Like drug addiction, sex addiction takes many forms. Among the most common, and among the most isolating and shameful, is compulsive masturbation. This is true for both male and female sex addicts. Of course, masturbation itself is not an unhealthy act. In fact, for most individuals it is a healthy part of sexuality. For sex addicts, however, compulsive masturbation (with or without porn use) can spiral out of control. Some compulsive masturbators have regular times to masturbate – when they wake up, in the shower, before lunch, when they get home from work, before bed, any time they’re alone, etc. Others are binge masturbators (much like a binge drinker), periodically disappearing into fantasy and masturbation for hours on end. Often, binge masturbation sessions are fueled by drug use – usually stimulants like meth or cocaine. Male compulsive masturbators may also abuse Viagra, Levitra, Cialis, and other erection enhancing drugs.
Like addicts of all stripes, compulsive masturbators engage in their addiction not to feel better, but to gain a sense of control over what they are feeling. For them, masturbation is a coping mechanism utilized less for self-pleasure and more for escape, self-soothing, and emotional distraction. In other words, compulsive masturbation is a way to avoid the emotional and/or psychological discomfort caused by life stressors and underlying issues like depression, anxiety, and unresolved childhood abuse, neglect, and trauma. Most often compulsive masturbators learn in adolescence (though sometimes earlier or later) how to use/abuse the intensity of sexual arousal and masturbation to mask and distract from emotional discomfort. Over time, especially in a “chronic stress” household (a house with ongoing substance abuse, neglect, mental illness, physical abuse, sexual abuse, etc.), a person can learn to use masturbation as his or her go-to “coping response,” an escapist answer to any and every form of pain and discomfort, including issues as seemingly benign as boredom or loneliness.
Many compulsive masturbators try to either limit or eliminate masturbation. Unfortunately, much like alcoholics trying to wean themselves off drinking, few achieve lasting change without outside assistance. Even worse, their behaviors tend to escalate over time. (Escalation is common with all forms of addiction.) Some masturbate more frequently, some masturbate for longer periods of time, and some up the ante by viewing progressively more intense/bizarre images or engaging in progressively more intense/bizarre fantasies. Many, perhaps most, do all of the above.
Without help, compulsive masturbators typically continue their behavior despite their desire to stop, even when they experience a variety of related negative consequences, such as:
Shame and Embarrassment vs. Seeking Help
Sadly, compulsive masturbators are often reluctant to seek help. Most often they view their sexual self-stimulation as embarrassing, shameful, dirty, sinful, and/or “a phase they should have grown out of by now.” These and other negative associations make compulsive masturbators unlikely to admit their problem, even to a paid therapist. Plus, many simply don’t see the connection between their constant escapist self-stimulation and their related life problems. Either way, if and when a compulsive masturbator does ask for help, that person is unlikely to mention masturbation. Instead, he or she will probably ask for help with the compulsion’s related symptoms – depression, isolation, severe anxiety, a pattern of non-intimate relationships, an inability to form new intimate relationships, sexual dysfunction, and the like. As such, many compulsive masturbators attend therapy for extended periods without ever discussing (or being asked about) masturbation. Thus, a core emotional problem can remain underground and untreated.
The Therapist’s Role
When a client comes into an assessment or a session expressing vague concerns about sex, fidelity, porn use, frequent STDs, and the like, counselors must gently press for more information. Basic questions that should always be asked in these situations (and perhaps in any bio-psycho-social assessment, even when sex does not appear to be a core issue) include:
If and when a client responds to these questions in ways that indicate possible compulsive masturbation or other sexual addiction issues, you should press forward with a more detailed sexual assessment. Sex addiction screening questions for both men and women are available on the Sexual Recovery Institute website. If addictive sexual behavior in any form is identified, you may wish to consult with a certified sexual addiction therapist or an addiction-informed sexologist. Excellent referrals can be found through the Society for the Advancement of Sexual Health and the International Institute for Trauma and Addiction Professionals.
If your client does indeed appear to have an issue with compulsive masturbation (or sex addiction in general), treatment is similar to work with other forms of active addiction. Typically this involves cognitive behavioral therapy coupled with psycho-education, behavioral contracting, addiction-focused group therapy, and 12-step recovery. Later, once the client has achieved a modicum of sexual sobriety (usually six months to a year), deeper underlying issues like unresolved early-life trauma can be addressed using more traditional forms of psychodynamic therapy. Early on, however, the more directive “here and now” approach is nearly always required, as these clients are simply not initially equipped with the ego strength and social support needed to not sexually act out when therapy gets difficult.
Many compulsive masturbators (like sex addicts in general) are initially resistant to treatment, and some cannot contain their behavior despite increasing levels of therapeutic intervention – medication, more sessions, more 12-step meetings, etc. If so, referral to an intensive outpatient program or an inpatient treatment facility may be the best course of action.
Robert Weiss LCSW, CSAT-S is Senior Vice President of Clinical Development with Elements Behavioral Health. A licensed UCLA MSW graduate and personal trainee of Dr. Patrick Carnes, he founded The Sexual Recovery Institute in Los Angeles in 1995. He is author of Cruise Control: Understanding Sex Addiction in Gay Men and Sex Addiction 101: A Basic Guide to Healing from Sex, Porn, and Love Addiction, and co-author with Dr. Jennifer Schneider of both Untangling the Web: Sex, Porn, and Fantasy Obsession in the Internet Age and Closer Together, Further Apart: The Effect of Technology and the Internet on Parenting, Work, and Relationships, along with numerous peer-reviewed articles and chapters.