Clinical management of defense mechanisms in sex addiction

This chapter briefly summarizes the nature of addiction screeners in general, and specifically discusses the history and utility of the Sex Addiction Screening Test Revised (SAST-R; Carnes, Green & Carnes, 2010). A study is presented to investigate the screening efficiency and accuracy of the SAST-R using a large sample of non-clinical online respondents. Results indicate that the SAST Core scale and PATHOS scale (Preoccupation, Ashamed, Treatment, Hurt, Out of Control and Sad), the primary screening scales of the SAST-R, discriminate between self-identified sex addicts and non-addicts with high sensitivity and acceptable specificity, and does so similarly across sub groups defined by sex and sexual orientation. The SAST-R Addiction Dimension scales (Preoccupation, Loss of Control, Relationship Disturbance and Affective Disturbance) perform as intended, accurately distinguishing between addicted and non-addicted groups defined by sex and sexual orientation, as does the SAST-R Internet scale. The Men scale, Women scale and Homosexual Men scale, each designed to capture sexual behavior variance distinctive of those groups, also performed much as intended, although there were unanticipated findings, particularly in regard to scale means of self-identified bisexual men and women. Implications of the results and future directions for research are briefly discussed.