Feature Article

Cybersex Use and Abuse: Implications for Health Education

Delores Dorton Rimington and Julie Gast

ABSTRACT

The is increasingly used as an outlet for sexual activity. This literature review explores key definitions, perceived benefits, risks, and consequences of engaging in cybersex, as well as its influence on youth and young adults. The accessibility, affordability, and anonymity of the Internet make it highly appealing to users. Increasing time spent online for sexual activity may lead to cybersex abuse and compulsive cybersex behavior. This poses a threat to relationships, work, and educational pursuits. Chatrooms are especially prominent as a slippery slope to more extreme sexual behaviors. Characteristics of cybersex users do not seem to be divided by subgroups such as gender, , and marital status. There are only limited amounts of research on youth and online sexual activity, but some research suggests that adolescents are engaging in cybersex. Moreover, college students appear to be at particular risk for developing cybersex compulsive behaviors. Increased health education about the dangers of potential cybersex addiction and abuse is needed. In addition, health educators need to add cybersex to their curricula to warn users of potential addiction.

THE WIDESPREAD INFLUENCE ever, cybersex becomes a social concern prevention of cybersex addiction. Currently, OF THE INTERNET when individuals spend so much time most health educators do not address the In a world where everything from bank- online that they neglect their relationships, issue of cybersex in their classrooms, nor ing and shopping to education and match- work, school, or other obligations.4 In re- do they arm their students or community making can be found online, it is little cent years viewing among with information about the potential dan- wonder that the United States Department Americans dramatically increased, largely gers associated with engaging in online of Commerce found that 51% of all U.S. due to increased access to the Internet.5 sexual behavior. Considering that cybersex households had access to the Internet.1 With the invention of the Internet, the pur- may pose a threat to current and subsequent Access to the Internet poses several concerns suit of sexual stimuli has become more ac- relationships, the absence of this type of for mental health professionals. Increased cessible, affordable, and anonymous.2,3,6 As education is significant.8 The purpose of access in individuals’ homes adds a new of the year 2000, it was estimated that 20 this literature review is to: dimension to health and psychological is- million people visited sexually themed Web 1. Explore the key terms of cybersex. sues when combined with sexually oriented sites monthly. This number continues to behaviors.2 The speed, availability, and increase, with sex being the number one convenience of the Internet, in combina- searched topic on the Internet.5 It is not Delores Dorton Rimington is a Master’s of Sci- tion with sexually oriented material, create surprising that cybersex addiction is on the ence candidate, Department of Health, Physi- the potential for the “next sexual rise,5 and college students appear to be at a cal Education, and Recreation, Utah State revolution.”3(p519) particular risk for cybersex abuse.7 University, Logan, Utah 84322-7000. Julie Just as not all users of alcohol become A review of the literature shows that Gast, PhD, is associate professor with the alcoholics, most cybersex participants do there is much information about cybersex, Department of HPER, Utah State University, not experience compulsive problems; how- but that little research is available on the 7000 Old Main Hill, Logan, Ut 84322-7000.

34 American Journal of Health Education — January/February 2007, Volume 38, No. 1 Delores Dorton Rimington and Julie Gast

