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Closing the Gap
Results from the Women’s Sexuality Survey
on Female Sex and Love Addicts
M. Deborah Corley, PhD
Sante Center for Healing
www.santecenter.com
[email protected]
1-800-258-4250
David L. Delmonico, PhD
Duquesne University
www.internetbehavior.com
[email protected]
412-396-4032
Objectives
Review results of Women’s Sexual Survey
differences between Non-FSLA & FSLA
Frequencies of Interest
Research Questions & Resulting Subscales
Hypersexual disorder/FSLA
Impact of Internet-Cybersex
Risk factors/Consequences of ACE
Health Issues/In Harm’s Way
Shame/Need for Affirmation
Clinical implications/red flags
Next steps in research – who will step up
FSLA / Women’s Sexuality Survey
Project in collaboration with Duquesne
University, Sante Center for Healing, and
Society for the Advancement of Sexual
Health (SASH)
Women’s Summit Group (14 women considered
experts in treatment of FSLA) developed 144
questions related to history, symptoms, acting
out behaviors, consequences
Survey on surveymonkey.com for 9 months
Over 500 valid responses (230 self-identified
non-addicts, 261 FSLA (95 SA, 166
Love/Relationship Addicts, 32 no selection)
FLSA Women’s Sexuality Survey 1
FSLA Group (n=261)
Non-FSLA Grp (n=230)
Average age 33
Average age 35
Range 18-73
Range 18-70
23% made >60K
16% had BA or above
90% heterosexual
55% com. Relationship
Average 7.2 years
33% made >60K
24% had BA or above
93% heterosexual
63% com. Relationship
Average 10.8 years
55% had no children
56% had no children
Mean – 1.02 children
Mean – 1.04 children
40% TX for sex problm
22% TX cybersex
problm
12% TX for sex problm
9% TX cybersex problm
Research Questions
Did the women who identified themselves as
female sex and love addicts also meet criteria as
outlined in other instruments (HBI, Kalichman
SCS, W-SAST)?
Were there differences on those scales for those
who identified self as sex addict compared to
those who ID self as love and relationship addict?
What if any was the impact of cybersex activity?
Were there factors that might highlight risk for
FSLA? (Adverse Childhood Experiences)
Research Questions 2
Were there similar consequences for ACE in our
groups?
What type of health consequences were present
for FSLA and were they different than the nonaddicts?
Did the addict groups put self “In Harm’s Way”
more frequently than the non-addict group?
Did the addict groups have more guilt/shame or
have a greater need for affirmation than nonaddicts?
FLSA Women’s Sexuality Survey 2
FSLA Group
67% feel bad abt sexual
behaviors
70% feel degraded
49% can’t control sex
desire
71% withdrawal sympt
67% compromised values
62% made failed efforts
to stop behavior
45% interferes with
family life
/responsibilities
Non-FSLA Group
23% feel bad abt sexual
behaviors
32% feel degraded
10% can’t control sex
desire
30% withdrawal sympt
21% compromised values
17% made failed effort
to stop behavior
11% interferes with
family life
/responsibilities
Measures
Hypersexual Behavior Inventory (Reid, et al,
2011)
19 item scale using 5-point Likert scale
Three factor model measuring control, consequences,
and coping associated with sexual thoughts, feelings
and behaviors. Reliability using Cronback’s alpha coefficient (Control a = .94, coping a = .90, consequences
a = .87)
W-SAST (Carnes, et. al., 2010)
25 item questionnaire, true/false response
Three factors measuring pre-occupation/loss of
control, relationship disturbance, affect disturbance.
Reliability scores a = .84
Sexual Compulsivity Scale (Kalichman, et al.,
1994)
10 item scales using 4-point Likert type scale endorsing
sexual thoughts, feelings and behaviors. Relability
scores from a = .86 - .87.
Subscale comparisons
Hypersexual Behavior Subscale (mirrored
items in HBI associated with control, coping,
consequences)
Three subscales assessing control (19 items, a =
.89), coping (15 items, a = .87), and consequences
(19 items, a = .85) associated with sexual
thoughts, feelings, and behaviors.
W-SAST (Carnes, et. al., 2010)
Same 25 item questionnaire, true/false response
Three factors measuring pre-occupation/loss of
control, relationship disturbance, affect
disturbance. Reliability scores a = .84
Sexual Compulsivity Scale (Kalichman, et al.,
1994)
8 items mirroring the SCS 10 item scales but with
true/false response
* p<.001
a = .89
* p<.001
a = .85
* p<.001
a = .87
Cybersex
(Corley & Hook, 2011, in press)
13.7% of sample identified self as having cybersex
problems
Participants spent average of 2.48 hr. per wk in
cybersex behavior (SD=5.52); 23.8 hr. per wk in
general use of computer (SD=19.59). FSA spent
significantly more time in cybersex behavior than did
FLRA and both addicted groups more than nonaddicts. Only small difference in ratio of cyber to
general use found.
The cybersex group spent significantly more time in
cybersex behavior than all other groups, experienced
more depression associated with their sexual
behavior, more withdrawal symptoms, & scored
higher on hypersexual behavior subscales.
Cybersex 2
(Corley & Hook, 2011, in press)
53% of sample exposed to pornography as a child
Participants who experienced childhood sexual abuse
or who were exposed to pornography were more likely
to report cybersex behavior.
Exposure to pornography as a child was stronger
predictor of hypersexual behavior than sexual abuse
as a child.
79% of cybersex group reported frequently visiting
porn website and chat rooms compared with 20% of
the addict/non-cybersex group and 6% of the nonaddicts.
