"Sexual Addiction": An Orthodox and Scientific View

Included in the category of substance abuse is the concept of tolerance. Tolerance is defined as "the need for increased amounts of the substance to achieve intoxication or desired effect" and/or diminished effects if the use of the substance remains the same and is not increased (DSM-IV-TR, 2000).

Substance withdrawal symptoms are related to the effects of the specific substance on the body. These symptoms can be reduced by chemically substituting similar substances. To help clarify these distinctions, consider these substances and the withdrawal symptoms associated with them:

In a previous article I noted that individuals are different concerning a number of characteristics associated with sexuality (Morelli, 2005). These include:

• Sexual Orientation: The sex of the individual the person is sexually attracted to, ie: same sex or opposite sex attraction.

• Sexual Desire or Strength: The degree of attraction, from weak to strong.

• Sex Partner Differences in Arousal
           Males: Multiple partners.
           Females: A single bonded individual.

• Gender Identity: The sexual characteristics a person perceives himself as having that are socially defined, irrespective of their biological sex.

Brotto and Graziottin (2004) define excessive sexual desire as "a persistent or recurrent excess of sexual desire, expressed as constant and/or intrusive sexual thoughts and/or fantasies, or perception of a high and/or strong sexual drive." These researchers point out that excessive desire leads to "(multiple) partnered or solitary behavior," and list the usual psycho-social consequences of acting out the hyperactive sexual desire: frustration, anger, aggression, unwanted pregnancies, sexually transmitted disease, paraphilia (unconventional sexual behavior, animals, inanimate objects).

In my clinical and pastoral experience I have encountered significant personal, social and occupational dysfunction as a result of compulsive hypersexuality such as cancelling dates and social functions, excessive staying at home, tardiness or absence from work, giving up friends, disengagement from spouse, just to name a few.

Brotto and Graziottin make no mention of the spiritual consequences of compulsive hypersexuality. The closest they come to the spiritual dimension is their conclusion that excessive sexual desire can cause personal distress and be egodystonic (thoughts and behaviors viewed by the individual as unacceptable or distressing). More on this below.

Attempts by medical and psychological researches to understand the etiology (physical causes) of hypersexuality draw from several sources:

• Substance abuse: e.g. cocaine and amphetamines (Black, Kehrberg, Flumerfelt and Schlosser (1997).

• Medical treatment: e.g. androgen, cortisone dopaminergic drugs (to treat Parkinson's disease).

• Medical conditions: e.g. Kluver-Busy Syndrome (temporal brain lobe damage caused by herpes, encephalitis, dementia, Alzheimers Disease, lipid [fat] metabolism deficiencies, cerebrovascular disease, trauma.) (Solms and Turnbull, 2002). Amygdala, Prefrontal and frontal lobe damage. (Anderson, Bechara, Damasio, Tranel and Damasio, 1999).

• Psychiatric Conditions: Obsessive Compulsive Disorder and Eating Disorders. (Black, Kehrberg, Flumerfelt and Scchlosser, 1997).

The common physiological underpinning of dependency and withdrawal syndromes deals with the reward system of the brain (Olds, 1958; Panksepp, 1993, 1998). Biogenic amines such as dopamine and related substances such as phenethylamine mediate "anticipatory eagerness" and sexual arousal suggests that there are compulsive qualities in human response (Leibowitz, 1983).

The behavioral aspect of this compulsion are outlined by Carnes (2001) who suggests that anxiety and dysphoric emotions are temporarily relieved by a "sexual high." Carnes outlines four phases that make up the dysfunctional cycle:

• Obsessional "trance like" preoccupation creating an overbearing need.

• Ritualistic behaviors such as looking at or passing by objects related to the obsession intensifying the sexual excitement.

• Sex acts that are actually performed.

• Dysfunctional - maladaptive emotions such as anxiety, depression, despair, hopelessness and worthlessness.

The Fathers are masters at understanding the type of preoccupying and sometimes obsessive thoughts discussed by the scientific clinicians and researchers. From the outset it is clear that the Fathers got their terms right. "Addiction" for example, is not a term the Fathers ever used. Instead, they refer to addiction as "passions" and "habits."

