Tag Archives: personality disorder

The Sex Addiction Personality

Talk about isolation. Aren’t they all in the closet, these so-called sex addicts? What else are we calling them, by the way? Ya know, what’s the underlying sh….stuff? What’s the personality upon which this pattern of miscreant behavior lies? Well, you know what to do. Make a few calls, talk to some people who say they’re trained in sex addiction (SA) because they’ve taken a handful of weekend courses. In one of their certificate-earning workshops an instructor may have covered the topic of personality pathology, or disorder. At this point, a few stats will have been brought out. About 65% of sex addicts will have also met criteria for narcissistic personality disorder, and another 20% will have narcissistic traits if not meeting full diagnostic criteria. And those subjects will likely be male, for the most part. I don’t know if the numbers will be that high—I’m making them up, of course. Anyway, although not studied very well (we must ever be reminded of this point!), female sex addicts are more likely diagnosed in greater numbers with borderline personality disorder, which is increasingly synonymous with PTSD because a lot or most of the former have the latter syndrome also. This means that while men in SA treatment are considered self-centered, objectifying, exploitative, and suffering from much concealed personal and especially sexual inadequacy, women are treated as having abandonment issues, having likely suffered sexual abuse and general societal disregard, and in their addictions they just can’t stop “loving” people to make themselves feel better.

             There. A bit simplistic, perhaps, but then I’m taking my aim at a field that is guilty of a whole lotta simplifying in my opinion so I’m mirroring them, to use a term employed to treat narcissists, actually. But don’t listen to me. Make your calls. Read the books that represent the “gold standard” of sex addiction treatment; the blurbs on the specialist websites; the bullet points within instructive blog essays that are nothing like mine. Tell me after you’ve done all your research that the above impression doesn’t stand as the orthodoxy of this field. It shouldn’t stand, you know, and not just because the orthodoxy relies upon stereotyped profiles borne of rote personality testing, inane questions like, “do you identify with the following: if I ruled the world it would be a better place (?)”, rather than clinical impressions formed over time in intensive relationship with and by someone educated and trained in what, after all, was originally (not mythically) a psychoanalytic concept. I’m referring to narcissism and borderline personality on this point, and the concept of Transference. However, there’s another reason why the typical personality narratives of sex addiction treatment should be challenged: they’re leaving out one important category.

             In Getting Read About Sex Addiction, I actually give this matter short-shrift, this being a secondary area of interest in mine and Joe Farley’s book—personality disorder, that is. If it weren’t for the offhand assignment of narcissism to so many addicts I might not have bothered, and one view I don’t venture is that high-profile, expensive, short-term treatment programs likely do serve a lot of narcissistic men, perhaps because they have money, lots of free time, and no doubt their powerful selves have rendered them attractive to affair-available women whom we should not profile as being drawn to narcissistic, powerful men because that is a.) not de rigeur, and b.) not very nice, whether it’s true or not. But there’s a lot of people out there, men and some women I figure, who are more porn-addicted than affair-seeking; more privately fantasy-seeking in the digital age; more in the cuts of 21st century society; exhibiting less bravado, if perhaps a similar, if more intellectualized disregard of using people for sex. There’s a word for this lesser spotted bird, this unicorn in the personality mix. It is a schizoid, not to be confused with a schizophrenic, and he (or she) is a thing, believe it or not. He (I guess I’ll go with another stereotype) has been written about for years, though it’s hard to say who was first to scribe on the matter.

             The first to make a labeling stab was Melanie Klein, who offered the term paranoid-schizoid to denote a “position” of development that entailed the defense of splitting (first termed by Freud), which in turn meant the keeping separate of good and bad internal objects (internalized caregivers, or parents), resulting in split object relations, the tendency to employ “mechanisms” that projected parts of self (unwanted) onto others so as to protect the ego and the idealized object. Klein was in fact influenced by W.R.D Fairbairn, an independently-thinking Scotsman whose conceptualizing wrought an “endopsychic structure” comprised of split objects allied to a split ego, yielding a fragile personality that seeks security in an inner world. It’s likely Fairbairn, not Klein, who gives us the idea of a schizoid that is nuanced from a paranoid (Klein), who is fundamentally withdrawn socially, prone to regression and especially isolation. Following Fairbairn, the likes of Wilfried Bion, while focusing upon psychotic processes, also observed the paradoxical contact-seeking need within this isolationist figure, and indeed regarded that such needs are intensified in tension with an aggressive withdrawal. Also, figures like Harry Guntrip in the sixties and beyond supplied clinical vignettes to help us understand the dilemmas of those who experience what Fairbairn termed a “futility” that manifests as apathy yet lies beyond the affective presentations of what we term depressive.

