Rewriting the Conversation Around Sex Addiction

Disclaimer (00:00:00):
Mental health rewritten is for informational purposes only and is not a substitute for medical advice,
diagnosis, or treatment, please consult a mental health professional for care. This podcast may include
sensitive topics. Listener discretion is advised.

Dominic Lawson (00:00:12):
Business trips, they were routine. Routine, another city, another deal, but
this trip feels well different. Daniel doesn't know why. He just knows he can't keep pretending because
see, this trip isn't a negotiation, a presentation or another deal to close. No, this is something else.
Something he has fought, denied, hidden from himself and everyone he loves. His wife's words, haunt
him,

Speaker 3 (00:00:51):
Get help or never come back.
Dominic Lawson (00:00:54):
He looks at the house one last time feeling the weight of his actions await. No amount of business deals
could ever lighten. And when you ask a behavioral health clinician, Daniel's story is not an uncommon
one.

Dr. Alexandra Katehakis (00:01:09):
What once might've been novel or fun or hot and exciting starts to become deeply burdensome because it
grates on people's integrity and their conscience, and they have to look at their partner and their kids
every day and lie and know that they're not who they say they are.

Dominic Lawson (00:01:24):
Daniel has left his home for years under the guise of success, ambition, and responsibility. And on the
surface, he has done everything right, A rising star in the company, a man on the brink of the C-suite, but
now he sits on the curb in front of his house in his gated community facing a truth. He can't negotiate his
way out of having to explain to two young, innocent faces, faces why daddy has to be gone for a while, a
long while, but even under the mountain of shame and guilt, he feels Daniel holds on to a single shred of
hope, a reminder that sometimes we can heal the things we once broke. Sometimes we get a second
chance to rewrite our narrative. Change begins with understanding and understanding begins with
reflection. My name is Dominic Lawson and welcome to Mental Health Rewritten.

Dominic Lawson (00:02:32):
In this episode of Mental Health Rewritten, we uncovered the complexities of sex addiction, compulsive
sexual behavior, exploring the impact on relationships, the hurdles and treatment and the societal and
cultural lenses that shape our understanding. Join us as we rewrite the conversation around sex addiction.
I had a conversation about the formation of this podcast with a clinician, and I told them we were going to
start with sex addiction, and she was like, wow, Dominic, you're really going off the deep end to begin,
huh? Well, I guess so. Sex is fundamentally a natural and pleasurable thing, and it's simply part of the
human experience. In every culture, in every generation. It connects us, drives intimacy, and honestly just
feels good. But just like anything else that brings pleasure, there can be a complexity to it. For some sex
can be tangled with pain, secrecy, or even compulsion.

Dominic Lawson (00:03:41):

What starts off as something natural can shift sometimes slowly, sometimes all at once into something
that feels out of control or even harmful. But let's go back to the complexity of the matter because let's say
you may actually suffer from sex addiction and you live in the United States, it may prove difficult for
someone to even believe you. A u gov study in 2018 shared that 52% of adults believe that the disorder
was real. That is a good thing. However, this next part is not 23% believe that it was not real, and another
25% were unsure. That part is alarming. When you add in the studies from the Mayo Clinic that suggests
between six and 8% of US adults could be classified as addicted to sex, we could be talking about
upwards of 24 million Americans and many health professionals fear that it may be increasing due to the
rise of apps devoted to hooking up or casual sex, more sexual topics being discussed on the internet and
social media, not to mention pornography, and that is such a big topic that we're going to take that on in
episode two.

Dominic Lawson (00:05:01):
And then there is the perception that it is a male-centered issue. And while it may be more common in
men, women are also affected and they often find a harder time finding a treatment solution due to that
stigma, often not as visible in self-help groups. And this isn't just a problem in the United States, it's
global. Take Rebecca Barker from the uk, she told the BBC in 2018 that at its worse, she was having sex
five times a day and it still wasn't enough. She said her partner loved the attention at first, but over time
even he became overwhelmed. Thereby highlighting that even when the addicted partner is being faithful,
the disorder can still be problematic for relationships in other ways. If you want to read more about
Rebecca's story, the link to that BBC article is there in the show notes. Rebecca's story isn't unique to the
UK around the world.

Dominic Lawson (00:06:05):
Sex addiction and the compulsions that drive it are shaped by more than just personal experiences. It's
culture, religion, and societal norms that influence not only how compulsive sexual behavior is
understood, but how it's treated or even ignored. Because let's say you live in a region of the world where
religion plays a dominant role. Think Middle East or parts of Latin America. Compulsive sexual behavior
is often framed as a spiritual crisis rather than a psychological one. Religious leaders frequently serve as
the first line of intervention guiding individuals through prayer, fasting, or counseling before mental
health professionals or even consulted. This approach offers comfort to some, but others. It delays
treatment or prevents it altogether. The fear of being judged as morally weak can keep individuals
suffering in silence. But what about societies where sexual health is approached with openness? Let's say
Scandinavia and the Netherlands here, sex addiction is rarely seen through the lens of morality.

