Subscribe to Lemonada Premium for Bonus Content

Description

Often when we hear about sex addiction, it’s used to excuse or justify bad behavior. In the last couple of years we can look to stories like Jeffery Toobin, Harvey Weinstein, and the Atlanta shooter Robert Long as examples of this. So how can we recognize and support people living with sex addiction and the stigma that comes with it? Nzinga talks to psychologist, sex expert and host of Sexology Podcast Dr. Nazanin Moali, to define sex addiction and pathways to recovery. Plus, Nzinga and Dr. Moali answer a listener question.

 

Please note, In Recovery contains mature themes and may not be appropriate for all listeners.

 

Click this link for a list of current sponsors and discount codes for this show and all Lemonada shows: Sponsor Links

 

Have an addiction-related question? We want to hear from you! Call 833-4-LEMONADA (833-453-6662) or submit your question through this form:  bit.ly/inrecoveryquestions

 

To follow along with a transcript and/or take notes for friends and family, go to www.lemonadamedia.com/show/in-recovery shortly after the air date.

 

Follow Dr. Harrrison on Twitter, IG, and FB @naharrisonmd

 

Stay up to date with us on Twitter, Facebook, and Instagram at @LemonadaMedia.

Transcript

SPEAKERS

Dr. Nzinga Harrison, Jordan, Dr. Nazanin Moali, Claire Jones

Dr. Nzinga Harrison  00:05

Thank you all for joining me today. This is Dr. Nzinga Harrison and I’m your host of IN RECOVERY This week we are talking about sex addiction. And I’m so excited to have one sexology podcast host, Dr. Nazanin Moali. She’s a clinical psychologist, sex and relationship expert with additional training in eating disorders and addiction. In addition to all of that, she’s a published researcher, and regularly speaks at major universities and international conferences. So we are going to pick her brain about what sex addiction actually is, how we know to have concern about ourselves or someone else in our lives, and where to get help if we do.

Dr. Nzinga Harrison 

Dr. Moali, so excited to have you on this show for a topic that a lot of people have a lot of questions about, so welcome.

Dr. Nazanin Moali 

Thank you, Dr. Harrison, it’s my pleasure to be here.

Dr. Nzinga Harrison 

Jumping right in, sex addiction often comes up as justification or an excuse when we see these explosive kind of quote unquote bad behavior, stories in the news, whether that’s like, the Atlanta shooter, Robert Long, or Jeffrey Toobin, or Tiger Woods. And so I want to use this episode for our listeners to really give a clear definition of what sex addiction is, what the symptoms of those look like, how do you intervene if you recognize those symptoms either in yourself or someone you care about? So maybe we start with the very first, which is the real definition of sex addiction.

Dr. Nazanin Moali 

Thank you so much for this opportunity. So how we define sex addiction in general, as when people have this out-of-control sexual behavior. It’s in our DSM newest version of DSM, which is the reference book that we use to help people to get diagnosis and get clarification around the struggles that they have. What’s interesting that they were not able to find enough research, so they can put this diagnosis in the DSM-5. But what we use as sex therapists as when people have out of control sexual behaviors, so it’s more of a subjective experience. When you feel your sexuality is out of control, you’re doing the behaviors that are not aligned with your values, at times they are harmful to yourself and to others.

Dr. Nazanin Moali  02:42

Unfortunately, many times people use this diagnosis, as you mentioned, as an excuse for bad behaviors, doing things that are illegal, but it could be a range of different behaviors that it could be when people are masturbating excessively, and it’s harming themselves or harming the relationship. At times people act out on a ways that they’re destructive for themselves and for the relationship. So it’s a more of a subjective experience of if your sexuality feels out of control in the literature and sex addiction.

Dr. Nazanin Moali 

People who define sex addiction, they define it as when people are doing behaviors that are kind of like the previous behaviors are no longer satisfying. And they’re doing more riskier and riskier behavior. But what’s problematic with that definition is that sometimes our sexuality evolves. And that’s completely okay. And if it’s not interfering with our relationship, with our mental wellness, then that can be normal.