             Why this schizoid personality develops is unknown, or at least unclear. D.W. Winnicott, not talking about schizoid personality, wrote encouragingly of the capacity to be alone, deeming it a kind of developmental achievement. Winnie thought the analytic situation a recreation of this bond, at least potentially so. It is something to learn to tolerate, this being alone thing, and he thought that mothers who weren’t “good enough” (cheesy phrase, much attributed to him whether he liked it or not) impinged upon their children with their own needs. Beatrice Beebe, a contemporary attachment researcher, called something similar the “maternal loom”, referring to mothers who get in their babies faces too much, overstimulating them (hello, future sex addict, maybe?) causing them to avert their gazes, look at…something else. Lacan’s followers, following Freud’s premises regarding infantile sexuality, and speaking of what Lacan termed the imaginary register, called this tense, overexcited state a jouissance. Bowlby’s acolytes, those who assigned attachment styles like the resistant/ambivalent category, will have known what Winnicott was on about and thought less of infantile sexuality. Meanwhile, those observing avoidant styles of attachment might have glanced at the schizoid phenomenon, or else they might have brushed up on their Meier’s Briggs material, thinking it all reminded of introversion or, if neurological tests were called for, perhaps autism. These are some of the analogue ideas. Point being, schizoid personality is something of a unicorn: a rarely seen, oft-dismissed category of human being, preferably called something else.

             And yet, the internal conflicts that the schizoid faces (or doesn’t) are not rare at all. Indeed, it might be that average human travails mirror what psychologists James Masterson and Ralph Klein termed the schizoid dilemma and the schizoid compromise. To explain these terms: the schizoid dilemma is to seek closeness with others while maintaining autonomy, bearing in mind that schizoid personalities tend to privilege the latter over the former, rendering them strange and detached. Their “compromise” is to find that which achieves human connection but doesn’t surrender autonomy, hence fantasy plus a unique affinity for the digital age. Now, there are many in our midst who would argue that species do not evolve or even survive if they don’t confront such dilemmas and discover compromises. Our growth depends upon our capacity and longing for community. At the same time, our sense of humanity, which includes a craving for uniqueness, decrees that fitting in, absorption, dilution of the one by the group leads to another kind of death.

There’s a slight hint amid theoretical thinkers that a schizoid isn’t really sexual. Perhaps they’d had too much of the maternal loom once upon a time—like, around the time that giraffes start walking in their corresponding development. Later, they (babies, not giraffes) gazed back, but only on their terms, voyeuristically we think. It’s that gaze…you know, that one. But regarding this diagnostic question, you might wonder who will care. Really, will it matter whether porn or sex addicts are secondarily tagged as narcissistic versus schizoid, or even the largely feminized category of borderline? They’re all pathologies, aren’t they? So, while I wind down my commentary on Getting Real About Sex Addiction in the dawn of its publication, I’m aware of stirring the pot on a lesser controversy.  Seriously, the parts of the book that will truly ruffle feathers are those that diss short-term treatment solutions versus psychoanalytic method; or, it’ll be the thread of dog whistling commentary about the sex addiction field’s anti-male bias. Some won’t care if the text actually contains even-handed commentary on both sexes, plus a tinge upon sexual minorities. For them, if sex addiction treatment is to be pathologizing, then it must only be so in reference to heterosexual men. Anything else is to disobey the latest memos about moral equivalence.

