Compulsive sexual behavior

November, 15th, 2023

, Overview, ,

Compulsive sexual behavior is sometimes called hypersexuality or sexual addiction. It’s an intense focus on sexual fantasies, urges or behaviors that can’t be controlled. This causes distress and problems for your health, job, relationships or other parts of your life.

Compulsive sexual behavior may involve different kinds of commonly enjoyable sexual experiences. Examples include masturbation, sexual arousal by using a computer to communicate, multiple sexual partners, use of pornography or paying for sex. But when these sexual behaviors become a major, constant focus in your life, are difficult to control, cause problems in your life, or are harmful to you or others, that’s likely compulsive sexual behavior.

No matter what it’s called or the exact nature of the behavior, untreated compulsive sexual behavior can damage your self-esteem, relationships, career, health and other people. But with treatment and self-help, you can learn to manage compulsive sexual behavior.

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Symptoms

Some signs that you may have compulsive sexual behavior include:

• You have repeated and intense sexual fantasies, urges, and behaviors that take up a lot of your time and feel as if they’re beyond your control.
• You feel driven or have frequent urges to do certain sexual behaviors, feel a release of the tension afterward, but also feel guilt or deep regret.
• You’ve tried without success to reduce or control your sexual fantasies, urges or behavior.
• 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 in spite of them causing serious problems. These could include the possibility of getting or giving someone else a sexually transmitted infection, the loss of important relationships, trouble at work, financial issues, or legal problems.
• You have trouble making and keeping healthy and stable relationships.

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When to see a doctor

Ask for help if you feel you’ve lost control of your sexual behavior, especially if your behavior causes problems for you or other people. Compulsive sexual behavior tends to get worse over time without treatment, so get help when you first notice a problem.

As you decide whether to seek professional help, ask yourself:

• Can I manage my sexual impulses?
• Am I distressed by my sexual behaviors?
• Is my sexual behavior hurting my relationships, affecting my work or causing serious problems, such as getting arrested?
• Do I try to hide my sexual behavior?

Getting help for compulsive sexual behavior can be difficult because it’s such a deeply personal and private matter. Try to:

• Set aside any shame or embarrassment and focus on the benefits of getting treatment.
• Remember that you’re not alone — many people struggle with compulsive sexual behavior. Mental health professionals are trained to be understanding and not judge people. But not all mental health providers are experienced in treating this condition. Look for a provider who has experience in diagnosing and treating compulsive sexual behavior.
• Keep in mind that what you say to a health care or mental health provider is private. But providers are required to make a report if you tell them that you’re going to hurt yourself or someone else. They also are required to report if you give information about sexual abuse of a child or abuse or neglect of someone who is vulnerable, such as an elderly or disabled person.

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Ask for help right away

Ask a health care provider for help right away if:

• You think you may hurt yourself or others because of uncontrolled sexual behavior.
• You feel like your sexual behavior is slipping out of control.
• You’re thinking of taking your own life. In the U.S., call or text 988 to reach the 988 Suicide & Crisis Lifeline, available 24 hours a day, every day. Or use the Lifeline Chat. Services are free and confidential.

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Causes

Although the exact causes of compulsive sexual behavior are not clear, possible causes may include:

• Changes in brain pathways. Compulsive sexual behavior, over time, might cause changes in the brain’s pathways, called neural circuits. This may happen especially in areas of the brain that are related to reinforcement. Over time, more-intense sexual content and stimulation are usually needed to get satisfaction or relief.
• An imbalance of natural brain chemicals. Certain chemicals in your brain called neurotransmitters — such as serotonin, dopamine and norepinephrine — help control your mood. When these are out of balance, your sexual desire and behavior could be affected.
• Conditions that affect the brain. Certain health conditions, such as dementia, may cause damage to parts of the brain that affect sexual behavior. Also, treatment of Parkinson’s disease with certain medicines may cause compulsive sexual behavior.

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Risk factors

Compulsive sexual behavior can happen in both men and women, though it may be more common in men. It can affect anyone, regardless of sexual orientation. Factors that may increase the risk of compulsive sexual behavior include:

• How easy it is to get sexual content. Advances in technology and social media give people easy access to intense sexual images and information.
• Privacy. The secret and private nature of compulsive sexual activities can allow these problems to worsen over time.

Also, the risk of compulsive sexual behavior may be higher in people who have:

• Problems with alcohol or drug use.
• Another mental health condition, such as depression, anxiety or a gambling addiction.
• Family conflicts or family members with problems such as addiction.
• A history of physical or sexual abuse.

