Treating Compulsive Sexual Behavior
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Purpose of Review
Here we review potential therapeutic approaches for treating compulsive sexual behaviors (CSB; also known as hypersexual disorder). We present the therapeutic goals of several psychological and, pharmacological treatment approaches, and state of the research on their effectiveness.
To date, no systematic studies with control groups have been conducted in the field of CSB treatment; however, there are documented case studies and small-sample studies indicating potential effectiveness of pharmacological treatment with naltrexone and SSRIs as well as mindfulness, CBT, and 12-step-based treatment approaches.
There is a whole field of CSB treatment waiting for systematic scientific investigation. Future research on CSB treatment should take in account a possibility of individual differences in psychological and neural mechanisms underlying CSB and help inform optimal selection of treatment modality for each patient.
KeywordsCompulsive sexual behaviors Treatment Sexual behavior Therapy
Compliance with Ethical Standards
Conflict of Interest
Yaniv Efrati declares no conflicts of interest.
Mateusz Gola reports a grant from the Polish National Science Centre, OPUS grant (2014/15/B/HS6/03792), and a scholarship from the Polish Ministry of Science (469/STYP/10/2015).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.•• Kafka MP. Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav. 2010;39(2):377–400. This article describes proposed for DSM-V criteria of hypersexual disorder. However hypersexual disorder was not included in the DSM-V, these criteria were acknowledged by researchers and used for compulsive sexual behavior disorder description in ICD-11. CrossRefPubMedGoogle Scholar
- 2.•• Kraus S, Krueger R, Briken P, First M, Stein D, Kaplan M, et al. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry. 2018;17(1):109–10. https://doi.org/10.1002/wps.20499. This article describes criteria of compulsive sexual behavior disorder proposed for ICD-11. CrossRefPubMedPubMedCentralGoogle Scholar
- 5.•• Gola M, Lewczuk K, Skorko M. What matters: quantity or quality of pornography use? Psychological and behavioural factors of treatment seeking for problematic pornography consumption. J Sex Med. 2016;13(5):815–24. https://doi.org/10.1016/j.jsxm.2016.02.169. This study shows, that the clinical nature of compulsive sexual behavior cannot be dfined by the frequency/amount of behaviors, but rather by the qualitative factors of behavior’s negative impact on one’s life. CrossRefPubMedGoogle Scholar
- 6.•• Gola M, Wordecha M, Sescousse G, Lew-Starowicz M, Kossowski B, Wypych M, et al. Can pornography be addictive? an fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology. 2017;42:2021–31. https://doi.org/10.1038/npp.2017.78. This study shows that individuals seeking treatment for problematic pornography use have similar alteration of brain reward system activation to that of pathological gamblers and individuals with substance use disorders—increased reactivity for cues predicting rewards (in this case erotic rewards). CrossRefPubMedGoogle Scholar
- 7.Gola M, Potenza MN. The proof of the pudding is in the tasting: data are needed to test models and hypotheses related to compulsive sexual behaviors. Arch Sex Behav. 2018; https://doi.org/10.1007/s10508-018-1167-x.
- 11.SASH – The Society for the Advancement of Sexual Health. Sexual addiction. Retrieved September 21, 2008, from http://www.sash.net/;2008.
- 12.Reid RC. Personal perspectives on hypersexual disorder. Sex Addict & Compulsivity. 2013;20(1–2):4–18.Google Scholar
- 15.• Reid RC, Garos S, Carpenter BN. Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sex Addict Compulsivity. 2011;18(1):30–51. This study shows more general characteristics of patients with compulsive sexual behaviors and most common comorbid sympthoms. CrossRefGoogle Scholar
- 16.• Kor A, Fogel YA, Reid RC, Potenza MN. Should hypersexual disorder be classified as an addiction. Sex Addict Compulsivity. 2013;20(1–2):27–47. Comprehensive review raising the most important questions about conceptualizations of compulsive sexual behaviors. Google Scholar
- 18.•• Kraus SW, Voon V, Kor A, Potenza MN. Searching for clarity in muddy water: future considerations for classifying compulsive sexual behavior as an addiction. Addiction. 2016;111:2097–106. Comprehensive review of research data speaking in favor and against conceptualization of compulsive sexual behaviors in an addiction framework. Google Scholar
- 24.• Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS ONE. 2014;9:e102419. One of the first fMRI study on males meeting criteria of compulsive sexual behaviors showing increased reactivity of brain reward circuits for explicit sexual materials in this group when compared to controls. CrossRefPubMedPubMedCentralGoogle Scholar
- 25.•• Gola M, Potenza MN. Paroxetine treatment of problematic pornography use: a case series. J Behav Addict. 2016;5(3):529–32. https://doi.org/10.1556/2006.5.2016.046 This case series shows that SSRI treatment may help reduce compulsive sexual behavior (CSB) in some patients and proposes a link between brain mechanisms and two different psychological processes playing role in CSB—anxiety/compulsivity and impaired impulse control.
