Internet Pornography Addiction

Family Court, August 20, 2009

Mark Schwartz, Sc.D. Castlewood Treatment Center for Eating Disorders 800 Holland Road 636-386-6611 www.castlewoodtc.com

1

ALEKSANDER I. SOLZHENITSYN

If there were evil people somewhere insidiously committing evil deeds, and it were necessary only to separate them from the rest of us and destroy them. But, the line dividing good and evil cuts through the heart of every human being, and who is willing to destroy a piece of his own heart?

-Gulag Archipelago 2

3

COMPULSIONS

(LARKIN & WHITING, 1991) “Compulsions serve as clues to the deeper stories of our lives, and individual’s history of emotional woundedness.” A compulsion covers up an interior emptiness. It indicates the presence of a control mechanism – a way of escaping something that is ultimately unescapable and unavoidable.

Compulsions represent attempts to compensate for low self-esteem and powerlessness.

4

DEPENDENCE

Addict comes to require, need or lean on behavior for maintenance of normal functioning. Tolerance refers to the body adapting to certain effects of the drug.

5

REPETITION

Nevertheless, the need to repeat also has a positive side. Repetition is the language used by a child who has remained dumb, his only means of expressing himself. A dumb child needs a particularly empathic partner if he is to be understood at all. Speech, on the other hand, is often used less to express genuine feelings and thoughts than to hide, veil or deny them and, thus, to express the false self. And so, there often are long periods in our work with our patients during which we are dependent on their compulsion to repeat – for this repetition is then the only manifestation of their true self.

-Alice Miller 6

SEX OFFENDERS ASCRIBING TO PAST TRAUMA BARNARD, HENKINS & ROBBINS (1993) Child Sexual Abuse Physical Assault Serious Accident Other Trauma Rape Military Combat Natural Disaster At Least One of the Above 30 20 16 15 9 4 1 40 71.0% 58.0% 31.0% 29.0% 17.0% 7.6% 1.9% 97.0% 7

ETHNIC DISORDER

  The disorder is a final common pathway for the expression of a wide variety of idiosyncratic personal problems and psychological distress; people who develop the disorder can range from mildly to severely disturbed.

They utilize these cultural preoccupations as defenses that enable them to escape from – and achieve some sense of control over – unmanageable personal distress, most of which revolves around issues of identity. Again, similar to hysteria, anorexia and bulimia are socially patterned, the fashionable style of achieving specialness through deviance.

8

TREATMENT OF ED PREMISES PHILOSOPHICALLY  Different developmental trajectories  Symptom has developed as a survival strategy  Symptom is logical, rational and adaptive  Symptom remission is dependent on understanding the logical development and allowing for a more optimal solution.

9

FUNCTIONS OF EATING DISORDER SYMPTOMS  Substitute for life itself, safeguards against anxiety  Modulates anxiety, needs states, self-esteem  Sympathetic problem to mask the truth  Maintaining her false self, object self, making her real needs with relationships with real people  Express her needs (power autonomy, comfort, soothing, recognition connection)  Recognize control of disavow needs  Medium for relational needs 10

WEB - GENERAL The number of people in the Unites States who use the World Wide Web is estimated at 158.3 million, averaging six accesses per week, six sites per visit, and spending an average of three hours and 22 minutes per week online (Nielsen-Net Ratings, 2001). This translates into over half of all American households and reflects a trend that grew by 58% over a 20-month period (Department of Commerce, 2000). The amount of information and opportunities is overwhelming, with an estimated one billion unique web pages available in January, 2000 (Inktomi, 2000).

11

CYBERSEX     As of January 1999, there were 19,542,710 total unique visitors/month on the top five pay porn websites, and there were 98,527,275 total unique visitors/month on the top five free porn websites.

In November 1999, Nielsen Net Ratings figures showed 12.5M surfers visited porn sites in September from their homes, a 140% rise in traffic in just six months.

Nearly 17% of internet users have problems with using sex on the net.

Severe problems with sex on the net exists for 1% of Internet users, and 40% of these extreme cases are women.

12

CYBERSEX, CONT.

     Most e-porn traffic, about 70% occurs weekdays between 9 am and 5pm.

There are 100,000 websites dedicated to selling sex in some way; this does not include chat rooms, e-mail or other forms of sexual contact on the web.

About 200 sex-related websites are added each day.

Sex on the internet constitutes the third largest economic sector on the Web (software and computers rank first and second), generating $1 billion annually.

The greatest technological innovations on the Web were developed by the sex industry (video streaming is one example).

13

OVER CONTROL; OUT OF CONTROL   Some acting-in individuals will instead develop realistic perfectionist righteousness and will channel their rage into taking care of others. They have such a great sense of neediness, which simultaneously evokes terror of allowing someone close enough to meet their needs, that they solve the dilemma by projecting their needs onto others and finding helpless children to take care of compulsively.