Dominic Lawson (00:07:21):
Instead, the focus is on harm reduction and healthy boundaries, but not abstinence. The contrast is
striking. While some cultures seek to restrict sexual behavior, others focus on rebalancing it. The result is
that treatment models can look radically different depending on where you are and what your society
values. In East Asia, technology and isolation play a different role in places like Japan and South Korea.
Compulsive sexual behavior is often tied to digital addiction and social withdrawal. It's less about
hypersexuality in the physical world and more about escaping into a virtual one. This rise in digital
compulsion highlights how technological and societal shifts can shape the expression of sexual addiction.
It's not just about sex, it's about connection, loneliness, and the need for intimacy and an increasingly
disconnected world. So across cultures, one truth emerges. Compulsive sexual behavior reflects more than
just individual struggles. It mirrors how societies define sex, morality, and identity. And while the
approaches may differ, the underlying need for understanding for connection remains universal. This I
admit, is a lot to take in. It's a very complex topic, but lucky for us, I have a very decent contact list of
experts that are well versed on these matters. Allow me to introduce you to one. Now,

Havi Kang (00:09:04):
One of the things is that people don't quite understand what sex addiction is, especially when they hear
that term. I think they have a lot of misconceptions, a lot of misunderstanding.

Dominic Lawson (00:09:13):
This is my really good friend, Javi Kang psychotherapist and trauma life coach. She also works at iap.
She dives deeper into this very complex topic,

Havi Kang (00:09:22):
But nowadays the ICD called it compulsive sexual behavior disorder.

Dominic Lawson (00:09:30):
You are probably curious why you heard that sound just now. I'll explain in a while after Havi finishes.

Havi Kang (00:09:36):
So now that our field is shifting into that language using compulsive sexual behavior disorder versus sex
addiction, however, there's still an underlying addictive component here when it comes to sex addiction.
And so when we think about addiction, there's those usual criteria that we're looking for when it comes to
sex addiction. We're looking for those exact same criteria, loss of control, preoccupation, withdrawal
escalation, negative consequences, all of those things that we would typically look for in an addictive
process. We're also looking for in sex addiction. If those things are not present for that client, then maybe
we're not working with a sex addiction. Maybe we're just working with someone who has a higher sex
drive, someone who has different interests,

Dominic Lawson (00:10:22):
Negative consequences. It's a theme that echoes throughout history. We've seen how unchecked sexual
compulsions have destroyed public figures from Hollywood moguls to CEOs. Daniel, who we will check
in with later may not be on magazine covers, but his struggle is the same. And when we think about
compulsive sexual behavior, we often only imagine it as a modern issue. But allow me to take you back to
1812 where Dr. Benjamin Rush regarded in 1965 by the American Psychiatric Association as the father of
American psychiatry is examining a morbid state of sexual appetite. In his book, diseases of the Mind
Rush recognized the profound personal and societal impacts of unregulated sexual desires long before
modern psychology coined terms like hypersexuality. He believed such urges could lead to moral and
physical decay. In chapter 18, rush included not just his reflections, but also personal letters he received
from distressed patients or their loved ones. One such letter detailed, the anguish of a young man
tormented by uncontrollable desires.

Speaker 5 (00:11:44):
My dear sir, I write to you in confidence and great shame, my son, A bright and hopeful youth now
wastes under the burden of desires. He cannot quell his pursuits once innocent have turned toward ruin. I
fear for his health and spirit, is there no cure for this affliction that robs him of his vigor? And standing

Dominic Lawson (00:12:09):
Rush's acknowledgement of such letters reveals the universal and enduring nature of this struggle. The
behaviors rush described are strikingly similar to those that are diagnosed and treated today. It also
signals how deeply ingrained and timeless this issue is because while the names and faces may change,

the patterns often remain the same. And while Daniel May not wear Trico hats and travel via horseback,
his situation looks very similar. Which leads me to the, you heard earlier when TAVI said

Havi Kang (00:12:50):
Compulsive sexual behavior disorder

Dominic Lawson (00:12:53):
Mental health rewritten is an educational podcast. I'm pretty sure you got that gist from the history lesson
we just gave you. But after all, we are an education company and much of the content you will hear on
this podcast is guided by the Diagnostic and Statistical Manual of Mental Disorders or the DSM, which is
in its fifth edition and the International Classification of Diseases or the ICD, which is in its 11th edition.
For a full explanation of what those things are, be sure to check out our explainer trailer on our RSS feed.
But when you hear that sound, that means someone on the show, more than likely a mental health
professional has mentioned something that we want to provide a full and detailed definition of, and that is
usually a disorder of sorts from the ICD 11 or DSM five. This is there to combat the sometimes harmful
and misinformation that you often see on social media and the internet.

Dominic Lawson (00:13:51):
We will share the definition and sometimes maybe even create a fictional scenario to help further explain.
So let's get to the first one. Compulsive sexual behavior disorder in the ICD 11, it is classified under
impulse control disorder. This disorder is characterized by a persistent pattern of failure to control intense,
repetitive sexual impulses or urges leading to repetitive sexual behaviors. The individual may engage in
these behaviors despite negative consequences or derive little satisfaction from them. The diagnosis
requires that the symptoms persist for an extended period, typically at least six months and cause
significant distress or impairment in personal, family, social, or important areas of functioning. It was
added to the 11th edition of the ICD in 2018 and effective for global use in January of 2022. But there is
something interesting here. The ICD 11 and the DSM five often work in tandem, but neither compulsive
sexual behavior disorder or sex addiction is in the DSM five. Why is that? Luckily, I know just who to
ask what say you Havi,

Havi Kang (00:15:10):
The DSM is still kind of figuring it out, right? They're still working on it. They're still trying to see if it
fits into the addiction section. So I think there's definitely movement towards that. The ICD was able to
make it fit into the compulsive nature of the diagnosis of this that comes with this too. And so it was able
to show up in the ICD, which I think is great because again, as clinicians, we can put more of a solid
diagnosis on it and be able to continue to treat whether it is a sex addiction, if there's that addictive
process. But compulsive sexual behavior disorder is very encompassing in that sense. It could really
encompass anyone who is maybe acting out sexually with others or even if it's just more of a virtual
presence.