Dr. Nzinga Harrison 

So many things there that I want to kind of emphasize that you put on. So the one was you said, not in keeping with your beliefs. And so I think a lot of where people struggle and wonder is this a sex addiction is because they may be having sexual behaviors that are not in keeping with broader beliefs, and are being having stigma attached to them. So you mentioned masturbation, and then the other thing you said was causing harm to your mental health or your relationships or otherwise negative consequences. And so one person may have a set of behaviors that’s incongruent with their beliefs and  causing harm in their relationships that would meet criteria for sex addiction. I’m not saying this like this is a question but this is a question and somebody else could have the exact same and it wouldn’t meet criteria for sex addiction.

Dr. Nazanin Moali  04:38

Yes, so I think it’s a value again, we don’t call it sex addiction. We call it out of control sexual behavior, but you’re absolutely right. At times I have couples coming in saying that my partner has a sex addiction but when they are in my office, we’ll realize that one of the partners aren’t comfortable with the partner watching porn, and that they call it sex addiction. And so you’re absolutely right that perhaps at times, we’re not comfortable about our fantasies about our kings about fetishes. And then we, because of the shame, the way we want to justify it, we call it sex addiction, which could be a normal part of human experience.

Dr. Nzinga Harrison 

So you talking about that couple, that theoretical couple in your office where one person is not comfortable with the other person watching porn. Leads me directly to this question, which is, how can you tell if it’s, quote, real, or if it’s quote, an excuse? Well,

Dr. Nazanin Moali 

it’s a tough fund, right? Because it’s a subjective experience, if the partner really feels that their life, like sexuality is out of control, then that would be within the realm of our control sexual behavior. But it’s interesting, if the person feels that way, then there’s some relational challenge, there is some distrust in the relationship. At times people use this as gaslighting. I have clients that they had multiple offers for a number of different reasons, maybe there are some personality challenges, perhaps there are some attachment issues, and they use this as an excuse to get out of accepting and being accountable for their behavior. So for some people, it could be a way that they manage their emotion. So with my clients that they are struggling with out-of-control sexual behavior, sometimes it’s rooted from trauma, and the trauma that we’re having pushed us to do these behaviors that is not healthy for our sexuality based on the person’s experience.

Dr. Nzinga Harrison  06:40

We actually had a woman in Season 1 who called in with a question and it was exactly that she had experienced very significant sexual trauma as a young child, and then in her 20s in college developed masturbation addiction, that was really like interfering with her ability to perform in school. And so how do you because it sounds like when we, we have the same difficulty in substance addiction, kind of with the subjective part and the objective part, but there are some objective measures we can look at, right?

Dr. Nzinga Harrison 

Like if I’m talking about alcohol use disorder, I can look at liver enzymes or I can look at a drug screen. If I’m talking about an opioid use disorder. I know whether you had an overdose. And so how do you Dr. Moali as a sex addiction expert, kind of tease apart? What might be miscommunication between a couple or what might be behaviors that are, quote within the realm of quote, normal, but the person is having some conflict? Because of stigma? How do you tease that apart for people?

Dr. Nazanin Moali 

Such a great question, Dr. Harrison, I worked at different levels of care for substance use. And I know sometimes with substance use, we have this objective measurements. And as you said that tests and even psychological assessment that we know what is dependent, what’s abuse, or now what is considered unhealthy, was challenging with sex addiction, that we try to do a number of different studies on brain imaging. And we were not able to find the same pathways that get laid out for addiction and as a current process addiction, specifically, this form of process addiction which is sex addiction, we have clearly have that for gambling addiction, but we don’t have that for sex addiction for that’s why for this right now, with the information that we’re having, we going based on subjective experience of a person.

Dr. Nazanin Moali  08:45

So when a client comes to me or a couple comes to me and they say that this has caused an issue for me. You’re absolutely right. I had clients that for hours, they masturbate, and it leads them to not show up to go to work, or perhaps it caused issues in their relationship with sexuality are not able to be intimate with a partner. And that is a sign that this is not working for them, regardless of the measurement, right? So I think we want to have, we are going to create a life based on our values, things that works for us. And when we’re noticing these behaviors, cause issues rupture in our relationship cause rupture in our work, then it is a problematic realm.

