Current Sexual Health Reports

, Volume 10, Issue 2, pp 57–64 | Cite as

Treating Compulsive Sexual Behavior

  • Yaniv Efrati
  • Mateusz Gola
Clinical Therapeutics (B McCarthy and RT Segraves, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Clinical Therapeutics


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.

Recent Findings

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.


Compulsive 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. 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. 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. This article describes criteria of compulsive sexual behavior disorder proposed for ICD-11. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lewczuk K, Szmyd J, Skorko M, Gola M. Treatment seeking for problematic pornography use among women. J Behav Addict. 2017;6(4):445–56.CrossRefPubMedGoogle Scholar
  4. 4.
    Reid RC, Davtian M, Lenartowicz A, Torrevillas RM, Fong TW. Perspectives on the assessment and treatment of adult ADHD in hypersexual men. Neuropsychiatry. 2013;3(3):295–308.CrossRefGoogle Scholar
  5. 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. 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. 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. 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. 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;
  8. 8.
    Ley D, Prause N, Finn P. The emperor has no clothes: a review of the “pornography addiction” model. Curr Sex Health Rep. 2014;6(2):94–105.CrossRefGoogle Scholar
  9. 9.
    Carnes P, Green B, Carnes S. The same yet different: refocusing the Sexual Addiction Screening Test (SAST) to reflect orientation and gender. Sex Addict Compulsivity. 2010;17:7–30.CrossRefGoogle Scholar
  10. 10.
    •• Coleman E. Is your patient suffering from compulsive sexual behavior. Psychiatric Ann. 1992;22:320–5. This is the first article proposing two psychological components underlying compulsive sexual behaviors, anxiety/compulsivity and impaired impulse control. CrossRefGoogle Scholar
  11. 11.
    SASH – The Society for the Advancement of Sexual Health. Sexual addiction. Retrieved September 21, 2008, from;2008.
  12. 12.
    Reid RC. Personal perspectives on hypersexual disorder. Sex Addict & Compulsivity. 2013;20(1–2):4–18.Google Scholar
  13. 13.
    Reid RC, Woolley SR. Using emotionally focused therapy for couples to resolve attachment ruptures created by hypersexual behavior. Sex Addict Compulsivity. 2006;13:219–39.CrossRefGoogle Scholar
  14. 14.
    Reid RC. Differentiating emotions in sample men in treatment for hypersexual behavior. J Soc Work Prac Addict. 2010;10(2):197–213.CrossRefGoogle Scholar
  15. 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. 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
  17. 17.
    • Love T, Laier C, Brand M, Hatch L, Hajela R. Neuroscience of internet pornography addiction: a review and update. Behav Sci. 2015;5(3):388–433. Comprehensive review of research data on compulsive sexual behaviors and internet pornography use. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 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
  19. 19.
    Kuhn S, Gallinat J. Neurobiological basis of hypersexuality. Int Rev Neurobio. 2016;129:67–83.CrossRefGoogle Scholar
  20. 20.
    Klucken T, Wehrum-Osinsky S, Schweckendiek J, Kruse O, Stark R. Altered appetitive conditioning and neural connectivity in subjects with compulsive sexual behavior. J Sex Med. 2016;13(4):627–36.CrossRefPubMedGoogle Scholar
  21. 21.
    Brand M, Snagowski J, Laier C, Maderwald S. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of Internet pornography addiction. NeuroImage. 2016;129:224–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Gola M, Wordecha M, Sescousse G, Marchewka A. Visual sexual stimuli—cue or reward? A perspective for interpretation of brain imaging findings on human sexual behaviors. Front Hum Neurosci. 2016b;10(402):1–7. Scholar
