Dr. Michael Ian Rothenberg, LCSW holds a faculty appointment at the University of Central Florida School of Social Work where he teaches courses in Human Sexuality and Child Abuse Treatment and Prevention and is the Founder and Clinical Director of the Center for Counseling and Sexual Health of Winter Park (Orlando), Florida where he provides counseling and therapy for straight, LGBT, gay, lesbian, bisexual and transgender adults, children and adolescents and specialized treatment for sexual addiction, pornography addiction, hypersexual behaviors and male survivors of childhood sexual abuse. Dr. Rothenberg has served as a keynote speaker, conference presenter, guest lecturer and panel participant at venues including Yale University, Peking University (Beijing, China) and The German Society for Social-Scientific Sexuality Research (Munich, Germany).
Q. Dr. Rothenberg, what is the definition of sexually impulsive and sexually complusive behaviors?
Sexually impulsive behaviors which can include “acting out” sexually in illegal or inappropriate ways can be seen as being influenced by environmental triggers such as a sights, sounds and smells. With sexually impulsive behaviors, there is an inability to resist an impulse, tension before engaging in the sexual behavior and a sense of release upon exhibiting the sexual behavior.
Sexually compulsive behaviors, or those behaviors that are sometimes characterized as hypersexual behaviors, can be seen as increased sexual thoughts and behaviors that can have negative or deleterious effects on an individual’s life. Rather than being triggered by environmental factors, sexually compulsive behaviors are often organic in nature.
Sexually compulsive behaviors are performed to avoid feelings of tension or increased anxiety. One might also describe sexually impulsive, or environmental, triggers as being “macro” and sexually compulsive behaviors as being “micro’ in nature.
Q. Are they are sign of general immaturity in adults?
Sexually impulsive behaviors are not necessarily signs of immaturity in adults. Sexually impulsive behaviors are also seen by some mental health practitioners as a type of impulse control disorder or paraphilia related disorder.
Q. Are alcohol and drugs catalysts for these behaviors?
Alcohol and drugs can sometimes be seen as catalysts for these sexual behaviors because, as a rule, they can lower inhibitions and, as such, can lead to an increase in sexually impulsive behaviors that can be harmful to an individual or to others.
Q. Are these a young adult behavior or do we also see this in teens?
Clinically, we see these sexually impulsive behaviors not only in teens and young adults but also in middle-aged and older adults as well.
Q. What is the treatment for these conditions?
Though there is currently no diagnosis in the DSM-IV that specifically addresses hypersexual behavior disorder, impulsive sexual behaviors or compulsive sexual behaviors related to internet pornography, challenges persist for clients and these topics are often mired in controversy. It is encouraging that Hypersexual Disorder is being discussed as a condition that is recommended for further study for possible inclusion in a future edition of the Diagnostic and Statistical Manual of Mental Disorders. Currently, preferred treatment for impulsive sexual behaviors includes a combination of individual, couples and group therapy along with medication.
Q. Dr. Rothenberg, how would you differentiate sexually impulsive behaviors and sexually compulsive behaviors versus promiscuity? Are we talking about the sheer number of sexual partners?
Speaking as a Clinical Sexologist, I do make a concerted attempt to avoid subjective words, like promiscuity, which can, oftentimes, be deemed moralistic or judgmental in nature. There are, indeed, many men and women who vastly enjoy and, wholeheartedly, embrace their sexuality, have, what might be considered, traditionally, a much higher libido than others, and who, for differing and personal reasons, have a healthy sex life with many sexual partners.
The great difference is that with sexually impulsive behaviors, rather than the aforementioned reasons, individuals are unable to resist an impulse to engage in sexual behaviors and this impulse is often brought about by a trigger in their environment.
The primary difference between those individuals who engage in sexually compulsive behaviors and those men and women who have active sex lives with multiple partners is that rather than thoroughly enjoying their sexuality and sexual activity on all levels, the individual is, instead, engaging in sexual behaviors to avoid feelings of tension and anxiety.
Q. How is being sexually impulsive or sexually compulsive different than being addicted to sexual encounters?
Depending upon the circumstances driving the sexual thoughts and sexual behaviors, being either sexually impulsive or sexually compulsive are, in fact, two alternative ways to describe what is commonly referred to, in the nomenclature, as sexual addiction.
Q. How does a person’s being in a steady romantic relationship affect sexually impulsive or sexually compulsive behaviors?
Because these hypersexual behaviors include a neurochemical reaction, the brain seeks ways to keep a steady flow of the neurochemicals that increase the very powerful sense of reward and pleasure. The sexual encounter that one would have with one’s partner or spouse cannot replicate the intensity and the duration of the neurochemical reaction that an individual would obtain from seeking sexual encounters outside the relationship.
Whether viewing hours of pornographic imagery, engaging in lengthy online sexual chats or cyber-sexual video-chats, perusing online personals or phone apps for potential sexual partners or driving to meet individuals for sexual encounters, the individual is receiving a steady flow of these powerful neurochemicals and, because of the immense feeling of pleasure and reward, the brain wants these chemicals to continue to flow.
Sexual addiction, therefore, is really about the “seeking” in that the brain is seeking a continuation of the neurochemical reaction for as long as possible. When we’re talking about sexual addiction we’re actually talking about an individual being addicted to their own neurochemistry.
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