IS SEXUAL COMPULSION A SIGN OF MENTAL DISTRESS
– OR DO SERIAL SHAGGERS JUST HAVE BIGGER APPETITES?
Words Jack Summerside
Images Jay Eff
It’s like eating peanuts; have one and you want another straight away.
You don’t enjoy them; you don’t even like them that much, but
they’re there; so you have one after another, and then a few more, just
because you can.” Meet Joseph, a bright, articulate and apparently self-composed
man in his late 20s, describing the sexual compulsion he has lived with since
his teens.
Multiple men
It’s difficult to imagine sexual compulsion on its own as a significant
mental health problem. After all, many gay men have lots of sex with lots
of partners. Year on year the Gay Men’s Sex Survey reports increases
in the number of gay men who say they have 30 or more sexual partners in a
year. Lucky buggers you may say, but getting plenty doesn’t necessarily
make you happy. But it doesn’t necessarily make you miserable either.Ford
Hickson, senior researcher at Sigma Research, says: “Volume of partners
on its own is a poor way of assessing ‘happiness’, In our study,
Sexual Health For All, we didn’t find a correlation between high or
low numbers of partners and people’s happiness with their sex life.”
But Joseph, who is HIV positive, may beg to differ: “It was only after
more than ten years of this repetitive cycle of sex and more sex that I finally
received a proper diagnosis of what was behind it: Borderline Personality
Disorder (BPD, see box, right). “Relationships were impossible to keep
going. Most were short and very volatile. I found myself clinging and uncontrollably
jealous whenever a boyfriend wasn’t there in person. I’d also
feel constantly abandoned when their attention was on something
else, even when they went to work or just to the shops.”
Positive strokes
It was only after a suicide attempt that the pieces were put together. Self-harming
and suicidal tendencies were the final piece of the jigsaw. This was the first
step for Joseph to able to begin to make changes.
“I’ve purposely avoided relationships because I now understand
they are a trigger for my BPD; starting relationships, ending them and the
bits in between. When I’m looking for someone else to give me the love
I can’t allow me to give myself.” Joseph made a conscious decision
to stop himself from relentlessly having sex: “I’ve even stopped
myself from cruising all the time and taken a break from being online for
hours searching for it.” Although Joseph feels happier for these changes,
he struggles with how to fill his time and find other ways get the ‘positive
strokes’ he used to get from a new conquest.
Borderline Personality Disorder
Most associate Borderline Personality Disorder (BPD) with the film Fatal Attraction.
Joseph’s no bunny-boiler, but he’s the first to admit that it’s
had a serious impact on his life and on those around him. Sexual compulsion
is often one of a suite of other compulsive behaviours that make up BPD. Risk
taking is another which may influence the type of sex you have and where you
have it, such as public places where there is a risk of being caught. BPD
is typically characterised by patterns of unstable and intense interpersonal
relationships; frantic avoidance of real or imagined abandonment and confusion
of identity about life choices, goals and career. Uncontrolled spending, binge
eating, reckless driving and some aspects of substance misuse are other common
compulsions associated with BPD. Mental health charity Mind say it is still
a ‘controversial diagnosis’ that can still be missed or misdiagnosed
by some less confident professionals.
Risky sex
At a population level, there are fairly obvious sexual health implications
when you are having so much sex with so many people. “There’s
a clearly proven correlation between higher numbers of sexual partners and
greater likelihood of contracting HIV and other sexually transmitted infections,”
says Will Nutland, head of health promotion at Terrence Higgins Trust. “The
more people you have sex with, the chances are one of them will have an infection.
If you have unprotected sex, there’s an increased risk of exposure to
those infections.” Of course, if you already have an STI or HIV and
are having sex with many men, the greater chance you will pass on that infection,
particularly if you’re driven to having riskier types of sex.
Joseph’s personal experience echoes these statistics. “I often
wonder if I hadn’t had BPD I probably wouldn’t be HIV positive
now. And I wonder who I might have put at risk since I became infected.”
Cruise unlimited
Sexual compulsion and sexual addiction are different ways of describing this
behaviour, although the term ‘sex addict’ is more likely to be
found in the pages of a tabloid than on the lips of a psychologist. This compulsion
doesn’t necessarily involve actually having sex. Cruising or just being
seen to be sexually available can be part of the same ‘problem’.
“Getting into this kind of pattern doesn’t mean you have a serious
mental health disorder,” says consultant psychologist and co-founder
of Terrence Higgins Trust (THT), Dr Rupert Whitaker. “But it can be
an indicator of other mental health difficulties. Things like depression,
low self-esteem, loneliness or feelings of isolation.” “It was
important I had a feeling of
sexual power; that people found me attractive and that I could exercise that
sexual power over them,” says Gareth, a gay man in his late 30s. He
has the looks and build to carry this off, but it doesn’t make Gareth
happy. “I find I just can’t switch off the cruise instinct. I
have to do it, even when it pisses other people off. Like when I’m taking
to friends but cruising over their shoulder at the same time. I’ve lost
friends because of it.”John is one of those friends. “It’s
hard to keep tolerating someone just using you like the straight man in a
comedy double act. You’re only there as someone to act as a foil to
their cruising. You feel like you’re worthless and just a prop,”
says John.
