“You didn’t get here overnight,” writes Claudia Black in her 2009 book, Deceived. It’s a solemn lesson, aimed at co-addicts, partners of sex and porn addicts—women, mostly—who are raised in households impacted by addictions of various kinds. Their childhood histories are “training grounds” for adult dysfunctional relationships, wherein such individuals engage in so-called co-addict behaviors: tolerating hurtful behavior, avoiding conflict, taking care of others, accommodating. Black describes a woman named Katy, a “perfect candidate for partnering with an addict”, who becomes compulsive in busy behaviors, attending to her children, her job, avoiding seeing and feeling, the anticipated rejection and abandonment by her sex-addicted husband (Black, 2009, P.85-86).
Profiles like the one above seem conducive to interventions that draw attention to patterns of dysfunctional behavior; patterns that implicitly predate the discovery of addictive behaviors by sexually addicted partners—this is according to adherents of the co-addict model, which is based upon the Al-anon 12-step recovery program. Treatment based upon this model prescribes self-examination for partners of sex addicts: examination of and responsibility-taking for repetitively destructive or self-defeating behaviors; examination of trauma repetitions, reenactments of familial scripts with the unconscious hope of creating new drafts in later life. The idea recalls certain 12-step slogans, such as the supposedly Einsteinian definition of insanity: doing the same thing over and over again, expecting a different result. This too is a derivative notion, echoing Freud’s concept of repetition compulsion, first published in 1914 at the outset of the First World War. The concept of trauma has gradually merged into the lexicon of psychology since then, reaching into or underlying our understanding of several mental health disorders, including addictions.
However, some practitioners and researchers might disagree upon the premises of partners of sex addiction treatment, and therefore differ significantly in therapeutic approach. In “From Victimhood to Victorhood” (published in the March/April issue of The Therapist), Alex Katehakis writes that a “major shift has occurred in treating partners of sex addicts”. The shift she describes is towards the Relational Trauma (RT) Model, in which practitioners emphasize that partners’ relational bonds are destroyed by betrayal, as precipitated by the discovery of sexual acting out—not a historical and ongoing pattern of destructive or self-defeating behavior by non-acting out partners. In the RT approach, practitioners eschew the implication that partners contribute significantly to an addiction by an elaborate, conscious or unconscious pattern of enabling. Such suggestions are misplaced and hurtful, if sometimes accurate, assert the proponents of the RT Model, while their interventions are by contrast comforting and affirming, emphasizing the depth of betrayal by a perpetrating partner. The champions of this position are The Association for Partners of Sex Addicts Trauma Specialists (or APSATS). Their members, as well as those of the hegemonic Certified Sex Addiction Therapist (CSAT) network refer to “sex addiction induced trauma” as a specified subset of a PTSD-like condition.
PTSD-like because while discovery of sex addiction has been deemed a life altering event and has even been demonstrated to be a traumatic event for partners, according to numerous researchers (Bergner & Bridges, 2002; Glass, 2003; Steffens, 2006), each stops short of applying the PTSD diagnosis, suggesting that many or most partners of sex addicts do not meet full criteria for the condition. A resulting controversy seems partly attributable to conflicting language in the DSM-V. Psychologist David J Ley argues that typical partners of sex addicts do not meet criteria of section C of PTSD code F43.10, “persistent avoidance of stimuli associated with the traumatic event(s)”, by pointing out that these partners often demonstrate “obsessive, ruminating fixation on the details of their partners’ betrayals and actions”. He states that the essential features of sex addiction—sexual betrayal, infidelity, lying—do not constitute trauma for partners, however repetitive these behaviors may be, and that describing them as such does disservice to those who need services relating to life threatening events. With respect to the diagnostic question, I observe that language in section E of code F43.10 indicates that “marked alterations in arousal and reactivity associated with the traumatic event(s)” do meet criteria for the diagnosis of PTSD. This includes hypervigilance, which would likely describe the partners Ley discusses in his writing. Perhaps at odds with the criteria of section C, this language of section E suggests that a more concrete understanding of “avoidance of distressing memories”, versus hypervigilance, is called for; or that alternating or interwoven patterns of avoidance and hypervigilance merit further discussion as features of partners’ clinical presentations.
