The CASRD and Trauma Model Explained
By Dr. Omar Minwalla, August 2020
What is Compulsive-Abusive Sexual-Relational Disorder (CASRD)?
Couples and individuals dealing with problematic sexual behaviors might typically hear the terms compulsive sexual behavior disorder or sexual addiction used to describe their experiences. But these words don’t fully capture the holistic nature of what actually goes on in these situations. An exclusive focus on sexual behaviors is incomplete, as problematic sexual behaviors are often accompanied by a tragic pattern of abuse and injury that deeply impacts partners and family members for years to come.
Compulsive-Abusive Sexual-Relational Disorder (CASRD) presents a more complete picture of the presence and impact of sexual acting-out behaviors. CASRD refers to problematic sexual behaviors in combination with associated patterns of domestic and intimate partner abuse that frequently lead to traumatic injuries. In other words, CASRD is a clinical syndrome that involves two pathological systems: one that relates to the inability to control sexual urges or behaviors and/or sexual entitlement (which we call compulsive-entitled sexuality, or CES), and another that includes integrity violations and abusive actions (integrity-abuse disorder, or IAD).
Many people suffer from CASRD and experience significant psychological, social, and life consequences as a result. These individuals, along with their partners and family members, often seek professional treatment and need clinical support. Unfortunately, we lack a formal, professional consensus on how to best diagnosis and treat this issue.
What is a Deceptive, Compartmentalized Sexual-Relational Reality (DCSR)?
The majority of people who struggle with repetitive and problematic sexual behaviors and seek clinical intervention are in relationships (often intimate partnerships or marriages), have families, and may be parents as well. In fact, most clinicians working with these individuals indicate that one of the primary motivators for treatment is the impact on the partnership, the marriage, and/or the family.
What has not been part of the focus in any of the dominant diagnostic and treatment models is that patterns of repetitive and problematic sexual behaviors are often part of a deceptive, compartmentalized sexual or relational reality (DCSR) within the context of intimate relationship(s). DCSRs are intentionally hidden and separated from the rest of the person’s life and reality, which has a huge, negative impact on the person’s partner and family.
In order to create and maintain a DCSR within an intimate relational context, a person has to violate the boundary of fidelity and corrupt the conditions of healthy relational functioning – respect, trust, honesty, and integrity – to such a degree that the partner often experiences psychological, emotional, and relational abuse. A DCSR involves intentional psychological manipulation of another person or people, chronic utilization of deceptive tactics, and an ongoing psychology and system of violation and manipulation. Tactics used by individuals in this type of situation include chronic patterns of lying, lying by omission, and psychological manipulation of the victim’s reality. This type of deceptive compartmentalization effectively keeps things hidden from people who are dependent on the person’s sexual-emotional-relational integrity and fidelity and forms a distinct criteria for diagnosing sexual acting act patterns as a sign of disorder. If confronted or discovered, these people will often use patterns of defending and blaming the victim or the relationship, rather than assuming responsibility for the deceptive, compartmentalized patterns of sexual or relational behaviors. These behaviors then often cause additional psychological, emotional, and relational abuse and harm.
What’s Wrong with Traditional Clinical Models?
Traditional clinical models for understanding sexual acting out problems have focused solely on the repeating sexual behaviors, while often ignoring the chronic sociopathic and abusive behavioral patterns. Essentially, these models have focused on only one part of a two-part problem. In doing so, they have neglected and omitted other significant problematic behaviors from clinical recognition and treatment.
Further, these models and practitioners do not view those who create and maintain deceptive, compartmentalized sexual or relational realities (DCSRs) as experiencing a form of mental disorder or abuse problem. Instead, the focus of traditional approaches is on the diagnosis of the sexual behaviors (compulsive or addictive), the lack of sexual control, the cause of the sexual behavior patterns, and the negative consequences experienced by the person who is sexually acting out. The primary problems with these models include:
- Failure to recognize the abuse. The first problem with traditional clinical models is that they don’t acknowledge the patterns of emotional, psychological, and relational abuse perpetrated on intimate partners and families of those with CASRD. Deceptive sexuality is indeed a particularly destructive form of intimate partner abuse and domestic abuse. Often, there are ongoing patterns of harm that victims experience for years, and the consequences are significant.