They also understood the distinction between compulsion and behavior. Nikitas Stithatos, the disciple and biographer of St. Simeon the New Theologian said, "A passion is not the same as a sinful act; they are quite distinct." The effects of pleasure as a reward system of the brain was noted by St. Simeon 1000 years ago -- long before the modern discovery. "A passion operates in the soul, a sinful act involves the body ... love of pleasures (are) noxious passions of the soul; but unchastity (is a) sinful act of the flesh," he taught (Philokalia IV).

The Church Fathers were able to discern the interactions between thoughts, passions and acts which has been the subject of current psychological research (Morelli, 2003). St. Gregory of Sinai wrote:

Sinful acts provoke passions, the passions provoke distractive thoughts and distractive thoughts, provoke fantasies. The fragmented memory begets a multiplicity of ideas, forgetfulness, causes the fragmentation of the memory, ignorance leads to forgetfulness, and appetites are aroused by misdirected emotions, and misdirected emotions by committing sinful acts. A sinful act is provoked by a mindless desire for evil and a strong attachment to the senses and to sensory things (Philokalia IV).

The Fathers taught that sense factors can evoke the passions, lust in this case. The senses are mainly visual, but can be auditory, taste, touch and smell as well. Research psychology is filled with studies suggesting cognition, memory and emotions scan also be triggered by such cues.

St. Gregory of Sinai expressed the cognitive factor well:

Distractive thoughts arise and are activated in the soul's intelligent faculty, violent passions in the incensive faculty, the memory of bestial appetites in the desiring faculty, imaginary forms in the mind and ideas in the conceptualizing faculty ... We are provoked to sin by such thoughts; the irruption of evil thoughts is like the current of a river, and when as a result of this we give our assent to sin, our heart is overwhelmed as though by a turbulent flood (Philokalia IV).

The senses are activated by such distractive thoughts. St. Gregory continued:

By the "deep mire" (Ps. 69:2) understand slimy sensual pleasure or the sludge of lechery, or the burden of material things. Weighed down by all this, the impassioned intellect casts itself into the depths of despair ... sin ... is named according to its external manifestation (Philokalia IV).

St. Maximus the Confessor expanded the teaching:

The power of sin is somehow mingled with the senses and induces the soul by means of sensual pleasure to have pity for the flesh, to which it is joined. When the soul pursues the impassioned and pleasurable cultivation of the flesh ... (it) is impelled to become the author of evil" (Philokalia II).

The Fathers recognized that these thoughts are so powerful that they cannot be entertained without succumbing to them. St. John of the Ladder warned:

Do not imagine that you will overwhelm the demon of fornication by entering into an argument with him. Nature is on his side and he has the best of the argument ... So the man who decides to struggle against his flesh and to overcome it by his own efforts is fighting in vain" (Philokalia I).

In 1938 behavioral research psychologist B.F. Skinner investigated the powerful effects of stimulus "elicitation" or "control" of behavior noted many centuries earlier by the Church Fathers. Skinner concluded that specific responses occur automatically (learned by repetition followed by reward) in the presence of specific stimuli or cues. Put another way, Skinner discovered that cues work because they signal the reward that follows a behavioral response.

To illustrate: a telephone rings (stimulus cue) and automatically a person picks it up and says "Hello." The picking up and "Hello" would not occur if the stimulus cue had not elicited it. The response of those suffering from sexual dependency works the same way. A visual stimulus such as a pornographic picture for example, controls the response, ie: actions that lead to further sexual arousal.

Skinner and others found that so called "neutral cues" associated with cues that "naturally" elicit responses eventually come to elicit the response themselves. A computer screen for example, appears to be a neutral cue. However, when the screen is frequently associated with pornographic images, it can elicit sexual arousal and the response associated with it. A response chain forms: Turn on the computer and then go to a pornographic website. Another, less obvious, example concerns the term "Red Light." The term is found everywhere in the country and can elicit the response: Park car, walk into the strip club, start a lap dance. These responses are reinforced by the reward system of the brain discussed above.

