actually how I met Dr. Kakis
in the first place for the LosAngeles screening of the movie,
(39:29):
accidentally Brave in it,
Maddie Corman tells the powerful storyof her experiencing betrayal trauma
in a very high profile way.
It was to the point that they hadto uproot their family and move.
Dr. Kajaki shares how far reachy itcan be and the delicate balancing act
many partners face.
(39:49):
And what's painful about it too,
for approximately 70 to 80%of these couples will work it
out and work through it. So it'svery difficult. For example,
if it were me to badmouth my partner andtell all my friends and family that he
cheated what he did and how muchmoney he stole. And then later,
three months later, sixmonths later saying,
(40:10):
we're getting back together and thosepeople and hear what they heard,
it's very difficult to repairrelationships. So again,
many women won't tell anybody becausethey don't know what they want to do. Yet.
The secrecy, the shame,
and the uncertainty leave manypartners feeling isolated,
unsure whether to speak out orprotect their relationship in silence.
(40:35):
But as painful as the betrayal is,
the question of what constitutesbetrayal is just as complex for
some infidelity is clearcut. That makes sense.
A physical affair or a hiddendouble life for others,
the boundaries blur iswatching pornography,
a breach of trust is flirting.
(40:56):
Or is it the emotional distancethat grows between two people?
In the quiet moments between intimacy,
Dr. Dodson unpacks how couplesdefine infidelity in different ways
and why understanding each other'sboundaries can be the key to preventing
future ruptures.
Well, it depends on expectations.
So I've heard conversationsand I've seen people that say,
(41:19):
if you flirt with somebody else,
you're cheating if you watchpornography or you're cheating, right?
So if there's any entity orthing or person that takes your attention off of me,
that is cheating.
And it depends on how this couple defineswhat that is for the relationship.
But oftentimes you do have onepartner saying, this is my boundary,
these are my lines. And if you crossthem, that means you are being unfaithful.
(41:41):
Oftentimes, there's one person in therelationship that doesn't see it the same.
And let's just use for thisinstance the man, right?
So whether it's a same sexcouple or heterosexual couple,
sometimes there is a persontypically the man that says,
that's not cheating if we do these things.
But I think that conversation reallygoes into what did that person's,
(42:02):
the other partner's expectations of ahealthy relationship? A lot of people want
their partner to be obsessed withthem so much in a healthy way because
that in their mind givesthem security and safety.
So that's what people arereally seeking, right?
So if you break that downand you slice it out,
people are really seekingsafety, security, connection,
(42:25):
and anything or person or thingthat breaks your connectedness,
to me, that removes this healingsafe is a form of cheating to them.
Sometimes that is accurate,sometimes it's not.
And so I think that's a fine linethat you get to flesh out in therapy,
you get to flesh out inconversations and multiple exercises.
(42:46):
There are a lot of tools that you can useto just have deeper conversations with
people. But I do think that it's reallyimportant to have these boundary setting
conversations in terms of learningwhat your partner's boundaries are,
learning what their expectationsof a healthy relationship,
learning what their examples were.
Because a lot of times when peoplecome into the room and I say, well,
(43:06):
how did you learn healthy sexual behavior?
How did you learn to havesex for the first time?
A lot of it came from either what wasan example of an unhealthy relationship
or pornography because then you hadcouples or somebody in the relationship
learning how to havesex through pornography.
Dr. Dotson's insight into boundariesreveal the delicate dance couples perform
(43:29):
each person defining what feels likebetrayal based on their personal
experiences, fears, and past wounds.
But as Dr. Dotson continues,
he highlights how these seeminglysmall fractures can evolve into deeper
disconnection. It'snot just about the act,
it's about what the actrepresents in the relationship.
(43:49):
The partner left feelingunwanted, unseen, or insecure,
isn't just reacting to the present moment.
Often they're responding to a longhistory of experiences that shaped their
understanding of trust andintimacy. That's what people want.
People want to be wanted.
So even going back to the exampleof the woman that says, well,
(44:11):
if you talk to her, you'recheating. She doesn't,
something in her life says that'swrong, because at some point,
maybe a man doing that was thestart of her being cheated on,
or that is speaking to an insecurityor that is a threat to some
degree. And even if the manor someone else is saying, oh,
(44:32):
you're blowing this out of proportion,
we have to get to what is threateningabout that to this person.