Dominic Lawson (00:15:54):
What Javi touches on is a critical shift in how we understand and experience compulsive sexual behavior.
Today. The internet, social media and mobile technology have made sexual content interactions more
accessible than ever before, blurring the line between healthy exploration and compulsive use. And this
accessibility changes not just the how, but the who. The landscape of sex addiction is evolving from what
we once saw as the classic sex addict is something more insidious and hidden, existing quietly behind
screens. A big part of that now is without proper protections, a much younger demographic now has access to this type of content. Javi breaks it down even further explaining how this divide between the
classic and contemporary sex addict plays out in practice.

Havi Kang (00:16:49):
So the classic sex addict is like the typical sex addict that you might think about who would get in their
car and go down the road to go do some cruising behavior to pick up a prostitute might go to a massage
parlor and pay for that massage or the happy ending. They might be the ones that went to Blockbuster to
go rent those DVDs to go purchase magazines, right? So there was a lot more physical behaviors involved
in that. There's a lot more that was required for them to get there fixed. Nowadays, the contemporary sex
addict, they don't have to get up and leave anywhere. They could be at home and still be engaging in this
compulsive sexual behavior, virtually on their phone, on their laptop. Video games also have now they
could meet a lot of people that way. So there's this big shift that's happening in that sense too.

Havi Kang (00:17:37):
Another component that might be different between a classic sex addict and a contemporary sex addict is
the trauma piece. A classic sex addict may have a lot more trauma, can origin trauma as well, that fuels
their behavior. Whereas a contemporary sex addict, they may not have that level of trauma. It's not like
they're reenacting some sexual trauma that they have been in, but purely because it's accessibility, because
they can just log on. And nowadays too, I feel kids at a younger age are getting access to sex or at least
understanding what it is at a much younger age than maybe you and I when we were younger. It took us
way to high school or college to really understand what sex is or even see a porno or anything like that.
So nowadays they're like 9, 10, 8. It's changing their brains in that sense, and they're having more access
to it at their fingertips.

Dominic Lawson (00:18:34):
Before we continue, I want to go back to something Javi said before

Havi Kang (00:18:38):
The DSM is still kind of figuring it out, right? They're still working on it. They're still trying to see if it
fits into the addiction section.

Dominic Lawson (00:18:46):
That's the thing about sex. It already carries so much stigma. Sprinkle in the fact that there are many that
are divided in the clinical world, and you can understand quickly why it is a tricky topic to tackle. But
that's exactly why we created mental health rewritten and started with the track focusing on sex because if
we're being honest, call it whatever you want. Sex addiction, compulsive sexual behavior disorder. Either
way, you can easily see why it's one of those topics people would rather not touch. What Javi describes is
part of a larger conversation happening across the mental health community, which means there has to be
dissenting opinions, and I think it would be irresponsible for me just to present only one side of this
conversation. Again, the ICD elevens, recognition of compulsive sexual behavior marked an important
step forward, but not everyone agrees. Here are some statements from various behavioral health
professionals featured in Psychology Today, including the first one from Dr. Dale Reger from the DSM
five task force. Just to clarify, because legal just handed me a note, while these are direct quotes from
clinicians, the voices you'll hear are AI generated recreations and not the actual clinicians. Let's hear what
Dr. Rieger had to say.

Speaker 6 (00:20:10):

There was concern that the evidence for sexual addiction as a distinct disorder was insufficient. While
some behaviors align with addiction models, we felt more research was needed to avoid pathologizing
normal sexual urges.

Speaker 7 (00:20:21):
Hesitation highlights deeper concerns. The line between hypersexuality and a high libido isn't always
clear. If we're not careful, diagnosing sex addiction can feel more like a moral judgment than a clinical
one.

Dominic Lawson (00:20:35):
As you can see, this debate isn't just cultural, it's clinical.

Speaker 8 (00:20:39):
There is ongoing debate over whether compulsive sexual behavior is best treated through addiction
frameworks or if it reflects deeper emotional and neurological issues rooted in trauma.

Dominic Lawson (00:20:50):
The lack of consensus doesn't just affect diagnosis. It shapes how treatment unfolds. For clients like
Daniel, this debate isn't academic. It's important because it shapes how people like him receive care and
whether their struggles are met with either compassion or skepticism. And for many, just finding a name
for what they're going through can be the first step towards healing. But this isn't the first time mental
health professionals have debated sexuality. In the 1940s and fifties, Alfred Kinsey's groundbreaking
research on human sexual behavior shook the foundations of what we thought. We knew his work was
controversial, but it paved the way for many of the conversations we are having today. These differing
opinions highlight the challenge facing researchers and clinicians alike. And as Javi points out, even those
working to expand our understanding of compulsive sexual behavior, face significant hurdles, not least of
which is the lack of long-term studies and the individuals willing to participate in the research.

Havi Kang (00:21:58):
There's a lot of research that's being done right now too with the addictive process when it comes to sex to
porn, and I think there's just not a lot of research backing it just yet. So I think that's part of what the panel
and the folks working for the DSM is trying to get more research, trying to get more information. There's
not enough people who can even say, Hey, I'm a sex addict, do research on me. So it's that lack of
consensus or lack of having people to even do the research on. And there's just insufficient empirical
evidence at this point. But there's a lot of hopes out there who are doing that currently. There's lots of
testing that's being done, lots of studies being done, so there's movement on it. But as with anything that
goes into the DSM, it takes time.

