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Death, Sex and Suffering

How can existential therapy inform how we think about men’s compulsive sexual behavior? Compulsive sexual behavior disorder (CSBD), more commonly referred to as sex/porn addiction or hypersexuality, is a debated and widely-misunderstood issue. The World Health Organization defines CSBD as a “ persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior” which can result in distress and impaired ability to attend to important life activities, self care and relationships. As in behavioral addiction, those with CSBD face escalating life consequences, diminishing satisfaction or desire with sex and overwhelming distress. In popular media the disorder is often portrayed comically, typically with uninhibited and crude characters attending sex addiction support groups in movies like Blades of Glory and Horrible Bosses 2.

The experience of CSBD however, is far from comical. Often, those affected by CSBD report feeling powerless and out of control, often acting against their personal values and damaging themselves and their relationships in the process. CSBD correlates with higher levels of shame, depression and anxiety, and the compulsive behaviors can lead people to engage in increasingly unsafe and risky sexual behaviors. CSBD often has roots in experiences of childhood abuse and neglect, and those experiencing it are at greater risk of co-occurring psychiatric illnesses. It should be noted that CSBD is distinct from healthy, meaningful sexuality, which can still involve casual sex, polyamory, kinks and historically marginalized forms of sexuality. It is not simply “having more/different sex than others.” For those with CSBD, sex has become something more: all-consuming, unmanageable, and, at its most extreme, a threat to one’s safety and wellbeing. Those with it suffer silently and, all too often, alone.

The fact is, CSBD goes much deeper than sex. Addiction models of treatment, which focus on reducing and/or eliminating sexual behavior, are effective for some with CSBD, but not everyone experiences CSBD as an addiction nor do they value a life without sex. Daniel Watter offers a different direction for treating men’s CSBD in his book, The Existential Importance of the Penis. Under Watter’s model, sex is framed as a potent, often sensory link to men’s vitality which can help them cope with anxiety, trauma and “death terror”, or the distress of being aware of one’s own mortality. In fact, the natural endorphin rush sex triggers in the body is the greatest one can experience without using substances. This serves the dual function of increasing positive sensations and “numbing out” painful ones. For those with CSBD, the role of sex has expanded to become a tool for managing needs and a potent (yet ultimately maladaptive) “remedy” to death and suffering.

Existential therapy turns towards concepts of death, isolation, freedom and emptiness as a means of processing and making meaning of core traumas which underpin CSBD. By addressing existential needs and anxieties, one can structure a life with intention, value and meaning. Treatment becomes not about pathologizing and suppressing sexuality, but rather about restructuring an intentional, safe and meaningful life in which one has a boundaried, yet fulfilling and adaptive, relationship with sex. Therapy can aid those with CSBD in learning skills and increasing behaviors which meet their core needs in ways that sex cannot. Sex then assumes a new role which contributes positively and constructively to one’s life. With an existential lens, we can provide holistic, affirming and empowering care to those experiencing the pain and stigma of CSBD.


Mike Shirek is a third-year graduate student completing his master’s degree from Lesley University in clinical mental health counseling with a specialization in expressive arts therapies. He received his Bachelor of Arts in psychology from Harvard University. He is a member of the International Expressive Arts Therapy Association and is working towards becoming a licensed mental health counselor and registered expressive arts therapist. Mike has 2 years of clinical mental health experience working in both partial-residential hospital and non-profit community settings. He has experience in exposure and response prevention (ERP) therapy, CBT and DBT skills, expressive arts interventions, trauma-informed care and narrative therapy techniques. He is committed to honoring individuals’ personal stories and experiences and seeks to empower individuals to pursue meaningful changes in their lives.

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