The Fathers also understood how entrenched the cues and associated behaviors can become. St. Nilus noted, "A practice leads to a habit, and habit takes root like second nature. It is difficult and painful to stir or transform a nature (Haucherr, 317).

St. Gregory of Sinai wrote,

"The cause and origin of the passions is the misuse of things ... (and) expresses the bias of the will ... " (Philokalia IV).

The Church Fathers were able to discern this process without any knowledge of behavioral neurophysiology and were aware of how subtly the process works. St Nilus wrote that it "attacks through alluring ruses." Ruses today include computer pornography, email spam, or semi nude models or performers in advertising and entertainment, for example.

Even presentations that appear innocuous on the surface can contain stimulus cues associated with arousal and the triggering of habits that prove corruptive in the end. St. Nilus described how seemingly innocent temptations grow. "Innocent sympathy, encounters, eyes and ... pleasantries ... Over time, a tenaciously clinging root makes the most skillfully and solidly built wall decay; it makes rock burst asunder" (Philokalia IV).

The prayer of the Orthodox Holy Unction Service reveals the spirit that enlivens all sexual healing:

Do thou receive also with thy wonted love for man, these thy servants who repent them of their iniquities, overlooking all their transgressions: For thou art our God, who hast bidden us to forgive those who call in sin, even unto seventy times seven; ... The blessing of our Lord God and Savior Jesus Christ: for the healing of the soul and body of the servant of God (...name...), always, now and ever, and unto ages of ages. Amen.

I. Awareness of the Problem or "Coming to Oneself"

The parable of the Prodigal Son shows us where healing begins. The Prodigal, the scripture tells us, " ... gathered all he had and took his journey into a far country, and there he squandered his property in loose living" (Luke 15:13). He did not miss his father.

The Prodigal's return to wholeness occurred when he "came to himself" (Luke 15:17). He still lived in the far country. His inheritance was spent. He was still separated from his father. Essentially the phrase means that the Prodigal became aware of his self-centeredness: his estrangement from others, his degradation, the wasting of his inheritance -- all the constituents that contributed to his state of spiritual poverty.

The Prodigal's self-centeredness is mirrored in our society with its preoccupation with sex. Self-centered sexual activity -- whether alone, with others, in groups, in same sex relationships, with animals and objects -- is so common and pervasive that for many people it is no different than brushing their teeth. Like the Prodigal, the person caught up in sexual dependency has to "come to himself" and develop a sense of inner grief over his situation. This is a difficult road since the person stuck in the mire of sexual dependency often does not see that he lives in spiritual swill.

The hymn sung on the Sunday of the Prodigal Son in Orthodox practice must become the prayer of the person mired in sexual sin:

When I disobeyed in ignorance Thy Fatherly glory, I wasted in iniquities the riches that Thou gavest me. Wherefore, I cry to Thee with the voice of the prodigal son, saying, I have sinned before Thee, O compassionate Father, receive me repentant, and make me as one of Thy hired servants.

St. Gregory taught that unless our life and action are accompanied by a sense of inner grief we cannot endure the incandescence:

(Our efforts) ... will always be accompanied by apathy and self-conceit ... distractions, daydreams, sluggishness, dissipation, indolence and the intellect benighted and callous. Then Jesus is hidden, concealed by the throng of thoughts and images that crowd the mind (Philokalia IV).

(Incandescence refers to the influence that thoughts, daydreams, and other interior deliberations have over the intellect that clouds its clarity and perception. Just as, say, a red light distorts the appearance of objects in a photographic dark room, the passions (or lusts) can direct and illuminate the thoughts in ways that distorts how the intellect perceives the world around it. In the context of sexual addiction, sexual fantasies and behavior lead to a sluggish, slothful, and callous intellect that hides the healing power of God.)

Psychologists note that awareness or "coming to oneself" is often preceded by some major life consequence of the sexual dependency like a poor job evaluation or job loss, discovery by a spouse, etc. For the Prodigal Son it was a famine where the swine had more to eat than he did.

