What is compulsive sexual behavior?
Compulsive sexual behavior (CSB) is a term that characterizes repetitive and intense preoccupations with sexual fantasies, urges, and behaviors that are distressing to the individual and/or result in psychosocial impairment. Individuals with CSB often perceive their sexual behavior to be excessive but are unable to control it. They act out impulsively (act on impulses and lack impulse control) or compulsively (are plagued by intrusive obsessive thoughts and driven behaviors). CSB can involve fantasies and urges in addition to or in place of the behavior, but it must rise to a level of clinically signiﬁcant distress and interference in one’s daily life to qualify as a disorder.
Over the centuries, compulsive sexual behavior has gone by many names, such as hypersexuality, hyperphilia, erotomania, satyriasis, promiscuity, Don Juanism, Don Juanitaism, and more recently sexual addiction, impulsive-compulsive sexual behavior, and paraphilia-related disorder. The terminology has often implied diﬀerent values, attitudes, and theoretical orientations.
How common is compulsive sexual behavior?
Please discuss with your doctor for further information.
What are the symptoms of compulsive sexual behavior?
The common symptoms of compulsive sexual behavior are:
- Your sexual impulses are intense and feel as if they’re beyond your control
- Even though you feel driven to do certain sexual behaviors, you may or may not find the activity a source of pleasure or satisfaction
- You use compulsive sexual behavior as an escape from other problems, such as loneliness, depression, anxiety or stress
- You continue to engage in sexual behaviors that have serious consequences, such as the potential for getting or giving someone else a sexually transmitted infection, the loss of important relationships, trouble at work, or legal problems
- You have trouble establishing and maintaining emotional closeness, even if you’re married or in a committed relationship
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.
What causes compulsive sexual behavior?
Although the causes of compulsive sexual behavior are unclear, they may include:
- An imbalance of natural brain chemicals. Certain chemicals in your brain (neurotransmitters) such as serotonin, dopamine and norepinephrine help regulate your mood. High levels may be related to compulsive sexual behavior.
- Conditions that affect the brain. Certain diseases or health problems may cause damage to parts of the brain that affect sexual behavior. Epilepsy, Huntington’s disease and dementia have all been associated with compulsive sexual behavior. In addition, treatment of Parkinson’s disease with some dopamine agonist medications may cause compulsive sexual behavior.
- Changes in brain pathways. Compulsive sexual behavior may be an addiction that, over time, might cause changes in the brain’s neural circuits — the network of nerves that allows brain cells to communicate with one another. These changes may cause pleasant reactions by engaging in sexual behavior and unpleasant reactions when the behavior is stopped.
What increases my risk for compulsive sexual behavior?
There are many risk factors for compulsive sexual behavior, such as:
- Alcohol or drug abuse problems
- Another mental health condition, such as a mood disorder (depression or bipolar disorder), or a gambling addiction
- A history of physical or sexual abuse
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is compulsive sexual behavior diagnosed?
Your doctor, psychiatrist or other mental health provider can do a psychological evaluation, which may involve answering questions about your:
- Physical and mental health, as well as your overall emotional well-being
- Sexual thoughts, behaviors and compulsions
- Use of drugs and alcohol
- Family, relationships and social situation
With your permission, your mental health provider may also request input from family and friends.
Determining a diagnosis
There’s an ongoing debate in the psychiatric community about exactly how to define compulsive sexual behavior because it’s not always easy to determine when sexual behavior becomes problematic.
Many mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, as a guide for diagnosing mental health problems. Because compulsive sexual behavior doesn’t have its own diagnostic category in the DSM-5, it may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder.
Some mental health professionals consider compulsive sexual behaviors as sexual activities taken to an extreme with significant and negative consequences. Although more research is needed to establish criteria, your mental health provider may consider whether the following factors are present when determining a diagnosis:
- You have a sexual preoccupation that fills a significant amount of your time thinking about, planning or engaging in sexual behavior.
- You engage in excessive sexual activity as a way to cope or to relieve negative moods or stress.
- You’ve made unsuccessful efforts to reduce or control sexual thoughts or behavior.
- You repeatedly engage in sexual behaviors, even though you recognize they’re harmful to you or others.
- You have significant personal distress about your sexual behavior, or it impairs your work, social life or everyday functioning.
Whatever the nature of your compulsive sexual behavior, push past your fear, shame or embarrassment and seek professional help. Getting the right diagnosis can be a relief and can guide treatment that will get your life back on track and save you and the people you care about a lot of anguish.
