Tiger Woods, Sex Addiction, and OCD
This is the first of a two-part series that discusses the differences between sex addiction and Obsessive-Compulsive Disorder (OCD).
Lately, sex addiction has become a hot topic in the news. Certainly, the biggest factor in this explosion of interest has been the revelation that Tiger Woods has had a seemingly infinite number of extra-marital affairs, and subsequent reports that he is undergoing treatment for sex addiction.
Is Sex Addiction OCD?
Every so often, the OCD Center of Los Angeles receives a call from a prospective client looking for treatment for sex addiction. These individuals (or their spouses) call us because they believe, or more frequently, have been told by previous therapists, that their sexual behavior is evidence of Obsessive-Compulsive Disorder (OCD). And invariably, they are surprised and confused when I inform them that sex addiction has absolutely nothing whatsoever to do with OCD.
In fact, the two conditions are radically different. Yes, both conditions include obsessional thoughts and compulsive behaviors. But people exhibit obsessive thoughts and compulsive behaviors in a whole host of conditions that are not OCD, including Anorexia Nervosa, Bulimia, Alcoholism, Drug Addiction, Pathological Gambling, Compulsive Shoplifting, Trichotillomania, and Body Dysmorphic Disorder.
So the question arises: what distinguishes sex addiction from OCD? In a word…pleasure.
Very simply put, individuals who are addicted to sex get pleasure from their behavior. Conversely, those with OCD get not a scintilla of pleasure from doing their compulsions. In fact, in fifteen years of treating clients with OCD, I have never once had a client report getting anything resembling pleasure in the course of doing a compulsion.
To better understand how OCD operates, it is helpful to understand the concept of the Obsessive-Compulsive Cycle. For the person with OCD, obsessions are specific, repetitive thoughts that are experienced as unwanted and extremely anxiety-provoking. And like all humans, people with OCD don’t like the feeling of anxiety. As such, those with OCD develop strategies do eliminate or reduce that anxiety. The compulsive and avoidant behaviors seen in OCD are done with the sole purpose of reducing or eliminating the immediate anxiety caused by these very specific thoughts. And the compulsions are often done repeatedly and in a ritualized fashion, sometimes for hours, until the individual feels some relief from the anxiety caused by these specific thoughts. This Obsessive-Compulsive Cycle is consistent and stable in all cases of OCD that I have ever seen.
Now let’s compare that to sex addiction. Are the obsessive sexual thoughts experienced by a sex addict prior to sexual activity unwanted and anxiety-provoking? I would argue just the opposite. It seems to me that the thoughts experienced by sex addicts are arousing and pleasurable. Some might argue that sex addicts experience various conflicting emotions prior to acting compulsively, including anxiety. But it seems self-evident that the primary feeling is one of sexual arousal. The thoughts the sex addict experiences after the fact may be distressing, but prior to that sexual activity, the thought of having sex is primarily experienced as pleasurable and desirable.
Conversely, those with OCD never feel any pleasure related to an obsession. Not for one second. Their obsessions are experienced as the worst kind of mental torture. In fact, on more than one occasion, I have had clients with OCD tell me that would gladly give up a limb if doing so would allow them to be free of their obsessions.
Likewise, the compulsive behavior done by a sex addict, whether it is sex with another person or masturbation, undeniably provides the individual with pleasure. The individual with OCD gets no pleasure whatsoever from doing compulsions. The person with OCD gets only a temporary reduction in anxiety related to the very specific fear about which they were obsessing.
Treatment for OCD vs. Treatment for Sex Addiction
Finally, it is also worth noting that if sex addiction is OCD, then by extension, it should respond to the same treatment as OCD. Multiple controlled research studies have consistently found that the most effective treatment for OCD is a very specific type of Cognitive Behavioral Therapy (CBT) called Exposure and Response Prevention (ERP). This therapy requires that the client purposely expose themselves to the very object or situation that generates their anxiety. For example, if one obsesses about contamination, this might mean purposely having repeated contact with specific items that one perceives as “contaminated”.
Applying this principle to sex addiction would suggest that the best treatment would be for the sex addict to purposely and repeatedly watch porn, spend private, non-sexual time with prostitutes, etc. This is not just unlikely to be a successful intervention – it is very likely to have the exact opposite of the intended effect. Simply put, asking a sex addict to purposely be around sexual triggers is like asking a heroin addict to purposely be around heroin.
So, if sex addiction is experientially different than all other types of OCD, and it doesn’t respond to the same treatment that is known to consistently be the most effective treatment for OCD, it stands to reason that it isn’t OCD.
Next week, we will continue our discussion by answering the question: “If sex addiction isn’t OCD, then what is it.”
•Tom Corboy, MFT, is the director of the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions. He can be contacted director@ocdla.com.
6 Comments to Tiger Woods, Sex Addiction, and OCD
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I do like the very simple explanation of the difference between the two: pleasure. I think that would be very helpful and easy for clients to understand.
I would would like to hear more concerning sex addiction that I would reason ti what you are saying sounds more valid then a sex addiction being OCD that does not bring pleasure.
Sileh,
Thank you for your comment. We will be posting the second part of this series on sex addiction within the next week. It will provide a in-depth discussion of diagnostic issues related to sex addiction
Katherine,
Thank you for your comment on our article.
I think people sometimes fail to see this fundamental difference – when doing compulsions, people with OCD are motivated by the desire to eliminate anxiety experienced in relation to very specific, very distressing thoughts. I believe that this is not the case for behavioral addictions, which all have a component of gratification / pleasure. Addiction is obviously complex, but the existence of gratification undeniably applies to addictions to gambling, sex, food, etc. Likewise, our clients with Trichotillomania and Dermatillomania almost always acknowledge getting gratification / pleasure from the process.
Very articulate, succinct, and well-though-out article. My practice focuses on clients with sex addiction at The Center for Counseling & Recovery, and you’re right in that the big difference is ‘pleasure.’ Without contradicting that idea, I also notice that many addicts (sex addicts or otherwise) display many obsessive-compulsive traits which do not constitute full-blown OCD or OCPD. For the sex addict who compulsively masturbates until raw or injured, there’s clearly no pleasure in it–that includes an OC component.
There’s clearly cross-over between OCD and sex addiction, but they’re not the same thing. I look forward to next week’s article!
Kevin,
Thank you for your comments.
I agree that there is a lot of overlap between OCD and compulsive sexuality. And we have treated clients who clearly have both conditions.
I would actually disagree with the idea that compulsively masturbating until raw is necessarily devoid of pleasure. I would think that there is still pleasure in the act (and in the orgasm), though it is obviously mixed with other emotions / sensations.
I think the issue really gets down to a question of motivation – is a person doing a behavior to eliminate anxiety related to a specific thought (which is OCD), or are they doing a behavior to get some sense of gratification (perhaps this is a better word than “pleasure” in this case, and is clearly not OCD).
I think another major difference is that those with OCD do not generally do compulsions in an attempt to deaden broad feelings of low-self worth, ennui, etc., although there are certainly situations in which those with OCD use compulsions to cope with emotionally overwhelming situations.
Our follow-up article will be published this week.