Behavioral and Pharmacological Treatment of Compulsive Sexual Behavior/Problematic Hypersexuality

Abstract

Purpose of the Review

The present article summarizes the available evidence to date on the pharmacological and behavioral treatment of compulsive sexual behavior/problematic hypersexuality and provides two case vignettes to illustrate potential approaches to treating different presentations of problematic sexual behavior in patients.

Recent Findings

To date, some evidence supports the use of several medications, such as selective serotonin reuptake inhibitors and naltrexone, as well as certain therapy techniques, including marital therapy, acceptance and commitment therapy, and cognitive behavioral therapy.

Summary

Unfortunately, little controlled research has been conducted or reported on optimal treatments for patients struggling to manage their problematic sexual behavior. Limited evidence for some options has been reported, but additional controlled, blinded research will be necessary to improve the specificity and quality of available care.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.•

    Odlaug BL, Lust K, Schreiber LR, Christenson G, Derbyshire K, Harvanko A, et al. Compulsive sexual behavior in young adults. Ann Clin Psychiatry. 2013;25(3):193–200. This study is notable as it addresses the presentation of compulsive sexual behavior amongst young adults, particularly a non-treatment seeking population. This information is critical for professionals working with young adults across both clinical and University settings.

    PubMed  Google Scholar 

  2. 2.

    Black DW. Compulsive sexual behavior: a review. J Pract Psychiatry Behav Health. 1998;4(4):219–29.

    Google Scholar 

  3. 3.

    Kaplan MS, Krueger RB. Diagnosis, assessment and treatment of hypersexuality. J Sex Res. 2010;47(2):181–98.

    Article  PubMed  Google Scholar 

  4. 4.

    Christenson GA, Faber RJ, De Zwaan M, Raymond NC, Specker SM, Ekern MD, et al. Compulsive buying: descriptive characteristics and psychiatric comorbidity. J Clin Psychiatry. 1994;55(1):5–11.

    CAS  PubMed  Google Scholar 

  5. 5.

    Black DW, Kehrberg LL, Flumerfelt DL, Schlosser SS. Characteristics of 36 subjects reporting compulsive sexual behavior. Am J Psychiatry. 1997;154(2):243–9.

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Coleman E, Raymond N, McBean A. Assessment and treatment of compulsive sexual behavior. Minn Med. 2003;86(7):42–7.

    PubMed  Google Scholar 

  7. 7.

    De Bienville DT. Nymphomania, or a dissertation concerning the furor uterinus. London: J. Bew; 1775. Trans. Wilmot ES.

    Google Scholar 

  8. 8.

    Esquirol E. Mental maladies; a treatise on insanity. Philadelphia: Lea and Blanchard; 1845.

    Google Scholar 

  9. 9.

    Fong TW, Reid RC, Parhami I. Behavioral addictions: where to draw the lines? Psychiatr Clin N Am. 2012;35(2):279–96.

    Article  Google Scholar 

  10. 10.

    Reid RC, Carpenter BN, Hook JN, Garos S, Manning JC, Gilliand R, et al. Report of findings in a DSM-5 field trial for hypersexual disorder. J Sex Med. 2012;9(11):2868–77.

    Article  PubMed  Google Scholar 

  11. 11.

    Grant JE, Potenza MN, Weinstein A, Gorelick DA. Introduction to behavioral addictions. Am J Drug Alcohol Abuse. 2010;36(5):233–41.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Grant JE. Impulse control disorders: a clinician’s guide to understanding and treating behavioral addictions. New York: WW Norton & Company; 2008.

    Google Scholar 

  13. 13.

    Grant JE, Atmaca M, Fineberg NA, Fontenelle LF, Matsunaga H, Janardhan Reddy YC, et al. Impulse control disorders and “behavioral addictions” in the ICD-11. World Psychiatry. 2014;13(2):125–7.

    Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Frohmader KS, Lehman MN, Laviolette SR, Coolen LM. Concurrent exposure to methamphetamine and sexual behavior enhances subsequent drug reward and causes compulsive sexual behavior in male rats. J Neurosci. 2011;31(45):16473–82.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Weintraub D, Siderow A, Potenza MN, Goveas J, Morales K, Duda J, et al. Association of dopamine agonist use with impulse control disorders in Parkinson’s disease. Arch Neurol. 2006;63(7):969–73.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Weintraub D, Koester J, Potenza MN, Siderowf AD, Stacy M, Voon V, et al. Impulse disorders in Parkinson disease: a cross-sectional study of 3090 patients. Arch Neurol. 2010;67(5):589–95.

    Article  PubMed  Google Scholar 

  17. 17.

    Sansone RA, Ferlan M, 9. Pramipexole and compulsive masturbation. Psychiatry (Edgmont). 2007;4:57–9.

    Google Scholar 

  18. 18.

    Mété D, Dafreville C, Paitel V, Wind P. Aripiprazole, gambling disorder and compulsive sexuality. Encéphale. 2016. doi:10.1016/j.encep.2016.01.003.

    PubMed  Google Scholar 

  19. 19.

    Stein DJ, Hollander E, Anthony DT, Schneier FR, Fallon BA, Liebowitz MR, et al. Serotonergic medications for sexual obsessions, sexual addictions, and paraphilias. J Clin Psychiatry. 1992;53(8):267–71.

    CAS  PubMed  Google Scholar 

  20. 20.

    Elmore JL. SSRI reduction of nonparaphilic sexual addiction. CNS Spectr. 2000;5(11):53–8.

    CAS  Article  PubMed  Google Scholar 

  21. 21.•

    Alsughier N. Compulsive masturbation treated with selective serotonin reuptake inhibitors. J Psychiatry. 2015;18:299. This report was notable as it provides additional evidence for the use of SSRIs in the treatment of problematic sexual behavior, with variations in presentation which may be beneficial for clinical consideration.

    Article  Google Scholar 

  22. 22.

    Kafka MP. Sertraline pharmacotherapy for paraphilias and paraphilia-related disorders: an open trial. Ann Clin Psychiatry. 1994;6(3):189–95.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    do Amaral MLSA, Scanavino MT. Severe compulsive sexual behaviors: a report on two cases under treatment. Rev Bras Psiquiatr. 2012;34(2):213–6.

    Article  PubMed  Google Scholar 

  24. 24.

    Kafka MP, Prentky R. Fluoxetine treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1992;53(10):351–8.

    CAS  PubMed  Google Scholar 

  25. 25.

    Kafka MP. Successful antidepressant treatment of nonparaphilic sexual addictions and paraphilias in men. J Clin Psychiatry. 1991;52(2):60–5.

    CAS  PubMed  Google Scholar 

  26. 26.

    Schupak C. Case report: lamotrigine/fluoxetine combination in the treatment of compulsive sexual behavior. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31(6):1337–8.

    Article  PubMed  Google Scholar 

  27. 27.

    Wainberg ML, Muench F, Morgenstern J, Hollander E, Irwin TW, Parsons JT, et al. A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men. J Clin Psychiatry. 2006;67:1968–73.

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Marazziti D, Dell’Osso B. Topiramate plus citalopram in the treatment of compulsive-impulsive sexual behaviors. Clin Pract Epidemiol Ment Health. 2006;2:9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Malladi SS, Singh AN. Hypersexuality and its response to citalopram in a patient with hypothalamic hamartoma and precocious puberty. Int J Neuropsychopharmacol. 2005;8:635–6.

    Article  PubMed  Google Scholar 

  30. 30.

    Azhar M, Varma S. Response of clomipramine in sexual addiction. Eur Psychiatry. 1995;10(5):263–4.

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Gulson M, Gulcat Z, Aydin H. Treatment of compulsive sexual behavior with clomipramine and valproic acid. Clin Drug Invest. 2007;27(3):219–23.

    Article  Google Scholar 

  32. 32.

    Coleman E, Gratzer T, Nesvacil L, Raymond NC. Nefazodone and the treatment of nonparaphilic compulsive sexual behavior: a retrospective study. J Clin Psychiatry. 2000;61(4):282–4.

    CAS  PubMed  Google Scholar 

  33. 33.

    De Sousa A. Compulsive masterbation treated with combined naltrexone and mirtazepine: case report and review. J Pak Psychiatr Soc. 2007;4(2):110.

