Adicción sexual y trauma psicológico: Orientaciones para el abordaje psicoterapéutico
Sexual addiction and psychological trauma: Guidelines for a psychotherapeutic approachBarra lateral del artículo
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La adicción sexual (AdS) se refiere a conductas caracterizadas por la incapacidad para controlar impulsos sexuales durante un periodo prolongado, causando malestar significativo y problemas en diversas áreas de la vida del individuo. Su origen está asociado a diversos factores, entre ellos el trauma psicológico (TP). El objetivo de este estudio fue describir la relación entre el TP y la AdS, así como proporcionar orientaciones para su abordaje psicoterapéutico. Se realizó una revisión sistemática siguiendo la declaración PRISMA, y se efectuó una búsqueda de artículos científicos en las bases de datos Scopus y Web of Science, abarcando publicaciones desde 2017 hasta 2022. Las palabras clave utilizadas fueron: “adicciones conductuales”, “adicción sexual”, “trauma psicológico” y “psicoterapia”. Se seleccionaron 12 artículos que cumplían con los criterios de inclusión: adicción sexual, trauma psicológico y abordaje psicoterapéutico. Se concluyó que el tipo de trauma psicológico más relacionado con el desarrollo de AdS es el abuso sexual infantil (ASI). Las terapias cognitivo-conductual (TCC) y cognitivo-analítica (TCA) demostraron ser efectivas en el tratamiento de la AdS según la evidencia disponible.
Sexual addiction (SDA) refers to behaviors characterized by the inability to control sexual impulses for a prolonged period of time, causing significant discomfort and problems in various areas of the individual's life. Its origin is associated with various factors, including psychological trauma (PT). The aim of this study was to describe the relationship between PT and SA, as well as to provide guidelines for its psychotherapeutic approach. A systematic review was conducted following the PRISMA statement, and a search for scientific articles was performed in the Scopus and Web of Science databases, covering publications from 2017 to 2022. The keywords used were "behavioral addictions", "sexual addiction", "psychological trauma" and "psychotherapy". Twelve articles were selected that met the inclusion criteria: sexual addiction, psychological trauma, and psychotherapeutic approach. It was concluded that the type of psychological trauma most related to the development of SSA is child sexual abuse (CSA). Cognitive-behavioral (CBT) and cognitive-analytic (CAT) therapies proved to be effective in the treatment of SA according to the available evidence.
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American Psychiatric Association (2014). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Publishing.
Bancroft, J., y Vukadinovic, Z. (2004). Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. Journal of Sex Research, 41(3), 225-234. doi:https://doi.org/10.1080/00224490409552230
Benjet, C., Karam, E., Kessler, R., McLaughlin, K., Ruscio, M., Shahly, V., Koenen, K. (2015). The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine, 46(04), 327-343. doi:https://doi.org/10.1017/S0033291715001981
Blankenship, R., y Laaser, M. (2004). Sexual addiction and ADHD: Is there a connection? Sexual Addiction and Compulsivity, 11(1-2), 17-20. doi:https://doi.org/10.1080/10720160490458184
Bracken, P. (2002). Trauma: Culture, meaning and philosophy (1 ed.). Whurr Publishers.
Breire, J., y Spinazzola, J. (2005). Phenomenology and Psychological assessment of complex posttraumatic states. Journal of Traumatic Stress, 10(5), 401-412.
Carnes, P. (1991). Don´t call it love: Recovery from Sexual Addiction. New York: Bantam Books.
