“I was a jerk,” says a patient about an argument with his spouse. He says the conflict was about dishes, and before that about whose turn it was to put the baby to sleep. Later, he reveals layers: he’s been trying to quit alcohol while his wife comes home drunk from a weekly “girls’ night”. He is further disentitled following her discovery of his recurrent porn use on their shared laptop a few weeks earlier. Their sex life has been negligible for nearly a year. They don’t talk about that. They argue about dishes.
In the treatment of compulsive sexual behaviors and their impacts upon loved ones, much attention is paid to the dual habits of pleasure seeking and conflict avoidance. Within the problem of conflict avoidance, an often employed if not directly identified habit is displacement, a defense mechanism first characterized by Sigmund Freud (1913) as that which transfers emotions from one idea to another to allay anxiety in the face of sexual and aggressive impulses. The alcoholic substitutes the bottle for the breast, gratifying an infantile oral impulse while disguising its expression. How does compulsive sex displace sexual instinct or substitute for it? Via perversion, Freud argued. Voyeurism, exhibitionism, fetishism, Don Juanism: these recurrent, habitual behaviors are all deemed unhealthy to one degree or another, but none is as “deviant” as an original sexual impulse from which the libidinal energy is displaced: incestuous desire.
Modern psychoanalysis does not insist that its unwitting patients engage in problem sexual behaviors because of an unconscious and unresolved Oedipal conflict, however much its adherents may think the theory still has merit. One derivative theory of displacement was popularized by Dr. Patrick Carnes in the treatment of what he terms sex addiction. Carnes (1983) explains that a sex addict holds negative core self-beliefs such as “I can’t trust anyone”, “no one would like me if they knew me”, and “my most important need is sex”. The antecedents of these beliefs are desexualized in Carnes’ model. The sex addict transfers onto ritualized sex his or her needs for companionship, tenderness, understanding, control and self-esteem; hence a rationale for a psychotherapeutic treatment that encourages patients to open up with their uncomfortable feeling states and seek alternative methods of affect regulation versus the “self-soothing” that compulsive sexual behaviors yield.
In diagnostic criteria and assessment protocols, “loss of control” is a sine qua non of substance use disorders and other addictive patterns. Amongst contemporary psychoanalysts who treat addiction, such as Dodes (2003), Director (2005), and Volkan (2021), a compulsive person’s loss of control is deemed paradoxical. The afflicted person seems drawn to experience that also appears to motivate an escape from the same phenomena. The alcoholic, sex addict, or compulsively “acting out” figure seems motivated to control an environment, other people; to seem omnipotent, in denial of “split off” states of vulnerability, of underlying helplessness. The result of their compulsive behavior, plus the indicator of a problem that merits treatment, is the loss of this sought-after control. Scrambling efforts to re-establish control are sometimes observed in extreme reversals, termed reaction formations by Freud (1907). The person with the escalating habit may adopt judgmental attitudes towards those who engage in the same problem behaviors. The impulse towards an opposing position (“I was a jerk”), or self-denial in the aftermath of a compulsive act, lessens the anxiety produced by the problem behavior in the first place.
The term “acting out”, often used by self-identifying sex addicts to denote a range of compulsive behaviors, is also derivative of psychoanalytic theory. Freud (1914) used the term acting out to indicate action that replaces memory, thought and feeling: “what is he acting out? His inhibitions, his attitudes, his pathological character traits”. This is a feature of the subject’s compulsion to repeat, in order to achieve mastery of trauma (via repetition), plus an unconscious desire to restore an original inorganic state (Freud, 1920). Death drive. An inclination towards insanity, “doing the same thing over and over again, expecting a different result”—self destructive action or tendency, a recovering addict might translate.
