The World Health Organization (WHO) Acknowledges Compulsive Sexual Behavior Disorder (CSBD)

The World Health Organization (WHO) Acknowledges Compulsive Sexual Behavior Disorder (CSBD)

Over the past twenty-five years, I have observed a wide variety of beliefs and values about human sexuality.  Some people believe in having many sexual partners while others think that having a monogamous relationship is right. Some individuals advocate having multiple sexual experiences as “normal and natural”.  While others indicate that sexual acts or thoughts can become obsessive, compulsive, and out of control. I know of professionals who become very frustrated during discussions about sexuality.  Both sides of the argument seem to have merit depending on how you view the situation.  Human sexuality IS a normal activity; however, for some sex turns into compulsive “acting out.”  At this point, the World Health Organization (WHO) is acknowledging research trends providing important information on this topic.  The World Health Organization (WHO) Acknowledges Compulsive Sexual Behavior Disorder (CSBD)

On July 2, 2018, The Social Post news reports WHO officially recognized their most current diagnostic manual, ICD-11 which categorized sex addiction as a form of mental illness.  This decision implies that sex addiction needs medical consultation and intervention.

According to Porn, the ICD-11 describes the condition of Compulsive Sexual Behavior Disorder (CSBD) in the following way:

Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intensive, repetitive sexual impulses or urges resulting in repetitive sexual behavior.  Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behavior; and continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it.  The pattern of failure to control intensive, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgements and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.

The ICD-11 does not specifically use the word “addiction,” rather it classifies CSBD as an “impulse control disorder.”  This is due to a person’s inability to control impulses to engage in repetitive sexual behavior.

The Social Post news reports that approximately 2% to 4% of the population experiences this condition.  Some professionals believe this number is higher due to the billions of dollars that are spent on the various areas in the sex industry.

Professionals in the field have been aware for some time that certain clients neglect their relationships, health, family, and work responsibilities, due to these sexual obsessions and compulsions.  Hopefully, for people suffering with this new diagnosis “CSBD” will understand their condition and feel more comfortable seeking treatment.

For more information or consultation, please contact me.

Betrayal Trauma

Betrayal Trauma

Have you heard of the term “Betrayal Trauma”?

In my practice, I have seen an increase in the number of individuals experiencing betrayal trauma. Betrayal trauma occurs when a person we are attached to or depend on significantly lets you down or more accurately, betrays your trust. In adult relationships, this person is often a spouse or lover who repeatedly violates the “trust bond”. The betrayed partner may experience verbal, physical, sexual or emotional abuse. This abuse can create uncertainty and ambiguity within the relationship and usually leads to a feeling of instability, like the rug has been ripped out from under you.

betrayal traumaBetrayal trauma results when an addict views pornography, goes to a strip club or participates in some other form of “sexual acting out”. When the betrayed partner expects their partner to be faithful, but instead is cheated on, then betrayal trauma can result.

The difficulty in the relationship comes to a head when a partner makes a clear discovery that the addict has betrayed the expected trust. Once the betrayal comes out in the open, the betrayed partner needs help working through the emotional devastation caused by the addicts’ behavior.

In a betrayal situation, the betrayed partner often feels like their life is spinning out of control or that they are going crazy. They often experience symptoms of anxiety. There is a body of research that suggests that partners married to sexually addicted spouses can and often do exhibit anxiety symptoms of Posttraumatic Stress Disorder (PTSD) following infidelity or even perceived unfaithfulness.

Robert Weiss, MSW describes some of the anxiety symptoms that a betrayed partner may experiences including depression, mood shifts, extreme emotional reactions, tearfulness, rage, anger, anxiety, and low self-esteem. They may have difficulty sleeping, waking up, or have nightmares. They may begin to investigative the addict by checking phone texts, phone numbers, computer logs, wallets, credit card bills or phone bills for signs of unfaithfulness.