2. Investigate the roles of marital status, tivities that may include: looking at pictures, to achieve this flow experience. Flow is ob- gender, and sexual orientation in cybersex engaging in sexual chat, exchange of sexual tained through a ritualized experience of behavior. emails, and “cybering,” where both parties surfing for the “perfect pick.” For example, 3. Identify perceived benefits, risks, and masturbate while exchanging sexual chat Philaretou, Mahfouz, and Allen found that consequences for individuals who engage in online.2 cybersex participants reported searching cybersex. Other definitions of cybersex include until they found the image or movie that 4. Investigate the influence of cybersex this from Schneider given in 2000 and 2004: was just what they wanted and then mas- on youth and college students. “any form of sexual expression that is ac- turbated to that specific image.16 Money 5. Identify the role of cybersex education cessed through a computer.”11,12(p208) In 2004, defined the construct of a “lovemap” as a for health educators. Cooper and colleagues defined cybersex as cognitive and emotional schema that pro- “using the…Internet to engage in sexually vides a map or outline for the individual’s EXPLORING KEY TERMS gratifying activities.”2(p131) This latter defi- preferred sexual relations and actions.17 Sex Addiction nition narrows the former from any sexual This behavior may exist both offline (e.g., The existence of sex addiction is still expression on a computer, to sexually ori- ) and online (e.g., chatrooms). debated among health care professionals. ented Internet use only. Another definition, When online, the individual customizes his Some believe that behaviors such as gam- given in 2004, described cybersex as “engag- or her perfect pick instead of searching bling, eating, or sex are not in themselves ing in sexual self-stimulation while online offline in clubs for someone who fits their 13(p1002) addictive but they are manifestations of with another person,” which is simi- ideal. Once the perfect pick is found, satis- 2 other underlying issues. Yet, the term ad- lar to “cybering.” This interaction could be faction is short-lived and the user then diction has been used to describe any form exchanging sexual e-mail, chatrooms, in- searches for a variation on the theme. For of self-destruction.9 Carnes defined addic- stant messaging, or Web cameras. Finally, the user there is always something more and tion as a “pathological relationship with a cybersex was defined in 2005 as “two or he or she is never satisfied.16 mood-altering substance or behavior.”10(p14) more people engaging in simulated sex Under this definition, drugs as well as any talk while online for the purposes of sex- CHARACTERISTICS mood-altering behavior would apply. When ual pleasure and may or may not include OF CYBERSEX PARTICIPANTS sexual behavior is used as a coping device, by one or more of the Characteristics of individuals involved in it is used to alter one’s mood. Compulsive participants.”14(p132) Clearly there exists a lack online sexual activities differ widely, but sexual behavior has been documented to of agreement in the literature regarding a there are trends. For example, users must alter brain function in a way similar to il- universal definition of cybersex. This dis- have access to the Internet, and most access licit drug exposure.9 Additionally, research- crepancy may lead to confusion and creates it at home. However, in a study of online ers documented that there can be a “high” challenges in planning and implementing sexual behavior, Cooper, Delmonico, and produced through sexual behavior similar cybersex abuse prevention programs. For Burg reported that 6 out of 100 employees to that of crack cocaine.11 The use of the example, one program may focus on the reported accessing sexual material at work.7 Internet for sex, or cybersex, to escape and Internet while another may focus preven- This included individuals meeting the cri- alter one’s mood fits into this category and tion efforts on pornographic CD Rom pur- teria for sexually compulsive behavior as is becoming more prevalent in cases of chases. For the purpose of this review, well as those with no sexual compulsions. as it is heretofore defined.11 cybersex will be defined as sexual expres- Who Engages in Cybersex? What is Cybersex? sions or interactions accessed through a Marital Status and Cybersex. In one Cybersex definitions have many varia- computer. study, researchers found that unmarried tions. Some researchers differentiate online Defining the Flow Experience individuals were overrepresented among sexual activity (OSA) from cybersex. OSA Cybersex abuse, as with other potentially those addicted to cybersex.7 Unmarried in- is defined as the “use of the Internet for any addictive behaviors, initially begins with dividuals may be more likely to report activity (text, audio, graphics) that involves reinforcement. For cybersex abuse this re- cybersex compulsive behaviors because they sexuality. This includes recreation, enter- inforcement is sexual gratification and re- may be searching for dating relationships. tainment, exploration, support around lease of tension.15 Sexual gratification is Ross, Masson, Daneback, and Tikkanen sur- sexual concerns, education, purchasing achieved though the flow experience.16,17 veyed men concerning their online sexual sexual materials, [and searching for] sexual Flow theory posits that one becomes so ab- behavior and found that 42.7% were in a partners.”2(p131) Cybersex has been defined sorbed in their online behavior that they (i.e., married, or as a subcategory of OSA and occurs when lose track of time and of themselves, becom- co-habiting) while 54.7% were not.3 Thus, individuals use the Internet to engage in ing oblivious to all around them.18 An indi- both married and single individuals engage sexual expression or sexually gratifying ac- vidual engaging in cybersex often has a goal in cybersex.