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Complications

Compulsive sexual behavior can cause many problems that affect both you and others. You may:

• Struggle with feelings of guilt, shame and low self-esteem.
• Develop other mental health conditions, such as depression, severe distress and anxiety. You also may think about or attempt suicide.
• Neglect or lie to your partner and family, harming or destroying important relationships.
• Lose your focus or engage in sexual activity or search internet pornography at work, risking your job.
• Have financial problems from buying pornography, internet or telephone sex, and sexual services.
• Get HIV, hepatitis or another sexually transmitted infection, or pass a sexually transmitted infection to someone else.
• Have problems with drugs and alcohol, such as using recreational drugs or drinking too much alcohol.
• Get arrested for sexual offenses.

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Prevention

Because the cause of compulsive sexual behavior isn’t known, it’s not clear how to prevent it. But a few things may help you keep control of problem behavior:

• Get help early for problems with sexual behavior. Identifying and treating early problems may help prevent compulsive sexual behavior from getting worse over time. Getting help also may prevent shame, relationship problems and harmful acts from getting worse.
• Seek treatment early for mental health conditions. Depression, anxiety or other mental health conditions can make compulsive sexual behavior worse.
• Get help for problems with alcohol and drug use. These can cause a loss of control that leads to poor judgment and sexual behaviors that aren’t healthy.
• Avoid risky situations. Don’t risk your health or that of others by putting yourself into situations where you’ll be tempted to engage in risky sexual activities.

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Diagnosis

You can ask your health care provider to refer you to a mental health provider with experience in diagnosing and treating compulsive sexual behavior. Or you may decide to contact a mental health provider directly. A mental health exam may include talking about your:

• Physical and mental health, as well as your overall emotional well-being.
• Sexual thoughts, behaviors and urges that are hard to control.
• Use of recreational drugs and alcohol.
• Family, relationships and social life.
• Concerns and problems caused by your sexual behavior.

With your permission, your mental health provider also may request information from family and friends.

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Making a diagnosis

There’s an ongoing debate among mental health professionals about exactly how to define compulsive sexual behavior. It’s not always easy to figure out when sexual behavior becomes a problem.

Many mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), published by the American Psychiatric Association, as a guide for diagnosing mental health conditions. Compulsive sexual behavior is not listed in the DSM-5-TR as a diagnosis, but sometimes it’s diagnosed as part of another mental health condition, such as an impulse control disorder or a behavioral addiction.

In the eleventh revision of the International Classification of Diseases (ICD-11), the World Health Organization defines compulsive sexual behavior disorder as an impulse control disorder.

Some mental health professionals consider compulsive sexual behaviors as sexual activities taken to an extreme that cause serious and damaging problems in life. More research is needed to come up with standard guidelines for diagnosis. But, for now, diagnosis and treatment by a mental health professional who has expertise in addictions and compulsive sexual behaviors will likely give the best results.

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Treatment

Treatment for compulsive sexual behavior usually involves talk therapy — also called psychotherapy — medicines and self-help groups. The main goal of treatment is to help you manage urges and reduce problem behaviors while still enjoying healthy sexual activities and relationships.

If you have compulsive sexual behavior, you also may need treatment for another mental health condition. People with compulsive sexual behavior often have alcohol or drug use problems or other mental health conditions, such as anxiety or depression, which need treatment.

People with other addictions or severe mental health conditions or who may be a danger to others may benefit from treatment that starts with a hospital stay. Whether inpatient or outpatient, treatment may be intense at first. Ongoing treatment across time may help prevent relapses.

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Talk therapy

Talk therapy, also called psychotherapy, can help you learn how to manage your compulsive sexual behavior. Types of talk therapy include:

• Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with more effective ones. You also can gain skills that help you manage urges and cope in different situations when needed. You learn ways to make these behaviors less private so you’re less likely to access sexual content.
• Acceptance and commitment therapy, which is a form of CBT that emphasizes accepting thoughts and urges and committing to a plan to deal with them. You can learn to choose actions that are in line with your important values.
• Mindfulness-based therapies, which help you live in the present and cope with difficult emotions and negative thoughts. These can help lower your anxiety and depression and improve your general well-being.
• Psychodynamic psychotherapy, which is therapy that focuses on being more aware of unconscious thoughts and behaviors. You can develop new insights into what motivates you. You also learn ways to resolve conflicts.

These therapies can be provided as individual, group, family or couples sessions. Sessions also can be provided in person or through video calls.

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Medicines

Along with talk therapy, certain medicines may help. These medicines act on brain chemicals linked to obsessive thoughts and behaviors. They lessen the chemical “rewards” these behaviors give when you act on them. They also can lessen sexual urges. Which medicine or medicines are best for you depends on your situation and other mental health conditions you may have.