Dominic Lawson (00:22:48):
As Javi mentioned, the lack of evidence and consensus has made it challenging for the DSM to fully
integrate sex addiction into his diagnostic framework. And maybe if there were more research, fewer
people would ask this question, what's the difference between a high sex drive and sex addiction? It's a
valid question, but before we unpack it, let's check in with Daniel. See, he's made it past an excruciating
day. One, a day spent filling out forms that led to a late night of staring up at the ceiling, wondering how he even got here. He didn't even unpack his suitcase, but here we are, day 13, things are still uneasy, but
he's starting to settle in. Daniel was in a group session, hands fidgeting, eyes darting to the floor,
surrounded by a circle of strangers almost two weeks in. And today it looks like for first time, he's going
to speak. I know this feeling. Maybe you do too. It's almost like the first day of school except for obvious
reasons. The stakes feel much higher, that tightness in your chest when it's finally your turn to speak, and
you're not even sure if your voice will come out. So when Daniel says,

Speaker 9 (00:24:07):
I don't really know what to say,

Dominic Lawson (00:24:09):
It feels like he's balancing on the edge of something unsure to take a step forward, but someone across
him nods and somehow that nod carries more weight than words

Speaker 5 (00:24:21):
None of us did. At first. Just start with what brought you here?

Speaker 9 (00:24:25):
My wife, she told me not to come back unless I got help. I've lied to her for years. I've lied to everyone. I
don't even know how to stop.

Dominic Lawson (00:24:34):
The room goes quiet, but it's not awkward is the kind of silence that feels safe, the kind that lets you just
breathe.

Speaker 5 (00:24:44):
You're in the right place, man

Dominic Lawson (00:24:46):
Here. And Danny opened up like that. It's a reminder of how much courage it takes to face these parts of
ourselves. His story reflects something universal, the need to be seen, the need to feel understood, and
that need, it doesn't always show up the way you expect. That's where the line between healthy desire and
compulsion starts to blur. So let's talk about it and bring in a new perspective to this conversation. So
think about

Dr. Justin Dodson (00:25:18):
It like this. It's a drug, right? So when you think about people that drink a lot, they're going to require
more and more alcohol to get buzzed or to get drunk when you're thinking about sex. If I don't get it, then
it becomes a crisis.

Dominic Lawson (00:25:33):
This is Dr. Justin Dotson. He's worked with countless men struggling to understand this difference, and
he's here to break down how hypersexuality takes root and why for many the real unmet need driving it
isn't even about sex at all.

Dr. Justin Dodson (00:25:50):  And that's what leads to infidelity, because now we're so convinced that we're not going to get caught and we're risking health and trust and all those things in order to get a need met at that time. So what that
moment is, it becomes sneaking around in order to get your need met. So you value having your need met
over the care and concern of other people. And a lot of people come to treatment because someone in
their life says, Hey, this is a problem. That's what the difference between hypersexuality and high sex
drive, because a high sex drive doesn't typically ruin the relationships. It's being unfaithful because you've
become hypersexual. Sneaking around isn't something that comes from high sex drive that comes from
hypersexuality because now it's an addiction because you compulsively need to seek out sex and habit in
order to satisfy yourself once.

Dr. Justin Dodson (00:26:42):
Maybe it was once a week, and then the more and more we do it, the more and more people require of it,
right? So you're never satisfied. That's the difference between high sex drive and hypersexuality, where
you're just seeing that you can't get enough and you need more and more in order to satisfy that unmet
need. But that unmet need is typically belonging and connection and something else that was missing in
an earlier point in life. But somewhere along the line, you learn that this sexual component is what
alleviated and what made you feel better. And a lot of men do it in private. That's what makes it
acceptable to them because you do it in private, but then when other people in your life are witnessing it
or noticing it, or it's taking away from your sexual activity with your partner or it's leading to infidelity,
then that's when, oh man, I got to do something about this.

Dr. Justin Dodson (00:27:30):
I have to change it or else I'm risking losing this person. And the reality is when men come into my office,
I tell them, you're not going to stop doing this today. You're not going to do this even though we had a
great session and we uncovered some things, you still have to unlearn to not use this thing. You still have
to replace something. And I've seen men where they can stop it. And then once they open that door, it's
Pandora's box again because they haven't learned how to truly execute and replace the behavior. And
sometimes it just depends on the resources that man and the motivation in order to undo the learning. But
it's possible. It's easier to catch it earlier on versus 20 years of doing something the same way all the time.
And there not being a true consequence.

Dominic Lawson (00:28:15):
Healing from hypersexuality starts with recognition. As Dr. Dotson explains, the line between high sex
drive and compulsive behavior becomes clear when trust goes away and secrecy grows and relationships
suffer. But awareness alone isn't enough. Change takes time. And unlearning old habits requires new,
healthier ones. That's why Dr. Dotson guides men through key questions, because honest reflection
reveals the door

Dr. Justin Dodson (00:28:45):
To healing. So these are some questions that I'd want men to ask themselves. Do you feel like you need
sex constantly? Are you constantly thinking about it? Is it hurting your relationship? So even if you're
only doing it with your partner, are you bending the boundaries of your partner or are you treating them in
a way that makes them feel sexualized or not good? You go behind your partner's back to watch porn. Are
you exhibiting behavior that would make them feel bad? A lot of people say, even though I'm only
sleeping with you, some partners say watching pornography is cheating. That's a whole nother
conversation. But some people do. Do you feel guilty after having sex or seeking sex from other people or
watching pornography? Do you lie about the behavior? Do you ever find that you are satisfied? Do you
disregard any negative consequences of you constantly trying to have sex with your partner or even stepping out? And do you ever feel satisfied? Answering those questions are going to be the first step in
figuring out if someone has a high sex drive or

Dominic Lawson (00:29:49):
Hypersexuality. What Dr. Dotson just described gives us a window into the complex, often blurry line
between high sex drive and hypersexuality. These questions aren't just diagnostic. They tap into the lived
experience of individuals struggling to discern whether their behaviors are part of a healthy sexual
expression or indicative of something more disruptive. And that's where professionals like Dr. Alexandra
Kaha has come in. She's the founder of the Center of Healthy Sex in Los Angeles, California. She's the
voice you heard at the top of the show when we first introduced Daniel. Her insight offers how clinicians
develop frameworks for addressing sexual health over the long term.