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Gender and Cybersex. Some studies in- ior. In a study of sexual orientation and RISKS AND CONSEQUENCES OF dicate that women are more likely to be in- cybersex, researchers reported that homo- CYBERSEX INVOLVEMENT volved in Internet chatrooms than are sexual and bisexual individuals were over- One major risk associated with online men.2,19 Yet, overall men outnumber women represented within the cybersex compulsive sexual behavior is damaging offline intimate in cybersex use.2 Researchers found that group, yet lesbians were underrepresented.7 relationships. For example, cybersex has women are also at risk for developing com- In an online survey, Ross and colleagues been termed, “virtual .”16 Below is pulsive cybersex behaviors.19 In a survey of studied men’s cybersex behaviors. They a review of the potentially harmful emo- more than 9,000 Internet users, women found that heterosexual and homosexual tional and physical effects of cybersex. made up 14% of the sample, yet they ac- men reported engaging in cybersex, and that Risk of Addiction/Compulsion 7 counted for 21% of the cybersex addicts. the sexual orientation of their reported Many cybersex researchers identified a Cooper and colleagues found that even cybersex behavior did not necessarily reflect relationship between compulsive behavior 14 though men are online for sexual purposes their self-reported sexual orientation. and cybersex in order to explain users’ ex- more frequently than women, women ap- cessive amount of time spent online in pear to be more apt to develop cybersex PERCEIVED BENEFITS sexual activities.2,7 Compulsions have been 2,19 addictive behaviors. OF CYBERSEX BEHAVIOR described as the desire to stop or to reduce According to a review by Ferree, women The Triple-A Engine the frequency of a behavior with the inabil- are more likely to desire and rela- The influx of cybersex behavior renders ity to do so.6 Sexual compulsion was defined tionships in their sexual experiences, which it impossible to ignore the perceived ben- by Cooper and colleagues as an “irresistible make ‘love’ or ‘relationship’ addictions more efits of engaging in this potentially risky urge to perform an irrational sexual act, 19 prevalent among women. This could ex- behavior. What are the rewards that render such as one that will result in negative plain why women are more likely to visit cybersex so appealing? Researchers have consequences.”2(p136) These conditions exist Internet chatrooms and initiate relation- proposed several mechanisms, one of which in some cybersex users’ patterns. Research- ships through the Internet.12 For example, is termed the “Triple-A Engine,” which sug- ers agree that online sexual compulsivity one study reported that women are more gests that the major benefits of using the refers to a person who is involved with likely than men to eventually meet an online Internet for pornography are primarily online sexual activity in a continuous way, sex partner in person. Schneider found that these three: anonymity, accessibility, and to the degree that it interferes with aspects 80% of women surveyed reported a real- affordability.2,6,7 Individuals are able to of work, social, and/or recreational dimen- life meeting with their online sex partner.4 access the online material from the privacy sions of one’s life.2,6,12 Often there are other This may make women who engage in of their own home without the potential aspects of compulsion, such as loss of con- cybersex more likely to be victims of sexual embarrassment or criticism associated trol or loss of the ability to regulate or stop violence. In another study, men reported with being sighted at an adult bookstore. the intensity and amount of the behavior.2,6 preferring surfing the Web for their Moreover, cybersex does not place partici- In one study, researchers reported the 9.2 cybersexual activities.2 Men did not seem pants at risk for sexually-transmitted infec- percent of the participants reported their to need the relational aspect as much as tions (STIs), and is easy to hide from a cybersex behavior felt out of control women because the visual component of spouse because there is no physical evidence (n=7000).2 Furthermore, in a study of 9,265 the Web was sufficient. Additionally, twice of the sexual experience.11 In a study by participants, 21 percent of all respondents as many men reported cybersex interfering Philaretou and others, make interviewees reported their cybersex involvement jeop- with their lives than did women.2 reported that some of the advantages of ardized an area of their life.7 Historically, women are considered a online sexual behavior include being able Cybersex can provide an avenue for sexually disenfranchised group. The to engage in sexual activity when their girl- extreme sexual behaviors which are likely Internet and chatrooms offer venues where friend is not interested or if the user does to lead to an addictive sexual disorder. a woman may anonymously release sexual not have a girlfriend. One interviewee re- Researchers identified that a number of inhibitions.7,19 Women tend to express more ported that cybersex is better than paying Internet users have preexisting sexual com- guilt after engaging in cybersex than do for prostitutes, and that an individual can pulsions or addictions, and the Internet men. This is illustrated by a comment from obtain free sexual material online.16 becomes a new outlet for the preexisting a participant in a study done by Schneider, Griffiths suggested additional perceived behavior.2,4 Conversely, use of the Internet who said, “It is not considered normal for a benefits of online sexuality include: conve- may also trigger a compulsion for some who woman to escape her pain through sex.”12(p269) nience, escape, and social acceptability.20 would not have a problem with pornogra- Sexual Orientation and Cybersex. Both While there are perceived benefits of phy otherwise.2,5 Schneider explained that homosexual and heterosexual individuals cybersex use, there exist risks that users may abuse starts out small and seemingly inno- reported engaging in online sexual behav- or may not recognize. cent. This then leads to a worsening of

