i The Routledge International Handbook of Sexual Addiction The concept of sexual addiction has gained increasing recognition in the academic and health- care communities since the 1990s. It has also captured the attention of the media, where there has been much debate over whether it can truly be described as an addiction. What is certain is that many people struggle with out of control sexual behaviour, which takes over their lives and has harmful consequences for their relationships, careers and finances. The Routledge International Handbook of Sexual Addiction brings together a comprehensive range of perspectives on sexual addiction from a worldwide selection of scholars and therapists. It sets out to define sexual addiction and to study its causes from a range of different psychological perspectives. A series of presentations of sexual addiction are outlined, including internet sexual addiction and the relationship between paraphilias and sex addiction. The handbook considers both individual and group treatment strategies, drawing on a wide range of approaches, includ- ing cognitive behavioural therapy, mindfulness and 12-s tep programmes. The book studies sex addiction in specific populations including women, adolescents and men who have sex with men. Finally, it considers some of the alternative discourses surrounding the concept of sexual addiction. This is the first comprehensive reference book to bring together global viewpoints on advances in research, theory and practice in one volume. This handbook provides an essential guide for academics and students of psychotherapy, counselling, nursing, addiction, sexualities, social work and health and social care, as well as professionals in practice and in training working with sexual addiction and related issues. Thaddeus Birchard is the founder of the Marylebone Centre. He has an MSc in psychosexual therapy and a doctorate in the treatment of hypersexual disorders. He is accredited by the British Association for Behavioural and Cognitive Psychotherapies and is the founder of the Association for the Treatment of Sexual Addiction and Compulsivity. He is the author of CBT for Compulsive Sexual Behaviour: A Guide for Professionals and Overcoming Sexual Addiction: A Self-H elp Guide (both Routledge). Joanna Benfield (MPhil) is a psychosexual therapist in private practice in London and France. She has a Diploma in Psychosexual and Relationship Therapy, and is a member of the British Association of Counsellors and Psychotherapists (BACP) and the College of Sexual and Relationship Therapists (COSRT). ii iii The Routledge International Handbook of Sexual Addiction Edited by Thaddeus Birchard and Joanna Benfield iv First published 2018 by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN and by Routledge 711 Third Avenue, New York, NY 10017 Routledge is an imprint of the Taylor & Francis Group, an informa business © 2018 selection and editorial matter, Thaddeus Birchard and Joanna Benfield; individual chapters, the contributors The right of Thaddeus Birchard and Joanna Benfield to be identified as the authors of the editorial material, and of the authors for their individual chapters, has been asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book has been requested ISBN: 978- 1- 138- 19320- 8 (hbk) ISBN: 978- 1- 315- 63951- 2 (ebk) Typeset in Bembo by Out of House Publishing v Dedicated to Raj Khera vi vii Contents About the Editors xi List of Contributors xii Foreword by Dr Stefanie Carnes and Dr Patrick Carnes xxv SECTION 1 An introduction to sex addiction 1 1.1 Introduction 3 Joanna Benfield 1.2 Whither sexual addiction? An overview 9 Stephen Southern 1.3 Sexual addiction: Terminology, definitions and conceptualisation 21 Gerard A. Schaefer and Christoph J. Ahlers 1.4 A biopsychosocial approach to sex addiction 27 Paula Hall SECTION 2 Presentations of sex addiction 39 2.1 Overview of presentations of sexual addiction 41 Ralph Earle and Rick Isenberg 2.2 Sexual addiction in the digital age 55 David L. Delmonico, Heather Putney and Elizabeth J. Griffin 2.3 The relationship between pornography and hypersexual behaviour 73 Philippe Bensimon vii viii Contents 2.4 Sexual addiction and paraphilias 83 Gerard A. Schaefer and Christoph J. Ahlers 2.5 The role of sexual fantasies in sexual addiction 94 Richard Newbury SECTION 3 The aetiology of sex addiction 105 3.1 The aetiology and differential diagnosis of sex addiction: An overview 107 Kenneth M. Adams and Todd Love 3.2 The neuroscience of sexual addiction 121 Frederick Toates 3.3 Written in the scars: Sex addiction as an attachment disorder 133 John Beveridge 3.4 The role of shame in sexual addiction: A review of empirical research 144 Manpreet K. Dhuffar and Mark D. Griffiths 3.5 Existential perspectives on working with sex addiction 154 Alex Smith SECTION 4 The treatment of sex addiction 165 4.1 Clinical assessment and diagnosis of sexual addiction 167 Joshua B. Grubbs, Joshua N. Hook, Brandon J. Griffin, J. Kim Penberthy and Shane W. Kraus 4.2 The importance of group psychotherapy for sex and love addiction recovery 181 Eric Griffin- Shelley 4.3 Group cognitive behavioural therapy for compulsive sexual behaviour 190 Thaddeus Birchard 4.4 Sex addiction, the 12 steps and therapy 203 Timothy D. Stein and Patrick Carnes 4.5 The process of couples’ therapy for sex and porn addiction 212 George Collins viii ix Contents 4.6 Mentalization- based therapy for sex addiction 224 Michael Berry and Austin Lam 4.7 Applying positive psychology to sex addiction 235 Jolanta Burke and Eoin Stephens 4.8 Using creative therapies to facilitate neuroplastic brain changes in sexually compulsive patients 247 Matthew Hedelius 4.9 A role for mindfulness meditation in treating sexual addiction 260 Kishore Chandiramani 4.10 Creativity and healing: Art therapy with sex addicts 268 Marie Wilson 4.11 Incorporating pharmacological treatment strategies 282 Florence Thibaut 4.12 When addictions merge: Assessing and treating the relationship between addictions 292 Robert Weiss SECTION 5 Sex addiction in specific populations 303 5.1 Sexual compulsivity and men who have sex with men (MSM) 305 Michael P. Chaney and Carol M. Burns- Wortham 5.2 Problematic sexual behaviours and adolescents 317 Maria Watters and Todd Spaulding 5.3 The female face of sexual addiction 327 Alexandra Katehakis 5.4 Working with female partners: Interventions from ten years of partners’ groups in the UK 338 Joy Rosendale 5.5 Navigating the minefield of facilitated disclosure: Strategies, techniques and potential pitfalls 353 Stefanie Carnes ix