Acting out individuals may move against and exploit self and others, directly or indirectly. Often, they will physically abuse children or neglect them, often alternating with smothering them. They will find themselves in frequent power struggles, insidiously directing their anger at several of their enemies, while simultaneously feeling like the victim.

14

TEA ROOMS  Humphreys called public restrooms “sexual marketing places” or “tea rooms.” A primary feature of their attraction was the risk-taking nature of sexual interactions there – the aphrodisiacal effect of danger. The “tea room” is not an encounter, it is a game, an adrenaline evoking adventure.

 The other motivating forces identified were: availability, invisibility, variety and impersonality of the “tea room” format.

15

THE NEW TEA ROOM             Curiosity explorers Paraphiliacs Liaison seekers Illicit – doing something not supposed to do Obsessing (compulsive-bind anxiety) Bi-sexuals looking to trick Singles looking for a partner, courtship and shyness Re-enactment of unfinished business Somebody wants you Get back to your partner Escape from boredom vs. Russian Roulette Be young and foolish again 16

CHARACTERISTICS OF CYBERSEX ABUSE PATIENTS Male N Percent Female N Percent Total N Characteristic Marital Status Married/Committed Divorced Separated Single 11 17.5

57.9

3 3 2 19 2 15.8

15.8

10.5

100.0

57.2

4 0 5 21 19.0

00.00

23.8

100.0

23 3 7 40 Percent 57.5

7 07.5

17.5

100.0

Employment Status White Collar Blue Collar Homemaker Student Unemployed Disabled 2 07.5

10 5 0 10.5

1 1 52.6

26.3

00.0

5 05.3

05.3

9 3 1 23.8

1 42.8

14.3

04.8

7 04.8

2 19 8 1 17.5

2 09.5

47.5

20.0

02.5

05.0

72.5

Psychiatric Status a Sexual abuse PTSD diagnosis Affective disorder Addiction status a Chemical dep. b Eating disorder c Sexual addiction 11 6 13 14 5 17 57.9

31.6

68.4

73.7

26.3

89.5

16 11 16 9 14 11 76.2

52.4

76.2

42.9

66.7

52.4

27 17 29 23 19 28 67.5

42.5

72.5

57.5

47.5

70.0

17

LIFETIME PREVALENCE OF MENTAL DISORDERS IN PERSONS WITH COMPULSIVE SEXUAL BEHAVIOR (CSB) AND IN NORMATIVE SAMPLES (NCS) Disorders Black et al Persons with CSB % Kafka & Prentky Normative Samples % Total N Percent Mood Disorder Major Depression Mania Anxiety Disorder Panic Disorder OCD GAD Phobic Disorder Substance Abuse Disorder Alcohol Abuse/Dependence Drug Abuse/Dependence Eating Disorder Anorexia Bulimia Other Schizophrenia Somatization Pathological Gambling 39 14 14 14 14 42 58 33 0 11 11 11 6 62 0 8 12 12 46 38 29 ---- ---- 0 ---- 0 6 1 2 2 ---- 9 16 6 <1 ---- 1 <1 ---- 17 1 4 ---- 5 ---- 24 12 ---- ---- 1 ---- ---- Key: ECA

–Epidemiologic Catchment; NCS– National Comorbidity Study; OCD-Obsessive-Compulsive Disorder; GAD-Generalized Anxiety Disorder

18

SELF-REPORTED INTERESTS OF CYBERSEX ABUSE PATIENTS Interest Paraphilias a Romance/Dating Swinging Chat/Social Outlet Homosexual Bisexual Gender Bending b Teens/Juveniles c Total 2 2 1 4 3 Male N 5 1 2 19 Percent 26.3

21.0

15.8

10.5

10.5

05.2

05.2

10.5

100.0

N 5 5 2 2 3 2 1 0 21 Female Percent 23.8

23.8

14.2

09.5

09.5

09.5

04.7

00.0

100.0

N 4 3 6 4 10 9 2 2 40 Total Percent 25.0

22.5

15.0

10.0

10.0

07.5

05.0

05.0

100.0

19

OVER CONTROL; OUT OF CONTROL 2

Typically, the disordered patient will cycle between over-control and out-of-control cycles; acting out and acting in cycles. The eating disorder patient acts with a rigid sense of beliefs and boundaries. The disorder patient acts with a rigid sense of beliefs and boundaries which allow her to organize the world by being angry at self and projecting and displacing the anger onto others. The result is interpretation of all transactions as one’s own fault, avoiding and complying with others and a sense of helplessness and powerlessness to solve problems or change.

20

OVER CONTROL; OUT OF CONTROL 3

  Some acting-in individuals will instead develop realistic, perfectionist righteousness and will channel their rage into taking care of others. They have such a great sense of neediness, which simultaneously evokes terror of allowing someone close enough to meet their needs, that they solve the dilemma by projecting their needs onto others and finding helpless children to take care of compulsively.

