In his pioneering research that focused mainly on male sex addicts, Patrick Carnes described in Out of the Shadows how early victimization experiences led to the formation of negative core beliefs (e.g. I am unworthy, I will always be abandoned, sex is my most important need). Highly charged early erotic experiences, often dangerous and/or abusive, coupled with powerful shaming messages, led to a preoccupation with sexualizing all feeling states. In other words sex-addicts-in-the-making, at an early age, learned to block out all painful feelings of inadequacy or loneliness through sexual fantasy, rituals, and an escalation of self-destructive sexual behaviors.

     In later research discussed in his book Don’t Call It Love, Patrick Carnes discovered that in general male sex addicts tend to objectify their partners and seem to prefer sexual behavior that involves relatively little emotional involvement. This leads male sex addicts to engage primarily in such activities as voyeuristic sex, buying prostitutes, having anonymous sex, and engaging in exploitative sex. This may be seen as a logical extension of the way that men in our culture are raised to view women and sex.

     As the dozens of pop psychology books on male-female relationships can attest, there is no end to the lament that men in our culture have difficulty with bonding and intimacy issues. We live in a culture that prizes competition and autonomy, particularly for men: getting ahead, going for the gold, becoming an individual, gaining mastery of feelings, making sexual notches on one’s belt. Taken to the extreme, these values can easily lead to extreme isolation, objectification of sex partners, an inability to express feelings, and a strong sense of entitlement at the expense of others—all fertile breeding ground for addictive behaviors. (I’ve been wanting to diagnose this phenomenon as "Independency syndrome," meaning putting too much emphasis on being independent.)

     Women sex addicts, on the other hand, tend to use sex for power, for control, and for attention. They score high on measures of fantasy sex, seductive role sex, trading sex, and pain exchange. Unlike the men, female sex addicts do not seem to be following an intensified trend already existing in the general culture. In fact, by acting out sexually, these women seem to be reacting against culturally prescribed norms.

     Author Charlotte Kasl has noted that women in our culture are primarily trained to be sexual codependents. In her book, Women, Sex, and Addiction, she defined such codependency as letting one’s body be used in order to hold onto a relationship, whether or not a woman really wants to have sex. In general, sex addicts tend to use (manipulate) relationships in order to have sex, whereas sexual codependents use (manipulate) sex in order to keep relationships. Neither has a clue as to true intimacy.

     Codependency has become an overused term, tending to brand all helping impulses as pathological. In her ground-breaking work on normal female development (In a Different Voice), Carol Gilligan describes how women create a sense of identity through relationships, through the development of an ego-in-context-of-relating. Male developmental theorists from Freud to Erikson have emphasized the need for human beings to become autonomous, basing these models on themselves and then projecting them onto women.

     Gilligan points out that normal female development involves an early need for intimacy skills, with autonomy becoming an issue when women are older, perhaps in their 30s or 40s. Men, on the other hand, are encouraged to find their autonomous identities first and then to explore intimacy skills.

     This may explain why, so often, we see the phenomenon of women going back to school after the kids are grown to "find themselves," at just about the point when their husbands may be wanting to get closer, wanting to "settle down." The point here is that a woman’s need to understand herself in the context of relationship is not by definition pathological. It is only when these normal developmental needs are distorted (usually through early abuse experiences), that desperate, compulsive, and obsessive behavior emerges, culminating in various women-who-love-too-much scenarios.

     Sex addiction in women cannot truly be understood without being constantly aware of the interrelationship of addiction and codependency. Often it appears in my outpatient practice that some women sex addicts are actually trying to "fix" their codependency (a self-perceived sense of weakness and vulnerability) by taking the initiative to act out sexually "like a man." Consider the following examples:

     * Kate, a 25-year-old woman, married, with a 3-year-old daughter. She had been incested for 12 years by her father, which she had difficulty seeing as abuse, because "he didn’t use force." This woman was so hyper-eroticized as a child that she sexualized all relationships, male and female. Her sexual acting out behavior had shifted from replaying abusive scenarios with men (hitchhiking, seeking out dangerous sexual situations) to a compulsive use of female prostitutes. Her primary sexual motive was to be in control, and buying women made her feel powerful.

     It became clear that this was less a question of sexual orientation than it was a need for sexual dominance in order to handle fears and other painful feelings. And in Kate’s mind, buying sexual favors from women was not as "immoral" as having illicit affairs with men. She did not want to become too dependent on her husband’s affections because of a deep fear of abandonment, but she paradoxically craved intimacy. In other words, Kate became a sex addict in order to hold off her fear of becoming too sexually codependent, which was what her father had trained her to be.

     * Marie, a 42-year-old entrepreneur, divorced, no children. Marie came into treatment saying, "every day I want to turn a trick." She, too, had been sexually abused as a child, and had tried to gain internal mastery of her feelings by becoming a call girl and madam, where she felt more in charge. Even though she had stopped practicing prostitution 7 years ago, Marie could not stop compulsively masturbating to the point of injuring her genitals, and she fantasized about turning tricks constantly. This sexual self-abuse was not her only coping mechanism; she was also a binge-purge bulimic.

     * Lila, a 34-year-old woman, married, with two adopted daughters. Lila came into treatment after attending a Family Week for her husband, who was a sex addict who cruised young men in public parks. He was very homophobic and wanted Lila to "cure him" of his attraction to men. He also hoped to "cure her" of her attraction to women, even though he had known throughout their 12-year marriage that she had always been primarily oriented towards lesbianism. After Lila stopped focusing on her husband’s acting out behavior as the cause of all their problems, she realized that she felt equally out of control about her own sexuality, and that she needed treatment for herself.

     Many women have found the fellowship of Sex and Love Addicts Anonymous helpful in reducing the shameful feelings that surround the problem of compulsive sexual behavior, which is the first step towards stopping this behavior.

     In Part Two of this article, I will discuss further the problems that continue to beset women sex addicts, which often leads to misdiagnosis and mistreatment by therapy professionals. I welcome any comments that readers may have about how gender differences can play out in sexual addiction recovery.