I’ve written many times before about all of the wonderfully positive aspects of sexuality, but I cannot examine the totality of sexual experience without acknowledging that some individuals can and do use sexuality for destructive purposes. Often as clinicians, we will see these destructive acts in the form of self-destruction– risky sexual behaviors in which the individual can end up badly hurt, dead, or in jail. Often these destructive behaviors are compulsively performed in the face of, and even due to the threat, of these dangers. In other words, the danger itself is what makes the behavior so arousing. I don’t think it’s enough though to simply understand that self-destruction is arousing. That makes it seem like any other kind of fetish or sexual proclivity. Rather, I think the other salient point to understand about this behavior, is that the individual believes that they are worthy of self-destruction. In other words, the individual may be aroused by destruction (or the “death drive” as Freud called it), but for him to continue seeking self-destruction, he must believe that this is what he deserves. So, fundamentally, if we are to try and change this individual’s self-destructive behavior, we must seek to change his relationship to himself.

Destructive behaviors of any kind, whether they are sexual or not, usually if not always involve underlying aggression. And as I’ve discussed in numerous other posts, aggression is fueled by anger and rage. So, destruction of any kind is fueled by anger, which is a simple enough observation. But it becomes an important consideration to keep in mind when understanding destructive sexual behaviors. For example, most of the paraphilias listed in the DSM-V, such as exhibitionism, voyeurism, frotteurism and so on, involve an element of coercion, in that the person on the other end is not consenting to the behavior. This aspect of non-consent is what defines the behavior as aggressive.

For example, the voyeur who is peeking in at a showering woman through a window is not doing anything physically violent or aggressive, but because the behavior is nonconsensual, it is experienced as aggressive by both the perpetrator, and the victim (if he/she becomes aware of what is going on). As evidence, if the woman turns around and sees the perpetrator, she will most likely shriek and call for help, because she has been violated. (I’m using the pronoun she for the victim and he for the perpetrator because overwhelmingly, sex offenders are male and heterosexual). Exhibitionists (the stereotype for example of the dirty old man in the trench coat) often only get turned on when the woman they flash becomes distressed. If the woman acts nonchalant or even laughs at him, this does not provoke the desired result and the offender becomes shamed and scurries off. In this case, as in many others, the actual arousing element of the flashing is the distress of the woman. So, the offender not only displays aggression (rage) towards the victim, but also and perhaps most importantly, believes that she is worthy of it, that she deserves it. It is this last piece which disinhibits the offender and allows him to act upon his desires.

Let’s now take a look at self-destructive sexual behavior. This may include deliberately having unprotected sex with total strangers, to being sexual in dangerous and inappropriate places (some of which overlaps with the behavior described above), to engaging in life-threatening behaviors (such as autoerotic asphyxiation, or choking oneself as part of sex play). I could make a long laundry list of self-destructive sexual behaviors that have been related to me in my consulting office, but I will spare readers the gory details. The point is that some self-destructive sexual behaviors can be quite extreme. There may be a natural tendency in the therapist to try and convince the individual to take a look at the negative consequences, to think of all that the individual has to lose, to come up plans to manage the behavior. But none of this will be completely effective if the individual believes he deserves all the consequences. Harm reduction interventions, where I may for example, help the client to look for ways to get his arousal needs met through safer means, such as porn, also fail to address the underlying conviction that the individual has that he deserves what he gets. So, what this individual ultimately experiences is intense rage at himself, which is experienced as a profound guilt that is so powerful that it almost feels that some sort of punishment is the only compelling thing that must be done.

Here’s a perfect example of what this kind of profound guilt and self-punishment may look like in the treatment room. Let’s say a client enjoys performing a certain type of sex act that is safe in a committed, consensual relationship, but can be quite dangerous when done unprotected with numerous anonymous strangers. Typically, if I ask this client if they would consider just containing the behavior to a relationship, the client may say that they could never do so because they would begin to disrespect the partner. So, already this gives a clear indication that the behavior is viewed as disgusting by the individual and so whomever it is shared with would then be the object of the disgust (contempt). However, while this individual may have reservations about doing the sex act to a partner, he has absolutely no qualms about strangers doing it to him. In other words, this individual is saying to himself “this disgusting act that is so arousing to me is only fit to be done to me and no one else because I alone am contemptible enough to deserve it being done to.” It doesn’t matter what the act is, just that it is subjectively viewed as disgusting by the individual.

Herein lies the problem of so many interventions, whether it is some form of 12-step fellowship, some “total abstinence” program, or even a harm reduction attempt– it doesn’t address the underlying contempt that the individual has for himself.  We may try some sex education, to destigmatize the “disgusting” sex act, but often the client is unwilling to hear it, and even if this intervention is successful, he will find something else to degrade himself with.  But here’s something that I find to be more effective… Within all of us exist various internal parts, like the little angel and devil on the main character’s shoulders in old-time cartoons. There’s a part of us that is looking towards growth and healing, and there may be a part of us that we dislike so much that we want to destroy. I know that if someone has come to therapy, they for sure they have that little angel inside them somewhere that is hoping to find happiness. When a self-destructive individual “acts out”, the part of him he loathes is so strong in its presence, that he has little or no access to the part of him that wants to find a way out. One of the most important things I try to do is to help individuals understand that they are not monolithic beings, that there are actually various parts to them that they can reach out to and connect with. I’ll skip a lot of steps, but in brief, one of the most important things I can help a self-destructive client do is to find love and empathy for the part of himself that he loathes the most– to forgive himself and extend compassion, rather than hatred and destruction to this overactive part of him that he finds to be so worthy of contempt.