Acting out individuals may move against and exploit self and others, directly or indirectly. Often, they will physically abuse children or neglect them, often alternating with smothering them. They will find themselves in frequent power struggles, insidiously directing their anger at several of their enemies, while simultaneously feeling like the victim.

21

SELF-INJURY

Whenever they begin having success in life or in love relationships, it upsets the equilibrium. They are confronted with the reality that they are not bad, evil or as damaged as they originally thought. The thinking and feeling initiates an intrusive cycle and creates anxiety, which results in self-destructive behavior to re-establish equilibrium. The result is a very delicate system in which eating is used to maintain the intimacy disorder.

22

EATING DISORDER PATIENTS’ EXPERIENCE OF RECOVERY  Ability to take responsibility for self and eschew victim mentality.

 Establishment of a sense of “true self,” “real me,” or “knowing who I am.”  Capacity to formulate goals, tolerate setbacks, yet maintain positive motivation to get better.

 Reclamation of sense of one’s personal power.

 Decreased emphasis on perfectionism.

 Firmer interpersonal boundaries; enhanced capacitates to set appropriate boundaries.

 Cultivation of sense of purpose, meaning of life.

23

RE-FRAMING THE MEANING OF SYMPTOMS      Start with the assumption that every symptom is a valuable piece of data!

Use psychoeducational material to make educated guesses about the meaning of symptoms, as a symptom-memory or a valiant attempt to cope.

Ask her, “How would this _____________have helped you to survive in an unsafe world? Helped you to feel less overwhelmed? Less helpless? More hopeful?” Look for what the symptom is still trying to accomplish: i.e., chronic suicidal feelings might offer comfort or a “bail-out plan;” cutting might help modulate arousal; social avoidance could be an attempt to avoid “danger.” Once it is clear what the symptom is trying to accomplish, then the therapist and patient can look for other ways to accomplish the same goal in a context that describes the patient as an ingenious and resourceful survivor, rather than a damaged victim.

24

SHAME

Feeling of exposure inherent to the experience that can accompany extreme amount of utter worthlessness. Feeling exposed results in the individual critically scrutinizing the minutest detail, heightening the awareness of being looked at and seen. The feeling of exposure can produce rage.

25

26

THERAPISTS JOB WITH ATTACHMENT TRAUMA 1.

2.

3.

4.

5.

Transformation of the self through relationship.

Provide a secure base for exploration, development and change.

Provide attunement in helping the clietn tolerate, modulate and communicate difficult feelings.

Affect regulating interactions for accessing disavowed or dissociated experiences strengthening narrative competence.

Deconstruct the attachment patterns of the past to construct new ones in the present.

(see David Wallin, Attachment in Psychotherapy, Guilford Press, 2007) 27

SUBTYPES OF CYBERSEX ADDICTS AND RECOMMENDED TREATMENT Subtype Male Cybersex Addicts Female Cybersex Addicts Loner Cybersex Addicts Paraphiliac Cybersex Addicts Recommended Treatment Chemical Dependence Treatment Sexual Addiction Recovery Depression Treatment Trauma Reconstruction Marital/Couple Therapy Sex Therapy Eating Disorder Treatment Sexual Addiction Recovery PTSD Treatment Depression Treatment Trauma Reconstruction Marital/Couple Therapy Sex Therapy Social Skills Training Depression Treatment Trauma Reconstruction Sex Therapy Social Skills Training Depression Treatment Trauma Reconstruction Sexual Arousal Reconditioning 28

FANTASY SATIATION THERAPY PROGRAM

I.

II.

a.

Patient’s current fantasies Range of deviant imagery b.

Range of non-deviant imagery a.

II. Write 4-5 pages of fantasy i.

One page including build up What is he doing during the day before he exhibits b.

c.

d.

i.

ii.

iii.

Two pages of scene Sensory (smell, taste, hearing, touch, sight) Thoughts Feelings One-half to one page of offense-activity One page of wind-down 29

FANTASY SATIATION THERAPY PROGRAM, CONT.

III. Borderline measure of arousal a. Verbalize each of the fantasies on audio tape b. Play tape and have him rate his cognitive arousal on scale IV. Selection techniques a. Each day he will (1) masturbate to non-violent fantasy and then (2) verbalize the most exciting component of the incest fantasy for 30 minutes into audio tape. On Day 10, we’ll listen to the baseline fantasies and compare arousal level.

b. If arousal to children is low or nil, the same procedures will be used for any other deviant imagery. If arousal is not low to children, eight more days of incest satiation is needed bfore the next baseline measure.

30

FANTASY SATIATION THERAPY PROGRAM, CONT.

V. Patient will be instructed not to use fantasies of illegal behavior in masturbation, intercourse or otherwise for duration of satiation. Erotic activity should be accompanied by fantasy or mutually consenting fantasy.

VI. Patient will be instructed to keep an accurate log of themes used to masturbate.

31