If you have difficulty breaking free of intrusive and repetitive sexual urges and thoughts, you might be living with compulsive sexual behavior.
Compulsive sexual behavior disorder (CSBD) or hypersexuality is commonly referred to as sex addiction. However, sex addiction as a condition is not formally accepted by all members of the medical community.
Though a diagnosis of sex addiction does not formally exist, compulsive sexual behavior can result in significant emotional pain and other devastating consequences.
Many people may ask, “Is sex addiction a real thing?”
In reality, compulsive sexual behavior goes beyond desire, and it’s a challenging reality for many people who live with it.
In fact, approximately 3% to 6% of the general population experiences symptoms of compulsive sexual behavior.
CSBD involves a variety of complex and intense unwanted sexual behaviors and fantasies that, at times, may become harmful to you and others.
The condition can be managed, though. It might require seeking the help of a health professional and committing to long-term treatment.
In this article, we use “sexual addiction,” a term written about, studied, and discussed in psychology and counseling groups and 12 step programs. Still, there is no evidence to suggest that sex addiction exists or that symptoms of compulsive sexual behavior may be explained as an addiction.
However, this is not to imply your symptoms and concerns aren’t valid or real. This clarification refers to formal terminology only.
Though sex addiction is a prevalent term, it is controversial and often misunderstood.
There’s no evidence that suggests sex can be defined as an addiction or that repetitive and persistent sexual behaviors are explained by one.
However, compulsive sexual behavior disorder refers to a long-standing pattern of repetitive sexual behaviors, fantasies, and urges.
These impulses may cause you great distress and friction in your relationships and make daily tasks, such as working or studying, more challenging.
The pattern of repetitive sexual activities and urges could also be explained by out of control sexual behavior (OCSB).
This is a newer concept that refers to a behavioral pattern instead of a clinical disorder as defined by Michael Vigorito, a sex therapist in the District of Columbia and co-author of “Treating Out of Control Sexual Behavior – Rethinking Sex Addiction.”
OCSB refers to intrusive and hard-to-control sexual urges, thoughts, and behaviors.
In CSBD and OCSB, your sexual thoughts, urges, and behaviors may become the main focus of your life. This could lead you to leave other aspects of your life unattended.
Despite the potential problems these impulses may cause you, stopping them might feel beyond your control, even when that’s your intention.
Although misunderstood and stigmatized, what many people categorize as “sex addiction” doesn’t refer to a personal choice.
These behaviors might not be something you do for pleasure or something you can turn on and off at will.
The causes of long-term uncontrollable sexual urges and behaviors are not well understood. People of all ages may experience the condition and for different reasons.
It’s probable that a combination of factors leads to compulsive sexual behaviors, including:
- chemical imbalances in the brain
- underlying or co-occurring mental health conditions
- childhood experiences
- childhood relationships with parents or guardians
- other lifestyle influences
Not all potential causes of sex addiction can be traced to trauma or underlying mental health conditions, though.
If you have a frontal lobe lesion, tumor, or seizure disorder, you may also have a greater chance of experiencing hypersexuality.
The diagnosis of CSBD or hypersexuality is sometimes challenging. This stems, in part, from the lack of consistency in fitting some of these behaviors within one mental health condition.
Although excluded from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), compulsive sexual behavior and what many call “sex addiction” are frequently seen in clinical settings.
The decision to remove it from the manual was controversial. Some mental health professionals who often see it firsthand and care for people living with symptoms didn’t agree with the exclusion.
Hypersexuality can still be diagnosed using the manual, though, by assigning it to the “Other specified sexual dysfunction” category.
On the other hand, the International Classification of Diseases, 11th Edition (ICD-11), includes compulsive sexual behavior disorder as a formal diagnosis. It is classified under impulse-control disorders, not addictions.
The ICD-11 is a diagnostic manual maintained by the World Health Organization to provide a global language for reporting and diagnosing diseases.
The ICD is not commonly used by mental health professionals in the United States. However, it’s consulted in many instances where the DSM-5 doesn’t offer specific diagnostic criteria for a given condition, such as in this case.
Compulsive sexual behavior, hypersexuality, and out of control sexual behavior can all be diagnosed by a psychiatrist or a psychologist, among other mental health professionals.
To reach a diagnosis, these professionals will talk with you about your personal and medical history, your concerns and challenges, and some of your behaviors and thoughts.
They will then compare the information gathered to the criteria set by diagnostic manuals or literature.
Obtaining a “sex addiction” diagnosis isn’t always a straightforward process. You’ll have to be willing to honestly share your sexual fantasies, urges, and behaviors with a mental health professional.
This level of candid conversation might be challenging for some people. To address this challenge, tests have been developed to ease you through the process.
The Sexual Addiction Screening Test might be one of the most common tools. Developed by Patrick Carnes, PhD, noted addiction recovery therapist, the 25-item, self-reported questionnaire helps assess your behaviors and thoughts.
The test has been modified and updated to reflect modern internet influences, such as pornography use.
Your health team might also want to rule out other conditions that may lead to hypersexuality.
In general, compulsive sexual behavior covers a broad array of symptoms.
These behaviors range in intensity and severity, but to be considered signs of mental health condition, they have to be evident across many situations and over an extended period of time.
