07/06/2010 05:12 am ET | Updated Nov 17, 2011

Sex Addiction and 'Pleasure Deafness'

He walked into my office -- the embodiment of any woman's worst fear. Tall, good-looking, and impeccably dressed, "David" was, on first impression, a great catch. Except he was also a
proud philanderer, a skilled seducer, an insatiable womanizer. And he was asking for my help.

"My girlfriend is absolutely gorgeous," he said. "She's a tall blonde with a perfect rack and rock hard abs. I don't know why I cheat on her. But I can't stop myself."

Featuring the current wave of celebrity womanizers and putative sex addicts -- be it David Duchovny, Charlie Sheen, or newcomers Tiger Woods and Jesse James -- cheating is once again on the media's menu du jour, and offers a Smorgasbord of water-cooler topics. Even the venerable Los Angeles Times seized the opportunity to run a front page story. While generally correct, the article also cited "some outspoken critics" who "doubt that hypersexual behavior is a disorder at all."

Does that mean some believe that sex addiction is simply a pop psychology label used to pathologize normal male behavior?,0,1660444.story

I'm not sure which side of that proposition I found more galling: that sex addiction isn't real, or that there's such a thing as "normal" male behavior. Since I'm not their therapist, I have no way of knowing if the rehab-resourceful Messrs. James and Woods are clinical sex addicts, so I won't bother speculating. But I can assure you that sex addiction is a very real condition.

Just as some drinkers can imbibe socially without causing problems in their lives while others become alcoholics, compulsive sexual behavior can become a physiological condition exhibiting the same neurological changes that occur in the brain of a substance abuser. As with any addict, the brain's ability to sense pleasure becomes stymied.

We call this pleasure deafness.

In other words, the pleasure threshold changes, becoming so high that the sex addict needs more and more sexual encounters to feel pleasure. This is what sex addiction looks like: a sex addict loses all sense of proportion and control, and engages in compulsive, self-destructive behavior such as draining a bank account to pay for sex services, masturbates so often they bleed, cheats on their significant other, or loses a job for porn-surfing on the company's dime.

It's a little about the sex, but mostly it's not. There are myriad psychological reasons why this behavior has become so pervasive. A common cause is ego. Like those quaint old "What kind of man reads Playboy?" ads, jammed full of products for the brand-conscious Hef wannabes, today's more in-your-face culture tells men that having lots of women is a status symbol.

Sex addiction is certainly not limited to celebrity cheaters living in their bubbles of entitlement and self-absorption. It may be easier for Woods or James, whose mix of fame, wealth, and opportunity enabled them to fill their needs, but the average Joe is just as vulnerable. As in David's case, women become objects to feed a man's self-aggrandizement. David continually sought out brief, superficial encounters that gave him the illusion of desirability. His compulsion wasn't simply about scoring the hottest woman; he wanted to be wanted. Believe it or not, men are actually more turned on by a woman's clear desire for him than by her looks.

When I opened a private practice a few years ago in lower Manhattan, I had planned to specialize in women's sexuality because my doctoral thesis had been about women's sexual desire. But much to my surprise, I was flooded by calls from men. In a matter of weeks, I found myself fully booked with men -- young, powerful, stressed-out traders, brokers, bankers, politicians.

I had never aspired to be a Wall Street sex therapist, and never imagined that I would travel into the inner sexual and psychological worlds of rich and powerful men. Among my earliest discoveries: While many men won't seek the treatment they need for depression, anxiety, or marital problems -- or ask directions if they're lost -- if there's a problem with their penis, they're likely to reach out for help. Don't believe those erectile dysfunction ads in which men are so uncomfortable about talking to a doctor. Sexual potency is central to a man's identity. And now, as a therapist and a woman, I had a unique opportunity to learn more about male sexual behavior while providing my patients a sanctuary for them to reveal what they couldn't say to their friends or the women in their lives.

David was one of the first men through my door, a rising star on Wall Street, with a model girlfriend and an apartment in Greenwich Village.

"I go out with the guys after work, and we start collecting numbers. I have it down to a science. There's a process to it, and nobody's better at it than me," he explained with a self-satisfied smile.

"First, I scan the bar for the hottest chick. I go over and start talking to her -- small talk to start. I know how to be aggressive without seeming eager. I try to make a specific compliment about her looks while sounding underwhelmed. I want to come off as being interested in who she is, so I ask her questions without talking too much about myself, except for occasional references to my financial status. I let her talk about herself and I listen for what she wants. Then I make that appear to be exactly what I have to offer."

David seemed to have written the book on how to pick up women - or at least read one.

"Then, I do the 'Take Away.' I turn away as if I've lost interest or I start to show interest in another girl--but never one of her friends --- that's an amateur mistake. I make her work to get my attention again. If she doesn't, I will talk to her again, but either way, my attitude is casual. Mildly interested. "Works every time. I do it several times a night!" he boasted.

The psychologist and sex therapist part of me had to maintain professional composure. The female part of me reacted to this kind of behavior with a degree of fear and contempt. I still can't decide what was most upsetting about his description. Was it a man who couldn't be satisfied no matter how perfect his girlfriend is, or the thought that men have some shared clandestine knowledge of how to manipulate women, and they use it for group sport?

David felt powerful when he was successful at his game, using women as mirrors to reflect his worth. At the same time, he told me quite earnestly that he longed for a monogamous relationship, but didn't know if he was capable of love.

"What you're describing is someone who wants to be desired, over and over," I said. "Who is it that you desire?"
He didn't have an answer, but his admission was a beginning. I knew we had a lot of work to do.

As our sessions continued and we explored his fears and hopes, it gradually became easier for me to feel empathy for him. Next time, I'll tell you the rest of David's story -- his treatment, and how things turned out.

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