Dr. Alexandra Katehakis (00:30:35):
I started this center in somewhere around the mid two thousands because when I went to graduate school,
I was really interested in human sexuality and the question of what makes for a long-term erotic
relationship and a monogamous committed relationship over time, because I didn't have a role model for
that. My parents divorced when I was 27 after 30 years of marriage, and 50% of the population divorced.
So that was really my question. And I sort of stumbled along this thing called sexual addiction. And at the
time, pat Carns, I just installed the sexual disorders unit here in LA at Del Lamo Hospital, and there were
just a handful of people treating the problem. And I had the good fortune of getting an internship and
starting to treat this thing called sex addiction. And initially, Dr. Kern's model was a cognitive behavioral
model where you just look at your thoughts and stop your behaviors and then you're good to go.

Dr. Alexandra Katehakis (00:31:35):
And after working in that model for about eight years, I started to think about what was missing was a
road towards sexual health, which of course was what a lot of his critics had said from the get go. But he
was only one man trying to figure out one problem. And so I started to look at the question of what is
healthy sexuality for people who are in recovery from sex addiction? And so with that, just following my
passion and my interests, I started to expand and had some interns working for me, and then together
collaboratively with my husband, Douglas Evans, we built Center for Healthy Sex so that we could have
intense intensive programs and groups and offer a full host of services for people struggling with this
problem.

Dominic Lawson (00:32:19):
One thing I know about recovery is that it's rarely linear. Dr. Kakis work has shown that many clients
carry unresolved trauma from childhood, often manifesting as compulsive sexual behaviors in adulthood.
Research indicates that approximately 70% of individuals with sexual addiction report histories of early
life trauma or neglect according to the College of Education at the University of Georgia. This led me to
wanting to know more about the link between trauma and the disorder that led to Dr. Kada Hawke's book
and 2016. In addition to that, how does she measure the impact of her work?

Dr. Alexandra Katehakis (00:33:02):
Well, that's tricky to measure. I'm sure I've seen thousands of people. Some will tell you I helped them
enormously or save their lives, and others might say it was okay, or I didn't get what I, so I don't know
how to measure that. But I do know that I feel incredibly grateful and honored to have had a front row
seat to many, many men and women's healing process when it comes to this problem. And so many
people whose sexuality was tampered with as a child, whether it was shamed or physically abused,
become sexually addicted and compulsive because they don't know how else to regulate their nervous systems. And in 2016, I published a book called Sex Addiction as Affect Dysregulation, which is a deep
dive into the underlying science, the neuroscience of what makes human beings human, and what happens
when we don't get the appropriate nurturing that we need from infancy forward. And how that is the
beginning of the making of all types of addicts that when a child is not getting soothing, comfort,
connection, regulation of their nervous system, they start to look for other things to do that for them,
whether it's video games or internet pornography or eating or not eating, starving themselves. And then of
course, later in life as teenagers and young adults, drugs, alcohol, you name it,

Dominic Lawson (00:34:32):
Dr. Kakis journey illustrates understanding sexual addiction and compulsive behavior often begins at the
intersection of personal experience and clinical insight. The search for answers, whether for a client or
oneself, reveals how deeply intertwined these behaviors are with our emotional histories. Sexual addiction
rarely exists in isolation. It reverberates through relationships and not just intimate ones creating distance,
mistrust, and pain even when recovery begins. Rebuilding those fractured connections presents its own set
of challenges. This begins a new chapter in this conversation, one that shifts from the personal experience
of addiction to its ripple effects on relationships, family, and the very fabric of intimacy. And it can be
summed up in a fairly new clinical term as we explore the ripple effects of addiction on relationships. One
term emerges repeatedly, betrayal, trauma at its core, betrayal trauma refers to the deep psychological
distress that occurs when someone we rely on for safety and emotional connection violates our trust in the
context of sexual addiction or compulsive sexual behavior.

Dominic Lawson (00:35:59):
Partners often experience this as a profound rupture, a shattering of the sense of security that forms the
foundation of intimacy. Dr. Jennifer Ed, who pioneered the concept, describes betrayal trauma as unique
because it's not just the act of the betrayal that causes harm, but the relational dynamic, the fact that the
betrayal comes from somewhat integral to our emotional wellbeing. This can lead to symptoms similar to
post-traumatic stress disorder or PTSD, but with the added complexity of navigating ongoing
relationships with the person responsible for the harm. Dr. Kaki explains this experience best through the
lens of someone who has sat with countless clients facing this very crisis.