Castro-Calvo, J., Gil, M., Giménez, C., Gil, B., y Ballester, R. (2020). Occurrense and clinical characteristics od Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples. Journal of Behavioral Addictions, 9(2), 446-468. doi:https://doi.org/10.1556/2006.2020.00025
Chatzittofis, A., Arver, S., Öberg, K., Hallberg, J., Nordström, P., y Jokinen, J. (2016). HPA axis dysregulation in men with hypersexual disorder. Psychoneuroendocrinology, 63, 147-253. doi:https://doi.org/10.1016/j.psyneuen.2015.10.002
Chen, L., Hassan Murad, M., Paras, M., Colbenson, K., Sattler, A., Garanson, E., Zirakzadeh, A. (2010). Sexual Abuse and Lifetime Diagnosis of Psychiatric Disorders: Systematic Review and Meta-analysis. Mayo Clinic Proceedings, 85(7), 618-629. doi:https://doi.org/doi.org/10.4065/mcp.2009.0583
Chiclana, C., Contreras-Chicote, M., Carriles-Cervera, S., y Rama-Víctor, D. (2015). Adicción al Sexo: ¿Patología independiente o síntoma comórbido? Cuadernos de Medicina Psicosomática y Psiquiatría de enlace(115), 19-26. Retrieved from https://n9.cl/8yzmp
Dickenson, J., Gleason, N., Coleman, E., y Miner, M. (2018). Prevalence of Distress Associated with Difficulty Controlling Sexual Urges, Feelings, and Behaviors in the United States. JAMA Network Open, 1(7), 1-10. doi:https://doi.org/10.1001/jamanetworkopen.2018.4468
Diehl, A., Clemente, J., Pillon, S., Santana, P., da Silva, C., y Mari, J. (2019). Early childhood maltreatment experienceand later sexual behaviorin Brazilian adults undergoing treatment for subtance dependence. Brazilian Journal of Psychiatric, 41(3), 199-207. doi:https://doi.org/10.1590/1516-4446-2017-0020
Echeburúa, E., de Corral, P., y Amor, P. (2005). El reto de las nuevas adicciones: objetivos terapeuticos y vias de intervención. Psicología Conductual, 13(3), 511-525. Retrieved from https://n9.cl/i8lxw
Echeburúa, E. (2012). ¿Existe realmente la adicción sexual? Adicciones, 24(4), 281-285. doi:https://doi.org/10.20882/adicciones.77
Efratí, Y., y Gola, M. (2018). Treating Compulsive Sexual Behavior. Current Sexual Health Reports, 10(2), 57-64. doi:https://doi.org/10.1007/s11930-018-0143-8
Efratí, Y., y Gola, M. (2019). The Effect of Early Life Trauma on Compulsive Sexual Behavior among Members of a 12-Step Group. The Journal of Sexual Medicine, 16(6), 803-811. doi:https://doi.org/10.1016/j.jsxm.2019.03.272
Ferrer-Olives, V., Farré-Martí, J., y Borja-Farré, S. (2016). Psicopatología y Personalidad en la Adicción al Sexo. Estudio Piloto. Cuadernos de medicina Psicosomática y Psiquiatría de Enlace, 117, 47-60. Retrieved from dialnet.uniroja.es/servlet/articulo?codigo=5564731
Figueroa, R., Cortéz , P., Accatino , L., y Sorensen, R. (2016). Trauma psicológico en la atención primaria: orientación de manejo. Revista Médica de Chile, 114(5), 643-655. doi:https://doi.org/10.4067/S0034-98872016000500013
Finkelhor, D., Ormrod, R., y Turner, H. (2009). Lifetime assessment of poly-victimization in a national sample of children and youth. Child Abuse and Neglect, 33(7), 403-411. doi:https://doi.org/10.1016/j.chiabu.2008.09.012
Ford, J., Elhai, J., Connor, D., y Frueh, C. (2010). Poly-Victimization and Risk of Posttraumatic, Depressive, and Substance Use Disorders and Involvement in Delinquency in a National Sample of Adolescents. Journal of Adolescent Health, 46(6), 545-552. doi:https://doi.org/10.1016/j.jadohealth.2009.11.212
Ford, J., Grasso, D., Hawke, J., y Chapman, J. (2013). Poly-victimization among juvenile justice-involved youths. Child Abuse and Neglect, 37(10), 788-800. doi:https://doi.org/10.1016/j.chiabu.2013.01.005
Ford, J., Stockton , P., Kaltman, S., y Green, B. (2006). Disorders of extreme stress (DESNOS) symptoms are associated with type and severity of interpersonal trauma exposure in a sample of healthy young women. Journal of Interpersonal Violence, 21(11), 1399-1416. doi:https://doi.org/10.1177/0886260506292992