II. Commitment to the Healing Program

The Fathers taught that healing takes determination and resolve. St. Gregory of Sinai noted for example that, "We energize [virtues] according to our resolve ... " Some Fathers such as St. Nikitas Stithatos wrote that determination arises from the incensive power of the soul. St Nikitas wrote, "our incensive power ... serves as a weapon," that provokes determination and resolve and thus in accord with the will of God. "When our desire and our intelligence, in a way that accords with nature, aspire to what is divine, then our intensiveness is for both of them a weapon of righteousness ... " he continued (Philokalia IV).

Psychologists understand the necessity for determination and resolve as an element of healing although they use different terminology. Bandura calls the process self efficacy and defines it as "the ability to develop a program or plan for action to reach a goal" (Bandura, 1986).

Generally people with higher self-efficacy are better able to attain goals. Psychological interventions that employ self-efficacy are incorporated into the treatment of sexual dependency and withdrawal. The major variables bringing about self efficacy are:

• Mastery experience: Practicing appropriate concrete graduated actions in respond to sexual cues. In the case of sexual dependency it may mean practicing throwing out pornographic magazines, videos, CDs, etc. and reporting specific and concrete feedback to a counselor as accomplished. Increased "assignments" are added. This may be viewed as mastering a series of sub-goals that lead to a final goal.

• Vicarious experience: Observing a peer model struggling with the same problem of performing an appropriate behavior in response to a sexual cue. It may be something as simple as watching a discarding behavior as described above, or calling someone into a room before turning on the computer, or placing an meaningful icon directly next to the computer screen.

• Prompting: Using key or phrases as cues to appropriate action followed by verbal approval as reinforcement (Morelli, 2005). For example, the person will verbalize, "throw pornographic magazines in trash," then throw them in the trash and follow up by saying, "Good job." In another example a person may say, "look over at icon immediately and start a prayer and hit the escape key on the computer" when encountering a pornographic image and do just that. Once accomplished he says out loud, "Good job."

• Perceptions of arousal: To have an accurate understanding of the physiological nature of the bodily arousal and know it can be managed.

In my clinical experience I discovered that that many of the people I treated for sexual dependency have a long history of trying to overcome their dependence. Their successive failures results in low self esteem and in some cases even serious depression that leads to low self-efficacy (Morelli 2005). Efficacy training therefore, is an import component in any healing process. The more success an individual experiences, the more his self-efficacy will increase.

III. Healing Comes From God

It is important to remember that the mastery exercises that help a person overcome his dependency can only be accomplished through God's power. St Nilus said, "It is difficult and painful to stir or transform a nature ... Nevertheless, God can do it: nature creates no obstacle to God ... therefore, one should not despair" (Haucherr, 1990).

The mastery experiences, indeed, the entire healing program, must be practiced in the context of a deepening communion with the loving, forgiving, and merciful God. Christ is the Good Shepherd who seeks out the person lost in the desert of sexual dependency. The patient must appropriate these words of Christ as his own, "I am the good shepherd; I know my own and my own know me, as the Father knows me and I know the Father; and I lay down my life for the sheep" (John 10:14-15); or, "What man of you, having a hundred sheep, if he has lost one of them, does not leave the ninety-nine in the wilderness, and go after the one which is lost, until he finds it?" (Luke 15:4).

The neurophysiologic basis of sexual arousal is also incorporated into the intervention process. Part of the therapy involves encouraging the patient to provide a "rationale" for the treatment steps. Understanding how the steps can help break the dependency encourages the patient to complete them (Jones, Britten, Culpepper, Gass, Grol, Mant, & Silagy, 2005).

A sex dependent individual comes to see that even a slight cue can activate the pleasure pathways in the brain. Knowledge of this physiological dimension of dependency mitigates feelings of despondency and discourages self-labeling as a moral failure because it provides the rationale for immediate and effective self-intervention.