And then you can getto the bottom of that,
the more you can flesh that out and reallyunderstand what they're really saying
behind that anger.
And for Daniel, thatprocess is still unfolding.
(44:55):
The work he's doing doesn't just livewithin therapy rooms or 12 step meetings.
And that brings us to a pivotalday in Daniel's journey.
The weight of healingrests not just on him,
but on the fragile threads of trust.
He's hoping to rebuildwith his wife because now
it's day 40 family day,
(45:18):
their meeting reminds us that healingisn't just a personal journey,
it's relational,
and the road to rebuilding trustbegins one fragile step at a time.
Daniel stands near the entrance ashis wife steps inside, arms crossed,
they haven't seen each other inover a month. She scans the room,
(45:38):
eyes landing on him. Hey, his wife nods,
but doesn't move closer. Daniel noticesher wedding ring still on her hand,
and it gives them hope, however fragile,
they sit outside beneaththe shade of an oak tree.
The kids couldn't make it.It's too hard for them.
They don't understand why you're gone.
(45:59):
I know I'm trying. She stillstudies him for a moment,
searching for signs ofthe man she married.
I want to believe you.
Daniel looks down at his hands.
I want that too.
As we step into the nextphase of this discussion,
(46:21):
Javi walks us through thetreatment landscape where denial,
trauma and addiction intersect,
and how clinicians navigate the complexterrain of recovery from 12 step
programs to holistic healing.
There's a good percentage of folks whoare coming to treatment because they got
caught by their partner, and nowtheir is making the ultimatum,
(46:42):
we need to work on this, or we'redone kind of a thing. For those folks,
it could be a bit moreof a challenge, right?
Because they might be more in denial.
So that might be the firsttreatment approach is really helping them understand,
is this a problem for you? Andwhere does this trace back for you?
Is there some trauma that'sbeing reenacted here,
or is it simply this addictiveprocess that you're engaging in?
(47:02):
Then we also have to assess if there'sany other addictions happening too.
Is there alcohol of drug abuse?
Workaholism is a really common onethat goes along with sex addiction,
substance abuse as well. For women,
oftentimes they have a lot ofexpectations when it comes to sex. A
lot of their expectationsare to a certain standard,
(47:23):
and so when that gets challenged,
they have their own internal distressthat comes up that leads them and
guides them to getting the help thatthey need. So they might be more willing,
more open to seek treatmenton their own, but also,
there's a good percentage of women whohave been in multiple affairs and they
also got caught and are coming totreatment for that same reason. But yeah,
(47:45):
the first pieces would be workingthrough any denial, and then from there,
really moving them into 12 step recovery.
A big piece of addiction isconnecting with others, being honest,
having accountability.
So being part of a 12 step groupwill be able to provide those things.
Group therapy is anotherreally good treatment approach for sex addicts or those
(48:07):
who have impulsivesexual behavior disorder,
group therapy family ifthey're in a relationship,
family or couples marriage therapy. Andthen just holistic approaches as well.
Yoga, exercise, meditation.
Another big piece for me too isworking on growing their sense of self.
As Harvey emphasizes.
Working through denial is one of themost crucial and challenging steps in
(48:30):
treating compulsivesexual behaviors. In fact,
studies show that denial canmanifest in various forms,
minimizing harm, refusing responsibility,
or rejecting the needfor treatment altogether,
hindering acknowledgementand delaying recovery.
And that's according to the WashingtonState Sex Offender Policy Board.
(48:51):
But once denial starts to lift thereal work of unpacking patterns,
exploring identity andconfronting shame begins now,
we shift to Dr. Kakis, who now leadsus deeper into the heart of recovery,
unveiling the frameworks, tools,
and therapeutic modelsthat shape lasting change.
Javi laid the foundation,
(49:12):
but Dr. Kakis picks up where the workbegins to unravel something unexpected,
yet profoundly human grief. Honestly,
that's not something I was expectingwhen I was researching this episode,
but when you take a step back,
it kind of makes sense becausein the process of healing,
there's often a reckoning,not just with the addiction,
(49:33):
but with the time relationships,
the pieces of self thatwere lost along the way.