Dr. Nazanin Moali 

And as you mentioned, that trauma could be one of the reasons that people are seeking comfort and in doing this behaviors, and it’s very different when you are using kind of like as sexuality kind of masturbating, compulsory kind of like sexual behavior as a way to call yourself because it’s not relational. You are almost in this trance, you’re not in a sexual interaction with someone else you’re in your mind and the same way that when someone is using substances when they’re shooting heroin, they’re not in the moment. They are kind of in their world. It’s the same with people are struggling with things. So it’s an opposite of being relational and you are stuck in your mind and disconnected with your surroundings.

Dr. Nzinga Harrison  10:13

Yeah. Okay, let’s take a quick break and jump into this when we get back.

Dr. Nzinga Harrison 

Okay, Dr. Moali, so jumping back in where we left off, how do people know when to get help or to ask someone that they care about to get help? And it might start with exactly what you said before the break, which is when it’s not relational?

Dr. Nazanin Moali 

Absolutely, yes. Not relational is huge. The other piece is like you’re doing things that are not congruent with who you are, right? That like you are having sexual interaction, like manipulating people, lying to get in bed with them. And that’s not who you are. That’s not the kind of person you are. Or perhaps you find it harder to be with partner, I see it lot. Because you mentioned that it’s, it’s not about being relational, right, I have couples that are coming into my practice, they rather masturbate because it’s less relational.

Dr. Nazanin Moali 

So they go to kind of like to the fantasy, so they’re not with a partner in the moment there. The other thing is like when our mental health challenges are driving this behavior, when our anxiety, ADHD, other addiction, kind of driving this behavior, that this is not coming from the place of healthy sexuality. So these are the few signs that shows that when these things are going on, perhaps you need support with getting out of this pattern.

Dr. Nzinga Harrison 

How do people find help for a condition that is super stigmatized?

Dr. Nazanin Moali

Knowing that, first of all, that your sexual health is important. And there was a study that showed that 40% of general population at some point in their life does struggle with their sexuality. So you’re not you’re not alone, right, you’re a huge number of people are struggling, and asking for help. It requires lots of courage, but you are helping yourself to get out of this situation, whether you’re working with a sex therapist, or someone that specialized in this area. This is what they do. Like they have lots of tools and strategies that can help you to get out of that place.

Dr. Nazanin Moali  12:30

Even a good first step would be listening to podcasts similar to this kind of listening that what our experts are talking about it. And when you find someone that the content resonate with you may be read more of their material and see if that’s speaking to you is congruent with what you want. But gathering information is really, really important. And you’re absolutely not alone. There’s so many people that are struggling with this.

Dr. Nzinga Harrison

That statistic is so impactful. 40% of people at some point in their lives has struggled with their sexuality. I think of that the same way as the suicide statistic that says 1 in 10 people has seriously thought about suicide, because we make it seem like you’re the only one. And what Dr. Moali just told us is we are not the only ones 40% of us. Right?  That is so powerful. And so one of the things I know people worry about and one of the fears we have and the stigma we have is like if I have a sex addiction, does that mean I’ll turn into a rapist or I’ll turn to a pedophile? Or I’ll turn into an unfaithful spouse, like all of the worst case, types of fears that we have around sex. And so can you talk to us about what the connection is between sex addiction, and those other very scary behaviors?

Claire Jones  

Especially with so much of what we see about sex addiction in the news and publicly being people who have done bad things, blaming it on their sex addiction.

Dr. Nazanin Moali  14:05

Such a great point that that you guys brought up? Right that sometimes as I mentioned, people are using this as an excuse for bad behaviors. And many people that I see that are struggling with out-of-control sexual behavior, it’s mostly harming them. Right? Like they’re watching lots of porn, and it’s harming it. And I’m not saying it in a dismissive way, but it’s harming their health. It’s harming their work. And majority of people I don’t think they turn to be a child molester or doing all those horrible things. Those are other mental health challenges that people are having. But what happens is that when we are there’s an aspect of us that we don’t like, and we continue to try to repress that it shows up in different parts of our life. But it’s not about like, I don’t think it’s like a one-on-one correlation that like you’re hooked on porn and next you’re going to be a child molester that we don’t have any evidence for that.