They may be easily triggered by their partner flirting with others, looking too long at others, or getting off the computer too quickly. They may have difficulty concentrating and completing daily tasks. They may obsess about the betrayal and have problems living in the present. They may exhibit addictive behavior themselves by using drugs, alcohol, gambling or spending. They may also eat too much or too little in response to the stressors.

Even though the betrayed partner exhibits symptoms of PTSD, a diagnosis of PTSD may not be necessary. With time and therapeutic intervention, the partners can recover and experience relief.

One of the best ways to self-soothe and heal from this trauma is to focus on establishing better boundaries. In her book, Moving Beyond Betrayal, Vickie Tidwell Palmer suggests that self-care through the use of boundaries is essential for healing. The boundaries include physical, intellectual, emotional and spiritual areas.

Boundaries are Essential for Healing

Physical – These boundaries include behavior to keep the partner safe such as not allowing for any abusive behavior, getting testing for STD’s, and only having protected sex.

Intellectual – Obtain as much information about the addiction as possible. The knowledge will help you better understand the situation and make better decisions.

Emotional – Seek support from appropriate people such as a knowledgeable addiction therapist, friends, sponsors, and family members who understand what is happening. It is important that you don’t try to go through this trauma alone. Connecting to supportive individuals can be very helpful.

Spiritual – Spiritual practices can provide a sense of hope, comfort, and peace during this difficult time.

In addition to setting boundaries, a final suggestion is to stay positive during the recovery process. Even though a person is thrown into a very difficult situation, they can find comfort in remembering their core values. This can prevent you from blaming yourself for the addict’s actions. Focusing on positive values can also help you avoid becoming bitter.   May your recovery be strong and your journey, be filled with hope.



Blog: Internet Pornogaphy by the Numbers; A Significant Threat to Society

As a professional, I am always looking for relevant information about what is happening in the lives of individuals and families.  Internet Pornography by the Numbers; A Significant Threat to Society is a compelling article with statistics about the significant costs of pornography in our world. The authors, Webroot Smarter Cybersecurity indicate that pornography use negatively impacts business productivity by 16.9 Billion dollars annually. However, they suggest that fiscal costs are only part of the story. They believe that the human costs are much more significant.

They quote Patrick F. Fagan Ph.D. psychologist, and former Deputy Assistant Health and Human Services Secretary, who says, “Pornography hurts adults, children, couples, families, and society. Among adolescents, pornography hinders the development of healthy sexuality, and among adults, it distorts sexual attitudes and social realities. In families, pornography use leads to marital dissatisfaction, infidelity, separation and divorce.”

The article sites many general, youth, and family statistics about pornography use. Some of the statistics are quite startling for example, every second approximately 28,258 users are watching pornography on the internet and every second approximately $3,075.64 is being spent on internet pornography. Obviously, a huge amount of time and resources are being directed toward pornography use.  The statistics also target the impact that pornography use is having on adolescents.   The teenagers exposed to high levels of pornography experience loneliness, depression, and lower sexual self-esteem. The statistics also indicate a significant impact on marriages. In 2010, the National Coalition for the Protection of Children & Families reported that 47% of families reported that pornography is a problem in their home. Pornography use increases the infidelity rate by more than 300%.

The article provides us with thought provoking statistics and material about pornography that should be considered in business and in our personal lives.

If you would like to learn more please visit:

Weekend Seminar

Weekend Seminar Client Relection

Being able to listen and share in a safe environment with other men from similar backgrounds was very revealing and comforting. Having Dr. Chen as the facilitator allowed a level of honesty and self-reflection that I have not felt before in SAA meetings.  Because of Dr. Chen’s intimate knowledge of our emotions, feelings, and past behavior, he was able to ask clarifying and revealing questions that probe for more deep and honest answers.  Dr. Chen always made me feel safe and comfortable.  He also added down time over meals to get to know everyone on a friendly level.  Dr. Chen’s ability to select a group of men that would be able to share openly for a weekend seminar and be able to bond and grow was a gift. The opportunity to have one-on-one time with every man not only helped me to get to know each of them better, but also opened-up a level of honesty that is not always available in group. I can honestly say that without having Dr. Chen as the anchor of my recovery, I would not have as much sobriety as I do today.