58% of cyber group reported relying on abusive
pornography or fantasies to feel aroused, compared
with 16% of addict/no cyber, & 10% of non-addicts
Hypersexuality in Women (other studies)
N=2450 / 18-60 yrs of age /Sweden
IC M=5.1, SD=5.4 (men M=5.5, SD=6.2)
Mast. M=1.6, SD=3.3) (men M=4.9, SD=6.9)
Hypersexual women similar to men
Early on set of intercourse; impersonal sex
Relationship instability
Diverse sexual experiences/same sex partners
Paraphilic interests
STD infections
Smoking; Alcohol & other drug abuse
General dissatisfaction with psychological health
and life in general
Women – sexually abused as children
Langstrom & Hansom (2006), Archives of Sexual Behavior, 35(1), 37-52
Risks identified other places
Carnes et al, 2010
Relationship disturbances – relationship problems as result of
sexual behavior; associated with seeking help
Affect disturbances included periods of depression, anxiety,
feeling degraded or shame
Associated features factor, childhood abuse, engaging in
S&M, sexual problems of parents, sex with minors
CDC – Adverse Childhood Experiences
ACE = psychological, physical, sexual abuse; household
dysfunction (i.e. living with addicted or substance abusing
member of household, mental illness, mother treated
violently, criminal behavior
Consequences – the more ACEs have, the more risk for
smoking, substance abuse, depression, suicide attempts,
depression, > 50 lifetime sexual partners, STD, IBS, cancer,
stroke, other health risks
Risks identified other places 2
CDC – Adverse Childhood Experiences
ACE = psychological, physical, sexual abuse;
household dysfunction (i.e. living with addicted or
substance abusing member of household, mental
illness, mother treated violently, criminal behavior
FLSA Women’s Sexuality Survey 3
FSLA Group
54% child sex abuse
36% adult sex abuse
63% exposed to porn as
child
Non-FSLA Group
43% child sex abuse
25% adult sex abuse
41% exposed to porn as
child
Risks identified other places 2
CDC – Adverse Childhood Experiences
Consequences – the more ACEs have, the more risk
for smoking, substance abuse, depression, suicide
attempts, depression, > 50 lifetime sexual
partners, STD, IBS, cancer, stroke, other health
risks, living with violent partner
FLSA Women’s Sexuality Survey 4
FSLA Group
Non-FSLA Group
25% got pg from SA
18% terminated SA pg
7% fertility problems
33% got STD
13% got pg from SA
10% terminated SA pg
2% fertility problems
14% got STD
10.3% attempted suicide
42% used alcohol/drugs
during sexual behavior
71% stayed in
relationship after
became abusive
3.1% attempted suicide
23% used alcohol/drugs
during sexual behavior
43 % stayed in
relationship after abuse
Medical Subscale
Sex & Love Addicts = no difference
SLRA = different from normals
Medical Subscale (a = .54) (4 items)
In Harm’s Way
Sex & Love Addicts = no difference
SLRA = different from normals
In Harm’s Way (a = .92) (29 items)
Guilt / Shame
All groups p<.001
Guilt/Shame (a = .90) (37 items)
Affirmation
Sex & Love Addicts = no difference
SLRA = different from normals
Need for Affirmation (a = .84) (16 items)
Boundary Violations
among Women
Sex with a minor?
*Pearson Chi-Square p<.01
Sex with a subordinate?
*Pearson Chi-Square p<.001
Clinical Implications
Women Sex, Love & Relationship Addicts Exist
Some aspects seem differentiated between women
identifying as sex addicts versus love addict
Some aspects seem the same
Sex Addicts More Difficulties
Cybersex is worthy of a second look in women and
its contribution to sexual problems
Placing oneself in the way of harmy is worthy of
clinical evaluation – relationship to trauma?
Suicide assessment for women SLRA is a must
Women can and do violate others’ boundaries
Where to now with research
Utilizing Women’s Sexuality Survey
ACE lens
Prevention - In Harm’s Way
What women seek in therapy
A more negotiated therapeutic relationship
When asking about abuse think about ACE
questionnaires
Think more globally and ask more questions about
what the process means for all aspects of their
lives (family, work, self) – Level of Burden
Need to be encouraged to “find their voice” in
therapy. Careful attending and listening to their
decisions, choices, and experiences is essential
Tend to focus on the relationship and not the
treatment tasks; find ways to use the relationship
to increase motivation to change through secure
attachment with you as therapist
Help them identify authentic self, good enough
mother, reliable friend
Assessment Tools
Hypersexual Behavior Inventory
([email protected])
Women’s Sex Addiction Screening Test
(w-SAST)
(Carnes – http://www.sexhelp.com)
Internet Sex Screening Test
([email protected])
Kalichman Sexual Compulsivity Scale
(Kalichman & Rompe, 1995)
Washton/Sealy Questions for Multiple
Addiction
(JOHN [email protected])
CDC ACE (www.cdc.gov/ace)
Defining Hypersexual Behavior Disorder
Over a period of 6 months, recurrent &
intense sexual fantasies, urges, or sexual
behaviors (SFUBs) in association with 3 or
more of the following 5 criteria:
Time consumed by SFUBs interferes with other
important non-sexual goals, activities and
obligations
Repetitively engaging in SFUBs in response to
dysphoric mood states
Or in response to stressful life events
Unsuccessful efforts to control or reduce these
SFUBs
Disregarding the risk for physical or emotional
harm to self or others
Defining Hypersexual Behavior Disorder 2
Significant personal distress or impairment in
social, occupational or other important areas
of functioning associated with these SFUBs
These SFUBs are not due to physiological
effect of an exogenous substance (drug of
choice or medication)
Specific if:
Masturbation
Pornography
Sexual Behavior with Consenting Adults
Cybersex
Telephone sex
Strip Clubs
Other