In terms of the theological anthropology of the Fathers, this self-knowledge and the self-intervention it inspires is tantamount to the awakening of the conscience. The sexual dependent behaviors are recognized as sin, and the struggle to overcome the temptations and habits takes the form of a spiritual struggle that leads to God. On the other hand, if the struggle is abandoned, the soul becomes even more enslaved to sin that leads to even greater estrangement from God.

The power to overcome sexual addiction comes from God. It is one of the deep mysteries of communion with God that the greater the dependency, the more grace God gives to overcome it. St. Nilus taught that, "stronger than the evil and culpable habit is God who created us ... " (Haucherr, 1990).

This teaching parallels step one of the Twelve Step Program that is used in the healing of addictive behaviors, including sexual addiction. (Sexaholics Anonymous deals with sexual addictions exclusively and can be effective in overcoming the affliction. Readers struggling with sexual addiction are encouraged to attend.) Absolute dependence on God however, was first taught by the Church Fathers many centuries ago. St. Makarios of Egypt wrote, "The devout soul ... attributes everything to God ... Man's body and soul, and even his very being, are his only by grace" (Philokalia III, 123).

Unless the Lord overturns the house of the flesh and builds the house of the spirit, all our labor is in vain. The sexually dependent person must offer to the Lord the weakness of his nature. St. John of the Ladder taught, "Admit your incapacity and without your knowing it you will win for yourself the gift of chastity" (Philokalia I). St. Symeon the Theologian wrote, "Without God's grace we can do nothing" (Philokalia IV, 133). Our Lord said," ... apart from me you can do nothing" (John 15:5).

In practical terms, healing requires not only the continual recollection of our complete dependency on God, but also deep and heartfelt prayer and participation in the sacraments of the Church.

IV. Practical Psycho-Spiritual Applications

St Hesychios the Priest explained how thoughts control us by representing the material things of the world and instructed us on how to deal with them " ... all evil thoughts are but images of material and worldly things. Yet if we persist in watchful prayer this will rid the mind of all such images. It will also make the mind conscious of ... the benefits of prayer and watchfulness" (Philokalia I).

Any healing for sexual dependency requires a program of stimulus control. Contemporary research psychologists recommend changing the stimulus cues by using distinct signals such as location, size, color and sensory modality (Martin and Pear 1992). For example, an icon (religious image) can be placed next to a computer screen to have a different stimulus to which to respond. Another example, the Bible or some books on the Church Fathers can occupy the shelves where a collection of pornographic tapes were formerly kept.

These modern practices were taught by St. John Cassian 1600 years ago:

Their coming [thoughts] is not within our power to control, but their expulsion is. The amending of our mind is also within the power of our choice and effort. When we meditate wisely on the law of God, study psalms and canticles, engage in fasting and vigils, and always bear in mind that is to come -- the kingdom of heaven, the Gehenna of fire and all God's works -- our wicked thoughts diminish and find no place.

St. Gregory of Sinai also recommended a treatment compatible with contemporary scientific behavioral science research: obedience and following a plan. He wrote:

If you are feeble in practicing the commandments yet want to expel your inner murkiness, the best and most efficient physic is trustful unhesitating obedience in all things. This remedy, distilled from many virtues, restores vitality and acts as a knife which at a single stroke cuts away festering sores. If, then, in total trust and simplicity, you choose this remedy out of all alternatives, you (will) excise very passion at once. Not only will you reach the state of stillness, but also through your obedience you will fully enter into it, having found Christ and become His imitator and servant in name and act.

Both spiritual and psychological factors must be integrated in the healing process. The following is a composite of instructions I gave to a person who is sexually dependent and desires healing:

• Get rid of the porn. All sexual stimuli must be eliminated from your life. This includes books, magazines, videos, CD's, DVD's, pictures, computer bookmarks, computer images, not opening any unknown email or websites. Stay way from strip clubs (even places as "family friendly" as Hooters for example). It also will mean knowing which TV programs are arousing. It is my experience that no progress can be made unless you admit you have a problem and make a firm commitment to: 1) Do everything you can do to heal this sin and problem; and 2) Be open to your Spiritual Father and counselor in all things pertaining to this issue.

