Compulsive sexual behavior

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 26, 2016
StartDiseasesCompulsive sexual behavior

Compulsive sexual behavior involves compulsive sexual fantasies and sexual behaviors that inhibit a person's quality of life. People with these behaviors may require professional treatment and therapy because they have an inability to discontinue their behavior in spite of negative consequences. It is also known as hypersexuality, sexual addiction, and sex addiction.


Definition & Facts

Compulsive sexual behavior is still a largely unstudied psychiatric disorder, and there is much about it that is not agreed upon or known. The subject of how to categorize compulsive sexual behavior is controversial and various arguments have been put forth for classifying it as either an obsessive-compulsive disorder, an impulse-control disorder, or an addictive disorder. It remains excluded from the Diagnostic and Statistical Manual of Mental Disorders. Nevertheless, patients seek help for compulsive sexual behaviors and treatment facilities have developed methods for treating patients.

Compulsive sexual behavior involves a deep-seated preoccupation with sexual urges, fantasies, or behaviors. For those with this condition, sexual stimulation becomes an obsession over time and begins to be used as a response to dysphoria and psychological stress. Compulsive sexual behaviors may involve excessive masturbation, watching pornography excessively, and compulsively seeking sexual intercourse.

Compulsive sexual behavior is destructive to the affected party and to other people around him or her. However, people with this condition cannot control their behavior despite multiple attempts to do so. People suffering from compulsive sexual behavior experience negative effects upon their self-esteem, relationships, and careers.

Symptoms & Complaints

Symptoms of compulsive sexual behavior include:

  • Feeling as though one's sexual desires and urges are out of control
  • Difficulty establishing sexual relationships based in emotional intimacy. Individuals who have compulsive sexual behavior have difficulties in maintaining relationships with their spouses or family members.
  • Engaging in risky sexual behaviors such as those that might cause sexually transmitted diseases, the destruction of valued relationships, or legal troubles (visiting prostitutes in jurisdictions where prostitution is illegal, for example).
  • Underlying problems like depression, loneliness or anxiety. Compulsive sexual behavior can serve as a distraction, a way of quelling negative emotions, and a form of self-medication.


Compulsive sexual behavior may be caused by a multitude of biological, environmental, and social influences:

  • An imbalance in brain chemicals may be the cause of compulsive sexual behavior. Some chemicals like dopamine and serotonin play a central role in mood regulation. If these neurotransmitters are produced in excess, it can contribute to compulsive sexual behavior. Certain dopamine medications used to treat patients with Parkinson's disease have been shown to increase compulsive behaviors, a syndrome that is called dopamine dysregulation syndrome.
  • Compulsive sexual behavior can also originate from certain diseases like epilepsy and dementia. These two disorders affect the parts of the brain that regulate sexual urges.
  • A change in brain communication pathways is a major cause of compulsive sexual behavior.

Diagnosis & Tests

Because compulsive sexual behavior isn't a formalized or recognized disorder, there is no established criteria for diagnosis. That said, there is a sexual addiction screening test (SAST) that some practitioners use as well as a proposed total sexual outlet test that considers the number of orgasms a person has per week as part of its diagnostic criteria.

An interview with the patient will be the primary means by which compulsive sexual behavior is addressed by a medical or mental health professional. Doctors or mental health professionals will ask questions of the individual and rely on the honesty of his or her responses. They will ask the patient about his or her sexual habits to determine if they are risky and/or compulsive.

Part of this inquiry will involve asking about the effect of sexual behavior on work, personal relationships, and family. The doctor or mental health professional will also attempt to evaluate a person's level of sexual control, whether or not he or she is able to concentrate at work, and whether or not the patient has meaningful intimate relationships.

A doctor or mental health professional will also inquire with the patient about his or her overall mental health. Mental disorders that underlie compulsive sexual behavior such as bipolar disorder and borderline personality disorder may be screened for and diagnosed. The doctor will also ascertain whether or not the patient struggles with substance abuse, drug addiction, or alcohol addiction. A patient's childhood history will also be explored as compulsive sexual behavior may have its roots in childhood abuse or trauma.

Treatment & Therapy

There are different types of medications that can be used to mitigate compulsive sexual behavior. 

  • Antidepressants like paroxetine, fluoxetine, and sertraline are used to treat compulsive sexual behavior.
  • Mood stabilizers are used to treat people with mental disorders like bipolar. Lithium is the most common mood stabilizer used to treat compulsive sexual behavior.
  • Antiandrogens are used to treat compulsive sexual behavior due to their capability of reducing the production of sexual hormones because sex hormones may contribute to sexual addiction.
  • Naltrexone is a drug used to block the pleasure associated with addictive behaviors. It can reduce cravings for illicit substances and compulsive activities and can be used to treat people with compulsive sexual behavior.

Psychotherapy is also used in treating compulsive sexual behavior. Cognitive behavior therapy helps patients to identify negative behaviors and practices. Once the patient becomes aware of these detrimental behaviors, he or she tries to avoid them and find new, constructive behaviors. Psychodynamic therapy enables patients to recognize unconscious negative thoughts that push them into addictive behaviors. Once patients are aware of the destructive thoughts, they can cultivate positive and productive thoughts.

Prevention & Prophylaxis

Mental health treatment via psychotherapy, group therapy, and counseling as well as psychiatric medications may help prevent mental disturbances before they manifest as compulsive sexual behavior. Individuals who already have compulsive sexual behavior must first admit they have a problem, seek help promptly, avoid triggers and join support groups. There is a twelve-step program for sex addiction that holds meetings which many find helpful in treating the behavior and preventing relapse.