According to the ICD-11, signs of compulsive sexual behavior disorder include:
- a significant preoccupation with sexual fantasies, impulses, and behaviors
- repetitive sexual activities to satisfy such fantasies and impulses
- unsuccessful attempts at stopping or decreasing sexual fantasies, impulses, and behaviors
- experiencing distress and significant challenges in relationships, occupational activities, and other important areas as a result of the compulsive sexual behaviors and impulses
Another important aspect of compulsive sexual behavior disorder is the duration of symptoms.
The ICD-11 says that you need to experience sex addiction symptoms for six months or longer to receive a diagnosis.
It’s important to also keep in mind cultural differences.
Feeling guilty, ashamed, or distressed about your sexual behaviors might be more common in some people than others. In this case, experiencing this type of distress wouldn’t by itself mean you have a sexual addiction.
Because it’s not a formal diagnosis, signs of “sex addiction” are not established.
On the other hand, not everyone living with compulsive sexual behavior will experience the exact same symptoms or with the same intensity. In fact, signs can take many forms depending on the unique circumstances of your case.
Some potential signs of compulsive sexual behavior include persistent and uncontrollable activities like:
- watching pornography
- engaging in sexual activities that put your safety at risk
- neglecting other aspects of your life to prioritize sexual activities
For example, you may have intense urges to watch pornography all the time. You may skip work or school to stay home to watch porn.
You might even lock yourself in the office bathroom to watch it on your phone. This, in turn, can lead to problems with your productivity and professional relationships.
You may be aware of this problem and it may cause you an intense deal of distress. Despite this, you find yourself unable to stop watching porn.
This might be a sign of a compulsive sexual behavior or out of control sexual behavior.
That said, you may enjoy watching porn frequently, but you know when to stop, and you do it at will whenever you need to attend to other businesses.
In this case, watching porn is likely not a sign of sex addiction. You’re able to stop yourself from doing it when needed, and the activity is not a cause of distress in your life.
This same rationale applies to another common sign of sexual addiction: compulsive masturbation. Again, you may enjoy masturbating often, but if you’re able to stop it at will and it doesn’t compromise your tasks, safety, and responsibilities, it’s not considered a compulsive sexual behavior.
Another potential sign of compulsive sexual behavior is a tendency to repeatedly engage in behavior that might put your or someone else’s safety in jeopardy. This could include having sex with strangers without protection or hurting yourself or others physically during sexual intercourse.
It’s important to distinguish sex addiction from having an active sexual life or having multiple sex partners.
The difference is how uncontrollable the behavior is and the extent to which these behaviors cause distress to you or someone else or interfere with your daily tasks.
Symptoms of compulsive sexual behavior can be managed and treated with the help of a mental health professional.
There are treatment options available, and you can discuss them with your therapist before deciding on one.
Psychosocial therapy examines the link between social influences and addiction-related thoughts and behaviors.
An alternative route for support is the California-based Foundry Clinical Group, which offers treatment for OCSB.
Not everyone in search of support or treatment finds these groups suitable. You can ask a medical professional for advice in finding the help that suits your needs.
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) will help you identify possible behavior triggers and will help reshape how you think about your sexual behaviors.
This type of therapy has a strong focus on prevention.
Psychodynamic therapy looks at the in-depth links between your thoughts and your sexual expression.
Therapy of this nature explores the deeper meaning behind feelings of shame, anger, and low self-esteem.
Out of control sexual behavior in a marriage or other romantic relationship can become a challenge for you and your partner.
Couple’s therapy can explore the symptoms of sexual addiction and re-establish trust as well as communication with your loved one.
There are no medications to treat sexual addiction. Still, your doctor may prescribe medications to address co-occurring symptoms or conditions, such as depression. They may also prescribe drugs to change your hormone levels to decrease your sex drive.
Compulsive sexual behavior can be treated, and it’s highly advisable to reach out for professional help. It may be crucial to do so if you:
- progressively take higher risks during sexual activities
- hurt yourself or others during sex
- have difficulty getting important tasks accomplished (e.g., school or work)
If left unaddressed, compulsive sexual behavior may interfere with many aspects of your life. In addition to feelings of embarrassment, guilt, and shame, you may also experience physical, mental, and social consequences.
These may include:
- sexually transmitted diseases
- sexually related physical injury
- loss of time and productivity
- financial strain
- arrest for solicitation or similar sexual activity
- loss of employment
- unrealistic sexual relationship expectations
- loss of intimacy
- loss of trust in relationships
Self-care strategies can complement your recovery efforts.
Following self-care strategies can do wonders for you while learning about sexual addiction and the professional treatment options available. Consider these tips:
- Try to get plenty of sleep.
- Consider exercising regularly.
- A nutrient-dense diet provides many benefits.
Physical health is only one aspect of self-care. Consider attending to your emotional state as well. Taking time for yourself and relaxing can be rejuvenating.
The often neglected aspect of self-care is a strong support network.
When you live with sexual addiction, it may feel difficult to speak with loved ones about what you are going through.
Finding a support group with people who share your experiences can be an invaluable way to work through struggles you might otherwise feel uncomfortable sharing.
Attending off and online support groups could provide you with additional resources.
When you live with symptoms of compulsive sexual behavior or out-of-control sexual behavior, you know these urges and the behaviors that follow are not a personal choice. You want to change, and it can be frustrating and hurtful not to do so.
Seeking the help of a mental health professional is highly advisable. They can help you cope with the distress, control your impulses, and modify some of your compulsive sexual behaviors.
If you or a loved one need somewhere to turn, there are resources available to you online, over the phone, and in person.