Compulsive sexual behavior disorder (CSBD), frequently referred to as sex addiction in the general discourse, has increasingly captured the interest of the scientific community. Reflecting this growing interest, CSBD was included in the 11th revision of the International Classification of Diseases (ICD-11),1 which was published in 2022 (World Health Organization, 2022). Despite the expanding body of research and its inclusion in the ICD-11, little is known about how CSBD is experienced in underrepresented populations, such as among women (Brand et al., 2024; Bőthe et al., 2023; Dhuffar & Griffiths, 2015; Kowalewska, Bőthe, & Kraus, 2024). This gap in understanding is where My Secret Life as a Sex Addict: How I Repaired the Damage by Paulina Pantyleva (Pantyleva, 2023) becomes particularly relevant. This unique book offers a deeply personal and vivid exploration of what the author describes as her journey through her self-described sex addiction, providing rare insights into the female experience of CSBD.
My Secret Life as a Sex Addict is structured into a foreword, three main sections with various chapters within them, and an afterword. It is a relatively light read, spanning roughly one hundred pages, with large typeface and straightforward language. What sets this book apart is its unique blend of freshness and relevance. While the tone may seem light at times, it effectively immerses the reader in the intense, raw, and unfiltered reality of a woman living with CSBD. Its vivid content almost makes the reader feel as though they are experiencing the issues themselves. That style of writing and insights place this book as particularly valuable for researchers and therapists as it offers a window into the mind of a person struggling with self-perceived sex addiction. In return, it could provide the reader a better understanding of the symptoms, mechanisms, and impacts of CSBD, particularly from a woman's perspective. It also provides insights on how CSBD impacts the author's loved ones (e.g., husband, children, friends). Additionally, the author talks about her other problems, such as her binge eating disorder, and impulsivity and compulsivity struggles. Thus, it offers the reader profound and reflective insights that go beyond mere sexual content and illustrates how comorbidities are experienced by someone struggling with CSBD. Finally, the book stands out for breaking the fourth wall, directly engaging the reader with questions that foster introspection.
In sum, My Secret Life as a Sex Addict sheds important light on the female experience of CSBD. The following lines will provide a deeper analysis of each section of the book, revealing the intricate dynamics of CSBD and its effects through the lens of the author's lived experience.
“Does Sex Addiction Really Exist?”
In the opening section titled “Does Sex Addiction Really Exist?”, the author delves into the complexities of CSBD and binge-eating disorder (BED). She begins by addressing the concept of sexual addiction, dispelling common misconceptions, and examining its frequent co-occurrence with other disorders. To understand her perspective, it is essential to first define CSBD and BED. CSBD is characterized by an enduring inability to control intense, repetitive sexual impulses, leading to prolonged sexual behavior lasting six months or more (World Health Organization, 2022). It affects approximately 3–10 % of men, and 2–7 % of women, and 6 % of gender-diverse individuals (Bőthe et al., 2023; Brand et al., 2024; Briken et al., 2022; Grubbs et al., 2023; Lewczuk, Wójcik, & Gola, 2022). Individuals with CSBD often focus excessively on sexual activities, struggle to reduce sexual behavior despite multiple attempts, and persist in such behavior despite adverse consequences or lack of satisfaction (World Health Organization, 2022). This condition can cause significant distress or functional impairment in various life domains, including personal relationships, social interactions, and professional responsibilities (World Health Organization, 2022).
BED, recognized in the Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-5) since 2013 (American Psychiatric Association, 2013), involves consuming large quantities of food rapidly, often within a two-hour period, accompanied by a sense of loss of control (American Psychiatric Association, 2013). To qualify as a binge-eating episode, it must include at least three of the following: eating more quickly than usual, eating until uncomfortably full, eating when not hungry, eating alone due to embarrassment, and experiencing negative emotions afterward (American Psychiatric Association, 2013). Between 2018 and 2020, global prevalence estimates for BED ranged from 0.6 to 1.8% in adult women and 0.3–0.7% in adult men (Giel, 2022). BED is highly distressing and is often linked to feelings of shame and guilt (Mars, Iqbal, & Rehman, 2024).
In the first six chapters, the author offers a deeply personal account of her experiences with CSBD from a female perspective. She also links her binge-eating behaviors to a broader pattern of self-destructive actions. By sharing her vulnerabilities, including the impact on her family and her fear of judgment, she adds a poignant and personal dimension to her narrative.