And the model that I use is what Icall a top down, bottom up model,
meaning we start with the cognitivebehavioral aspect of it using Patrick
Kane's task model.
And that model is in a book he wrotecalled Basing the Shadow. It's a workbook.
(49:55):
It's a terrific workbook forpeople to get started with.
So it's really lookingat all the secrets, lies,
excuses and problems people have,
and looking at their cycle of addictionand looking at what kind of sex
addict they are becausethere are 12 types.
Now, if you're working with acertified sex addiction therapist,
(50:17):
there are several instruments thatpeople take self-report measures to look
at what kind of sex addict they are, whatkind of activities they've been up to.
So we really kind of unearth the wholething, all the secrets and the lies.
And by unearthing it all,
it starts to reduce the amount ofshame the person has around their
behaviors because shame silences us.And so when people start to talk about
(50:42):
this problem, they startto feel better faster,
and they start to come out ofdenial by telling themself,
it wasn't that bad or Ididn't do it that much.
Because when you really start to writeall this stuff down and see that it's
been decades of your life,
you start to see howpervasive a problem it was.
And with that comes grief and loss.
(51:02):
People really have togrieve the loss of time,
the loss of relationships,how they hurt other people,
and also were hurtingthemselves all along the way.
So that's really in a nutshell,
the first layer of treatment.
And with that goes attending 12step meetings for the fellowship so
(51:24):
that people can be in groups with otherpeople who have experienced the same
thing historically,
whether it's in their childhoodstories or their acting out stories,
their repeated cheating,
the marriages they've gone through andstart to see that they're not alone,
and that the people that they're withare good people. They're people just like
them. They just had a bad startto life and have done bad things.
(51:47):
And then after that periodof time, which can take six,
eight months a year,
then I start to work in a deeper waywith people in what's called more
psychodynamic psychotherapy of reallylooking at the childhood trauma
hurts,
helping people to feel in their bodiestoday what they couldn't feel then
(52:07):
because it was so dangerous. Andthat process is a process of,
you could call it reparentingreclamation of the self,
but from a neural perspective,
these are circuits thathave become uncoupled,
and people feel it because theyreport feeling dead at the core or
chronically depressed or highly anxious.
(52:31):
And it's the recoupling of these circuitsgoing back and getting that child and
bringing them back into the present momentthat starts to help people feel more
neurally integrated.And when they're more neurally integrated,
they'll tell you that theyhave had a spiritual awakening,
that they feel lighter, free, or happier,
that the promises of alcoholicsanonymous start to come true.
(52:54):
But this is a good threeto five year process,
which sounds long,
but when you think about how long ittakes somebody to get into therapy and get
help, sometimes they're in theirforties. It's really not that long,
and you're going to be threeto five years older anyway.
So do you want to be three to five yearshealthier or in a deeper hole than you
are right now?
(53:16):
What Dr. Kaha is reveals,
he strikes at the core of whatlong-term healing truly demands.
It's not just stopping. The behavior isabout reclaiming the parts of yourself.
The addiction buried. The processis slow and often painful,
but it opens up the door to somethingdeeper, connection, integration,
(53:37):
and sometimes redemption.
Sex addiction hides in plainsight, woven into jokes, TV dramas,
and celebrity scandals. In our culture,
the line between desire anddisorder, blurs, pop culture,
(54:00):
sometimes normalizes, indulgence,
often dismissing compulsive sexualbehavior as a high sex drive.
This can leave those strugglingfeeling misunderstood or invalidated,
and that can be very dangerous.Javi takes it from here,
unpacking how these cultural messagesshape and sometimes distort our
(54:22):
understanding of sex addiction.
I think, again,
our current culture isyou can watch any movie,
there's going to be some type of a sexscene in there, right? And I think too,
just in culture, evenwhat's going on right now,
there's a lot of highprofile folks who are getting
arrested, who are facing jail time,who have huge allegations against them.
(54:45):
And absolutely there's that misconception.
They think it's just having lots of sex,
having a high sex drive or hypersexuality.