  23. 23.
    Gola M. Decreased LPP for sexual images in problematic pornography users may be consistent with addiction models. Everything depends on the model. Biol Psychol. 2016;120:156–8. Scholar
  24. 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. 25.
    •• Gola M, Potenza MN. Paroxetine treatment of problematic pornography use: a case series. J Behav Addict. 2016;5(3):529–32. 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.
  26. 26.
    •• Kraus SW, Voon V, Potenza MN. Should compulsive sexual behavior be considered an addiction. Addiction. 2016;111(12):2097–106. Review of the arguments in favor and against of conceptualizing CSB as behavioral addiction. CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Potenza MN, Gola M, Voon V, Kor A, Kraus SW. Is excessive sexual behaviour an addictive disorder? Lancet Psychiatry. 2017;4(9):663–4. Scholar
  28. 28.
    •• WHO. ICD-11 beta draft. (2017). (accessed September 26, 2017). WHO’s proposition of compulsive sexual behavior criteria.
  29. 29.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). Arlington: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  30. 30.
    WHO (World Health Organization). International classification of diseases and related health problems, 10th Revision. Geneva, Switzerland: Author; 1992.Google Scholar
  31. 31.
    Krueger R. Diagnosis of hypersexual or compulsive sexual behavior can be made using ICD-10 and DSM-5 despite rejection of this diagnosis by the American Psychiatric Association. Addiction. 2016;111:2110–1.CrossRefPubMedGoogle Scholar
  32. 32.
    Walton MT, Cantor JM, Bhullar N, Lykins AD. Hypersexuality: a critical review and introduction to the “sexhavior cycle”. Arch Sex Behav. 2017;46(8):2231–51. Scholar
  33. 33.
    Efrati Y, Gola M. Compulsive sexual behavior: a twelve-step therapeutic approach. J Behav Addict. 2018 (in press).Google Scholar
  34. 34.
    Reddick GT, Heiden-Rootes KM, Brimhall AS. Therapists’ assessments in treating “Sex Addiction” and their relationship to clients’ gender, relationship status, and exclusivity status. J Marital Fam Therapy. 2016;43(3):537–53. Scholar
  35. 35.
    Heiden-Rootes KM, Brimhal AS, Jankowski PJ, Reddick GT. Differentiation of self and clinicians’ perceptions of client sexual behavior as “problematic”. Contemp Fam Ther. 2017;39:207–19. Scholar
  36. 36.
    Brewer G, Tidy P. Sex addiction: therapist perspectives. Sex Relat Ther. 2017;1–14. doi:
  37. 37.
    Chaplin R. Psychiatrists can cause stigma too. Br J Psychiatry. 2000;177:467–70.CrossRefPubMedGoogle Scholar
  38. 38.
    Derbyshire KL, Grant JE. Compulsive sexual behavior: a review of the literature. J Behav Addict. 2015;4:37–43. Scholar
  39. 39.
    Estellon V, Mouras H. Sexual addiction: insights from psychoanalysis and functional neuroimaging. Socioaffect Neurosci Psychol. 2012;2:118–4.CrossRefGoogle Scholar
  40. 40.
    Garcia FD, Assumpção AA, Malloy-Diniz L, De Freitas AAC, Delavenne H, Thibaut F. A comprehensive review of psychotherapeutic treatment of sexual addiction. J Groups Addict Recover. 2016;11:59–71. Scholar
  41. 41.
    Miles LA, Cooper RL, Nugent WR, Ellis RA. Sexual addiction: a literature review of treatment interventions. J Hum Behav Soc Environ. 2016;26(1):89–99.CrossRefGoogle Scholar
  42. 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. 43.
    Beck AT. Cognitive therapy and the emotional disorders. New York: International Universities Press; 1979.Google Scholar
  44. 44.
    Garcia FD, Thibaut F. Sexual addictions. Am J Drug Alcohol Abuse. 2010;36:254–60.CrossRefPubMedGoogle Scholar
  45. 45.
    Gerber J. Treatment of sexually compulsive adolescents. Psychiatr Clin N Am. 2008;31:657–69.CrossRefGoogle Scholar
  46. 46.
    Rosenberg KP, Carnes P, O’Connor S. Evaluation and treatment of sex addiction. J Sex Marital Ther. 2012;40(2):77–91.CrossRefGoogle Scholar