García, F., y Thibaut, F. (2012). Sexual Addictions. The American Journal of Drugs and Alcohol Abuse, 36(5), 254-260. doi:https://doi.org/10.3109/00952990.2010.503823
Hallberg, J., Kaldo, V., Arver, S., Dhejne, C., Jokinen, J., y Görts Öberg, K. (2019). A Randomized Controlled Study of Group-Administered Cognitive Behavioral Therapy for Hypersexual Disorder in Men. The Journal of Sexual Medicine, 16(5), 733-745. doi:https://doi.org/10.1016/j.jsxm.2019.03.005
Iruarrizaga, I., Estévez, A., Momeñe, J., Olave, L., Fernández-Cárdaba, L., Chávez-Vera, M., y Ferre-Navarrete, F. (2019). Dificultades en la regulación emocional, esquemas inadaptados tempranos, y dependencia emocional en la adicción al sexo o comportamiento sexual compulsivo en la adolescencia. Revista Española de Drogodependencias, 1(44), 79-103. Retrieved from https://dialnet.unirioja.es/servlet/articulo?codigo=6877067
Kellett, S., Simmonds-Buckley, M., y Totterdell, P. (2017). Testing the effectiveness of Cognitive Analytic Therapy for Hypersexuality Disorder: An intensive time-series evaluation. Journal of Sex y Marital Therapy, 43(6), 501-516. doi:https://doi.org/10.1080/0092623X.2016.1208129
Kingston, D., Graham, F., y Knight, R. (2017). Relations Between Self-Reported Adverse Events in Childhood and Hypersexuality in Adult Male Sexual Offenders. Archives of Sexual Behavior, 46(3), 707-720. doi:https://doi.org/10.1007/s10508-016-0873-5
Kjellgren, C. (2018). Outcomes for Treatment of Hypersexual Behavior Provided by Specialized Social Welfare Units. Research on Social on Social Work Practice, 29(1), 103-112. doi:https://doi.org/10.1177/1049731518757030
Kotera, Y., y Rhodes, C. (2019). Pathways to Sex Addiction: Relationships with Adverse Childhood Experience, Attachment, Narcissism, Self-Compassion and Motivation in a Garder-Balanced Sample. Sexual Health and Compulsivity, 26(1), 54-76. doi:https://doi.org/10.1080/10720162.2019.1615585
Kraus, S., Krueger, R., Briken, P., First, M., Stein, D., Kaplan, M., Reed, G. (2018). Compulsive Sexual Behaviour Disorder in the ICD-11. World Psychiatric, 17(1), 109-110. doi:https://doi.org/10.1002/wps.20499
Kuzma, J., y Black, D. (2008). Epidemiology, prevalence and natural history of Compulsive Sexual Behaviour. Psychiatric Clinics of North America, 31(4), 603-611. doi:https://doi.org/10.1016/j.psc.2008.06.005
Labadie, C., Godbout, N., Vaillancourt-Morel, M.-P., y Sabourin, S. (2018). Adult Profiles of Child Sexual Abuse Survivors: Attachment Insecurity, Sexual Compulsivity, and Sexual Avoidance. Journal of Sex y Marital Therapy, 44(4), 354-369. doi:https://doi.org/10.1080/0092623X.2017.1405302
Laconi, S., Sinanian, A., Andreoletti, A., y Chabrol, H. (2020). Traumatic events, age of onset, anxio-depressive symptoms and addictive behaviors in a sample of young adults recruited online. Annales Medico-Psychologiques, 179(5), 425-431. doi:https://doi.org/10.1016/j.amp.2020.12.002
Lew-Starowicz, M., Lewczuk, K., Nowokowska, I., Kraus, S., y Gola, M. (2020). Compulsive sexual behavior and dysregulation of emotion. Sexual Medicine Reviews, 8(2), 191-205. doi:https://doi.org/10.1016/j.sxmr.2019.10.003
Llorente, J., y Iraurgi-Castillo, I. (2008). Tratamiento cognitivo conductual aplicado en la deshabituación de cocaína. Trastornos Adictivos, 10(4), 152-274. doi:https://doi.org/10.1016/S1575-0973(08)76374-8
Maniglio, R. (2011). The Role of Child Sexual Abuse in the Etiology of Substance-Related Disorders. Journal of Addictive Diseases, 30(3), 216-228. doi:https://doi.org/10.1080/10550887.2011.581987
McCann, L., y Pearlman, L. (1990). Psychological trauma and the adult survivor: Theory, therapy and transformation (1 ed.). Brunner/Mazel.