And so there is a lot of misconception,
and my suggestion would be at leastdo a bit of research or listen to
these kinds of podcasts tokind of figure out, okay,
what do they mean when they say that?
(55:06):
It's almost thrown out there as a joke.
Javi highlights how cultural perceptionsoften downplay or distort the reality
of sex addiction.
This disconnect between societalunderstanding and clinical truth
creates a barrier that those whomight otherwise seek help are trapped
between shame and the fearof not being taken seriously,
(55:29):
which is why we wanted toend with Dr. Alexandra Kaki.
Stepping in again to remind us thecondition is officially recognized as.
Compulsive sexual behavior disorder.
And why that language we use matters.
The InternationalClassification of Diseases book,
it's called the ICD,it's in the 11th issue,
(55:51):
is put out by the WorldHealth Organization in the World Health Organization in
2021 or 22 recognizedcompulsive sexual behavior
disorder.
And I think colloquiallyand in the zeitgeist,
we call it sex addiction.
So it's important for people listeningto know there is a bonafide diagnosis for
(56:11):
it now,
but we still all call it sex addictionbecause it's easier. It's a shorthand.
Everybody knows what it is.
Sex addiction is real,
not just a buzzword or moral failing.
It has a name and a place in the ICD 11.
Once again,
this official recognition doesn'tjust validate the experience of those
(56:35):
struggling.
It opens the door to morecompassionate structured paths
toward healing.
But recovery isn't just aboutdefinitions of clinical terms.
It's about the quiet personal victories,
the conversations thatwere once too hard to have,
and the apologies that felt impossible,
(56:55):
and the relationships that beginto heal and repair peace by
piece. And for Daniel,
that work has carried him to this moment,
day 60 graduation day.
But this isn't the end.It's a beginning one.
He doesn't have to face alone. Ashe walks out on the overcast sky,
(57:20):
Daniel steps out of the facility walkingtowards his wife as she waits in the
parking lot. And as he walks towards her,
he glances back at the building.
A few of the men from hisgroup wave from the entrance,
he lifts his hand and return,
and his wife welcomes him in.
Ready.
(57:41):
I think. So he climbs in resting hishand over hers on the gear shift.
I know there's still a long way to go.
His wife squeezes his hand.
We'll.
Get there.
And as they pull away,
Daniel watches the facilitydisappear in the rear view mirror,
but this time he's not runningaway from it for the first time,
(58:04):
he's driving towards something better.
Next time on mental health rewritten,
we shift the focus from sex addictionto pornography. In this episode,
we explore the fine line betweenconsumption and compulsion and the often
overlooked realities behind thescenes of the adult film industry.
(58:27):
We'll hear from the clinicians weheard from today that treat pornography
addiction,
but we will also hear from someonewho's lived on the other side of the
camera.
So it was during thepandemic in 2020, actually,
specifically October of 2020,
I found myself struggling financially.
I found myself battling homelessness,
(58:49):
and I needed a way to makemoney. I kind of had just said,
what else do I have to lose?
Tune in next time as we confrontthe myths, hear the stories,
and rewrite the conversation aroundPornography and mental health.
Mental health rewritten created bythe Owls Education Company, is hosted,
(59:11):
written, and producedby me. Dominic Lawson,
executive producer Kendall Lawson.
Cover Art was created by AlexandriaIngs of Art Life Connections.
Sources to create this episodeare included in the show notes.
Be sure to review and subscribe to theMental Health Rewritten podcast on Apple
Podcast, Spotify, or whereveryou like to listen to podcast,
(59:35):
and also let people knowabout the podcast. We would appreciate that very much.
Five star ratings are always helpful.
You can also watch snippets of some ofthe conversations that didn't make the
episode on Instagram,on our Instagram page,
mental Health rewritten podcast,
and in the form of YouTube shorts onour Education Company YouTube page.
(59:57):
For a full transcript of thisepisode and other resources,
go to www.mentalhealthrewritten.com.
There you can read our blog,
leave us a review or leave a voicemailwhere you can ask a question or let us
know what you think about the showwhere we may play in a later episode.
Thank you so much for listening tothe Mental Health Rewritten Podcast,
(01:00:17):
where prioritizing mentalhealth is not optional.
Take care of yourself.
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