However, masturbating to porn on the internet so often that it interferes with your daily life so that you cant function at work or at home, is a problem. 

Replacing human interaction with porn so that it interferes with your relationships, makes it a problem. 

If you have blisters on your hands or genitals and done it anyway, thats a problem. 

If you are hiding it and feel ashamed and hate yourself because you cant stop, thats a problem. If you have wanted to quit and couldnt, its a problem.

Having an affair does not necessarily make you a sex addict. 

It might make you unhappy and threaten your marriage, but it does not qualify as purely pathological. 

If you are having affairs that you cannot control, if you are hiding and lying and feel shame and feel driven to do it even when you have wanted to or promised to stop, that is a problem. 

Compulsive infidelity is a serious issue and can be indicative of a deeper problem, which can be assessed by a professional counselor or therapist.  Its not fun and its not cool, and its painful to everyone involved.

Picking up strangers compulsively for sex does not make you a sex addict, although it can be a symptom.  It can also mean other things. 

For instance it can mean you have an impulse control problem due to drugs or alcohol.  It can mean you might be manic and in a bipolar disordered mood swing.  It can mean that you are self destructive and acting out a suicidal urge.  It can mean that you are questioning your sexual identity and trying to test out your homosexual urges.  It does not mean you are sex addicted, BUT IT CAN. 

Sex addiction looks different to different people. 

From the outside it can look like you are just being selfish, that you cant control your body, that you are narcissistic.  It can also look like you dont care about the people you love.  Although that might be true, many times its not. 

To find out what all of these or other hypersexual behaviors mean in you or in your loved ones, email me for an assessment.  See the simple questionnaire in this blog to get an idea if you have a problem, or contact a licensed professional counselor in your area. 

There is help.

Dr Tammy Nelson

tammy@tammynelson.org

If you are addicted to sex or sexual behaviors, you probably dont care what we, the professionals, call it.  If you have a problem with sexual dependency or hyperactive sexuality, it means you have tried to stop acting in a certain way sexually and you cant.

Being a sex addict does NOT just mean that you love sex and cant get enough.  It does NOT just mean that you have a lot of sex and think about it all the time.  It does NOT just mean that you wonder if you might be normal. 

Sex addiction is a process disorder which means you have tried to quit and cant.  You may have tried to stop your behaviors, and regardless of the consequences, found that you couldnt.   People who have sex addiction issues are not enjoying sex.  They are ashamed, hiding their compulsions, and suffering deeply by the time they realize they need help.  

If you are wondering if you have a problem with sex addiction or sexual dependency syndrome, take the easy assessment in the next blog entry, and if you need help, reach out.  Email me or someone in your area who specializes in sex therapy or addiction. 

And know you are not alone, there is help. 

Dr Tammy Nelson

tammy@tammynelson.org

 
Answering yes to any one of these questions identifies a significant risk that should be diagnosed and handled by a professional.

Please email me for more information at tammy@tammynelson.org

So many couples experience infidelity - more than half.  So if you are reading this and wondering if you are alone in your pain, and in your anger, you're not.  If you or your spouse has been unfaithful, its not unusual.  That doesnt mean its not a huge shock, and you are probably reevaluating and taking stock of your relationship right about now.

But does it mean you have to end the relationship?

Maybe not.

First, there are many different kinds of infidelity. 

You and your partner probably had two kinds of monogamy agreement when you made a commitment to each other.  The first is the explicit monogamy agreement - the one you made in front of others, maybe a marriage vow.  You promised to love each other and be faithful.  But there is another monogamy agreement that happens in relationships - I call it the implicit monogamy agreement.  This is the unspoken and many times misunderstood agreement that both of you make to each other, but probably understand differently. 

The implicit understanding that you have about monogamy might be much different than your partners.  You might think that sleeping with just your spouse means fidelity. But they might think that sleeping with just you and also looking at pornography still means that they are monogamous.  You might disagree.  But did you ever have this conversation?  Have you ever talked about pornography, internet relationships, prostitutes, or did you just expect that OF COURSE your partner wouldnt do that to you?  And of course they should just KNOW that this meant that they were cheating on you.

But if your monogamy agreements are not discussed and renegotiated on a regular basis, then misunderstandings, hurt feelings and betrayals can happen throughout your relationship.

Can you survive infidelity?  Sure.  Sometimes talking about what happened opens up a new understanding of what the expectations are.  Sometimes talking about what was going on in your relationship before a secret is revealed creates a new level of intimacy.  Sometimes infidelity brings to light new issues that need to be discussed.  Learning new ways to communicate, particularly with the help of a good therapist, can help couples begin a whole new relationship.  This might not happen if it wasnt for the affair blowing up the relationship you have now.

Dont give up right away if you find out your partner has been having an affair.  Sometimes it can and should mean the end, but sometimes you can survive it.  And sometimes it can make you stronger than ever. 

Call me or write me if you or your partner wants more information on surviving infidelity.

