ABSTRACT
Drive theory views sexual compulsion as a maladaptive response to early developmental difficulties that render the adult unable to form a compromise between individual instinctual wishes and external societal demands. Splitting tends to be the main defence used by those engaged in sexual compulsions. Sexual compulsion was a way of avoiding intimacy. It is important, both for clinicians and, sometimes, for patients, to hold in mind a separation between what E. Coleman delineated as paraphilic and non-paraphilic compulsions. Working with patients whose lives have been consumed by sexual compulsion requires a capacity to analyse the aetiology of the compulsion and provide an alternative to it. The chapter deals with a case study on Tony who grew up in the midst of perversion and madness. As has been demonstrated through Tony’s case, sexual compulsions are often a way of anaesthetising the agony of shame. For many male survivors the prospect of intimacy contains within it the threat of psychic annihilation.