The author begins by detailing her struggles with sex addiction, depression, and health issues such as high blood pressure and cholesterol. She describes binge-eating as a coping mechanism for stress and emotional pain. She critiques previous therapeutic approaches, such as self-help books and social media fitness advice, and recounts her pivotal breakthrough with mindset coach Dana Lee Chapman, who helped her address both her eating disorder and sex addiction.
The subsequent chapters challenge the stigma surrounding female sex addiction, highlighting that women, though less frequently discussed in this context, face similar issues. The author contrasts the stereotypical image of the “desperate” or “slutty” addict with her own life as a successful professional, mother, and wife. This perspective helps readers understand that addiction can often be concealed behind a façade of normalcy or success.
A key theme throughout these chapters is the misunderstanding of sex addiction itself. The author critiques outdated terms like “nymphomaniac” and emphasizes that sex addiction is more than just physical acts. Using Gabor Maté’s definition of addiction, she explains that it involves compulsive behavior, impaired control, and persistent negative effects, focusing on emotional and psychological escape rather than the act of sex itself. This approach provides readers with insight into the complex emotional and psychological factors underlying addiction.
In the final chapters of this section, the author underscores that sex addiction is not solely about the physical act but about a deeper emotional need for escape through fantasies. Her reflections highlight the personal and societal challenges in recognizing and treating sex addiction, encouraging readers to consider how their own behaviors and coping mechanisms might impact their lives and to reflect on the necessity for change.
“Overdosing on Sex”
The section “Overdosing on Sex” is composed of 19 chapters and serves as the book's pièce de résistance. This part of the book delves into the origins, progression, and consequences of the author's sex addiction, offering critical clinical insights for therapists and researchers.
The author begins by describing her childhood, specifically being sexually groomed and taken advantage of at the age of eight by a child no more than four years older than her. These repetitive events were pivotal for her, as they gradually led her to become hypersexual. Although her sex addiction began in childhood, it remained manageable and “normal” until her mid-twenties.
The following chapters describe the triggers of her sex addiction in her mid-twenties and how she used her addiction as a coping mechanism for the excessive stress in her life. These sections provide insights on the patterns of behavioral addictions the author experienced. For example, engaging in sexual behaviors released a surge of endorphins that initially made her feel great and sexy, reducing her urge to binge eat. However, when these positive feelings faded, she would binge eat to comfort herself from the shame she was feeling. Here, the reader gains a better understanding of how her self-esteem fluctuated throughout different moments of her sex addiction.
These chapters detail how the author reached her lowest point and her breaking point, which motivated her to work to overcome her addiction. She recognized the pain her actions caused her husband and children, and that the sexual encounters she participated in left her feeling disgusted rather than fulfilled. Far from bringing her pleasure, these experiences deepened her sense of regret and discomfort. The reader can observe the intricate details about how the author dealt with the duality and ambivalence of her behaviors. She wanted to experience extreme sexual practices (e.g. submissive sexual experiences), but at the same time, she felt like she was too much of a “good girl” to do so. The reader can also witness her thought processes as she navigates the alternating cycle of indulging in her addiction and returning to reality.
In sum, these chapters highlight the colliding nature of her many struggles for the reader. The author discusses her eating disorder, how she overcame cancer, the impact of her sex addiction on her marriage, and her thoughts of becoming a sex worker despite being a mother, wife, and pediatrician. She describes worsening her addiction by engaging with men she found repulsive to boost her self-esteem. Readers can also learn about how she tried to 'treat' it by becoming a burlesque dancer.
“Overdosing on Sex” is a powerful section that explores the author's journey from childhood trauma to severe sex addiction. It provides critical insights into the development and impact of her addiction, including its effects on her self-esteem, relationships, and personal identity. The section vividly details her struggles, coping mechanisms, and the eventual realization that led her to confront and work to overcome her addiction.
“My Recovery”
In the concluding section of the book, the author offers a profound reflection on her journey. A pivotal moment occurs at a tailor shop, where Jerry, the tailor, imparts a significant spiritual lesson that greatly contributes to the author's recovery. Jerry observes that some individuals conceal their true nature behind superficial attributes—such as physical appearance, talent, or intelligence—and advises using affirmations, such as “God is with me,” to reclaim one's energy and soul from such people. This guidance prompts the author to engage in a deeper exploration of spirituality, reframing her traumatic experiences and personal struggles. The author candidly discusses the exhaustion, both physical and emotional, that results from interactions with energy-draining individuals, and reflects on the self-blame and guilt associated with personal issues, including the challenges faced by their son with a disability. The chapter suggests that spiritual healing and mindset coaching might be effective means of addressing and overcoming such challenges.