36 American Journal of Health Education — January/February 2007, Volume 38, No. 1 Delores Dorton Rimington and Julie Gast

behaviors. For example, one interviewee editorial, Delmonico explained that online Behaviors Leading to Cybersex reported finding it necessary to enter the communications fail to involve all of the Chatrooms are a potential risk in house before her children so that they did senses, as in-person relationships do.22 cybersex activities. They can be a gateway not see their father masturbating in front Without stimulating all five senses, the re- for other, more risky behaviors, such as of the computer.4 lationship breaks down to a one-dimen- offline meetings. Some consider chatrooms In one study researchers found a pattern sional experience which lacks the depth a “slippery slope” toward more compulsive of becoming “increasingly addicted to developed in real-life relationships. Inter- sexual behaviors, especially for individuals online pornography.”16(p159) The time spent action in an online relationship is not able who are prone to addictions.7 Introduction online started out small and then increased to meet the needs of human relationships, to chatrooms often begins with curiosity, to a typical week of spending 8–12 hours and prevents the development of the “sixth or seeking companionship.24 There, within surfing the Internet for sexual material. sense,” the one that tells us if a relationship the cloak of anonymity, participants are in- They desired to stop but reportedly could is “good” or “bad.”22 Schnarch explained troduced to differing graphic and erotic not. They expressed concern and guilt for that individuals in cybersex relationships behaviors that alone they might not con- their behavior, especially if they were ever can present themselves however they feel sider participating in. With support and discovered by family members. Overall, they most comfortable, which limits disclosure encouragement from others in the reported a lack of control of their behavior. and leaves the relationship fake and mis- chatroom, they begin to find the new be- One participant stated that it was like get- leading.23 haviors appealing and even preferable to ting “high;” there is the same euphoric feel- The Impact on Relationships traditional sexual behaviors. These new be- ing and drive for more.16 Consequences of engaging in online sex haviors often play out in both online and How Much is too Much? Cooper, potentially affect family members and the offline intimate relationships.4,24 Delmonico, and Burg reported a positive individual’s ability to seek and maintain In an email survey to partners of correlation between the amount of time offline intimate relationships. In a study by cybersex addicts, 30.9% of the surveys re- spent online and problematic cybersex that Schneider, one participant stated that he ported that cybersex activities were a con- was potentially compulsive.7 The Marital had “turned off [his] emotions” and “was tinuation of other compulsive sexual behav- and Sexuality Center and MSNBC con- unavailable to [his] family.”12(p260) Cooper iors that existed prior to Internet ducted a survey and found that 6.5% of the reported that individuals can spend so involvement.4 Other behaviors included male Internet-using population who took much time in an online relationship that phone sex, , frequenting prosti- the survey reported spending nearly six offline relationships atrophy without the tutes, going to massage parlors, and involve- hours per week in cybersex activities.21 Ad- time and attention needed to develop or ment in traditional pornography (e.g., ditionally, researchers reported that those maintain them. The offline relationship magazines, videos, and movies), often since who engaged in 11 or more hours per then suffers and often terminates.6 One par- their teen years.4 This suggests pornogra- week of Internet pornographic behavior ticipant lamented, “If I had spent the time phy can lead to other, more extreme behav- experienced intrapersonal and interper- and energy on my instead of iors. With the addition of the Internet and sonal problems in financial, legal, occupa- online, we would have grown together its easy access for the younger population, tional, and recreational areas of their lives.3 rather than apart.”12(p262) This pattern of it is more likely that individuals will begin A similar study reported a mean of 2.6 (SD obsession with cybersex often leads to prob- to explore pornography at a younger age. = 5.31) hours per week spent engaged in lems with intimacy and other psychologi- Therefore, mere exposure to online sex is online sexual activity within their study cal problems.2,12 Family members in particu- likely to increase the rates of compulsive sample.2 Those who reported spending 11 lar tend to suffer from compulsive cybersex cybersex behavior simply by increasing the or more hours per week in online sexual use. Schneider reported on individuals in number influenced. As these data indicate, pursuits were nearly 2 standard deviations committed relationships with a cybersex addicts frequently begin their exposure to above the mean in time spent engaging in addict. Participants reported feeling devas- sexual material a young age. cybersex, which falls into the range of a tation, betrayal, loss of self-esteem, mistrust, clinical disorder.2 fear, and lack of intimacy with their real- CYBERSEX AND YOUTH Cybersex and Relationships life partner. Others reported feeling sexu- Because of the negative effect that com- Cyber relationships likely leave the user ally inadequate, unattractive, and ugly. The pulsive cybersex behavior has on users and unfulfilled. The cyber world and its illusory behaviors lead to separation or divorce their family relationships, it is crucial to reality can be a barrier to real intimacy. Par- among 22.3% of the sample; two partici- understand when and how the behavior ticipants are sometimes caught up in their pants became physically abusive to their starts. This will allow better prevention fantasies to the extent that the interactions husbands, and two reported hospitalization techniques to be implemented. Most stud- barely resemble a real relationship.15 In an for suicidality.4 ies explain the impact of compulsive sexual