- Failure to recognize the trauma. Traditional clinical models do not recognize or understand the trauma symptoms experienced by these partners and family members. Sadly, however, this type of trauma is pervasive, intensely distressing, and in need of timely and appropriate diagnosis and treatment. Traditional models have ignored these trauma-related symptoms, and few practitioners in the psychological field as a whole have a solid conceptualization of this type of trauma.
- Failure to recognize and support the victims. In addition to not recognizing the trauma, many clinical models lack consciousness about the victims of CASRD. There has been a profound neglect of the partners and families who are exposed to, and impacted by, these problems. Traditional treatment models have either excluded partners and family members from clinical consideration or, even more damaging, have tended to misdiagnose them. Some models rely on general couples or sex therapy approaches, while others still use victim-blaming interventions based on the traditional concepts of co-sex addiction and codependency. Partners are often “educated” that their responses and reactions are actually part of the relationship problem or are symptoms of a co-addiction that require treatment and management. Unfortunately, none of these approaches appropriately recognize, diagnose, or attempt to treat the victimization and specified trauma-related symptoms.
- Failure to identify a disorder.The field frequently uses terms such as sex addiction, compulsive sexual behavior, out of control sexual behavior, and impulse control problem. But these terms do not attempt to describe any type of abuse problem, sociopathic behavior patterns, or conduct disorder. The field has clearly failed to recognize the presence and impact of deceptive sexuality as a type of disorder. There is no established awareness of an integrity-abuse disorder as the cause of the abuse/trauma. And there are no notable efforts put towards recognizing the role of a systemic abuse problem in causing significant trauma-related symptoms.
Unfortunately, abuse and trauma caused by deceptive sexuality are buried in the shadows of normalization, denial, and our collective lack of insight.
This needs to change.
Abuse and specified trauma caused by deceptive sexuality must be researched and more deeply understood by psychological practitioners and clinical researchers. We must better understand so that we can develop effective diagnostic and treatment approaches that address both sexual behaviors and abuse patterns that result in experiences of short- and long-term trauma.
What is The CASRD and Trauma Model?
The CASRD and Trauma Model expands the understanding, diagnosis, and treatment of sexual acting out disorders. It identifies deceptive sexuality as a form of domestic abuse. It represents a clinical step forward in the field and a significant advancement in the treatment of sexual acting out problems. This model confronts the traditional and current models of treatment and brings a critical set of new arguments to the ongoing debate related to sex addiction and compulsive sexual behaviors. This new clinical paradigm is organized around three foundational clinical concepts: compulsive-entitled sexuality (CES); integrity-abuse disorder (IAD), and a resulting specified type of trauma among victims (CASRD-Induced Trauma, or CAIT).
The CASRD Model revises the clinical paradigm of sexual acting-out behaviors in at least three important ways:
- The CASRD and Trauma Model expands the traditional, single-concept diagnosis of either sex addiction or compulsive sexual behavior to include compulsive-entitled sexuality (CES), recognizing the role of sexual entitlement as a major factor that contributes to problematic sexual behavior patterns.
- The CASRD and Trauma Model gives attention to the roles that conduct disorder and covert psychological and relational abuse behaviors play in sexual acting-out behaviors and considers these pathological patterns to be a type of integrity-abuse disorder (IAD).
- The CASRD and Trauma Model identifies partners and family members of people with CASRD as victims of abuse who often experience devastating trauma symptoms. As such, this model shines a light on the abuse-victim dynamic that so frequently occurs in these situations and challenges the codependency view that has often been associated with the single-concept diagnosis of co-sex addiction.
The CASRD and Trauma Model proposes that compulsive-entitled sexuality (CES) and integrity-abuse disorder (IAD) cause individuals to sexually act out in ways that lead to significant traumatic injuries for their victims. Importantly, the model recognizes that in such situations, abuse problems exist in addition to sexuality issues. Further, this model replaces existing victim-blaming models with abuse-trauma awareness and treatment approaches.
What is Compulsive-Entitled Sexuality (CES)?
