From a self-psychological perspective, sex addiction can be viewed as repeated unsuccessful attempts at remedying central deficits in an uncohesive psychic structure. The sex addict uses sex in an attempt to compensate for the deficits in the self's capacities for tension regulation, self-soothing and self-esteem regulation, as well as, preventing regressive fragmentation. Until these psychic structures can be built for the sex addict, these deficits will continue to be disabling. A case formulation exemplifies some of the foundations upon which the self-psychology is used in conceptualizing a client's narcissism, hypochondria and sadomasochistic behaviour.