Dr. Nzinga Harrison 

Good. I think that’s really the fear and not necessarily people have that fear about themselves, but they have that fear about others.

Claire Jones 

Okay, we’ll be right back with Dr. Moali after we listen to a couple of ads.

Dr. Nzinga Harrison 

All right, we’re back. We have a question from a listener that we’d love for you to answer Dr. Moali.

Jordan 

Hi, my name is Jordan. Personally, I’ve struggled a lot with different various addictions. But one that I hadn’t really realized was an addiction until probably this past year was dating apps. I grew up in Wisconsin, in not a super urban area. And as a gay kid, things were not easy for me. And I think in middle school, once I got a smartphone and stuff, I immediately kind of use that as an outlet to connect with people in a way that I didn’t feel like I was allowed to. And I think probably by the time I was in seventh or eighth grade, I was I kind of had developed this transactional idea about sex and sexuality.

Jordan  16:39

I even was sexting I guess, at that age, and using various apps to connect with other gay teenagers, I guess. And sometime, not teenagers. And so I was becoming addicted to the dating apps. And I was on Grindr and Tinder and Bumble and Hinge, or anything you can think of pretty much, I guess. And I guess my question is, recently I deleted them for good. Finally, I guess I’m hoping. And I guess my question is, how do I move on? Like, I guess I let go and recognize that it was an addiction and validation that I was getting in this transactional thing, whether it be sexting or sex itself, how do I rebuild a healthy mindset in my brain, because I think I still really just kind of avoided it.

Jordan 

Now after I just I deleted that I just kind of don’t think about it. But I haven’t really replaced what I was getting from that addiction with anything healthy, and I still struggle with thinking about sex and invalidation and dating. It’s all really, it makes you feel really vulnerable. And I don’t I still feel like I’m not exactly sure where to go, I guess. So, I hope that was detailed enough. And I provided a good explanation. And I hope maybe you can answer my question. Thank you.

Dr. Nazanin Moali  18:18

What a rich question. I love that this person shared this part of themselves with us. So, so beautiful. Dr. Harrison, I have few thoughts. Can I share that?

Dr. Nzinga Harrison 

Yes, please jump right in. Excellent.

Dr. Nazanin Moali 

So I see this a lot that this behaviors can turn to this form of validation. So there is a void inside there is something going on that’s unmet. And we haven’t addressed that challenge. And then we’re seeking validation through the sexting. This is this lesson I mentioned, transactional way of connecting with people that in the moment is rewarding, but I know working with hundreds of people and similar situation that leads to guilt and shame and feeling of dissatisfaction. So I think this is a wonderful step that this listener deleted these apps that’s important.

Dr. Nazanin Moali

But similar to what he mentioned, it’s important to kind of think about what kind of a needs I was getting met through this app? What was it that I enjoyed getting out of this? Was it being with other people, or if it was from the childhood wound that I had, or previous trauma, that I was seeking this rush and excitement? I think that’s really, really important to identify, and our sexuality is important. So of course, we don’t want you to white knuckle this. My invitation for the […] is to create a sexual health plan, kind of thinking about what kind of a sexual life, sexuality I would like to have. What would that entail, whether it’s kind of like being in a committed relationship or with a partner that’s truly see me and sexuality is part of that, and also kind of creating this plan that will prevent you from going back to that app.

Dr. Nazanin Moali  20:07

So that kind of, perhaps if their anxiety is an issue, working on anxiety management challenges, many, many of my clients that they are seeking their attention through the dating apps, sometimes they can benefit from fine tuning their relational skills, kind of thinking about what do I need to learn to thrive in a dating scene that could come from working with a therapist who has gone from going to the group, so you will learn the skills required for you to be able to have the relationship that you want to have, but my invitation for you is like, perhaps maybe take a 30 to 60 day break from these apps, making this commitment that I’m not going to go there and focusing on addressing the underlying challenges that was making these apps. So exciting and interesting for you.