Compulsive-Entitled Sexuality (CES) refers to an inability or an unwillingness to control sexual urges or behaviors, even when they cause significant negative consequences. People may experience CES because of a compulsive-addiction disorder and/or a pathological level of perceived sexual entitlement. Indeed, many patients present with at least some behavioral control problems and sexual entitlement.
Examples of CES include a lack of ability to control impulses or a perceived sense of entitlement, to engage in problematic patterns of pornography use, infidelity, prostitution, cybersex, flirting, and sometimes this can extend into clinical concerns such as sexual offending, abuse of power in the workplace, etc.
The CASRD and Trauma Model proposes that CES is one of the primary symptoms of the CASRD diagnosis. In addition to being a main driver of problematic sexual behavior patterns, CES also plays a big role in associated abusive behaviors such as lying, deception, and psychological manipulation.
What is Integrity-Abuse Disorder (IAD)?
The other primary criteria of the CASRD diagnosis is integrity-abuse disorder (IAD), which is a type of conduct disorder that is defined by a significant lack of integrity and a covert relational abuse system. IAD is characterized by sociopathic patterns of behavior (antisocial behaviors that are characterized by long-term patterns of disregard for, or violation of, the rights of others, deficits in conscience, deception and manipulation, impulsivity and recklessness, a lack of empathy toward others or remorse, coupled with a disregard for social norms or moral conduct. These types of behavior patterns can lead to repeated harm and abuse within relationships, particularly with intimate partners and family systems.
The creation and maintenance of a deceptive, compartmentalized sexual or relational reality (DCSR) in the context of an intimate relationship is a form of intimate partner abuse (or domestic harm when there is a family system), often including patterns of lying, psychological manipulation of others’ realities (gaslighting), violation of sexual and emotional fidelity, covert deceptive tactics, blaming the victim and the relationship, and defensive lack of responsibility. Deceptive sexuality and having a DCSR is also inherently a form of abuse in that it relies on dominance and control by intentionally preventing others from knowing the truth. It prohibits partners from being able to respond in healthy ways based on being informed about their reality. Further, deceptive, compartmentalized sexual or relational realities are fundamentally dehumanizing, treating others as objects to be used and exploited for purposes that serve the abuser.
The CASRD and Trauma Model proposes that these abusive, deceptive, and manipulative behaviors, which happen within an intimate relationship and in combination with sexual acting-out problems, meet criteria for a type of conduct disorder/sociopathic pattern known as IAD. IAD, along with CES, is a primary criteria and symptom of the CASRD diagnosis.
What is CASRD-Induced Trauma (CAIT)?
Compulsive-abusive sexual-relational disorders often involve the victimization of others through entitled sexuality and patterns of psychological, emotional and relational abuse. The harm that is done often constitutes intimate partner abuse as well as harm to the family system as a whole. CASRD-Induced Trauma (CAIT) is a psychological term that describes both the traumatic impacts and the trauma symptoms caused by compulsive-abusive sexual-relational disorder (CASRD). Many partners and family members of those with CASRD develop symptoms that meet most of the criteria for post-traumatic stress disorder and complex trauma, including exposure to extreme stress, intrusive re-experiencing trauma, constant triggering and reactivity associated with hyperarousal and hypervigilance, persistent avoidance, and negative alterations in both thoughts and mood. Some experience anxiety about potential disease and contamination, fears about child safety, social isolation, embarrassment and shame, and intense relational rupture and attachment injuries. Acute post-traumatic stress often occurs around the time that a partner finds out about the sexual acting-out behaviors and the deceptive, compartmentalized, sexual-relational reality (DCSR). Complex trauma gradually develops in response to the long-term progressive patterns of psychological, emotional, and relational harm that are associated with maintaining a deceptive, compartmentalized sexual or relational reality (DCSR). Complex trauma-related symptoms include progressive negative alterations to emotional functioning, thoughts, self-perception and self-awareness, relational integrity and relational functioning, perceptions of the abuser, and how the person relates to other human beings and their life or reality. Complex trauma may also impact a person’s survival instincts and erode their ability to rely or depend on their second brain.