Dr. Alexandra Katehakis (00:36:48):
It's a really important topic and relatively new when we think about trauma. But imagine that you are
living in an idyllic marriage, whether it's heterosexual, homosexual, doesn't matter, and you have a life
that you're pretty perfect, you're grateful, you're both employed, you have two beautiful children. You
work in the community. Maybe you're even involved in your church, and you find out that the person that
you have been in love with and trusted all this time is not the person you thought they were. In fact, not
only they are lying like you didn't just catch them in a lie, but you start to learn that for the 25, 30 years of
your marriage, they've never ever been faithful to you. And that they've had multiple sexual partners, not
just one, but 2050 sex workers, strip clubs, affair partners, spending thousands, sometimes as much as a
million dollars on this affair, partner or partners over time. And so what happens with people typically
women, is the reality. It's like a massive internal earthquake where what they thought was solid ground is
no longer solid ground. And they don't know who to trust. They can't trust themselves because one of the
refrains is How come I didn't see this? Why didn't I know this? And also, how could he do this to me?
And everybody thought he was so nice and so perfect, and we were the perfect family. So the partner's
reality gets unbelievably jolted like an earthquake

Speaker 8 (00:38:28):

Like I needed it, needed it. You needed sex workers and affairs. You needed to betray me, our children,
our community. Was I not enough for you? It wasn't about you. It was never about you not being enough.
It sure feels like it was about

Dominic Lawson (00:38:46):
The emotional devastation. Dr. Kada Ock is describes is most certainly a real one. Research indicates that
approximately 16% of married individuals in the US have admitted to infidelity at some point in their
marriage. But perhaps the most surprising thing is that healing is possible. See, despite the initial
devastation, studies show that around 60 to 75% of couples affected by infidelity choose to stay together
and work through the betrayal. And is this concept of betrayal trauma is actually how I met Dr. Kakis in
the first place for the Los Angeles screening of the movie, accidentally Brave in it, Maddie Corman tells
the powerful story of her experiencing betrayal trauma in a very high profile way. It was to the point that
they had to uproot their family and move. Dr. Kajaki shares how far reachy it can be and the delicate
balancing act many partners face.

Dr. Alexandra Katehakis (00:39:50):
And what's painful about it too, for approximately 70 to 80% of these couples will work it out and work
through it. So it's very difficult. For example, if it were me to badmouth my partner and tell all my friends
and family that he cheated what he did and how much money he stole. And then later, three months later,
six months later saying, we're getting back together and those people and hear what they heard, it's very
difficult to repair relationships. So again, many women won't tell anybody because they don't know what
they want to do. Yet

Dominic Lawson (00:40:24):
The secrecy, the shame, and the uncertainty leave many partners feeling isolated, unsure whether to speak
out or protect their relationship in silence. But as painful as the betrayal is, the question of what
constitutes betrayal is just as complex for some infidelity is clear cut. That makes sense. A physical affair
or a hidden double life for others, the boundaries blur is watching pornography, a breach of trust is
flirting. Or is it the emotional distance that grows between two people? In the quiet moments between
intimacy, Dr. Dodson unpacks how couples define infidelity in different ways and why understanding
each other's boundaries can be the key to preventing future ruptures.

Dr. Justin Dodson (00:41:13):
Well, it depends on expectations. So I've heard conversations and I've seen people that say, if you flirt
with somebody else, you're cheating if you watch pornography or you're cheating, right? So if there's any
entity or thing or person that takes your attention off of me, that is cheating. And it depends on how this
couple defines what that is for the relationship. But oftentimes you do have one partner saying, this is my
boundary, these are my lines. And if you cross them, that means you are being unfaithful. Oftentimes,
there's one person in the relationship that doesn't see it the same. And let's just use for this instance the
man, right? So whether it's a same sex couple or heterosexual couple, sometimes there is a person
typically the man that says, that's not cheating if we do these things. But I think that conversation really
goes into what did that person's, the other partner's expectations of a healthy relationship?

Dr. Justin Dodson (00:42:05):
A lot of people want their partner to be obsessed with them so much in a healthy way because that in their
mind gives them security and safety. So that's what people are really seeking, right? So if you break that
down and you slice it out, people are really seeking safety, security, connection, and anything or person or
thing that breaks your connectedness, to me, that removes this healing safe is a form of cheating to them. Sometimes that is accurate, sometimes it's not. And so I think that's a fine line that you get to flesh out in
therapy, you get to flesh out in conversations and multiple exercises. There are a lot of tools that you can
use to just have deeper conversations with people. But I do think that it's really important to have these
boundary setting conversations in terms of learning what your partner's boundaries are, learning what
their expectations of a healthy relationship, learning what their examples were. Because a lot of times
when people come into the room and I say, well, how did you learn healthy sexual behavior? How did
you learn to have sex for the first time? A lot of it came from either what was an example of an unhealthy
relationship or pornography because then you had couples or somebody in the relationship learning how
to have sex through pornography.

Dominic Lawson (00:43:24):
Dr. Dotson's insight into boundaries reveal the delicate dance couples perform each person defining what
feels like betrayal based on their personal experiences, fears, and past wounds. But as Dr. Dotson
continues, he highlights how these seemingly small fractures can evolve into deeper disconnection. It's
not just about the act, it's about what the act represents in the relationship. The partner left feeling
unwanted, unseen, or insecure, isn't just reacting to the present moment. Often they're responding to a
long history of experiences that shaped their understanding of trust and intimacy. That's what people
want.

Dr. Justin Dodson (00:44:06):
People want to be wanted. So even going back to the example of the woman that says, well, if you talk to
her, you're cheating. She doesn't, something in her life says that's wrong, because at some point, maybe a
man doing that was the start of her being cheated on, or that is speaking to an insecurity or that is a threat
to some degree. And even if the man or someone else is saying, oh, you're blowing this out of proportion,
we have to get to what is threatening about that to this person. And then you can get to the bottom of that,
the more you can flesh that out and really understand what they're really saying behind that anger.

