Sex Addiction: in the Eye of the Beholder?
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SEX ADDICTION: IN THE EYE OF THE BEHOLDER? A COMPARISON OF ‘SEX ADDICTS’ VERSUS ‘NON-ADDICTS’ ON MEASURES OF SEXUAL BEHAVIOUR, PERSONALITY, CATEGORICAL THINKING, SEXUAL ATTITUDES, AND RELIGIOSITY. DANIELLE MAYES, BA., MSc., PhD. Thesis submitted in part fulfilment of the requirements for the degree of Doctor of Clinical Psychology to the University of Nottingham DECEMBER 2015 1 Thesis Abstract Introduction: ‘Sex addiction’ appears to have been largely accepted within clinical fields and popular culture. However, despite its 30 year history, the concept remains ill-defined and lacking in empirical data. Indeed, proponents of sex addiction continue to debate its terminology, definition, nosology, and aetiology, with a coherent model of the ‘disorder’ yet to be offered. An alternative account presented by the social constructionist model argues that the reason for this contention is because, rather than a pathological disorder, sex addiction represents a social construction. Those who argue from this perspective suggest that sex addiction has been created to pathologize sexualities which fail to promote dominant sexual norms. Whilst this argument appears convincing, it is not clear why some may be more influenced by these dominant sexual norms and thus pathologize their sexuality, whilst others do not consider their sexuality to be problematic. The answer to this may lie in certain individual differences, in particular, personality, thinking dispositions, sexual attitudes, and religiosity. Aims: This was an exploratory piece of research which aimed to compare sex addicts (SAs) to ‘non-addicts’ (NSAs) on the dependent variables: sexual behaviour, the Big Five personality traits, categorical thinking, sexual attitudes, and religiosity. Design: A convergent parallel design was employed, using questionnaires to collect quantitative and qualitative data. Method: A self-selecting sample (N = 214) was recruited via poster and online advertisements placed in general public sites such as pubs and clubs, and sex addiction and sexual interest forums. Participants completed an online questionnaire comprising: a) an assessment of ‘sex addiction’ via participant’s self-identification and a clinical screening tool (the Sexual Addiction Screening tool; SAST); b) a free text box in which participants explained their self-identification; c) 2 a questionnaire collecting demographic data and assessing the variables under investigation. Results: Participants’ constructs of sex addiction largely mapped onto the dominant model of sex addiction. This was particularly evident within SAs’ responses. Conversely, a number of themes within NSAs’ responses diverged from the sex addiction model and expressed a positive view of sex. Subsequent statistical analyses comparing self-identified SAs to NSAs found SAs reported a greater frequency of solo sex and evidenced more categorical thinking. No other significant differences were observed, with the exception of neuroticism whereby SAs scored higher when samples were matched for sexual activity. When the SAST defined the groups, SAs reported a greater frequency of solo sex and anal sex, and reported a higher number of partners for oral sex and anal sex. These SAs also scored significantly higher in neuroticism and were less satisfied with their current sexual activity. Discussion: The study demonstrates the immersion of the dominant model of sex addiction within sociocultural norms and suggests that SA participants in particular have internalised these norms into their interpretive frameworks. The subsequent comparison between the groups suggests that idiographic factors may interact with these discourses, meaning some are more influenced than others by these discourses. In particular, those with a propensity to think inflexibly (categorical thinking) and/or a predisposition to respond with negative emotionality and worry (neuroticism) may be more likely to appraise their sexuality as problematic and this identify as a SA. The study also lends support to the idea that the SAST tools may unduly pathologize sexual behaviours which are considered ‘unconventional’. 3 Acknowledgments I would first like to thank the many people who took the time to take part in this study. Thanks also to my supervisors Roshan das Nair and Nima Moghaddam who have encouraged and supported me throughout the duration of the project. Finally, I am ever indebted to my friends, family and partner for their continued support throughout another academic endeavour. This is the last one, I promise! 4 Statement of contribution I, Danielle Mayes, declare that this thesis is the product of my own original work which I have carried out whilst enrolled on the Trent Doctorate in Clinical Psychology. I have received regular input and supervision from my supervisors, Dr Roshan das Nair and Dr Nima Moghaddam through the development, execution and write up of this research. I carried out the recruitment and data collection for the study. Both supervisors offered consultation during the data analysis and interpretation stages. 5 Table of Contents SYSTEMATIC LITERATURE REVIEW ...................................................................... 5 1. Introduction ....................................................................................................... 7 2. Method ............................................................................................................. 9 3. Results ........................................................................................................... 11 4. Discussion and conclusions ........................................................................... 31 References ............................................................................................................... 35 Appendices .............................................................................................................. 40 JOURNAL PAPER ................................................................................................... 44 Abstract ................................................................................................................ 46 Introduction ........................................................................................................... 48 Method .................................................................................................................. 52 Results .................................................................................................................. 56 Discussion ............................................................................................................ 68 Conclusions .......................................................................................................... 73 EXTENDED PAPER ................................................................................................. 81 1. EPISTEMOLOGY ........................................................................................ 82 2. BACKGROUND .......................................................................................... 83 2.1. The construct of sex addiction .............................................................. 83 2.2. A critical appraisal of the concept of ‘sex addiction’ ............................ 104 2.3. A social constructionist model of sex addiction ................................... 105 2.4. An alternative explanation .................................................................. 108 2.5. Aims and research questions ............................................................. 114 3. METHODS ................................................................................................ 116 3.1. Design ................................................................................................ 116 3.2. Ethics .................................................................................................. 116 3.3. Participants ......................................................................................... 118 1 3.4. Measures ............................................................................................ 119 3.5. Procedure ........................................................................................... 129 3.6. Qualitative data analysis ..................................................................... 130 3.7. Statistical analyses ............................................................................. 131 4. RESULTS.................................................................................................. 135 4.1. Thematic analysis of participant responses ........................................ 135 4.2. Psychometric properties of measures ................................................ 148 4.3. Comparing self-identified ‘sex addicts’ to ‘non addicts’ ....................... 148 4.4. Comparing SAST-identified ‘sex addicts’ to ‘non addicts’ ................... 151 4.5. Overview of comparisons ................................................................... 154 5. DISCUSSION ............................................................................................ 158 5.1. Summary of findings ........................................................................... 158 5.2. Implications of the study ..................................................................... 164 5.3. Critical evaluation ............................................................................... 167 5.4. Directions for future research ............................................................