Sex as self-medication
Gareth realised that, despite his good looks and seemingly confident exterior,
he needed to repeatedly bolster his self-esteem either by having sex, or at
least winning sexual interest from other people.
This compulsion caused his other relationships to suffer, which in turn drove
him on with his compulsion as he was no longer getting a sense of self-worth
from friendships or other interests. Gareth admits he’s becoming increasingly
isolated and depressed because of the cycle he’s got into. He also feels
it’s too hard to change and is worried that as he gets older he will
find it harder and harder to get the positive buzz from being able to pull
men at the drop of a hat. “I’ve just got used to using sex as
a kind of medication for what the real issue is. And now I’m lost to
know what to do as an alternative.”
Saying n... yes
John went through a different journey. “I felt like crap because I felt
compelled to compete with Gareth. “I knew I wasn’t in the same
league, but what I didn’t realise was cruising was as much down to technique,
practice and confidence as it was to looks alone. “I just saw my mates
being able to pull all the time. For years I thought it ‘just happened’
to them and not to me because I was plain Jane.” The more John’s
confidence decreased, the less he was able to pull, and this led to a downwards
spiral into depression. “I couldn’t afford to knock back anyone
prepared to have sex with me. I couldn’t risk saying no to unprotected
sex either, in case that meant they wouldn’t want to have sex with me
at all. It wasn’t till I was diagnosed with HIV that I got the wake-up
call.”
Symptoms and causes
So, too much sex can sometimes be a symptom of undiagnosed mental health problems;
sometimes it can be used to mask depression and sometimes it can even cause
it. Sexual compulsion can also have a
negative effect on those around you. It can be especially problematic if drink
and drugs are thrown into the mix. Adam, a mental health support worker with
a London borough, who has been diagnosed with HIV for three years and with
depression for a lot longer, says it is a familiar pattern. “HIV carries
huge stigma as does mental health. A lot of people can’t cope with the
powerful feelings that plague them day and night; fears about life expectancy,
feeling damaged and anxious. They seek comfort from sex, drugs and alcohol
to periodically block out the pain. But as they take bigger risks they often
compound feelings of guilt and loneliness until they get to a point where
they no longer care.” He thinks one-to-one therapy is the most effective
treatment but accepts the NHS does not provide enough.
How much is too much?
The big questions are: how much sex is too much and how many partners are
too many? And when does a does a varied sex life end and sex addiction start?
We are conscious that any attempt to grapple for answers risk providing
headline fodder to tabloid newspapers that are only too happy
Are you self-medicating with sex?
Answer yes or no to the following:
• Do you pursue sex in inappropriate places and times?
• Has having or looking for sex ever got in the way of important things
like your job or seeing family or friends?
• Has your pursuit of sex ever had a bad impact on close personal relationships?
• Do you ever find yourself having sex with people you don’t find
attractive simply to avoid going home alone?
• Do you find yourself needing drugs or alcohol to help you deal with
getting or having sex?
• Do you find having sex is more about ‘just having another one’
than enjoying the experience?
• Do you find yourself regretting having sex with someone, or at a particular
time
or place?
• Do you have sex just to make you feel better about yourself?
to cast gay men as amoral and unable to sustain ‘normal’ relationships.
The real answer though is probably that there’s no single definition
of ‘too much sex’; the ‘line’ will vary from person
to person. What’s right for you is different from what’s right
for someone else. But to give you an idea, try the test (see box, below left).
All about balance
Many of us will answer yes to a lot of these questions and still not have
significant mental health problems. But if you find yourself saying, “Yes,
more than I feel comfortable with…’ to most of them, it may mean
something is out of kilter in the role sex plays in your life. You may want
to take another step and seek some professional help to try to restore the
balance.
Christine Mead, head of Wellbeing Services at THT in London agrees counselling
can be useful for people with sex problems. “Some clients want to look
at ways they can give other parts of life more meaning. Emotional support
can be a good way to explore different ways you could try.”
If you are HIV positive and unhappy with your sex life, you are not alone.
In a Sigma survey, ‘What Do You Need?’, sex came top of a list
of 18 things people living with HIV were unhappy about. By comparison, ‘taking
treatments’ came third from bottom. So you might want to keep an eye
on the way you use sex. But remember, there’s nothing wrong with a few
notches on the bed-post; the only problem is that too many might weaken the
bed-frame.
• www.mind.org.uk/information/booklets.
Follow the index for its online booklets on Borderline Personality Disorder
and Confidence & Self-Esteem
• If you have concerns about sex and mental health, your GUM or HIV
clinic is the best place to start looking for local services