Dominic Lawson (00:44:52):
And for Daniel, that process is still unfolding. The work he's doing doesn't just live within therapy rooms
or 12 step meetings. And that brings us to a pivotal day in Daniel's journey. The weight of healing rests
not just on him, but on the fragile threads of trust. He's hoping to rebuild with his wife because now it's
day 40 family day, their meeting reminds us that healing isn't just a personal journey, it's relational, and
the road to rebuilding trust begins one fragile step at a time. Daniel stands near the entrance as his wife
steps inside, arms crossed, they haven't seen each other in over a month. She scans the room, eyes landing
on him. Hey, his wife nods, but doesn't move closer. Daniel notices her wedding ring still on her hand,
and it gives them hope, however fragile, they sit outside beneath the shade of an oak tree.

Speaker 8 (00:45:54):
The kids couldn't make it. It's too hard for them. They don't understand why you're gone.

Dominic Lawson (00:45:59):
I know I'm trying. She still studies him for a moment, searching for signs of the man she married.

Speaker 8 (00:46:07):
I want to believe you.

Dominic Lawson (00:46:08):

Daniel looks down at his hands.

Speaker 9 (00:46:11):
I want that too.

Dominic Lawson (00:46:18):
As we step into the next phase of this discussion, Javi walks us through the treatment landscape where
denial, trauma and addiction intersect, and how clinicians navigate the complex terrain of recovery from
12 step programs to holistic healing.

Havi Kang (00:46:34):
There's a good percentage of folks who are coming to treatment because they got caught by their partner,
and now their is making the ultimatum, we need to work on this, or we're done kind of a thing. For those
folks, it could be a bit more of a challenge, right? Because they might be more in denial. So that might be
the first treatment approach is really helping them understand, is this a problem for you? And where does
this trace back for you? Is there some trauma that's being reenacted here, or is it simply this addictive
process that you're engaging in? Then we also have to assess if there's any other addictions happening too.
Is there alcohol of drug abuse? Workaholism is a really common one that goes along with sex addiction,
substance abuse as well. For women, oftentimes they have a lot of expectations when it comes to sex.

Havi Kang (00:47:20):
A lot of their expectations are to a certain standard, and so when that gets challenged, they have their own
internal distress that comes up that leads them and guides them to getting the help that they need. So they
might be more willing, more open to seek treatment on their own, but also, there's a good percentage of
women who have been in multiple affairs and they also got caught and are coming to treatment for that
same reason. But yeah, the first pieces would be working through any denial, and then from there, really
moving them into 12 step recovery. A big piece of addiction is connecting with others, being honest,
having accountability. So being part of a 12 step group will be able to provide those things. Group
therapy is another really good treatment approach for sex addicts or those who have impulsive sexual
behavior disorder, group therapy family if they're in a relationship, family or couples marriage therapy.
And then just holistic approaches as well. Yoga, exercise, meditation. Another big piece for me too is
working on growing their sense of self.

Dominic Lawson (00:48:24):
As Harvey emphasizes. Working through denial is one of the most crucial and challenging steps in
treating compulsive sexual behaviors. In fact, studies show that denial can manifest in various forms,
minimizing harm, refusing responsibility, or rejecting the need for treatment altogether, hindering
acknowledgement and delaying recovery. And that's according to the Washington State Sex Offender
Policy Board. But once denial starts to lift the real work of unpacking patterns, exploring identity and
confronting shame begins now, we shift to Dr. Kakis, who now leads us deeper into the heart of recovery,
unveiling the frameworks, tools, and therapeutic models that shape lasting change. Javi laid the
foundation, but Dr. Kakis picks up where the work begins to unravel something unexpected, yet
profoundly human grief. Honestly, that's not something I was expecting when I was researching this
episode, but when you take a step back, it kind of makes sense because in the process of healing, there's
often a reckoning, not just with the addiction, but with the time relationships, the pieces of self that were
lost along the way.

Dr. Alexandra Katehakis (00:49:38):

And the model that I use is what I call a top down, bottom up model, meaning we start with the cognitive
behavioral aspect of it using Patrick Kane's task model. And that model is in a book he wrote called
Basing the Shadow. It's a workbook. It's a terrific workbook for people to get started with. So it's really
looking at all the secrets, lies, excuses and problems people have, and looking at their cycle of addiction
and looking at what kind of sex addict they are because there are 12 types. Now, if you're working with a
certified sex addiction therapist, there are several instruments that people take self-report measures to
look at what kind of sex addict they are, what kind of activities they've been up to. So we really kind of
unearth the whole thing, all the secrets and the lies. And by unearthing it all, it starts to reduce the amount
of shame the person has around their behaviors because shame silences us.

Dr. Alexandra Katehakis (00:50:40):
And so when people start to talk about this problem, they start to feel better faster, and they start to come
out of denial by telling themself, it wasn't that bad or I didn't do it that much. Because when you really
start to write all this stuff down and see that it's been decades of your life, you start to see how pervasive a
problem it was. And with that comes grief and loss. People really have to grieve the loss of time, the loss
of relationships, how they hurt other people, and also were hurting themselves all along the way. So that's
really in a nutshell, the first layer of treatment. And with that goes attending 12 step meetings for the
fellowship so that people can be in groups with other people who have experienced the same thing
historically, whether it's in their childhood stories or their acting out stories, their repeated cheating, the
marriages they've gone through and start to see that they're not alone, and that the people that they're with
are good people.