Not that an attention to schizoid process (or cultural messages that simulate the attention) isn’t encoded in the semi-public dialogue anyway. Consider the rhetoric that accompanies identity politics: when a person is talked about as a victim or survivor, at least in part because they belong to a marginalized group, their advocates might still reference a schizoid process by referring to denied aspects of self. These will be the split-off aspects of self, which in the case of a sympathetic figure, will be his or her denied positive or resilient qualities that have been insufficiently nurtured and are therefore insufficiently recognized by the subject, hence what they need is building up, empowerment, etc. Meanwhile, those who are cast as addicts or perpetrators or some other disparagement may be described as having a similar intrapsychic process, only their denied qualities will fall under the umbrellas of guilt and inadequacy, hence what they need is bringing down, deflation, and so on. You could call this justice if you like but you might also notice the employment of psychoanalytic thought to support whatever cause you choose. Anyway, I’ll sign off for now on a relatively benign point of interest. Sex addicts: more schizoid than narcissistic, don’t you think?

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A Meeting of Trauma and Character

In a crude way, I think I have been caught within the divide that Candace Orcutt describes very well in Trauma In Personality Disorder.  For many years, while working in the field of substance abuse, I was assimilated into a clinical milieu that prioritized character work, more or less, while ignoring trauma work. Then, during the early part of the last decade, I was awkwardly moved to take the level I training for EMDR, the first third of which resembled a late-night infomercial. It was a heady atmosphere, with therapists and social workers enthusing over the prospect of diminishing symptoms in five sessions or less.

            Orcutt’s wonderful book is helping me melt the uneasy feeling that these two realms—character and trauma work—are mutually exclusive goals. No one ever said so directly, nor have I ever put that belief into words. But it’s been in the dialectics, somehow: the discussions between professionals working in teams, or voices heard at conferences, case presentations. Someone will speak of the need for boundaries, limit-setting with a patient, and on cue, someone else will counter with reminders about past traumas, the need for empathy and patience, as if these concepts were all at odds with one another.

I think it’s the same for readers of my novel, Crystal From The Hills. My protagonist, Chris Leavitt, doesn’t readily inspire empathy, largely because his characterlogical defenses (drug abuse, acting out, denial and regression) dovetail with dissociation, creating an aloof, if intriguing figure; a man who is difficult to reach, feel into.  

            I appreciate the breakdown of technique into the five steps: functioning, containment, strengthening, Cognitive and behavioral change, and insightful and dynamic change. There’s a common sense approach here, above all: the patient’s functioning, their surrounding circumstances, provides the “holding environment” for the work. An assessment of such circumstances is where the work starts. Secondly, containment: therapy draws attention to acting out, denying, blaming, substance abuse and other addictions, and the destructive consequences. In strengthening, a consciousness awakes, an afflicted individual starts to take responsibility; a therapist informs that setbacks may happen as a matter of the therapeutic process, or teaches relaxation techniques. The therapist doesn’t rush to provide insight ahead of the patient’s readiness. The patient realizes that the process of individuation occasions anxiety and sadness. Orcutt appears to paraphrase abandonment depression as part of trauma work.

            I appreciated Orcutt’s examples of confrontation of particular defenses. Most are readily understandable. It is even helpful to have each defense assigned a distinctive look and sound. The art of writing is to make ideas seem simple; the technique effortless. I know it isn’t. In the technique that is outlined here, the palette of interventions is widened. Therapeutic neutrality is flexed, and supportive comments and confrontations seem to live together in a therapeutic style. The case of Mrs. X called for many skillful interventions: confronting avoidance (p. 53, 55) and sustaining the thought as she defended against insight. Excellent. Integration is followed by a supportive comment from the therapist, a reminder that trauma distorts time, but that threats are no longer in the moment. Nicely illustrated. The case gets more vivid as Mrs. X becomes more anxious, starts calling the therapist in off hours, with panic about paralysis in her wrists, the fear that she is being held down. She abreacts. The therapist does some reality testing, followed by reassurance, encouragement. Reading this made me nervous, I have to say: this sounds draining.

            Yet the acting out isn’t done. Upon calling for hypnosis, Mrs. X “learns” of her father’s sexual molestation of her, and considers legal action, which would be undermined by the hypnosis, actually. In anger, she turns upon the therapist, who becomes a stand-in for a negligent mother. Like Chris Leavitt, perhaps, she is fascinating and disturbing all at once.

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