This section provides readers with a glimpse into how spirituality can be integrated into personal healing processes. It presents practical methods for incorporating spirituality into one's recovery, potentially offering empowerment to those seeking spiritual dimensions of personal growth. Additionally, it advocates for addressing past traumas with compassion and acceptance, supporting a holistic approach to healing that encompasses both positive and negative experiences.
However, the emphasis on spiritual insights may not resonate with those preferring a more secular perspective. Furthermore, the reliance on personal experiences can sometimes limit the broader applicability of the lessons shared. The pronounced focus on spirituality may hinder readers from considering other valuable aspects of healing and could alienate those whose beliefs differ.
Overall, the final chapter conveys a message of resilience and invites readers to embark on their own journeys of healing and self-discovery. It provides space for reflection on personal experiences and spiritual insights, fostering lasting peace and understanding.
Foreword + afterword: Healing will take as long as it takes
Coach Dana Lee Chapman is the individual with whom the author worked to not only understand her issues but also to gradually alleviate them. At the beginning and end of the book, the author notes that our thoughts and beliefs need to be altered to change destructive behaviors and make room to foster acceptance, calm, and inner peace. These words make sense.
However, a closer examination of Dana reveals that she is neither doctor, therapist, or sexologist. She is a fitness coach with a minor in kinesiology and charges a substantial fee for her services. She offers online programs, virtual follow-ups, and private coaching sessions at her studio. Given her lack of qualifications to address nearly 30 years of trauma and mental health issues, this raises concerns about the appropriateness of her approach for such severe conditions. Nevertheless, the author states that her consultations with Dana were beneficial.
Dana's spiritual approach seemed to work for the author, offering relief where medication and conventional discussions of past traumas did not. It is commendable that she has stated that she has made progress. Considering that the author is a pediatrician, her critical thinking skills might have also helped her in her healing process. However, not everyone has the necessary knowledge or health education to discern which treatment is effective from those that are not.
This situation highlights a significant concern: while non-traditional approaches can be beneficial for some, they should not replace professional medical and psychological care, especially for individuals with extensive trauma and mental health issues. The author's positive experience with Dana's methods underscores the importance of personal agency and finding what works for oneself. However, it also serves as a reminder of the need for proper qualifications and critical thinking when seeking help for serious health concerns. Ultimately, each person's healing journey is unique, and it is crucial to strike a balance between alternative approaches and evidence-based practices.
Science-based treatment options
Childhood sexual abuse (CSA) can be associated with compulsive sexual behaviors (CSB) (Slavin, Scoglio, Blycker, Potenza, & Kraus, 2020), problematic pornography use (PPU) (Gewirtz-Meydan & Godbout, 2023), and BED (Emery, Yoon, Mason, & Neumark-Sztainer, 2021; Rosenberg, Lahav, & Ginzburg, 2023). While women often experience increased issues related to sexual dysfunction following CSA (Aaron, 2012; Gewirtz-Meydan & Godbout, 2023), they can also exhibit CSB (Slavin et al., 2020). This aligns with the experiences described by the author of the book. The potential causes for CSB, PPU or binge eating are varied and can include avoiding painful or negative emotions or a false sense of control (Bőthe et al., 2024; Gewirtz-Meydan et Godbout, 2023). There is a connection between CSA and the three mental health issues mentioned above: lack of impulse control and compulsive behaviors, which some survivors may use as coping strategies (Dworkin, Javdani, Verona, & Campbell, 2014; Estévez, Ozerinjauregi, Herrero-Fernández, & Jauregui, 2019; Meyer, Cohn, Robinson, Muse, & Hughes, 2017).
Addressing the complex aftermath of CSA requires a comprehensive approach that integrates both psychological and medical interventions. As an example, considering her history of CSA, the author could have begun treatment with a trauma-focused intervention. In therapy, a psychologist or sex therapist should assess the co-occurrence of other mental health and medical conditions. It is crucial to identify triggers for symptoms —whether emotional, cognitive, or behavioral—and to provide skill training in areas such as developing problem-solving skills, conflict management, time management, and coping strategies. Mindfulness and meditation exercises (Brand et al., 2024; Briken et al., 2024; Buehler, 2008; Hilbert, 2020) can also be beneficial. Additionally, a physician may prescribe medication, such as antidepressants, to support the treatment process (Brand et al., 2024; Briken et al., 2024; Hilbert, 2020).