McCubbin, J., Zinzow, H., Hibdon, M., Nathan, A., Morrison, A., Hayden, G., . . . Switzer, F. (2016). Subclinical Posttraumatic Stress Disorder Symptoms: Relationships with Blood Pressure, Hostility, and Sleep. Cardiovascular, Pschyatric and Neurology, 1-9. doi:https://doi.org/10.1155/2016/4720941
Ménard, A., y MacIntosh, H. (2021). Childhood Sexual Abuse and Adult Sexual Risk Behavior: A Review and Critique. Journal of Child Sexual Abuse, 30(3), 298-331. doi:https://doi.org/10.1080/10538712.2020.1869878
Meyer, D., Cohn, A., Robinson, B., Muse, F., y Hughes, R. (2017). Persistent Complications of Child Sexual Abuse: Sexually Compulsive Behaviors, Attachment, and Emotions. Journal of Child Sexual Abuse, 26(2), 140-157. doi:https://doi.org/10.1080/10538712.2016.1269144
Odlaug, B., Lust, K., Schreiber, L., Christenson, G., Derbyshire, K., Harvanko, A., .Grant, J. (2013). Compulsive sexual behavior in young adults. Ann Clin Psychiatric, 25(3), 193-200. Retrieved from https://www.ncbi.nlm.nih.gob/pubmed/23926574
Padilha-Netto, N., y Rezende-Cardozo, M. (2007). A adicção sexual nas fronteiras da perversão. Revista Latinoamericana de Psicopatología Fundamental, 20(4), 705-727. doi:https://doi.org/10.1590/1415-4714.2017v20n4p705.6
Ports, K., Ford, D., y Merrick, M. (2016). Adverse childhood experiences and sexual victimization in adulthood. Child Abuse and Neglect, 51, 313-322. doi:https://doi.org/10.1016/j.chiabu.2015.08.017
Saladino, V., Eleuteri, S., Zamparelli, E., Petrilli, M., y Verrastro, V. (2021). Sexual Violence and Trauma in Childhood: a case report based in strategic counseling. International Journal of Environmental Research and Public Health, 18(10), 5259. doi:https://doi.org/10.3390/ijerph18105259
Simpson, T., y Miller, W. (2002). Concomitance between childhood sexual and physical abuse and substance use problems: A review. Clinical Psychology Review, 22(1), 27-77. doi:https://doi.org/10.1016/S0272-7358(00)00088-X
Slavin, M., Scoglio, A., Blycker, G., Potenza, M., y Krauz, S. (2020). Child sexual abuse and Compulsive sexual behavior: A systematic Literature review. Current Addiction Reports, 7(1), 76-88. doi:https://doi.org/10.1007/s40429-020-00298-9
Urrútia, G., y Bonfill, X. (2010). Declaración PRISMA: una propuesta para mejorar la publicación de revisiones sistemáticas y metaanálisis. Medicina Clínica, 135(11), 507-511. doi:https://doi.org/10.1016/j.medcli.2010.01.015
Van Gordon, W., Shonin, E., y Griffiths, M. (2016). Meditation awareness training for the treatment of sex addition: a case study. Journal of Behavioral Addiction, 2(5), 363-372. doi:https://doi.org/10.1556/2006.5.2016.034.
Verdura-Vizcaíno, E. J., Ponce-Alfaro, G., y Rubio-Valladolid, G. (2011). Adicciones sin sustancias: juego patológico, adicción a nuevas tecnologías, adicción al sexo. Medicine, 10(86), 5810-5816. Retrieved from https://n9.cl/awao8
Wizla, M., Kraus, S., y Lewczuk, K. (2022). Perspective: Can psychedelic-assisted therapy be a promising aid in compulsive sexual behavior disorder treatment? Comprehensive Psychiatry, 115, 1-5. doi:https://doi.org/10.1016/j.comppsych.2022.152303
Wong, C., Clark, L., y Marlotte, L. (2014). The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth. Journal of Interpersonal Violence, 31(5), 831-854. doi:https://doi.org/10.1177/0886260514556770
World Health Organization. (2018). Décima Revisión de la Clasificación Internacional de las Enfermedades. Descripciones Clínicas y pautas para el diagnóstico. Meditor.