Honest Recovery

Sexual Addiction-Assessment and Treatment

Sexual Addiction Conference – Assessment and Treatment


The training at this conference will enable professionals to identify 10 criteria for addiction. They will understand the addiction cycle. They will recognize how early trauma and other components enable an addiction to develop. Providers will be able to identify 10 types of compulsive behavior revealed through research.

Who Should Attend

Therapists who work with individuals and couples who are having personal and relationship problems. In some cases, the individual’s and couple’s struggles might be due to underlying sexual addiction issues.

Date: February 28, 2018

Time: 9:00 am until 12:00 noon

Location: Salt Lake City Public Library

Salt Lake City Public Library

210 East 400 South

Salt Lake City, UT 84111


Single Registrant: $45

Group Rate (4 or more): $35 each

Registration Link:

Continuing Education Credit: 3 hours

The following organizations have approved CE credit for this course:

The Utah Psychological Association

Utah Association of Social Workers

The course relates to Marriage and Family Therapy work. The training will help MFT providers identify sexual addictive behavior when applicable.

Course Director: Steven J. Chen, Ph.D.

Steven was trained in Clinical Psychology and obtained his Ph.D. in 1992. He has worked at a variety of settings and has more than 25 years’ experience in psychology. Steven has worked with numerous individuals suffering from addiction, including alcohol, sex, and drug dependence. He utilizes a unique intensive outpatient approach, which is highly effective in helping those with addiction as well as spouses and family members. He is a certified sex addiction therapist (CSAT).

For more information about the conference, please see the training section of the website.




Dear Dr. Chen,

I am very grateful for your guidance and instruction.  For over 50 years, I have dealt with sexual addiction.  I have found it unbeatable despite my most ardent, sincere and determined efforts to control it.  Almost three years ago my life hit rock bottom.  I finally understood my life was uncontrollable and I could not beat the addiction by myself.  Quite by chance I met with Dr. Chen.  I told him my story and he said that I was a sex addict.  He handed me a book about sexaholism and told me to attend a 12-step meeting.  He told me that sex addiction was a disease.  He would work with me to help me manage the disease, but that I would never be cured.  Since that time with Dr. Chen’s help, my personal surrender, and the help of other recovering addicts, I have embarked on a path of spiritual rebirth.  This spiritual rebirth consists of physical, mental and emotional recovery.

I think that recovery has many components.  I cannot be completely successful without religious, social and professional therapy components working together equally.  I am grateful to have found all three components.  Even more grateful that my recovery is happily proceeding with a life connected to God, loved ones, and others.  I have appreciated Dr. Chen’s wisdom, suggestions, and constant reinforcement of me as a person of value throughout the process.

Sincerely,  Grateful

Dear Grateful,

I appreciate your kind words.  It has been a pleasure helping guide you through the recovery process.  As we have discussed on many occasions, recovery is not a destination. Recovery  is a life long undertaking that one must recommit to each day.  The process is not easy.  As you have experienced, there are many challenges.  However, with patience and persistence, the life improvements you experience will be well worth the effort.

All the best,  Dr. Chen

Considering Different Aspects of Perfectionism


It is important to understand the differences in perfectionism.  There are two types of perfectionists, adaptive and maladaptive.   Although they tend to have similarly high levels of academic success, maladaptive perfectionists experience much higher levels of self-criticism.   These high levels of self-criticism may be related to depression.  This is according to a study appearing in the Journal of Counseling Psychology (Vol. 51, No. 2).

In the study, which is part of a research program led by psychologist Robert B. Slaney, PhD. of Pennsylvania State University, the team used Slaney’s Almost Perfect Scale.  The scale was used to measure 273 undergraduate students’ self-reported perfectionism.  The scale gauges the level of people’s high standards, associated with positive aspects of perfectionism.  It also measures their levels of “discrepancy,” a negative aspect of perfectionism associated with dissatisfaction with performance.