Dr. Nzinga Harrison 

Dr. Moali, I know you have to go. But I wish you could stay because this has been so amazing. So we probably just have to do a part two.

Dr. Nazanin Moali 

I would love that. Thank you.

Dr. Nzinga Harrison 

Thank you so much for being here. That answer was so helpful, and hopeful, which I think we often miss when we’re talking about addiction. So thank you.

Dr. Nazanin Moali 

Thank you so much.

Claire Jones 

We’ll definitely have a part two.

Dr. Nazanin Moali 

Thank you.

Claire Jones 

So listeners, send in all your sending all your sex addiction.

Dr. Nzinga Harrison 

I literally want to do a sex addiction AMA with Dr. Moali

Dr. Nazanin Moali

I would love that. Thank you so much for having me here. And thank you for this opportunity.

Claire Jones 

So Nzinga, I have listened to Dr. Moali’s podcast, quite a bit, actually, before she even came on the podcast. So I’m already quite a bit of a fan girl. But I am curious to hear what your biggest takeaways from our conversation with her are and what your general thoughts are.

Dr. Nzinga Harrison  22:11

Yeah, I’ve really loved her compassionate approach. So oftentimes, when you hear people, as she corrected me, she said, We don’t call it sex addiction. We call it uncontrolled sexual behaviors. A lot of times when we hear people talking about this topic, even if they’re not saying judgmental words, you feel like you can kind of sorta hear it or feel it. And that was just 100% absent from her, like she was totally the person that you could go in her office and say, I’m worried about this sex related behavior that I’m having. I think what was really poignant about what she said was kind of what we’re continuously trying to reinforce on in recovery is that it comes from somewhere, one, so root causes, which are different for everybody, but certainly can be associated with childhood trauma, adverse childhood events, depression, anxiety, other untreated mental health needs. So root causes for sure.

Dr. Nzinga Harrison

And then she touched on a bit, she didn’t call it the magic formula, but that’s what we call it on this show, about how you get to it. And she really put an emphasis. So we talked about biological, psychological, social, cultural, political, I really felt her emphasis on cultural when I asked the question, how do you know if it’s a problem, because we don’t have like a blood test, we can draw, or we don’t have a set of DSM criteria that we can go to. I thought that was so powerful, because we have a lot of preconceived notions that we’ve been trained into about what sexual behaviors should be what sexual behaviors should not be. And she really was just emphasizing, like, you can define what healthy sex behaviors are for you, but at the point that you become uncomfortable with your sexual behaviors or sexual thoughts, or at the point that starts interfering with your relationships or interfering with your life function and other ways, is the way that she was describing That’s how you know it might be becoming a problem.

Claire Jones  24:35

Yeah, I think that was the part of it that I liked the most so much to was like, you know, part of what makes this I think a more complicated issue is that it doesn’t have a criteria in the DSM five, like a lot of other addictions that we talked about. It doesn’t have a mild or moderate or severe, sort of like, step numbered process. It’s like, You are the one that gets to define what your threshold is for yourself. And that’s part of why it’s complicated. But I also think it’s like you get to sort of set up that boundary for yourself. And therefore, if you were the person who is really comfortable having sex and multiple times a day, that’s great. If that is one that feels good for you, that’s amazing. But if you’re the kind of person where having that much sex is detrimental to your life, or is affecting your relationships in a negative way, then maybe it’s something that needs to be addressed. I think it really goes hand in hand with the way that we defined addiction early on in this show, which is like a continued behavior, despite negative consequences, it’s like that can apply to anything which I think she really highlighted well, in our conversation with her.

Dr. Nzinga Harrison 

Importantly though there, although we’re emphasizing like you are doing things that you wouldn’t necessarily due because of either thoughts or sexual behaviors as being kind of like a flag, that you may be having trouble with this. She really also did emphasize, and I think this is important that part of that is the way we’re interacting with others, right? So like for those people who are important to us, whether that’s a significant other or a spouse, or somebody else in your life, she’s like, you know, if you’re engaging in sexual activities, and it’s losing the relational aspect, I thought that was a really kind of like nuanced point that she was making that was like, if you have typically been engaging in sexual behaviors as part of a relationship.

