By Robert Weiss, LCSW, CSAT
Leslie Fisher, MSW, LISAC, CSAT

Of all the types of sexual acting out, compulsive masturbation is one of the most secret and isolative. The person engaging in this sexual activity is often the last to seek help, often not seeing or understanding their behavior as problematic. This is often related to familial, societal, or religious shame associated with the act of masturbation. Many clients report that their internalized messages around masturbation are that the act itself is “dirty”, “shameful”, or “sinful.”

While most sex addicts actively seek treatment, pushed by some obvious consequence of a legal, occupational, health or relational type, the solitary nature of the compulsive masturbator’s behavior leaves their actions less subject to the direct consequences of other forms of sexual acting out. The addict engaging in compulsive masturbation seeks therapeutic intervention for help as a last resort, seeking relief from anxiety, obsession, isolation and the inability to seek or maintain healthy intimate relationships. Some compulsive masturbators do experience consequences through the viewing of inappropriate materials i.e. child pornography or through masturbating in inappropriate places i.e. the workplace or an automobile. However, the most frequent consequence of compulsive masturbation is a life devoid of intimacy, removed from feeling and filled with hidden shame.

As to the behavior of compulsive masturbation itself this can take place in differing forms. For example there are men who masturbate daily as a part of their “morning or evening routine.” Jay, in treatment for sex addiction for several years now, has the following to say about his experiences,
Looking back now I can see that before I started working on this I had huge denial about how compulsive and driven an experience masturbation was in my life. Because the behavior itself was so built into my routines and I saw it like washing my hands or brushing my teeth I never thought of it as something that could interfere with my attempts at sexual relationships or self-esteem as a man. My association with masturbation was simple, every morning when I showered I masturbated to fantasy and every night before I went to sleep I masturbated to porn to help me relax. I never questioned it and at 37 years old I had a 22-year history of this behavior before I got into treatment and was asked the question by my therapist, “how often do you masturbate and why do you choose to masturbate when you do”? Choose? I never chose. Masturbation is just what I did.

Interestingly, Jay did not come into treatment seeking help for a problem with masturbation. Jay actually entered treatment to eliminate having multiple sexual affairs and resolve ongoing challenges with romantic commitment. He had long wanted to get married and have a family and was concluding from his experiences that he was unable to create that. It was only during the course of his initial treatment assessment that the questions regarding masturbation were posed to him and he was forced to consider changing this life-long behavior.

While some like Jay compulsively masturbate in a brief, routine fashion, others can act more as binge masturbators. They may find themselves spending hours at a time “lost” in fantasy, porn use and masturbation. Unlike the routine masturbator, the binge masturbator is likely to be acting in relationship to specific stimuli that they are unable to tolerate. Likely responding to some strong internal, intolerable affect combined with an identifiable trigger or stimulus, this type of compulsive masturbator can lose hours or even days to the computer, videos, with or without drug use and masturbation. They can literally lock themselves up at home, or in motel rooms and disappear into their masturbatory escape.

This type of behavior is not unlikely to result in genital injury due to the amount of time and energy devoted to the masturbation. While usually the injury and pain is not sought for pleasure, the binge compulsive masturbator will not use physical damage as a guide toward stopping or self-care. Instead they will likely continue their sexual activity, even hurting themselves further and bringing about more shame.

The person who masturbates to the point of injury presents some specific clinical challenges. The etiology of the compulsive masturbator is complex. As with other clients we see for sexually acting out behaviors, there was often a history of shame, abuse, and neglect in their family of origin. Many clients who engage in compulsive masturbation recall beginning the behavior at a very early age as their only form of respite and escape from an environment filled with fear, secrecy, and trauma.

For the compulsive masturbator who does so to the point of injury, the analytical aspects of self-harm are varied. Often, the person describes a sense of dissociation and depersonalization. Engaging in self-harm allows the person to simultaneously dissociate from their overwhelming anxiety and emotional pain, while at the same time feeling some sense of “aliveness” through their physical pain. Following the masturbatory self-harm episode, the person has a cathartic flood of endorphins that may provide a “numbing” effect.

Of particular interest in examining this form of self-harm behavior is to looking at the associated neuropathways. The arousal neuropathway is about pleasure and intensity. One of the most common methods of stimulating arousal pathways are high-risk sex, which masturbating to the point of injury would be included in. The numbing neuropathway produces a calming, relaxing, soothing, or sedative process. Masturbation creates an analgesic experience in the brain.

The fantasy neuropathway focuses on escape through obsession, preoccupation, and ritualization. At the core of such obsessions is a governing fantasy that may involve the ultimate escape from their internal psychic world flooded with the pain, shame, and trauma of their early family of origin experiences.

Combining the arousal, numbing, and fantasy pathways together creates a powerful neurochemical package for the client who masturbates to the point of injury. They are able to achieve high states of arousal through the masturbation. When the physical act becomes painful through repetition, cutting, or the combination of inserting physical objects to cause pain, the client achieves a high state of arousal followed immediately by numbing and fantasy.

Frequent masturbation and ejaculation stimulate acetylcholine/parasympathetic nervous functions excessively, resulting in the over production of sex hormones and neurotransmitters such as acetylcholine, dopamine and serotonin. Abundant and unusually amount of these hormones and neurotransmitters can cause the brain and adrenal glands to perform excessive dopamine-norepinephrine-epinephrine conversion and turn the brain and body functions to be extremely sympathetic. In other words, there is a big change of body chemistry when a client compulsively masturbates.

For the client engaging in compulsive masturbation, they often experience problems with concentration and memory. This is a dangerous side effect of compulsive masturbation and signals that the brain is being over drained of acetylcholine. This behavior can also drain the motor nerves, neuromuscular endings, and tissues of acetylcholine and replace it with too much stress adrenalin which is where memory loss, lack of concentration, and eye floaters come from. To fight these symptoms, the chemical levels in their body needs to be balanced.

Treatment

Treatment and recovery for the compulsive masturbator can also be a varied and complex issue. The most commonly suggested first aspect after therapeutic engagement is suggesting a celibacy contract, which involves a prescribed period of no sexual activity with self or others, any pornography, chat rooms, affairs, etc. The primary goal of the celibacy period is to allow the fear, anxiety, pain and shame that the client has been endeavoring to escape from the opportunity to surface. It is in this place of affective awareness that the client can often for the first time begin to glimpse the myriad of issues they have sought escape from and the ritualized fantasy they have often engaged in.

During this celibacy period, the clinician has the opportunity to obtain a detailed sexual history, a detailed family of origin history, and begin the sacred process of understanding how the client became socialized around their sexually compulsive behaviors as well as the process of self-harm as an escape mechanism.

As the client’s treatment progresses, the clinician is able to illuminate how their distorted self-belief system has concretized their belief that acting out with masturbation increases their sense of isolation and separateness. What the client seeks in their masturbatory fantasy world probably centers on sexual acts with others yet their compulsive masturbation reinforces the belief that, “I am alone, no one will desire sexually; therefore I am responsible for meeting more core sexual needs alone.”