• Watch the eyes. Let me tell you about the plight of one person who came to me for help. A person cleaned up his computer and thought that all sex oriented images were removed. In a flash one X-rated image flashed in front him. This led him to sin.
  The Church Fathers talked about "custody of the eyes" and how right they were. Even the sight of a beautiful female or male in our society dressed in clothes our society considers appropriate and found in everyday settings like work, shopping, and (sorry to say) even at Church, can be enough to arouse your passions and lead to entertainment of a fantasy that leads to the sinful behavior.

• Be vigilant. Always have a competing response ready. The Fathers told their spiritual children to avoid all sensory stimulation related to the passion. They recommended substituting the Jesus Prayer ("Lord Jesus Christ, Son of God, have mercy on me a sinner") or any other prayer that reaches out to God as a way of conquering the onslaught of unbridled, sexual lust.
  Their counsel is wisdom from the Holy Spirit and you would be wise to follow it. They understood how even the slightest cue could arouse the passion of lust and lead the person to entertain it in his mind. Saying a prayer, reading scripture, gazing at an icon, studying the teachings of the Church Fathers, are powerful competing responses that can defeat the lust that used to overpower you.

• Commit to your healing program completely. I am going to give you homework and require a daily follow-up by phone or email. If the only way to deal with a troubling cue is to call me, then call me. Put my number in speed-dial and have your phone available always. Your commitment to this cannot be only ninety-nine percent because the one percent can undo you. God wants one-hundred percent. The Fathers taught and the psychologists know that only one-hundred percent will work. Put another way, "cold turkey" is the only way the treatment works (Morelli, 2005).

• Understanding the proper context for sexual relations. In theological terms, the return from a sexual dependency back to wholeness is repentance, metanoia in Greek that means a change (in this case a restoration) of the mind. In order to help the person put their change of mind in a spiritual context, instructions in the Orthodox Christian view of the holiness of sex is given.
  The individual is told that sex is holy. Properly understood, sexual relations are a participation in the creative acts of God expressed and contextualized in the love of husband and wife in marriage that replicates the self-emptying love of Christ towards His Church.
  I tell the patient that sex is a beautiful gift from God and blessed when practiced in the way that God prescribed. Lust is pernicious. Instead of leading to a loving union, a creative complementary of love that replicates the union of Christ to his Church, sex becomes self-centered. It degrades into an individual act of lust that is manipulative and isolating. It uses the other person in unloving and controlling ways.

V. Repentance

The recurrent theme for the sexually dependent person is the words of our Lord to St. Peter's question, "Lord, how often shall my brother sin against me, and I forgive him? As many as seven times?" asked St. Peter. Jesus replied, "I do not say to you seven times, but seventy times seven" (Matthew 18: 21-22).

The fact is that sexual dependency is a hard sin to overcome. There may be failures along the way. While the admission of this fact can be construed as a license to sin, the scriptures are clear that our liberty is never to be used for an occasion for the flesh. Put another way, God recognizes the difference between authentic and inauthentic repentance. If this knowledge is used as a justification for sin, no true repentance occurred no matter how many words might have been expended in prayer. If the fallen brother calls out to Christ like the thief on the cross however, they will find the forgiveness of God.

A wise person once said that God doesn't look where we have come from, only where we are going. If repentance is drawn from a desire for a pure heart, the repentant will find God no matter how many times they have failed. "Blessed are the pure in heart, for they shall see God" (Matthew 5:8).

In this context my instruction to the suffering person continues:

God does not want us to sin. Nevertheless, the fight against sin can make us stronger and, in the end, even wiser. Again, one of the deep mysteries of salvation is that the person who has been forgiven of many sins also often develops a deep reservoir of compassion for others suffering from the same affliction. The person attacked by the demon of lust (as the Church Fathers called the force that elicited the temptation) and afflicted with the sickness of lust, will have a greater understanding of the sickness once he is healed than the person who never experienced this kind of struggle.