  47. 47.
    Birchard T. CBT for compulsive sexual behaviour, a guide for professionals. Hove: Routledge; 2015. 206 ppGoogle Scholar
  48. 48.
    Hallberg J, Kaldo V, Arver S, Dhejne C, Öberg KG. A cognitive-behavioral therapy group intervention for hypersexual disorder: a feasibility study. J Sex Med. 2017;14:950–8.CrossRefPubMedGoogle Scholar
  49. 49.
    Ryle A, Kerr IB. Introducing cognitive analytic therapy: principles and practice. Chichester: Wiley; 2002.CrossRefGoogle Scholar
  50. 50.
    Calvert R, Kellett S. Cognitive analytic therapy: a review of the outcome evidence base for treatment. Psychol Psychother. 2014;87:253–77.CrossRefPubMedGoogle Scholar
  51. 51.
    Ryle A, Kellett S, Hepple J, Calvert R. Cognitive analytic therapy at 30. Adv Psychiatr Treat. 2014;20(4):258–68.CrossRefGoogle Scholar
  52. 52.
    Baer RA. Mindfulness training as a clinical intervention: a conceptual and empirical review. Clin Psychol Sci Pract. 2003;10(2):125–43.CrossRefGoogle Scholar
  53. 53.
    Kabat-Zinn J. Mindfulness-based interventions in context: past, present and future. Clin Psychol Sci Pract. 2003;10:144–56.CrossRefGoogle Scholar
  54. 54.
    • Reid RC, Bramen JE, Anderson A, Cohen MS. Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. J Clin Psychol. 2014;70:313–21. Article presenting application of mindfulness treatment for compulsive sexual behaviors. CrossRefPubMedGoogle Scholar
  55. 55.
    Shorey RC, Elmquist J, Gawrysiak MJ, Anderson S, Stuart GL. The relationship between mindfulness and compulsive sexual behavior in a sample of men in treatment for substance use disorders. Mindfulness. 2016;7(4):866–73.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 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;
  57. 57.
    Brotto LA, Basson R, Luria M. A systematic review of neurobiological and clinical features of mindfulness meditations. J Sex Med. 2008;5:1646–59.CrossRefPubMedGoogle Scholar
  58. 58.
    Brotto LA, Erskine Y, Carey M, Ehlen T, Finlayson S, Heywood M, et al. A brief mindfulness-based cognitive behavioural intervention improves sexual functioning versus wait-list control in women treated for gynecologic cancer. Gynecol Oncol. 2012;125:320–5.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Van Gordon W, Shonin E, Griffiths M. Meditation awareness training for the treatment of sex addiction: a case study. J Behav Addict. 2016;5(2):363–72.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Wilson W. Alcoholics anonymous. New York: Alcoholics Anonymous World Services; 1939/2001.Google Scholar
  61. 61.
    Carnes P. Recovery start kit. Carefree, AZ: Gentle Path; 2008.Google Scholar
  62. 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
  63. 63.
    Chapman RJ. Spirituality in the treatment of alcoholism: a worldview approach. Couns Values. 1996;41:39–50.CrossRefGoogle Scholar
  64. 64.
    Galanter M, Dermatis H, Post S, Sampson C. Spirituality-based recovery from drug addiction in the twelve-step fellowship of narcotics anonymous. J Addict Med. 2013;7(3):189–95. Scholar
  65. 65.
    Kauffman SM, Poulin J. Coherency among substance abuse models. J Socio Soc Welf. 1996;13:163–74.Google Scholar
  66. 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
  67. 67.
    Jellinek EM. The disease concept of alcoholism. New Haven: Hill House Press; 1960.CrossRefGoogle Scholar
  68. 68.
    DuPont RL, McGovern JP. A bridge to recovery: an introduction to 12 steps programs. Washington: American Psychiatric Press; 1994.Google Scholar
  69. 69.
    Ronel N. Goes with the wind: twelve-step program therapy. Ramat Gan: Bar-Ilan University (Hebrew; 2012.Google Scholar
  70. 70.
    Carnes P, Delmonico DL, Griffin E. In the shadows of the net. Center City: Hazelden; 2001.Google Scholar
  71. 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