Grade point average (GPAs) for adaptive and maladaptive perfectionists did not differ significantly.  However, maladaptive perfectionists rated themselves as significantly, less satisfied with their GPAs, says one of the researchers, psychologist Jennifer Grzegoek, PhD, of Iowa State University.


“The amazing thing here is that maladaptive folks are meeting the same standards but feel more like failures,” Grzegoek says.

More research is needed.  But evidence from this study indicates some potential applications in therapy:  Perfectionism has been associated with nonresponsive to short-term treatment for depression.  As a result of this, Grzegoek advises therapists to attend to signs of self-criticism and discrepancy in clients.

“Those patients often fail to see perfectionism as a problem, instead considering their high standards to be the secret of their success and something they’re very unwilling to talk about  giving up, ” She says.  “However, we are finding that it is discrepancy, rather than the mere presence of high standards, that is problematic in maladaptive perfectionism.  This may be helpful for perfectionistic clients who are willing to give up their high standards, but who are willing to examine their discrepancy, ” she says.

Source:  American Psychological Association:  Monitor:  Volume 35. No. 5 May 2004


What is Sex Addiction?

What is Sexual Addiction?

Sexual Addiction (SA) is a real diagnosis.   Sex addicts engage in persistent and escalating sexual behaviors undeterred by negative consequences such as health risks, legal problems, financial problems, and broken relationships.  Sex addicts try to escape reality by altering their mood using sex.  The illness is progressive and creates chaos in the lives of the addicts and their families.

John is a 40 year-old male, married for 15 years to an attractive woman he met in college.  They have two children, live in the suburbs, and make a comfortable living.  However, the financial stress of a mortgage, paying for two cars and feeling like they were on a financial merry-go-round led John to use pornography to escape into a fantasy world.  Over time he also began seeking massage parlors where the woman sometimes performed illegal sexual favors.  Gradually he slipped further and further into a negative place of depression, disconnection and irritability and anger.

Sex addiction affects males and females of all ages.   The early seeds of addiction frequently begin during the teenage years but may not start until the 20’s or even 30’s.   Estimates are that between 3% to 5% of the population seek treatment for this issue, though the actual number of people afflicted is likely much higher.  Nevertheless, some studies have placed the number of sex addicts at between 10 and 15 million people in the United States.  Research also suggests that 80% of sex addicts are male.  While the exact causes are unknown, males may have a higher prevalence due to the over sexualization of women via advertising messages and cultural influences objectifying women in the United States.  Many professionals believe that the proliferation of online sexual activity is a major contributor in the development of sexual addiction. 

Sex as a Drug

Sex addiction is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as hypersexual disorder.  It is not yet called “sex addiction” because studies are ongoing.  Professional associations have struggled with recognizing sexual addiction as an mental disorder or brain disease much like alcoholism was not recognized as a medical illness until relatively recently.  But the lack of formal acceptance of this condition by some mainstream professional associations does not diminish the hurt, pain and devastation this condition causes to millions of individuals, couples and families.

Neuroscience uses brain imaging to verify the existence of addictions.  Imaging reveals that all addictions, including sex addiction, stimulate the same pleasure centers of the brain.  When an individual views pornography, seeks sexual contact through a provider of sexual services or seeks sexual activity outside a committed relationship, a pathway is developed in the brain and repeated acting out behavior gradually deepens this neural pathway.  As time goes on, the desire and need for continued and even escalating sexual behavior can develop into sexual addiction. 

Sex and relationship addictions are considered intimacy disorders.  It is thought that an addict lacks the skills to develop close intimate relationship with a person, usually because these skills were not learned in early life.  Many people who were raised in a harsh, controlling or perhaps highly permissive environment are at higher risk to develop sexual addiction.  Feelings of inadequacy, rejection or low self-esteem can provide an environment for sexual addiction to flourish.   When a person isn’t able to connect with their primary caregiver or parental figures in a truly healthy manner, a lack of intimacy, emotional isolation and feelings of loneliness often develop

Sex addiction often progresses to the point that an addict will risk everything for sexual escape.  Many addicts feel deep shame about acting outside their values, and fear the risks and consequences, but are unable to quit.  Others minimize their problem or deny their addiction.