Dr. Nzinga Harrison  26:41

And now your sexual behaviors are starting to create space in that relationship. That’s another way that you might be like, even if you’re thinking to yourself, I don’t see any trouble with this. This is kind of how we think about the cage when we talk about substance use disorder. And that A is have you ever been annoyed when somebody else mentioned it to you? I feel like that’s kind of along the same spectrum. Even if you maybe can’t recognize for yourself yet that the people around you start recognizing that this sexual behavior or this sexual thoughts, whatever they might be, are starting to kind of change how you interact with them. Hmm, I want to bring her on foreign asked me anything for an AMA listeners, if you like this idea, then just go ahead and flood us with all of your questions. And then we’ll get her on to do that, because I have my own questions totally.

Dr. Nzinga Harrison 

We didn’t get a lot into treatment. And so this is why I would love to bring her back also, because I am not a sex expert. Although we can definitely apply a lot of my knowledge from substance use disorders to sex addiction, there are some specific types of therapies that have been shown to be helpful. And so I just wanted to run through a few of those for our listeners, and then invite Dr. Moali back so we can get some in depth expert opinion on these. So one is definitely like we always say, out of control sexual behaviors. Thank you, Dr. Moali. So there have been some specific types of interventions that have shown to be helpful for people who are experiencing out of control sexual behaviors.

Dr. Nzinga Harrison  28:27

One, going back to this idea of root cause, so you always hear me saying like, please, please, please see a psychologist, see a licensed clinical social worker, see a sex therapist, in this case, see a psychiatrist to get evaluated for depression, anxiety, trauma, other mental health conditions that might be contributing to an inability to control your sexual behaviors. Second is, cognitive behavioral therapy. So you know, CBT, as it is affectionately known as, is really figuring out how your thoughts affect your emotions, affect your behaviors, affect your thoughts, affect your behaviors, affect your emotions, affect your thoughts. So think of that kind of like on a three-point triangle that can whip itself around.

Dr. Nzinga Harrison 

A lot of times you won’t even realize what’s triggering you to have thoughts sometimes it’s an emotion that triggers a thought that triggers an out-of-control sexual behavior. Sometimes it’s an out-of-control sexual behavior triggers that emotion, triggers the need to relieve that with another out-of-control sexual behavior. And so CBT is a way to kind of like, investigate the connection between your thoughts, your emotions so that you can open up some space between your thoughts and emotions. That gives you a chance to choose what behavior you’ll engage in. Next, and then group therapy, individual therapy support groups, some people certainly have sexual behaviors that are out of control enough that warrants like an inpatient stay.

Dr. Nzinga Harrison  30:06

And then there’s a specific therapy that we use for trauma because there’s a significant overlap here that’s called EMDR. Eye Movement Desensitization and Reprocessing. You know, if you’re listening to this episode, and you have concern for yourself, or you have concern for somebody that you care about, there are a lot of good resources on the web, like I said, with Dr. Moali. She pointed us to some that we can trust. But the point being, take the risk, we always say this, take the risk to ask for help, because there actually are experts like Dr. Moali that can help.

Claire Jones 

I think that’s great. So if you also want to have Dr. Moali on for a second episode, you should send in your questions about sex, or addiction, or eating disorders or any of those subjects. If not, Nzinga and I will just send all of our questions. It’ll just be a free for all within Nzinga and I and Dr. Moali. But as always, you can send your questions to our voicemail at 833-453-6662 or our Google form, which is bit.ly/inrecoveryquestions. And we will see everyone next week. Thank you.

CREDITS

IN RECOVERY is a Lemonada Media Original. This show is produced by Claire Jones and edited by Ivan Kuraev. Jackie Danziger is our supervising producer. Our theme was composed by Dan Molad with additional music by Kuraev. Stephanie Wittels Wachs and Jessica Cordova Kramer are our executive producers. Rate us, review us, and say nice things. Follow us at @LemonadaMedia across all social platforms, or find me on Twitter at @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help to stigmatize addiction together.