Compulsive Sexual Behaviors

Compulsive sexual behavior is sometimes called hypersexuality, hypersexual disorder, nymphomania or sexual addiction. It’s an obsession with sexual thoughts, urges or behaviors that may cause you distress or that negatively affects your health, job, relationships or other parts of your life.

Compulsive sexual behavior may involve a commonly enjoyable sexual experience (for example, self-stimulation) that becomes an obsession and becomes disruptive or harmful to you or others.

Other compulsive sexual behaviors are outside the bounds of commonly accepted conduct (for example, paying for sex or having extramarital affairs) and cause distress. And these behaviors could have negative consequences.

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

Symptoms

Compulsive sexual behavior symptoms vary in type and severity. Some indications that you may be struggling with compulsive sexual behavior include:

• 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

When to see a Doctor

Seek help if you feel like you’ve lost control of your sexual behavior, especially if your behavior causes problems for you or other people. Compulsive sexual behavior may escalate over time, so get help when you first recognize there may be 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 resulting in negative consequences, such as getting arrested?


• Do I try to hide my sexual behavior?

Seeking help for a sexual behavior can be difficult because it’s such a deeply personal 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 providers are trained to be understanding and discreet. But not all mental health providers are experienced in treating compulsive sexual behavior, so make sure you find a therapist who is competent in this area.


• Keep in mind what you say to a doctor or mental health counselor is kept confidential, except in cases where you report that you’re going to hurt yourself or someone else, you report sexual abuse of a child, or you report abuse or neglect of someone in a vulnerable population.

Seek treatment right away

Seek immediate treatment if:

• You think you may cause harm with uncontrolled sexual behavior


• You have bipolar disorder or other problems with impulse control, and you feel like your sexual behavior is slipping out of control


• You are suicidal — if you’re thinking of attempting suicide, call 911 or your local emergency number, or the National Suicide Prevention Lifeline (in the United States) at 1-800-273-TALK (1-800-273-8255)

Causes

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.

Risk factors

Compulsive sexual behavior can occur in both men and women, though it’s more common in men. It can also affect anyone, regardless of sexual orientation — whether heterosexual, homosexual or bisexual.

Compulsive sexual behavior may occur in people who have:

• 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

Complications

Compulsive sexual behavior can have numerous negative consequences 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, extreme stress and anxiety


• Neglect or lie to your partner and family, harming or destroying meaningful relationships


• Accumulate financial debts buying pornography and sexual services


• Contract HIV, hepatitis or another sexually transmitted infection or pass a sexually transmitted infection to someone else


• Engage in unhealthy substance use, such as drug or alcohol abuse


• Be arrested for sexual offenses


• Lose your focus or engage in sexual activity at work, risking your job

Preparing for your appointment

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

• Talk to your family doctor. Your doctor can do a thorough physical exam to look for any health problems linked to your sexual behavior. Your doctor may refer you to a psychiatrist, psychologist or other mental health provider for a more in-depth exam and treatment. Your doctor may also provide you with information about local providers, support groups, websites or other resources.


• Make an appointment with a mental health provider. If you don’t have a doctor’s recommendation, check with a local medical center or mental health services to find a psychiatrist, psychologist or other mental health provider with experience in sexual behavior issues. Or look at credible websites online, or check your phone book. 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. Examples include The Society for the Advancement of Sexual Health, Sex Addicts Anonymous, and COSA, a recovery program for men and women whose lives have been affected by someone else’s compulsive sexual behavior. These groups may be able to refer you to an appropriate mental health provider for diagnosis and treatment as well as provide other recommendations and 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.

What you can do

Before your appointment:

• Make notes about your behavior, including when and how often it occurs and what seems to trigger it or make it worse.


• List any legal, employment or relationship problems caused by your behavior.


• Note any other mental health issues you have, whether diagnosed or not, such as depression or anxiety. Other mental health conditions often occur along with compulsive sexual behavior and may need treatment as well.


• Take an honest look at your substance use— alcohol and drug abuse are common in people with compulsive sexual behavior, so be ready to discuss this with your doctor.


• Prepare key personal information, including any recent or past traumatic events, current stresses and recent life changes.


• Make a list of all medications, vitamins or supplements that you’re taking and the dosages.


• Prepare questions to ask your doctor ahead of time, in order of priority, to help you make the most of your time together.

You might want to ask your doctor questions such as:

• Why am I doing these things even when it makes me feel bad?


• What treatments are available to me?


• Which do you recommend?


• Would a support group or a 12-step program be helpful for me?

What to expect from your doctor

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

• When did you first begin noticing harmful sexual behavior or desires?


• Have your behaviors caused legal, relationship or employment problems, or significant 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, if anything, appears to increase your sexual urges?


• Have you ever caused or been the victim of physical, emotional, psychological 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 illegal drugs?

Tests and diagnosis

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.

Treatments and drugs

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.

Psychotherapy

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.

Medications

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:

• Antidepressants. 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. 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 groups

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.

Coping and support

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

• 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.

Prevention

Because the cause of compulsive sexual behavior isn’t known, it’s not clear how it might be prevented, but a few things may help keep this type of behavior in check:

• Get help early for problems with sexual behavior. Identifying and treating early symptoms may help prevent compulsive sexual behavior from getting worse over time or escalating into a downward spiral of shame, self-esteem problems and harmful acts.


• Seek treatment early for mental health disorders. Compulsive sexual behavior may be worsened by depression, anxiety or obsessive-compulsive behavior.


• Identify and seek help for alcohol and drug abuse problems. Substance abuse can cause a loss of control and unhappiness that can lead to poor judgment and may push you toward unhealthy sexual behaviors.


• Avoid risky situations. Don’t jeopardize your health or that of others by putting yourself into situations where you’ll be tempted to engage in risky sexual practices.