Regarding diagnosis, among the criteria for loss of control is the patient’s experience of “marked distress” related to recurrent behaviors and their impacts upon occupational or educational activity, or social and family functioning. Ley (2024) writes that it’s problematic if criteria for diagnosis is met simply because failure to control intense, sexual impulses or urges elicits distress due to moral incongruence based on religious values. Ley reports that he and others are pleased to see that the World Health Organization’s ICD-11 category of compulsive sexual behavior disorder (CSBD) features an exclusion statement for those whose marked distress is due entirely to moral judgments and disapproval about sexual impulses, urges, or behaviors. So, recurrent sexual behaviors should not be deemed out of control simply because they place someone at odds with religious dogma. But what about moral judgments that are not religious in pedigree, that are based upon a more fashionable Superego? What if, in the course of treatment, a subject is “educated” in a humanistic moral view which states that compulsive sexual behaviors demean and objectify women, or the view that CSBD induces betrayal trauma in impacted partners? If a subject is initially unmoved or unaware of the consequences of their behaviors but later exhibits distress because they’ve been taught that their behaviors harm loved ones and strangers, would they then meet criteria for the CSBD diagnosis? The question and grey area that’s being mined here is whether a person’s distress is externally-sourced and not the result of an internal conflict.
Psychoanalysis holds that assessment of that which is internalized is problematic when ideas are repressed and affects are dissociated. However, just because the subject is unconscious of internal experience doesn’t mean that distress isn’t in the psyche, there to be uncovered in treatment. The subject acts, repeats, instead of remembering, thinking, or feeling, and while Freud was not writing in the context of addiction per se when he conceptualized repetition compulsion, he may have provided with it the most important foundational idea in modern psychology pertaining to addiction. Further, this theory is relevant to treatment of impacted partners of sex addicts/those diagnosed with CSBD. Stephanie Carnes (2008) writes, “you may be questioning how your family background contributed to your choice to be in relationship with an addict. When older, it’s possible that you sought out mates who replicated aspects of your childhood”. In my experience, this kind of speculation is unpopular with some impacted partners, especially those who adopt a fixed, “your problem, not mine” attitude in treatment.
This patient’s idea for their own treatment is a palliative approach designed to offer emotional support and relief of suffering, not interpretations of underlying pathology that may lead to re-enactments of relationship problems. This is “victim-blaming”, assert clinicians who are allied to this position. Often, the result is a muddied clinical picture in which impacted partner patients are educated about complex trauma, which suggests developmental arrests that long predate the discovery of a partner’s compulsive sexual behaviors. Meanwhile, a preferred takeaway from treatment is that of an episodic trauma assessment and related syndrome, derived principally from the discovery-of-sexual behavior event, with long-standing lingering effects. The complexity is assigned to the extension of hyper and hypo arousal reactions to a variety of contexts, including “triggers” that don’t explicitly concern sexual behaviors. This patient feels threatened by any exploration of their pre-discovery, historical traumas, believing alongside their advocates that it will falsely mitigate the responsibility of their sexually compulsive partners.
A notable exception is their recognition of parallels to discovery events and prior clues towards disturbing problems. I find amongst impacted partners a tendency to remember instances in families of origin wherein family problems were denied or rationalized, or else censored from discussion until evidence of problems crossed a threshold—something like a discovery event—that compelled attention to the once ignored problems. These partners speak of “felt” experiences, times they knew something was wrong but didn’t protest, only to then feel betrayed and enraged when they later felt entitled to speak. Discovery of sexually compulsive patterns in their later partners does indeed replicate this history, they observe. One thing they won’t know is how this kind of phenomena was characterized in yet another psychoanalytic theory that has been paraphrased or re-branded by other models of treatment. What Freud called deferred action, or afterwardness as early as 1895, and what French psychoanalysts later called the apres-coup, refers to how sexuality in particular is transmitted in childhood via enigmatic messages, are constructed in fantasies, and are later presented in reality, the sexual-as-translated, which is then disturbing in effect. We don’t speak or even think of what we don’t or didn’t once understand, or that which is forbidden to speak of or think about. We speak about the dishes instead.
Graeme Daniels Psychewriter 