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behavior on older adults even though these tion was “college students” (17%).14 College most diverse population of youth for health compulsive behaviors often begin in the students are likely to be dating and are at education activities. It is doubtful educators teen or young adult years.4,5 Therefore, the an age when romantic relationships are part other than health educators will be address- need to address online sexual behavior of of their lifestyle. There is a need for better ing this issue in the classroom. Just as health youth becomes apparent. education and prevention for people in this educators routinely teach about the signs It is impossible to determine how many age group. and symptoms of other abusive and addic- youth and children are accessing online tive behaviors, we also need to be alerting sexual material because online behavior is CYBERSEX EDUCATION AND both secondary and college students to the practically anonymous. Adults and children PREVENTION dangers of cybersex abuse. Based on the re- alike can change their age and gender in- How can school and community health search available, these symptoms may in- formation in chatrooms. Regardless, there educators promote cybersex education and clude: has been a rise in the number of children prevention? From a community health per- • Time: if Internet related cybersex use es- and teens seeing counselors for problems spective, local health promotion staff calates, especially if they no longer have time 5 associated with online sexual behaviors. should be speaking to church groups, par- for other activities they previously enjoyed. Because it is illegal for those under 18 to ent organizations, civic organizations, and • Mood: if an individual is using cybersex access online sexual material, many minors local and state governments about the need activities to cope with depression or stress. are reluctant to disclose any such behavior, for prevention programs. These could also what benefits they derive, or the extent of be viable outlets to house cybersex preven- • Guilt: if an individual feels guilt or re- their online sexual behavior. Yet, there are tion programs once community awareness morse after cybersex use. studies reporting adolescents engaging in has been raised about cybersex addiction • Relationships: if personal relationships are cybersex. Ross, Rosser, and Stanton found (e.g., public libraries, churches). These com- neglected or ignored. that teenage homosexual men reported en- munity resources could be a way to conduct • Responsibilities: if work, family, or aca- gaging in cybersex, with the mean age of educational outreach beyond the public demic responsibilities are neglected. 13 16.05 + 4.85. A study done at the Univer- schools. However, implementing preven- • Concern from others: if an individual’s sity of New Hampshire found that 1,501 tion programs take resources. Advocacy to cybersex use is a concern to others. Internet users ranging from 10 to 17 years fund state and local community health pro- • Illegal activities: if an individual is break- of age revealed the following: One in five grams for cybersex prevention programs is ing the law related to cybersex use (e.g., un- received a sexual solicitation over the needed. To treat those already addicted to derage user, soliciting sex from underage us- Internet in the past year, and one in 33 re- cybersex, programs such as Sexoholics ers, etc.). ceived an aggressive approach, defined as an Anonymous and mental health profession- individual requesting a meeting, calling on als trained to treat sexual addiction are • Loss of control: if an individual has a the telephone, or sending regular mail. One needed in our communities. desire to stop or reduce cybersex use but in four was exposed to unwanted online For this review, no research-based pre- cannot do so. pictures, and one in 17 received threats or vention curriculum on cybersex could be To date, no cybersex abuse prevention harassment. These adolescents claimed to found for any age group. As noted above, curriculum materials exists. There are, how- report less than 10 percent of the sexual so- secondary and college students appear to be ever, materials on safe Internet use for licitations they received to authorities, and at higher risk than the general population youth. While safe Internet use is important, reported only 3 percent of unwanted expo- for cybersex use and abuse as well as un- there is a need for students to learn that sure occurrences to authorities.25 An FBI wanted sexual advances via the Internet. cybersex use can become problematic and report found that cybersex offenses have a Additionally, there is evidence that cybersex even addicting. School counselors should longer lasting effect than other porno- use, as with other addictive behaviors, typi- also be aware of the warning signs of graphic material, as once the material is cally begins with young people and may cybersex abuse and can therefore help iden- online it can be transferred to different us- escalate into more problematic behaviors tify children at risk. Should a student be ers quickly and is very difficult to destroy with time.4,5 found violating the school policy related to before it has done harm to many individu- It is estimated by the U.S. Department using school computers to access pornog- als, especially youth.26 of Education that 54.3 million children are raphy, this should be considered a warning Cooper and colleagues, found that col- enrolled in primary and secondary schools sign and should be addressed by the school. lege students were overrepresented within in the United States and 17.5 million people Should a student or his or her parents feel the cybersex compulsive group.7 Similarly, are enrolled in post-secondary education use is approaching compulsion, health edu- Ross and colleagues found that study par- settings.27 Therefore, schools are an ideal cators need to refer students to mental ticipants’ most frequently reported occupa- outlet to reach the greatest number and health services, ideally with professionals

