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by Alexandra Katehakis
W. W. Norton, 2016
Review by Anna Westin on May 9th 2017

Sex Addiction as Affect Dysregulation

With insight that can only be developed from years of professional experience and detailed research, counselor and clinical director Alexandra Katehakis provides a comprehensive account of sex addiction from a neurobiological perspective. Dr. Patrick Caines hails the book as a 'touchstone…for understanding addiction', and the detail and depth with which it provides an overview of the field leaves me in no doubt that he is correct. 

In Sex Addiction as Affect Dysregulation, Katehakis suggests that sex addiction needs to be understood in detail as an addiction that can be engaged with in a way that brings people back into healthy relationships with others.  She engages with different therapeutic theories, providing insightful anecdotal illustrations from her own clinical practice. For those unfamiliar with neurobiology, Katehakis' first couple of chapters may be a tough to follow, due to the sheer quantity of information given. Figuring out exactly what Psychobiological Approach to Sex Addiction, or PASAT (a combination of Twelve Steps CBT treatment with affect regulatory psychotherapeutic engagement), involves took a bit of time for my non-counselling background.  However, I found that as the book progressed, a clear structure develops that accessibly outlines its many facets, eased with the inclusion of charts and illustrative references. 

The book starts with an in-depth analysis of research and approaches to addiction.  Katehakis acknowledges the complexity of engaging with this concept, even though she has limited the discourse to sex addiction.  Of this complexity she says that though 'unifying substance and behavioural addictions behavioural addictions through a grasp of their identical neurological workings yields a powerful paradigm for understanding and healing SA…no universal, formal recognition of SA pertains' (p. 37).  While the jury is still out amongst researchers as to whether addiction is, in fact, a 'chronic brain disorder' (p. 6), Katehakis' account shows how difficult the experience can be for people, and details the depth of work required for healing. 

Particularly helpful in this book was the exploration of a healthy concept of self-love; a part of addiction therapy that can be overlooked in more behaviourally inclined accounts.  This is especially relevant to treating sex addiction and addressing the patterns of shame that activity can elicit in a person. Katehakis' own narratives of her struggles with engaging effectively with clients, and the powerful synergy between the interdisciplinary therapies engages the reader in the synchronicity of the treatments developed.  Also of help was the clarification between forms of addiction, such as the distinction between love addiction (LA) and sex addiction (SA). 

The book is extensively referenced, with a solid bibliography for those who are interested in reading more. It works through the intricacies of a particular form of addiction in a way that is respectful to clients, while addressing their experience neurobiologically and relationally.  An insightful and thoroughly informative account.


© 2017 Anna Westin


Anna Westin, PhD candidate and visiting lecturer, Arts and Humanities, St. Mary's University, Twickenham, London