The foundation of this spiritual warfare will be prayer. The Psalmist tells us where to begin:

Let us pray to the Lord:

"My refuge and my fortress; my God, in whom I trust." For he will deliver me from the snare of the fowler and from the deadly pestilence; He will cover me with his pinions, and under his wings I will find refuge; His faithfulness is a shield and buckler. I will not fear the terror of the sexual demon, nor all his subtle cohorts. God will deliver me; and God will protect me, because He knows my name. For thou art the God of Mercy and Forgiveness and do thee do we ascribe Glory to the Father and the Son and the Holy Spirit, now and ever and unto ages of ages. Amen. (Based on Psalm 90: 3-5, 14)

St. Gregory of Palamas said, "I also hold that philosophy is one of the natural gifts of God, as are also the discoveries of human reason, the sciences ... I give each the honor it merits" (Philokalia IV). We too can confidently pick up the tools of science and use them alongside prayer, the sacraments, and the wisdom of the Fathers to fight the captivity to lust and the sexual dependency it creates in our modern world.

Andereson, S.W., Bechara, A., Damasio, H., Tranel, D. Damasio, A. (1999). Impairment of Social and Moral Behavior Related to Early Damage in Human Prefrontal Cortex. Nature Neuroscience. 2 1032-1037.

Bandura, A. (1986). Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice Hall

Black, D.W., Kehrberg, L.L.D., Flumerfelt, D.L., and Schlosser S.S. (1997). Characteristics of 36 Subjects Reporting Compulsive Sexual Behavior. American Journal of Psychiatry. 154: 243-249.

Brotto, L.A. and Graziottin A. (2004). Hyperactive Sexual Desire in Women. Urodinamica. 14: 84-87.

Carnes, P. (2001). Out of the Shadows: Understanding Sexual Addiction. Center City, MN: Hazelden.

Dollard, J., & Miller, N.E. (1950). Personality and Psychotherapy. NY: McGraw-Hill.

Hausherr, I. (1990). Spiritual Direction in the Early Christian East. Cistercian Publications, St. Joseph's Abbey: Spencer, MA.

Jones R, Britten N, Culpepper L, Gass DA, Grol R, Mant D, Silagy C, eds. (2005) Oxford Textbook of Primary Medical Care. Oxford: Oxford University Press.

Liebowitz, M.R. (1983) The Chemistry of Love. Boston: Little, Brown.

Martin, G. & Pear, J. (1992). Behavior Modification: What It Is and How To Do It. Englewood Cliffs, NJ: Prentice Hall.

Menninger, K. (1973). Whatever Became of Sin? NY: Hawthorn Books.

Morelli, G. (2005, July 19) Sex is Holy: Psycho-Spiritual Reflections in a Secular World. http://www.orthodoxytoday.org/articles5/MorelliSexIsHoly.php

Morelli, G. (2005, August 11). Homosexuality: Some Psycho-Theological Reflections and Pastoral Implications. http://www.orthodoxytoday.org/articles5/MorelliHomosexuality.php.

Olds, J. (1958). Self stimulation experiments and differentiated reward systems. In H. H. Jasper, L. D. Proctor, R. S. Knighton, W. C. Noshay, R.T. Costello (eds), Reticular Formation of the Brain. Boston: Little, Brown.

Palmer, G.E.H., Sherrard, P., & Ware, K. (Eds.). (1979). The Philokalia: The Complete Text Compiled by St. Nikodimos of the Holy Mountain and St. Makarious of Corinth (Vol. I).Winchester, MA: Faber and Faber.

Palmer, G.E.H., Sherrard, P. & Ware, K. (1981). The Philokalia II . Faber & Faber: London.

Palmer, G.E.H., Sherrard, P. & Ware, K. (1995). The Philokalia IV . Faber & Faber: London.

Panksepp, J. (1993) Neurochemical control of moods and emotions: amino acids to peptides. In M. Lewis and J.M. Haviland eds. Handbook of Emotions. NY: Guilford.

Skinner, B.F. (1938). The Behavior of Organisms: An Experimental Analysis. NY: Appleton-Century-Crofts.

Solms, M. Turnbull, O. (2002). The Brain and the Inner World. London: Kamac.