Warning Signs

Sex addiction is characterized by sexual preoccupation and an inability to stop detrimental behaviors.  The following are warning signs of sexual addiction:

Preoccupation with sexual thoughts and or behavior

Using sex to cope with anxiety or escape reality

Engaging in sexual behaviors that violate personal values

Lying to others to hide sexual acting out

Frequently engaging in online sexual activities

Loss of productivity at work

Loss of income

Participating in criminal sexual behaviors such as seeking out prostitutes or child pornography

Blaming other for one’s sexual behaviors

Engaging in high risk sexual behaviors

Putting self and others at risk for STDs

Loss of relationships due to sexual acting out

Feelings of guilt and shame after sexually acting out

Recovery from Sexual Addiction

Recovery from sexual addiction requires more than stopping the behavior, it depends upon behavioral change.  There are many components to sexual addiction.  A good psychological intake is helpful in determining underlying components.  The person may need medication to help with symptoms of depression, anxiety, obsessive compulsive disorder, etc.  They could also benefit from attending a support group.  If a person seriously engages in the recovery process, they can escape the chaos that sexual addiction creates.

Source – The Storm of Sex Addiction, Rescue And Recovery, by Connie A. Lofgreen, MSW, CSAT



We’ve probably all felt stress.  Sometimes it’s brief and highly situational, like being in heavy traffic.  Other times, it’s more persistent and complex – relationship problems, an ailing family member, a spouse’s death.  And sometimes, stress can motivate us to accomplish certain tasks.

Dangerous Stress

Stress becomes dangerous when it interferes with your ability to live a normal life for an extended period of time.  You may feel “out of control” and have no idea of what to do, even if the cause is relatively minor.  This in turn, may cause  you to feel continually fatigued, unable to concentrate, or irritable in otherwise relaxed situations.  Prolonged stress may also compound any emotional problems stemming from sudden events such as traumatic experiences in your past, and increase thoughts of suicide.

Natural Reactions

Stress can also affect our physical heath because of the human body’s built-in response mechanisms.  You may have found yourself sweating at the thought of an important date, or felt your heartbeat pick up while watching a scary movie.  These reacts are caused by hormones that scientists believe helped our ancestors cope with the threats and uncertainties of their world.

If the cause of your stress is temporary, the physical effects are usually short-term as well.  In one study, the pressure of taking exams led to increased severity of acne among college students, regardless of how they ate or slept.  The condition diminished after exams were over.  Abdominal pain and irregularity have also been linked to situational stress.

The longer your mind feels stressed; however, the longer your physical reaction system remain activated.  This can lead to more serious health issues.

Physical Wear and Tear

The old saying that stress “ages” a person faster than normal was recently verified in a study of women who had spent many years caring for severely ill and disabled children.  Because their bodies were no longer able to fully regenerate blood cells, these women were found to be physically a decade older than their chronological age.

Extended reactions to stress can alter the body’s immune system in ways that are associated with other “aging” conditions such as frailty, functional decline, cardiovascular disease, osteoporosis, inflammatory arthritis, type 2 diabetes, and certain cancers.

Research also suggests that stress impairs the brain’s ability to block certain toxins and other large, potentially harmful molecules.  This condition is also common to patients suffering from Alzheimer’s Disease.

Pressure Points

Although sudden emotional stress has been linked to severe heart dysfunction in otherwise healthy people, scientists are uncertain whether chronic stress alone causes cardiovascular disease.  What is clear is that excessive stress can worsen existing risk factors such as hypertension and high cholesterol levels.  Studies also show that people who are quick to anger or who display frequent hostility – a behavior common to those under stress – have an increased risk of heart disease.

Feelings of despair that accompany stress can easily worsen into chronic depression, a condition that can lead you to neglect good diet and activity habits.  This, in turn, can put you at a greater risk for heart disease, obesity, and kidney dysfunction.