Dr. Tammy Nelson

tammy@tammynelson.org

Pornography Addiction

Assessment

This is a quick unscientific questionnaire that may help someone to identify themselves as addicted to sex or suffering from sexual dependency syndrome.   

1. Are you hiding the fact that you are using pornography from your partner?
 
2. Are you using pornography as a physical or an emotional substitute for sex your partner?
 
3. Is porn taking up a significant amount of the free time in your life to the detriment of other things that are more important to you?
 
Answering yes to any one of these questions identifies a significant risk that should be diagnosed and handled by a professional.

 Watch for more on this topic.  There are ways to help.

(Credit to R. Lowe for his contribution to the creation of this assessment.)
(for more on Pornography Dependency Syndrome see www.tammynelson.org)

 Dr. Tammy Nelson

There are many reasons someone experiences hyper sexuality.  The term Sexual Dependency Syndrome (SDS) as Dr Joe Kort describes in his recent newsletter, (go to http://www.joekort.com/newsletter/ for more info) allows for many possibilities, including sexual addiction.  

Sexual fantasies and desires are the erotic code underlying addiction, and this information, when understood, can help us decipher if someone is really addicted to the process of pursuing sex and scoring it, or if they are compulsively using the act of orgasm through masturbation and sex acts with another person to change their brain patterns and feel a chemical high. 

Sometimes, people compulsively cheat on their partners, and this relationship dysfunction becomes an addictive pattern, but is more closely related to childhood issues and pathology around intimacy and connection.  Actual addiction to sex itself is difficult to define.  If someone has a relationship pattern where they move closer to a partner, and then they get scared and sabotage their commitment by acting out with someone else, this may be a sign that psychotherapy is necessary to help process the meaning of these patterns and restore health and balance to their lives.

If someone is repeatedly paying for sex through prostitutes, online sex, or with internet porn, and not telling their partner, this is a different sexual dependency.  If this behavior interferes with their lives, and with their relationships, the dependency can then be defined as crossing over into addiction.

As one of my guest writers shared in a previous column in this blog, Robert Lowe came up with this list to determine if pornography is a problem.  I think it’s actually a quite accurate diagnostic tool and I have modified it to include all sexual behavior.

Here's a quick unscientific questionnaire that may help someone to identify themselves as addicted to sex and as a result being 'unfaithful' to their partner.
 
1. Are you hiding the fact that you are acting out sexually from your partner?
 
2. Are you using sex with something or someone else as an  emotional substitute for sex your partner?
 
3. Is sex taking up a significant amount of the free time in your life to the detriment of other things that are more important to you?
 
Answering yes to any one of these questions identifies a significant risk that should be diagnosed and handled by a professional.

In order to make a true differential diagnosis of Sexual Dependency Syndrome (SDS) whether we are talking about Porn addiction or Sex addiction, there has to be a thorough assessment by a licensed professional.  Only then can there be accurate and empathetic treatment for the sexually dependent person and their partner.

If you want a true diagnosis with real empathic treatment, a good therapist with experience treating sexual dependency syndrome (SDS) should be sought out.  A Certified Sexologist, a Certified Sex Therapist or any licensed psychotherapist with good clinical knowledge and experience in addiction and relationship treatment may be able to help.   For a referral please write to tammy@tammynelson.org or to joekort@joekort.com

If you are a professional  and  want more help treating clients like Tiger Woods or other sexually dependent types, or want to examine your own counter transference which often interferes with treating sexually disordered patients, look for our upcoming teleclass on Sexual Dependency Syndrome beginning this March, 2010.  For more info go to http:///www.tammynelson.org.teleclasses or email tammy@tammynelson.org

Best wishes to Tiger and his family and everyone else out there brave enough to work on their issues,

Dr. Tammy Nelson

Is there such a thing as sex addiction? 

Can someone become compulsive about sex, using it to avoid feelings and responsibilities?  Yes.  Can sex be a way to numb out and avoid being in a true intimate relationship?  Of course.  Can sex be something to obsess about? Can it interfere with your marriage?  Your job?  Can you overspend on sex?  Can you have sexual experiences that you would rather avoid, feeling powerless over your behavior and causing shame and embarrassment to rule your life?  Yes to all of the above.

So why should there be a question abou why sex addiction even exists?

In the world of psychotherapy, there are several schools of thought about this.  As of now, sex addiction is not a true diagnostic category.  There is no code for diagnosing someone with sex addiction like there is for manic depression, eating disorders, or other psychiatric illness. 

Yet many compulsive dysfunctions started this way, without diagnostic criteria that were agreed to by a majority of the psychological community.  Giving things a label helps professionals to come up with criteria to diagnose a problem; it helps to provide treatment to deal with the pain. 

Perhaps the problem is not that there is no formally agreed upon diagnostic criteria for sex addiction, but rather that there is little written or researched on how to treat it.