In terms of CSB, there appears to be a reduction in symptoms associated with CSBD with certain medications (e.g., naltrexone, selective serotonin reuptake inhibitors). However, it is currently impossible to make favorable recommendations for any pharmacological treatment for CSBD based on the limited size of the literature (Borgogna, Owen, Johnson, & Kraus, 2023; Brand et al., 2024; Turner et al., 2022). There are also few studies on the use of psychoeducation or cognitive-behavioral therapy (CBT) and their effects on reducing CSBD-related symptoms (Brand et al., 2024). Psychoeducation is used to improve knowledge about the disorder in both families and individuals with CSB. For example, it can inform families about the symptoms of the disorder or educate individuals with CSB about the financial, legal, or health consequences. Regarding CBT, it may assist in mitigating compulsive behaviors, altering dysfunctional beliefs, lowering perceived shame and stress, and promoting improved self-esteem. Although these treatments can serve as interesting avenues, high-quality treatment studies are lacking to make definitive conclusions (Antons et al., 2022; Brand et al., 2024; Turner et al., 2022).
General considerations
While this book offers valuable clinical and research insights into CSBD from a woman's perspective, it has notable limitations. Firstly, the book lacks thorough scientific review, despite presenting what appear to be factual claims about CSBD. For example, the author asserts that 100% of individuals with addiction have been either sexually, emotionally, or physically abused as children, a statistic that is highly unlikely and lacks proper citation. Additionally, the author also puts significant emphasis on Coach Dana and spirituality, casting them as a treatment for CSBD. This is somewhat problematic because coaches often lack rigorous training and do not adhere to scientific guidelines (e.g., Dana charged $6,000 USD for her services to the author, which can raise a number of ethical concerns). This could mislead readers unfamiliar with evidence-based treatment methods, potentially leading them to view this book as their sole reference for treatment options for their issues. The book could have included a disclaimer at the beginning, clarifying that it is not intended as a guide or reference for treating CSBD and is purely based on the author's personal experience. Alternatively, experts in the field could have been involved in managing the book's content.
Secondly, the books lack a cohesive structure. In other words, it does not have a clear linearity and resembles more an intimate journal. The author frequently revisits the same points across different sections, which can cause confusion and make it difficult to follow the author's narrative and the organization of the content. Lastly, the author seems to minimize her CSA experience, maybe to protect herself from the pain of facing what she lived. In fact, she states that she never felt she was sexually assaulted, despite the reality that, as a child, she was groomed and experienced abuse. She also expresses reluctance to come forward, fearing it would ruin her aggressor's life if she acknowledged what happened to her. Minimizing this lived experience could influence her readers who have also experienced sexual assault by leading them to downplay their experience and remain silence. In that sense, it is quite problematic because it perpetuates the burden of the assault on the victim. The focus should be shifted on the aggressor for their actions. In sum, it is important for the author to acknowledge and validate what she went through, placing her and her readers on a path towards healing and empowerment.
Conclusion
My Secret Life as a Sex Addict: How I Repaired the Damage raises a critical question for its reviewers: To what extent and under what conditions should personal narrative take precedence over scientific accuracy when addressing complex psychological conditions such as CSBD? Paulina Pantyleva's book offers a raw and immersive account of one woman's experiences with sex addiction and its interaction with binge eating. This is where the book's strength lies: it provides an unfiltered perspective on the author's personal struggles, offering a subjective yet insightful view of living with CSBD. However, the book has not undergone rigorous scientific review and incorporates a subtle spiritual tone, promoting non-traditional therapies—such as the author's consultations with a fitness coach. This narrative highlights the ongoing challenge of balancing personal experiences with the need for scientifically validated treatments. It underscores the importance of integrating both personal insights and empirical research to develop a more comprehensive understanding of psychological conditions.
Conflict of interest
We have no known conflict of interest to disclose.
Acknowledgements
Thank you, Dr. Beáta Bőthe, for your support in all our projects and for your valuable feedback, which helps us improve our work.
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Although the ICD-11 uses the terminology “Compulsive Sexual Behavior Disorder” (CSBD), the term “sex addiction” is used in this paper in accordance with the terminology used by the author of the referenced book.
