Interview with Center for Healthy Sex Clinical Director Alexandra Katehakis

Interview with Center for Healthy Sex Clinical Director Alexandra Katehakis. This interview is one in a series of expert interviews on the blog. We add new interviews on a regular basis. Please see our complete list of insightful interviews

1. How common is sexual addiction these days and what forms of it are most common (i.e. cybersex, pornography, prostitution, etc)?

It is estimated that approximately 9 to 12 million adults in the US are sexually addicted. There’s no real way to know the exact number, and I suspect these numbers are low, but we do know that sexual addiction is on the rise as evidenced by the number of people looking at pornography, buying sexual services, and seeking help for sexual addiction.

The most common form of sex addiction is most likely cybersex addiction due to the “triple engine” of the three A’s: Access, Anonymity, Affordability. In “The Social Costs of Pornography” report by The Witherspoon Institute in Princeton, N.J. (2010) one 2008 study of undergraduate and graduate students ages 18-26 showed 69 % of the men and 10 % of women viewed pornography more than once a month. The Witherspoon report also states that men look at pornography online more than they look at any other subject. The report cites research that 66% of 18-34 year old men visit a pornographic site very month. In 2006, a British Nielsen NetRathings survey revealed that 9 million men (almost 40% of the adult male population) and 1.5 million women (an increase of 30%) logged onto sex websites in 2005.

Here are some other statistics:

  • Size of the Pornography Industry $57.0 billion world-wide  ($12.0 billion US):
  1. Adult Videos $20.0 billion
  2. Escort Services $11.0 billion
  3. Magazines $ 7.5 billion
  4. Sex Clubs $ 5.0 billion
  5. Phone Sex $ 4.5 billion
  6. Cable & Pay Per View $ 2.5 billion
  7. Internet $ 2.5 billion
  8. CD-Rom $ 1.5 billion
  9. Novelties $ 1.0 billion
  10. Other $ 1.5 billion
  • Porn revenue is larger than all combined revenues of all professional football, baseball and basketball franchises.
  • US porn revenue exceeds the combined revenues of ABC, CBS, and NBC (6.2 billion)
  • Child pornography generates $3 billion annually

2. How has sexual addiction changed in the last several years? Is it more common? Are the cases harder to address? Are the addictions more severe and result in riskier behavior? Please explain.

More people are coming forward and admitting that they have a sexual addiction problem today than three years ago. I don’t know if it’s more common, but I do know that more and more people are seeking help with slightly less shame than ten years ago. As more people come forward with the problem, there is less stigma attached to having the problem, which can encourage people to seek help. The cases are no more difficult or severe today than ten years ago nor are the behaviors any riskier than they’ve ever been. However, as with any addiction, sex addicts will experience an escalation in behaviors or tolerance over time. They need to make the behaviors more intense, more frequent, and riskier in order to experience the same “high.”

  • Other signs of sexual addiction are:
  1. Loss of control where the person engages in more of the experience then they want.
  2. A pattern of out of control compulsive behaviors over time.
  3. Repeated specific attempts to stop the behaviors which fail.
  4. Significant amounts of time lost doing and recovering from the behaviors.
  5. A Preoccupation and obsession about or because of the behaviors.
  6. An inability to fulfill obligations related to work, family, school, and friends.
  7. Failure to stop the behaviors even though the person has experienced negative consequences such as social, legal, financial, or physical.
  8. Escalation for more intensity.
  9. Losses such as loss of family, friends, hobbies, relationship, and work.
  10. Withdrawl symptoms can occur when stopping the behaviors such as significant distress, anxiety, restlessness, irritability, or physical discomfort.

3. Your program treats something called “Sexual Anorexia.” Please explain what this is and how a person may have come to develop it.

People who suffer from sexual anorexia tend to avoid sex and often have an underlying social phobia or extreme shyness. They will either completely avoid any type of sexual pleasure including masturbation or will limit their sexual activities to anonymous encounters. At the core of sexual anorexia is a fear of intimacy and an inability to tolerate any kind of criticism or rejection leaving the person withdrawing from any human contact that would pose a threat.

People who are sexually anorexic are often consumed with self-doubt and a dread of sexual pleasure so they avoid contact at all costs. They often report an extreme internal emptiness and will deprive themselves on many levels (having nice clothing, friends, a clean car, etc.).

Sexual anorexia is an obsessive state that is devoted to avoiding sex and can dominate the person’s life. Deprivation of sex, like compulsive dieting or hording, can make a person feel powerful and as if they are defending themselves against being hurt. Their preoccupation with avoiding sex can be a distraction for all of life’s problems. Sex becomes the silent enemy to be avoided at all costs but the ultimate cost is the annihilation of an essential part of oneself – namely ones sexual expression and the gift of giving and receiving pleasure.

4. Are there any types of sexual problems that are worthy of ending a relationship? Are there any issues that are just too severe to completely “cure”?

If you are involved with a sex addict who is ultimately endangering you or your family then you should seriously consider ending the relationship. Each person has to make this judgment call for themselves and with professional help if at all possible. People who engage in sexually offending behaviors can have difficulty completely stopping the behaviors. With intensive therapy and a high level of vigilance, people can restore their lives but it takes a lot of time and effort. As with everything, no two people are alike and professional help should always be sought.

5. What are your top tips for anybody seeking to achieve ultimate sexual health?

The idea of “ultimate sexual health” is an aspiration and I’m not sure anyone ever achieves it. I think the goal is to define sexual health and what it means for you. Healthy sex includes intensity, but “intensity with connection” is what distinguishes it from addictive sex.

Here are some guidelines for healthy sex:

  • Healthy sex is not secretive or shameful to yourself or the other person
  • Healthy sex is not abusive in any way.
  • Healthy sex is not used to ignore or escape your feelings
  • Healthy sex requires an emotional connection of some sort with the other person
  • Healthy sex is about love, respect, mutual caring, giving and receiving pleasure, and a desire to know yourself and your partner in a deeper way.

In my book, Erotic Intelligence: Igniting Hot, Healthy Sex While in Recovery from Sex Addiction, I define the Four Cornerstones of Intimacy as a guide for experiencing high sexual desire with a partner over time.

The Four Cornerstones of Intimacy are as follows:

  • Self-Knowledge: You take a stand for what’s really true for you, even when it’s uncomfortable, in order to create change. You know who you are, and you allow space and respect for your partner to do the same.
  • Comfort and Connection: You develop the capacity to comfort your anxieties and connect without being in reaction to your partner’s feelings.
  • Responsibility with Discernment: You are assertive, speak up for yourself, take responsibility for your actions, contribute to all interactions, and tell the truth even though it may be difficult for your partner to hear.
  • Empathy with Emotion: You use your emotional ability to recognize and feel another person’s thoughts and moods.

Through honest conversations about who you are and what you do and don’t like sexually, you will create an intimacy with your partner that’s born out of honesty. This kind of intimacy sets the stage for healthy, intimate, and erotic sex.

About Alexandra Katehakis:,  Erotic Intelligence

Alexandra Katehakis, M.F.T. is Founder and Clinical Director of the Center for Healthy Sex in Los Angeles, California. She is a Certified Sex Addiction Therapist and Certified Sex Therapist specializing in the treatment of sexual addiction and other sexual disorders. Ms. Katehakis is author of “Erotic Intelligence: Igniting Hot Healthy Sex After Recovery From Sex Addiction,” HCI Publications 2010. She has published in the Psychotherapy Networker and Family Therapy Magazine. In 2009, she published “Affective Neuroscience and the Treatment of Sex Addiction,” Journal of Sexual Addiction and Compulsivity. Contact:

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