- 28.•• WHO. ICD-11 beta draft. (2017). http://apps.who.int/classifications/icd11/browse/l-m/en (accessed September 26, 2017). WHO’s proposition of compulsive sexual behavior criteria.
- 30.WHO (World Health Organization). International classification of diseases and related health problems, 10th Revision. Geneva, Switzerland: Author; 1992.Google Scholar
- 33.Efrati Y, Gola M. Compulsive sexual behavior: a twelve-step therapeutic approach. J Behav Addict. 2018 (in press).Google Scholar
- 36.Brewer G, Tidy P. Sex addiction: therapist perspectives. Sex Relat Ther. 2017;1–14. doi: https://doi.org/10.1080/14681994.2017.1347618.
- 42.Weiss R. Treating sex addiction. In: Coombs RH, editor. Handbook of addictive disorders: a practical guide to diagnosis and treatment. Hoboken: Wiley; 2004. p. 233–72.Google Scholar
- 43.Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1979.Google Scholar
- 47.Birchard T. CBT for compulsive sexual behaviour, a guide for professionals. Hove: Routledge; 2015. 206 ppGoogle Scholar
- 56.Brem MJ, Shorey RC, Anderson S, Stuart GL. Depression, anxiety, and compulsive sexual behavior among men in residential treatment for substance use disorders: the role of experiential avoidance. J Clin Psychol Pychother. 2015; https://doi.org/10.1002/cpp.2085.
- 60.Wilson W. Alcoholics anonymous. New York: Alcoholics Anonymous World Services; 1939/2001.Google Scholar
- 61.Carnes P. Recovery start kit. Carefree, AZ: Gentle Path; 2008.Google Scholar
- 62.•• Efrati Y., Mikulincer M. Individual-based compulsive sexual behavior scale: its development and importance in examining compulsive sexual behavior. J Sex Marital Ther. 2018;44(3):249–59. This study shows a two-faceted view of CSB—related to either dominant solitary sexual activity or sexual activity with a sexual partner or partners. Google Scholar
- 65.Kauffman SM, Poulin J. Coherency among substance abuse models. J Socio Soc Welf. 1996;13:163–74.Google Scholar
- 66.McCrady BS. Recent research in twelve-step program. In: Graham WG, Fasam F, Shultz TK, editors. Principles of addiction medicine. Chevy Chase: American Society of Addiction Medicine; 1998. p. 707–17.Google Scholar
- 68.DuPont RL, McGovern JP. A bridge to recovery: an introduction to 12 steps programs. Washington: American Psychiatric Press; 1994.Google Scholar
- 69.Ronel N. Goes with the wind: twelve-step program therapy. Ramat Gan: Bar-Ilan University (Hebrew; 2012.Google Scholar
- 70.Carnes P, Delmonico DL, Griffin E. In the shadows of the net. Center City: Hazelden; 2001.Google Scholar
- 71.• Carnes P. Don’t call it love: recovery from sexual addiction. New York: Bantam; 1992. Comprehensive qualitative description of clinical cases with compulsive sexual behaviors. Google Scholar
- 77.Kowalewsk E, Sroslak K, Gola M. Which dimensions of human sexuality are related to the compulsive sexual behaviors (CSB)? Three studies with Multidimensional Sexuality Questionnaire and individuals seeking treatment for CSB (under revision).Google Scholar
- 80.Gola M. One or multiple neural mechanisms of problematic pornography use? J Behav Addict. 2016;5(S1):16–7.Google Scholar
- 88.Ferree MC, editor. Making advances: a comprehensive guide for treating female sex and love addicts. Royston: Society for the Advancement of Sexual Health; 2012.Google Scholar
- 91.Miller WR, Moyers TB. The forest and the trees: relational and specific factors in addiction treatment. Addiction. 2015;110:410–3.Google Scholar