Compulsive sexual behavior is a condition in which an individual cannot manage their sexual behavior. Persistent sexual thoughts interfere with their ability to work, maintain relationships, and complete their daily activities.
Some people refer to compulsive sexual behavior as sexual addiction. However, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) published guidelines advising that sex addiction and porn addiction are not diagnosable psychological disorders due to a lack of empirical evidence.
A 2014 review reports that 3–6% of people in the United States experience compulsive sexual behavior.
In this article, we explain compulsive sexual behavior, including its symptoms and treatments, and the controversies around its diagnostic criteria.
What is compulsive sexual behavior?
The American Psychiatric Association (APA) do not classify compulsive sexual behavior as a diagnosable mental health disorder.
Debate continues as to whether the APA should include compulsive sexual behavior in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The World Health Organization (WHO) included compulsive sexual behavior in the International Classification of Diseases (ICD-11) and defined it as an impulse disorder “characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior.”
The APA describe addiction as a condition that causes “changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavior control.” These changes can be visible on brain scans.
However, the APA define addiction as a dependency on a substance and not an activity.
The following characteristics indicate compulsive sexual behavior:
- repetitive sexual activities that become a central focus of the person’s life, to the point of neglecting health and personal care or other interests, activities, and responsibilities
- numerous unsuccessful efforts to significantly reduce repetitive sexual behavior
- continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it
- a pattern of failure to control intense sexual impulses or urges and the resulting repetitive sexual behavior over an extended period, for example, 6 months
- persistent behaviors that cause marked distress or significant impairment in personal, family, social, educational, and occupational function, as well as in other important areas
Distress that relates entirely to moral judgments and disapproval of sexual impulses, urges, or behaviors is not sufficient to meet this requirement.
Mental health authorities have not yet established compulsive sexual behavior as a medical condition, although it can adversely affect families, relationships, and lives.
One of the difficulties of identifying compulsive sexual behavior is that one person might have a different sex drive, or libido, from the next. As a result, someone may consider their partner’s behavior to be sexually compulsive only because they have a higher sex drive.
More research is necessary to determine whether doctors should treat compulsive sexual behavior as a disorder.
People with compulsive sexual behavior may fixate on different sexual practices. Some people might experience an overwhelming urge to masturbate, while others may feel a compulsion to engage in sexual intercourse with several different partners a day.
This variation makes the condition harder to define.
Activities that can sometimes have a link with compulsive sexual behavior include:
- compulsive masturbation
- multiple affairs, sexual partners, and one night stands
- persistent use of pornography
- practicing unsafe sex
- meeting with sex workers
Behaviors and attitudes may include:
- an inability to contain sexual urges
- detachment, meaning that the sexual activity does not emotionally satisfy the individual
- strong feelings of attraction to others alongside continually being in love and starting new romances, often leading to a string of relationships
- feelings of guilt and shame
- giving up social, work-related, or recreational activities to pursue sexual stimulation
Even though evidence does not support the diagnosis of compulsive sexual behavior, it can still have a severe effect on people who engage in it and those around them.
Untreated compulsive sexual behavior can result in intense feelings of guilt and low self-esteem. Some people may develop severe anxiety and depression.
Other complications may include:
- family and relationship problems, including breakups
- financial problems
- sexually transmitted infections (STIs)
The causes of compulsive sexual behavior remain unclear.
Some studies theorize that compulsive sexual behavior shares the same reward system and circuits in the brain as substance addiction. However, there is no empirical evidence that supports this.
Underlying mental health conditions, such as depression, may also trigger compulsive sexual behavior. Different mood states, including sadness, loneliness, and happiness, might also lead to an inability to control sexual behavior in people with the condition.
The debate is ongoing regarding the diagnostic criteria for compulsive sexual behavior. There are different sets of criteria for diagnosing the condition.
Compulsive sexual behavior is not a formal diagnosis, according to the DSM-5. The APA suggest that this is due to a lack of evidence supporting its viability as a medical condition. However, the WHO included compulsive sexual behavior in the ICD-11.
As not enough evidence is available to support the connection between compulsive sexual behavior and the psychological circuits of addiction, these criteria do not have wider application in the diagnosis of compulsive sexual behavior.
The increasing number of examples of compulsive sexual behavior and its consequences have expanded the discussion of the disorder as a legitimate mental condition. However, more empirical evidence is necessary before major health authorities add compulsive sexual behavior as a standalone diagnosis.
Compulsive sexual behavior can be difficult to treat, as a person may rationalize their behaviors and thought patterns. People who engage in compulsive sexual behavior may deny that there is a problem.
Current treatment options aim to reduce mental health symptoms and manage any excessive urges to engage in sexual relations. Methods also encourage the nurturing of healthy habits and relationships.
The following treatment options are available:
Cognitive behavioral therapy (CBT): This type of psychological therapy provides a variety of techniques and tools that help the individual change their behavior. CBT can equip a person to learn new positive coping skills and reduce unwanted sexual urges.
Prescription medications: These might include anti-androgens, such as medroxyprogesterone (Provera), as well as selective serotonin reuptake inhibitors (SSRIs), including fluoxetine (Prozac). While a doctor may prescribe these drugs to reduce sexual urges, the Food and Drug Administration (FDA) have not approved any medications for treating this condition.
The support of friends and family is crucial for aiding recovery from compulsive sexual behavior. Compulsive sexual behavior can be difficult for others to understand and tolerate, especially if it has already caused damage in relationships.
However, a strong support network helps reduce unwanted sexual behavior and may support the creation of a healthy sexuality.
People with compulsive sexual behavior experience persistent sexual thoughts that interfere with their relationships, work or study, and everyday lives.
It can lead to severe anxiety and depression, as well as a range of other complications.
Experts remain unsure of the cause of this behavior, but various treatment options are available to help a person manage it.
Although some people refer to compulsive sexual behavior as sexual addiction, the APA do not classify it as a mental health disorder.