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who have a background in treating sexual Cybersex participants enjoy the privacy Approach. New York: Wiley Press; 1999:519–545. addictions.7,12 that the Internet offers in online sexual ex- 4. Schneider JP. Effects of Cybersex addic- If schools do not already have a policy periences. The perceived benefits for par- tion on the family: Results of a survey. Sex Ad- related to cybersex, one should be put into ticipating in cybersex consist of the Triple- dict Compul. 2000b:7:31-58. place. Policies may include: supervising stu- A Engine: accessibility, affordability, and 5. Freeman-Longo RE. Children, teens, and dents while they access the Internet, install- anonymity; and not being exposed to sex on the Internet. Sex Addict Compul. ing filters on all school computers to limit STIs.2,7,12 Even though some individuals are 2000;7:75–90. cybersex access, having teachers type in successful in stopping cybersex behavior, 6. Cooper A. Sexuality and the Internet: Surf- search terms for students while online, and many become compulsive users which can ing into the new millennium. CyberPsy Behav. delineating disciplinary measures if rules place them on a downward slope that can 1998;1:181–187. are violated by staff or students. Of course, lead to addiction. 7. Cooper A, Delmonico DL, Burg R. parental education is needed on the follow- College students are more likely than cybersex participants, abusers, and compulsives: ing: tips for safe surfing for children at other occupations to report compulsive New findings and implications. Sex Addict home, how to discuss the topic of cybersex cybersex involvement.7 Increasingly, youth Compul. 2000;7:5–29. with their child, and potentials signs of are participating in cybersex and many un- 8. Enough is Enough. Just harmless fun: cybersex abuse. Both the school health edu- derage teens have been exposed to un- 2000. Available at: http://www.enough.org/ cator and counselor can take a lead in edu- wanted online sexual solicitations via e-mail justharmlessfun.pdf. Accessed October 3, 2005. cating parents about these issues. With any or in chatrooms.5,25 Earlier education about 9. Roller CG. Sex addiction and women: A sexuality-related topic, there may be paren- the potential dangers of cybersex needs to nursing issue. J Addict Nurse. 2004;15:53–61. tal or community opposition to adding be taught. This may best be served in the 10. Carnes P. Out of the shadows. 3rd ed. Cen- cybersex prevention to the public school schools, and needs to especially focus on ter City, MN: CompCare; 2001. curriculum. Schools will likely need to take teens and young adults, as they are at par- 11. Schneider JP. Understanding and diag- steps to raise awareness that cybersex abuse ticular risk for cybersex compulsive behav- nosing sex addiction. In: Coombs RH, ed. Hand- is (1) a growing problem, (2) that it typi- iors. Just as they educate about drugs and book of Addictive Disorders: A Practical Guide to cally starts with young people, and (3) that alcohol, health educators need a researched- Diagnosis and Treatment. Hoboken, NJ: John it can escalate into addiction, similar to based curriculum added to their classes to Wiley & Sons, Inc.; 2004:197–232. other addictive behaviors.7,11 better inform youth and college students 12. Schneider JP. A qualitative study of about the risks, consequences and warning cybersex participants: Gender differences, re- CONCLUSION signs of cybersex dependence. covery issues, and implications for therapists. The Internet is becoming an increasingly Further research should focus on the Sex Addict Compul. 2000;7:249–278. popular way of accessing erotic sexual ma- perceived benefits or perceived barriers of 13. Ross MW, Rosser BRS, Stanton J. 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