Stress can also complicate your ability to recover from serious illness.  A Swedish study found that women who have suffered heart attacks tend to have poorer chances of recovery if they are also experiencing marital stressors such as infidelity, alcohol abuse, and a spouse’s physical or psychiatric illness.  On the other hand, stress management training is a proven method for helping speed recovery following a heart attack.

What Can You Do

Learning to deal with stress effectively is a worthwhile effort, even if you already consider yourself capable of handling anything life sends your way.  Many of the most common long-term stressors – family illness, recovery after injury, career pressures – often arise without warning and simultaneously.  Stress management is particularly valuable if your family has a history of hypertension and other forms of heart disease.  There does appear to be a mind and body connection with stress.

Source:  American Psychological Association


Attention-Deficit Hyperactivity Disorder

This article provides basic information on attention-deficit hyperactivity disorder (ADHD) in children and describes an approach to getting services and supports, called “systems of care,” that helps children, youth, and families thrive at home, in school, in the community, and throughout life.

In a classroom of 30 children or youth, it is likely that at least two students are affected by ADHD.  This surprisingly common condition makes it hard for children and youth to control their behavior (sit still, think before speaking or acting, etc.) and/or to pay attention.  If left untreated, it can lead to school or job difficulties, depression, relationship problems, and substance abuse.

What is attention-deficit hyperactivity disorder (ADHD)?  There are three types of ADHD:  the hyperactive-impulsive type, the inattentive type, and a type that is a combination of both.  The severity of ADHD varies among children, even siblings, so no two children will have exactly the same symptoms.  Also, you may hear that girls have lower rates and less severe cases of the disorder than boys.  More research is needed on this subject, but girls may have lower rates of the hyperactive type.

ADHD signs of hyperactive and inattentive types are as follows:                                                                                                                                                                                                       beach

Hyperactive-Impulsive – Feeling restless, often fidgeting with hands or feet, or squirming while seated; running, climbing, or getting up in situations where sitting or quiet behavior is expected; blurting out answers before hearing the whole question; and having difficulty waiting in line or taking turns.

Inattentive – May appear not to be listening or seems easily distracted by irrelevant sights and sounds; often failing to pay attention to details, and making careless mistakes; rarely following instructions carefully, and often losing or forgetting things like toys, pencils, books or other tools needed for a task; and often skipping from one uncompleted activity to another.

Experts believe that in some cases, heredity plays a role in whether or not a child has ADHD.  Symptoms of ADHD are first seen in children before age 6 and may cause problems at home, at school, or in relationships.  Sometimes, it is hard to tell if a child has ADHD because symptoms can be mistaken for typical childhood behaviors or other mental health issues, and ADHD often occurs at the same time that other conditions are present.  Equally important are the roles that a family’s culture and language play in how causes and symptoms are perceived and then described to a mental health care provider.  Misperceptions and misunderstandings can lead to delayed diagnoses, misdiagnoses, or no diagnoses – which are serious problems when a child needs help.  That is why only qualified health care or mental health care providers can diagnose ADHD, and why it is important that supports be in place to bridge differences in language and culture.

What happens after an attention-deficit hyperactivity disorder diagnosis?  If a qualified health care or mental health care provider has diagnosed your child with ADHD, he or she may suggest several different treatment options, including a combination of strategies for managing behaviors, medications, and talk therapy.  Your child’s health care or mental heath care provider may also suggest enrolling in a system of care, if one is available.

What is a system of care?  A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families.  Families – as well as children and youth – work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person’s cultural and linguistic needs.  Specifically, a system of care can help by: tailoring services to the unique needs of your child and family; making services and supports available in your language and connecting you with professionals who respect  your values and beliefs; encouraging you and your child to play as much of a role in the design of a treatment plan as you want; and providing services from within your community, whenever possible.

Data collected nationally suggests that systems of care are effective in treating attention-deficit hyperactivity disorder.

Source – U. S. Department of Health and Human Services