Medicines used to treat compulsive sexual behavior are often prescribed mainly for other conditions. Examples include:

• Antidepressants. Certain types of antidepressants used to treat depression, anxiety or obsessive-compulsive disorder may help with compulsive sexual behavior.
• Naltrexone. Naltrexone (Vivitrol) is usually used to treat alcohol and opiate dependence. It blocks the part of your brain that feels pleasure with certain addictive behaviors. It may help with behavioral addictions such as compulsive sexual behavior or gambling disorder.
• Mood stabilizers. These medicines are generally used to treat bipolar disorder, but they may reduce compulsive sexual urges.
• Anti-androgens. In men, these medicines lessen the effects of sex hormones called androgens in the body. Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behavior is dangerous to others.

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Self-help groups

Self-help and support groups can be helpful for people with compulsive sexual behavior and for dealing with some of the issues it can cause. Many groups are modeled after the 12-step program of Alcoholics Anonymous (AA).

These groups can help you:

• Learn about your disorder.
• Find support and understanding of your condition.
• Identify additional treatment options, coping behaviors and resources.
• Help prevent relapse.

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 appeal to everyone. Ask your mental health provider to suggest a group or ask about options other than support groups.

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Coping and support

You can take steps to care for yourself while getting professional treatment:

• Follow your treatment plan. Attend scheduled therapy sessions and take medicines as directed. 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.
• Find out what drives you. Identify situations, thoughts and feelings that may trigger sexual urges so that you can take steps to manage them.
• Avoid risky behaviors. Set up boundaries to avoid risky situations. 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. Or stay off the smartphone and computer or install software that blocks pornographic websites. Making these behaviors less private and more difficult to do can help break the addictive cycle.
• Get treatment for problems with drugs or alcohol or other mental health conditions. Your addictions, depression, anxiety and stress can feed off each other, leading to a cycle of behavior that isn’t healthy.
• Find healthy outlets. If you use sexual behavior as a way to cope with negative emotions, explore healthy ways to cope. For example, start exercising or get involved in recreational activities.
• Practice relaxation and stress management. Try stress-reduction methods such as meditation, yoga or tai chi.
• Stay focused on your goal. Recovery from compulsive sexual behavior can take time. Stay motivated by keeping your recovery goals in mind. Remind yourself that you can repair damaged relationships, friendships and financial problems.

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Preparing for an appointment

You can look for help for compulsive sexual behavior in several ways. To begin, you may:

• Talk with your primary care provider. Your provider can do a physical exam to look for any health problems that may be linked to your sexual behavior. Your provider may then refer you to a psychiatrist, psychologist or other licensed therapist for a more in-depth exam and treatment. Your provider also may give you information about support groups, websites or other resources.
• Make an appointment with a mental health provider. If you don’t have a health care provider’s suggestion, check with a local medical center or mental health services to find a psychiatrist, psychologist or other licensed therapist with experience in sexual behavior issues. Or look at trusted websites online. Government websites and local agencies such as the Department of Health and Human Services or the Department of Veterans Affairs may be able to help you find a mental health provider.
• Look into online or local support groups that are known as trustworthy. These groups may be able to refer you to an appropriate mental health provider for diagnosis and treatment. They also may have other suggestions for support online or in person. Some groups are faith-based, and others are not.

Here’s some information to help you get ready for your appointment.

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What you can do

Before your appointment, gather this information:

• Notes about your behavior, including when and how often it occurs and what seems to trigger it or make it worse. Include what helps to resist the urges.
• Health, legal, work or relationship problems caused by your behavior.
• Any other mental health conditions you have, such as depression or anxiety, that also may need treatment.
• An honest look at your alcohol and recreational drug use — be ready to discuss this with your provider.
• Key personal information, including any recent or past traumatic events, current stresses and recent life changes.
• All medicines, vitamins, herbs or other supplements that you’re taking, and the doses.
• Questions to ask your provider to help you make the most of your time together.

Some questions to ask include:

• Why am I doing these things even when it makes me feel bad?
• How can I better manage my ongoing, intense sexual urges?
• What type of treatment might help in my case?
• Would a support group or a 12-step program be helpful for me?

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What to expect from your doctor

Be ready to answer questions from your provider, such as:

• When did you first start noticing sexual behavior or desires that cause you problems?
• Have your behaviors caused health, legal, relationship or work problems?
• Have your behaviors caused major distress in your daily life?
• Does your behavior feel like it’s getting more extreme or out of control?
• What, if anything, seems to lessen your sexual urges?
• What appears to increase your sexual urges?
• Have you ever caused or been the victim of physical, emotional or sexual abuse?
• Has your behavior hurt you or others in the past? Are you afraid it may hurt you or others in the future?
• What other mental health conditions do you have?
• Do you drink alcohol or use recreational or illicit drugs?

Prepare for questions ahead of time so you have time to discuss your main concerns.