Without a prognosis predetermined by a history of treatment methodology, we dont know what will work and what wont.  So, frankly, we dont know what hurts.  And we dont want to screw anyone up.  We are - perhaps - and this is just a guess - tip toeing around the diagnosis because we would then have to work up treatment plans and methods to help sex addicts, and this is more difficult than it sounds.

Famous people on tv and in the press and even in books are working hard right now to provide good care and treatment of sexual compulsion.  Sometimes we watch this and its more like a train wreck than treatment, and sometimes the care and respect for the patient is amazingly and sensitively rendered and one has to wonder if this in and of itself is what provides the cure.

Maybe in the relationship the therapy is provided.  Its in this therapeutic milleux, the space between client and therapist, healer and receiver, patient and doctor, that the real healing begins.  When the compulsion to act out with the body and the senses can be turned down a notch and the real people can sit across from one another and be SEEN the work begins.  Perhaps this is the first step.

Is sex addiction real? 

Ask the sex addict.

Ask the therapist treating their partners and families.

Does it matter what we call it?

What really matters is how we treat it.

Let the diagnosticians figure out the details.

Meanwhile, I have my next patient in the waiting room biting her nails.  She's waiting for me to open my office door.  She's scared, and she's hiding her face behind her hair.   I gotta go.

Passionately yours,

Dr. Tammy Nelson

I hadnt seen him in at least 15 years. 

We had connected through email, and stayed in touch recently through Facebook.  We exchanged pictures of our kids, texted a few times, talked on our cell phones as we were driving to respective conferences.   Coincidentally (or maybe not - hey, we liked each other for a reason) we were both pursuing PhD's when we connected, and as mine is finished (this past week) and I feel somewhat complete (for at least 5 minutes) its interesting to have this blast from the past standing in my office staring down at me from his considerable height, and smiling at me with that familiar grin.  Like another cycle of my life has been closed, and come around again to remind me where I came from. 

We talked about our history, our parents, our lives at the time we knew each other, and before.  And now.  He confessed he was nervous around me, and I wondered why.  I feel like the same person.  I havent changed.  Well, ok, I have gotten older.  Grayer.  Thicker around the middle.   But I am still young in my mind.  Only I have more diplomas on the wall.  And I feel luckier.

I feel lucky to have the life that I do.  Lucky to work at a career that I would do for free, but that pays me well.  Lucky that I can write every day if I want to, and sometimes do.  Lucky that I have the husband I do, who supports me in never ending and surprising ways.  Lucky to have beautiful, smart, amazing and healthy children. 

And I feel lucky to have friends in my life that are bright, challenging, and that are interested enough to seek me out and stay my friend on Facebook.  No one has blocked me so far.  That I know of.  And some actually drive long distances and stop by to see me, after 15 years.   How lucky is that?

Facebook may be a time waster, a trouble maker, a distance creator.  But its also a connector, a friend finder, a reuniter.  And for some, a way to keep the love alive.

For all of you who want to find me on facebook, feel free to friend me.

Follow me on Facebook http://www.facebook.com/pages/Getting-the-Sex-You-Want/70524292128
and Twitter http://twitter.com/healhere2

Stay Passionate,

Dr. Tammy Nelson

Movies and books in popularity right now include topics like - Cheating on your wife with your ex-wife; finding out your husband was cheating with multiple women; marrying your husband to give him citizenship; eating, loving and praying to get over your divorce and spend your big literary advance...

All this entertainment about screwing up marriage and commitment and sex and relationships is really a deeper look at whether or not we can really make a go at this grand experiment we call LOVE.

How did it all get so complicated? 

In Europe they call blended families "patchwork" families.  After divorce, we remarry and bring together our children with someone else's.  This blending and sewing together of the patchwork of our lives, integrating rules and habits, affections and inconsistencies, creates more tension than we know how to handle sometimes.  But we do it.  Because its worth it.  Because we LOVE. 

So maybe we dont always get it right.  Maybe we stumble, we fall, we crash into someone else's bed.  Ooops.  Sometimes we committ to someone or something when we think we can and we really want to and then the reality of a real intimate relationship is so terrifying that we leap out of the frying pan as quickly as we jumped in.  Sometimes its not as easy as it looked from outside.   But we try.  For LOVE.

I like to think that most of us wake up in the morning and think "Today I am going to do the best I can..." and we work toward that goal.  Some days we feel good about it and hit the finish line and wipe our brow and say "phew - no one got hurt today - it was a good day...!" 

And other days we lie awake and wonder how we screwed it up as bad as we did. 

Love is a universal longing.  Regardless of how often we do it poorly, or how many mistakes we make.  I want to believe that our basic instinct, like survival, is to cut off our own foot sometimes in order to get out from under the rock we feel is crushing us from above. 

And yes, sometimes the rock is in our heads. 

For those days that you and I are dumb as rocks, I hope you have people to love you like I do.  People to forgive you, and take you back.  To build room for your children, to welcome you into their arms, and to understand that love forgives all things.

Good luck out there.

Its rocky.

Passionately Yours,

Dr. Tammy