Treatment of sexually compulsive adolescents

James Gerber
Psychiatric Clinics of North America 2008, 31 (4): 657-69
We clarified the nature of sexual compulsivity in adolescence, addressed who is labeled as "sexually compulsive youth," conceptualized the underlying factors of sexual compulsivity, and outlined a treatment format. We focused on trauma, dissociation, attachment, and self-concept. We questioned the conventional perceptions of who is included in this group. We reiterated that the belief that sexually compulsive adolescents are abusive males is no longer considered accurate. The evolution and accessibility of the Internet only raises greater concerns about compulsive sexual behavior, as more adolescents are brought into therapy because of Internet use to seek sexual interaction or stimulation. The sexually compulsive youth is as likely to be the clean-cut, high-achieving, intelligent student as is the economically deprived, juvenile delinquent on the street. This article began with the observation that adolescents rarely receive any direct, accurate information about sexuality and intimacy. The messages taken in through music, television, movies, politicians, popular press, clergy, and school are polarizing and contradictory. Beyond this are the implications as to how we, as a society, treat the youths that do present with sexual behavior problems. We have tended to treat these youth (as well as adults) with disdain and to designate sexually abusive youth the same as adult offenders with harsher, more punitive treatment interventions. Research and clinical experience now strongly question this type of response. This article is consistent with this leaning. Early psychological injury, from sexual abuse, physical abuse, exposure to violence, attachment trauma, or early sexualization, is at the root of sexually compulsive behavior. While it is necessary to reign in out-of-control and destructive behaviors, if we acknowledge that the source of the behavior is psychological injury, then it is cruel and inconsistent to treat the individual with disdain or as a pariah. The same dilemma is present with adult sexual addicts and offenders. Our society must develop a response to sexually compulsive or offensive behavior that can protect those who need protection, while implementing a rational legal response and providing treatment options for the underlying injury. Perhaps even more importantly, our society must learn how to educate adolescents about sexuality with clear, accurate information that includes not only reproduction but sexual response and intimacy as well.

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