  72. 72.
    • Bostwick JM, Bucci JA. Internet sex addiction treated with naltrexone. Mayo Clin Proc. 2008;83(2):226–30. First case study on naltrexone use for compulsive sexual behavior treatment. CrossRefPubMedGoogle Scholar
  73. 73.
    Gola M, Skorko M, Kowalewska E, Kołodziej A, Sikora M, Wodyk M, et al. Polish adaptation of sexual addiction screening test - revised. Psychiatr Pol. 2017;51(1):95–115.CrossRefPubMedGoogle Scholar
  74. 74.
    Gulsun M, Algul A, Semiz U, Ates M, Doruk A, Ebrinc S, et al. A case with euprolactinemic galactorrhea induced by escitalopram. Int J Psychiatry Med. 2007;37:275–8.CrossRefPubMedGoogle Scholar
  75. 75.
    Raymond NC, Grant JE, Coleman E. Augmentation with naltrexone to treat compulsive sexual behavior: a case series. Ann Clin Psychiatry. 2010;22(1):56–62.PubMedGoogle Scholar
  76. 76.
    Kraus SW, Meshberg-Cohen S, Martino S, Quinones LJ, Potenza MN. Treatment of compulsive pornography use with naltrexone: a case report. Am J Psychiatry. 2015;172(12):1260–1. Scholar
  77. 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
  78. 78.
    Coleman E. Compulsive sexual behavior: new concepts and treatments. J Psychol Hum Sex. 1991;4:37–52.CrossRefGoogle Scholar
  79. 79.
    Gola M, Miyakoshi M, Sescousse G. Sex, impulsivity and anxiety: interplay between ventral striatum and amygdala reactivity in problematic sexual behaviors. J Neurosci. 2015;35(46):15227–9. Scholar
  80. 80.
    Gola M. One or multiple neural mechanisms of problematic pornography use? J Behav Addict. 2016;5(S1):16–7.Google Scholar
  81. 81.
    • Stark R, Klucken T. Neuroscientific approaches to (online) pornography addiction. In: Montag C, Reuter M, editors. Internet addiction. Cham: Springer International Publishing; 2017. p. 109–24. Review of neuroscientific literature on problematic pornography use. CrossRefGoogle Scholar
  82. 82.
    Ciocca G, Limoncin E, Di Tommaso S, Mollaioli D, Gravina GL, Marcozzi A, et al. Attachment styles and sexual dysfunctions: a case–control study of female and male sexuality. Int J Impot Res. 2015;27(3):81–5. Scholar
  83. 83.
    Hsu B, Kling A, Kessler C, Knapke K, Diefenbach P, Elias JE. Gender differences in sexual fantasy and behavior in a college population: a ten-year replication. J Sex Marital Ther. 1994;20(2):103–18. Scholar
  84. 84.
    Levin RJ. Sexual arousal—its physiological roles in human reproduction. Annu Rev Sex Res. 2005;16(1):154–89.PubMedGoogle Scholar
  85. 85.
    Wilson GD. Male-female differences in sexual activity, enjoyment and fantasies. Personal Individ Differ. 1987;8(1):125–7. Scholar
  86. 86.
    Wilson GD, Lang RJ. Sex differences in sexual fantasy patterns. Personal Individ Differ. 1981;2(4):343–6. Scholar
  87. 87.
    Wood JR, McKay A, Komarnicky T, Milhausen RR. Was it good for you too? An analysis of gender differences in oral sex practices and pleasure ratings among heterosexual Canadian university students. Can J Hum Sex. 2016;25(1):21–9. Scholar
  88. 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
  89. 89.
    McKeague EL. Differentiating the female sex addict: a literature review focused on themes of gender difference used to inform recommendations for treating women with sex addiction. Sex Addict Compulsivity. 2014;21(3):203–24.CrossRefGoogle Scholar
  90. 90.
    Dhuffar MK, Griffiths MD. Barriers to female sex addiction treatment in the UK. J Behav Addict. 2016;5(4):562–7. Scholar
  91. 91.
    Miller WR, Moyers TB. The forest and the trees: relational and specific factors in addiction treatment. Addiction. 2015;110:410–3.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Beit-Berl CollegeKfar SabaIsrael
  2. 2.Institute of Psychology, Polish Academy of SciencesWarsawPoland
  3. 3.Swartz Center for Computational Neuroscience, Institute for Neural ComputationsUniversity of California San DiegoSan DiegoUSA

Personalised recommendations