Dr. Alexandra Katehakis (00:51:41):
They're people just like them. They just had a bad start to life and have done bad things. And then after
that period of time, which can take six, eight months a year, then I start to work in a deeper way with
people in what's called more psychodynamic psychotherapy of really looking at the childhood trauma
hurts, helping people to feel in their bodies today what they couldn't feel then because it was so
dangerous. And that process is a process of, you could call it reparenting reclamation of the self, but from
a neural perspective, these are circuits that have become uncoupled, and people feel it because they report
feeling dead at the core or chronically depressed or highly anxious. And it's the recoupling of these
circuits going back and getting that child and bringing them back into the present moment that starts to
help people feel more neurally integrated.

Dr. Alexandra Katehakis (00:52:41):
And when they're more neurally integrated, they'll tell you that they have had a spiritual awakening, that
they feel lighter, free, or happier, that the promises of alcoholics anonymous start to come true. But this is
a good three to five year process, which sounds long, but when you think about how long it takes
somebody to get into therapy and get help, sometimes they're in their forties. It's really not that long, and
you're going to be three to five years older anyway. So do you want to be three to five years healthier or
in a deeper hole than you are right now?

Dominic Lawson (00:53:16):
What Dr. Kaha is reveals, he strikes at the core of what long-term healing truly demands. It's not just
stopping. The behavior is about reclaiming the parts of yourself. The addiction buried. The process is
slow and often painful, but it opens up the door to something deeper, connection, integration, and
sometimes redemption. Sex addiction hides in plain sight, woven into jokes, TV dramas, and celebrity
scandals. In our culture, the line between desire and disorder, blurs, pop culture, sometimes normalizes,
indulgence, often dismissing compulsive sexual behavior as a high sex drive. This can leave those struggling feeling misunderstood or invalidated, and that can be very dangerous. Javi takes it from here,
unpacking how these cultural messages shape and sometimes distort our understanding of sex addiction.

Havi Kang (00:54:25):
I think, again, our current culture is you can watch any movie, there's going to be some type of a sex
scene in there, right? And I think too, just in culture, even what's going on right now, there's a lot of high
profile folks who are getting arrested, who are facing jail time, who have huge allegations against them.
And absolutely there's that misconception. They think it's just having lots of sex, having a high sex drive
or hypersexuality. And so there is a lot of misconception, and my suggestion would be at least do a bit of
research or listen to these kinds of podcasts to kind of figure out, okay, what do they mean when they say
that? It's almost thrown out there as a joke,

Dominic Lawson (00:55:09):
Havi highlights how cultural perceptions often downplay or distort the reality of sex addiction. This
disconnect between societal understanding and clinical truth creates a barrier that those who might
otherwise seek help are trapped between shame and the fear of not being taken seriously, which is why
we wanted to end with Dr. Alexandra Kaki. Stepping in again to remind us the condition is officially
recognized as

Dr. Alexandra Katehakis (00:55:37):
Compulsive sexual behavior disorder,

Dominic Lawson (00:55:39):
And why that language we use matters.

Dr. Alexandra Katehakis (00:55:43):
The International Classification of Diseases book, it's called the ICD, it's in the 11th issue, is put out by
the World Health Organization in the World Health Organization in 2021 or 22 recognized compulsive
sexual behavior disorder. And I think colloquially and in the zeitgeist, we call it sex addiction. So it's
important for people listening to know there is a bonafide diagnosis for it now, but we still all call it sex
addiction because it's easier. It's a shorthand. Everybody knows what it is.

Dominic Lawson (00:56:19):
Sex addiction is real, not just a buzzword or moral failing. It has a name and a place in the ICD 11. Once
again, this official recognition doesn't just validate the experience of those struggling. It opens the door to
more compassionate structured paths toward healing. But recovery isn't just about definitions of clinical
terms. It's about the quiet personal victories, the conversations that were once too hard to have, and the
apologies that felt impossible, and the relationships that begin to heal and repair peace by piece. And for
Daniel, that work has carried him to this moment, day 60 graduation day. But this isn't the end. It's a
beginning one. He doesn't have to face alone. As he walks out on the overcast sky, Daniel steps out of the
facility walking towards his wife as she waits in the parking lot. And as he walks towards her, he glances
back at the building. A few of the men from his group wave from the entrance, he lifts his hand and
return, and his wife welcomes him in

Speaker 7 (00:57:39):
Ready,

Dominic Lawson (00:57:41):
I think. So he climbs in resting his hand over hers on the gear shift.

Speaker 9 (00:57:47):
I know there's still a long way to go.

Dominic Lawson (00:57:50):
His wife squeezes his hand.

Speaker 9 (00:57:52):
We'll

Speaker 8 (00:57:52):
Get there,

Dominic Lawson (00:57:54):
And as they pull away, Daniel watches the facility disappear in the rear view mirror, but this time he's not
running away from it for the first time, he's driving towards something better. Next time on mental health
rewritten, we shift the focus from sex addiction to pornography. In this episode, we explore the fine line
between consumption and compulsion and the often overlooked realities behind the scenes of the adult
film industry. We'll hear from the clinicians we heard from today that treat pornography addiction, but we
will also hear from someone who's lived on the other side of the camera.

Speaker 9 (00:58:37):
So it was during the pandemic in 2020, actually, specifically October of 2020, I found myself struggling
financially. I found myself battling homelessness, and I needed a way to make money. I kind of had just
said, what else do I have to lose?

Dominic Lawson (00:58:56):
Tune in next time as we confront the myths, hear the stories, and rewrite the conversation around
Pornography and mental health. Mental health rewritten created by the Owls Education Company, is
hosted, written, and produced by me. Dominic Lawson, executive producer Kendall Lawson. Cover Art
was created by Alexandria Ings of Art Life Connections. Sources to create this episode are included in the
show notes. Be sure to review and subscribe to the Mental Health Rewritten podcast on Apple Podcast,
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