Ley’s position is interesting in so far as it challenges the premise of the RT model, the sex addiction-induced trauma assertion. While the assignment of trauma to sex addiction may be debatable, it might lead us to consider what life altering events are brought on for partners by other addictions. Alcoholics and gambling addicts also engage in patterns of deception and blaming alongside their destructive behaviors, yet we do not hear of “alcoholism induced trauma” or “gambling addiction induced trauma” as it might pertain to partners or families of drinkers and gamblers. With respect to sex addiction, I’d suggest that it is not so much the presentation of PTSD-like symptoms that warrants a specialized assessment label, or the pervasiveness of deception, or even the ongoing denial of partners’ assertions that sex addicts often exhibit. Rather, I think it’s the nature of the behavior, the context of the lies and deflections—sex—that hurts so deeply. After all, what is harder for our clients to talk about than problems relating to sex? What elicits shame, triggers vulnerability, rage, more than this traditionally-cited root of psychoneurosis?
At least trauma has been codified into psychiatric nomenclature. The same can not be said of sex addiction and codependency, neither of which is delineated within the DSM-V, still. While proponents of RT and co-addict models appear to accept the existence and clinical relevance of sex addiction, or Hypersexual Disorder (as it was proposed to DSM-V committees), they differ with respect to codependency. Proposal for inclusion of a Codependent Personality Disorder was originally made by Timmen L. Cermak in 1986. The diagnostic criteria for the condition then included such statements as “continued investment of self-esteem in the ability to control oneself and others”, “assumption of responsibility for meeting others’ needs to the exclusion of one’s own”, “enmeshment in relationships with personality disordered, chemically dependent, or impulsive individuals”. Cermak’s proposal also included a category which outlined other symptoms, including “excessive reliance on denial’, and “hypervigilance”, which should sound familiar, as the language of the DSM-V criteria for PTSD appears to echo this juxtaposition of ideas/symptoms.
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA. American Psychiatric Publishing.
Bergner, R. & Bridges, A. (2002). The significance of heavy pornography involvement for romantic partners: research and clinical implications. Journal of Sex & Marital Therapy, 28, 193-206.
Black, Claudia (2009). Deceived. Hazelden. Center City, Minnesota.
Carnes, P. (1989) Contrary to Love. Hazelden.
Carnes, S., Lee, M. A., Rodriguez, A. D. (2012) Facing Heartbreak: Steps to Recovery for Partners of Sex Addicts. Gentle Path Press.
Cermak, T. (1986). Diagnosing and treating codependence. Minneapolis, MN: Johnson institute
David J Ley (2012, September) “Abusing the Term Trauma”. Retrieved from https://www.psychologytoday.com/abusing-the-term-trauma/
Durham, M.S. (2000) The Therapist’s Encounters with Revenge and Forgiveness. In “Psychological Repair: the intersubjective dialogue of remorse and forgiveness in the aftermath of gross human rights violations”. Journal of the American Psychoanalytic Association. Volume 63. Number 6. December 2015
Glass, S. (2003) Not just friends: Protect you relationship from infidelity and heal the trauma of betrayal. New York, NY. The Free Press.
Klein, M. (1975) Love, Guilt and Reparation and Other Works, 1921-1945. London: The Free Press, 2002.
Steffens, B. A., & Rennie, R. L. (2006) The traumatic nature of disclosure for the wives of sexual addicts. Sexual Addiction & Compulsivity, 13, 247-267.
Steffens, B. A., & Means, M. (2009) Your Sexually Addicted Spouse: How Partners Can Cope and Heal. New Horizon Press.