How is compulsive sexual behavior treated?
Treatment for compulsive sexual behavior typically involves psychotherapy, medications and self-help groups. A primary goal of treatment is to help you manage urges and reduce excessive behaviors while maintaining healthy sexual activities.
If you have compulsive sexual behavior, you may also need treatment for another mental health condition. People with compulsive sexual behavior often have alcohol or drug abuse problems or other mental health problems that need treatment — such as obsessive-compulsive behaviors, anxiety, or a mood disorder such as depression.
People with other addictions or severe mental health problems or who pose a danger to others may benefit from inpatient treatment initially. Whether inpatient or outpatient, treatment may be intense at first. And you may find periodic, ongoing treatment through the years helpful to prevent relapses.
Certain forms of psychotherapy, also called talk therapy, may help you learn how to manage your compulsive sexual behavior. These include:
- Psychodynamic psychotherapy, which focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts
- Cognitive behavioral therapy, which helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones
These therapies can be provided in an individual, group, family or couples format.
Certain medications may be helpful because they act on brain chemicals linked to obsessive thoughts and behaviors and reduce the chemical “rewards” these behaviors provide when you act on them.
Which medication or medications are best for you depend on your situation and other mental health conditions or addictions you may have. You may have to try several medications, or a combination, to find what works best for you with the fewest side effects.
Medications used to treat compulsive sexual behavior are often prescribed primarily for other conditions. They include:
- Those most commonly used to treat compulsive sexual behavior are selective serotonin reuptake inhibitors (SSRIs). These include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and others.
- Mood stabilizers. These medications are generally used to treat bipolar disorder, formerly called manic depression, but may reduce uncontrolled sexual urges. An example is lithium (Lithobid).
- Naltrexone (Revia, Vivitrol) is generally used to treat alcoholism and blocks the part of your brain that feels pleasure with certain addictive behaviors.
- Anti-androgens. These medications reduce the biological effects of sex hormones (androgens) in men. One example is medroxyprogesterone (mud-rok-see-pro-JES-tur-own). Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behavior is dangerous to others, such as pedophilia.
- Luteinizing hormone-releasing hormone. This medication may reduce obsessive sexual thoughts by reducing the production of testosterone.
Self-help and support groups can be helpful for people with compulsive sexual behavior and for dealing with all the issues it can cause. Many groups are modeled after the 12-step program of Alcoholics Anonymous (AA).
In addition to helping you make changes directly, these groups can help you:
- Learn about your disorder
- Find support and understanding of your condition
- Identify additional treatment options and resources
- These groups may be Internet-based or have local in-person meetings, or both. If you’re interested in a self-help group, look for one that has a good reputation and that makes you feel comfortable. Such groups don’t suit everyone’s taste, so ask your mental health provider about alternatives.
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage compulsive sexual behavior?
The following lifestyles and home remedies might help you cope with compulsive sexual behavior:
- Stick to your treatment plan. Take medications as directed and attend scheduled therapy sessions. Remember that it’s hard work, and you may have occasional setbacks.
- Educate yourself. Learn about compulsive sexual behavior so that you can better understand its causes and your treatment.
- Discover what drives you. Identify situations, thoughts and feelings that may trigger sexual compulsions so that you can take steps to manage them.
- Avoid risky behaviors. Identify your unique risk situations and set up boundaries to avoid these. For example, stay away from strip clubs, bars or other areas where it might be tempting to look for a new sexual partner or engage in risky sexual behavior. It’s a good idea to stay off the computer or install software that blocks pornographic websites.
- Get treatment for substance abuse or other mental health problems. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of unhealthy behavior.
- Find healthy outlets. If you use sexual behavior as a way to cope with negative emotions, explore healthy ways to cope, such as through exercise and recreational activities.
- Practice relaxation and stress management. Try stress-reduction techniques such as meditation, yoga or tai chi.
- Stay focused on your goal. Recovery from compulsive sexual behavior can take time. Keep motivated by keeping your recovery goals in mind and reminding yourself that you can repair damaged relationships, friendships and financial problems.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Compulsive sexual behavior. http://www.mayoclinic.org/diseases-conditions/compulsive-sexual-behavior/basics/definition/con-20020126. Accessed September 26, 2017.
Compulsive Sexual Behavior. https://www.psychologytoday.com/blog/why-cant-i-stop/201608/compulsive-sexual-behavior. Accessed September 26, 2017.
Review Date: September 27, 2017 | Last Modified: September 27, 2017