    Google Scholar 

  34. 34.

    Elmore JL. Psychotropic medication control of non-paraphilic sexual addiction in a female. Sex Relat Ther. 2005;20(2):211–3.

    Article  Google Scholar 

  35. 35.

    Kuzma JM, Black DW. Compulsive disorders. Curr Psychiatry Rep. 2004;6(1):58–65.

    Article  PubMed  Google Scholar 

  36. 36.

    Grant JE. Clinical practice: obsessive-compulsive disorder. N Engl J Med. 2014;341(7):646–53.

    Google Scholar 

  37. 37.

    Botswick JM, Bucci JA. Internet sex addiction treated with naltrexone. Mayo Clin Proc. 2008;83(2):226–30.

    Article  Google Scholar 

  38. 38.

    Grant JE, Kim SW. A case of kleptomania and compulsive sexual behavior treated with naltrexone. Ann Clin Psychiatry. 2001;13(4):229–31.

    Article  PubMed  Google Scholar 

  39. 39.••

    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. This report is quite notable as it provides further support for the use of naltrexone for the treatment of compulsive sexual behavior. Consistency across reports suggests that naltrexone is an important consideration when treating this disorder.

    Article  PubMed  Google Scholar 

  40. 40.

    Raymond NC, Grant JE, Kim SW, Coleman E. Treatment of compulsive sexual behaviour with naltrexone and serotonin reuptake inhibitors: two case reports. Int Clin Psychopharmacol. 2002;17(4):201–5.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Raymond NC, Grant JE. Augmentation with naltrexone to treat compulsive sexual behavior: a case series. Ann Clin Psychiatry. 2010;22(1):56–62.

    PubMed  Google Scholar 

  42. 42.

    Berrettini W. Opioid neuroscience for addiction medicine: from animal models to FDA approval for alcohol addiction. Prog Brain Res. 2016;223:253–67.

    Article  PubMed  Google Scholar 

  43. 43.

    Khazaal Y, Zullino DF. Topiramate in the treatment of compulsive sexual behavior: case report. BMC Psychiatry. 2006;6:22.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Fong TW, De La Garza R, Newton TF. A case report of topiramate in the treatment of nonparaphilic sexual addiction. J Clin Psychopharmacol. 2005;25(5):512–4.

    Article  PubMed  Google Scholar 

  45. 45.

    Bell DS. Anticonvulsant treatment of compulsive sexual behavior. Ann Clin Psychiatry. 2012;24(4):323–4.

    PubMed  Google Scholar 

  46. 46.

    Kafka MP, Hennen J. Psychostimulant augmentation during treatment with selective serotonin reuptake inhibitors in men with paraphilias and paraphilia-related disorders: a case series. J Clin Psychiatry. 2000;61(9):664–70.

    CAS  Article  PubMed  Google Scholar 

  47. 47.

    Safarinejad MR. Treatment of nonparaphilic hypersexuality in men with a long-acting analog of gonadotropin-releasing hormone. J Sex Med. 2009;6:1151–67.

    CAS  Article  PubMed  Google Scholar 

  48. 48.

    Deepmala, Slattery J, Kumar N, Delhey L, Berk M, Dean O, et al. Clinical trials of N-acetylcysteine in psychiatry and neurology: a systematic review. Neurosci Biobehav Rev. 2015;55:294–321.

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Yau YH, Potenza MN. Gambling disorder and other behavioral addictions: recognition and treatment. Harv Rev Psychiatry. 2015;23(2):134–46.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Shepherd L. Cognitive behavior therapy for sexually addictive behavior. Clin Case Stud. 2010;9(1):L18–27.

    Article  Google Scholar 

  51. 51.

    Orzack MH, Voluse AC, Wolf D, Hennen J. An ongoing study of group treatment for men involved in problematic internet-enabled sexual behavior. Cyberpsychol Behav. 2006;9(3):348–60.

    Article  PubMed  Google Scholar 

  52. 52.

    Del Giudice MJ, Kutinsky J. Applying motivational interviewing to the treatment of sexual compulsivity and addiction. Sex Addict Comp. 2007;14:303–19.

    Article  Google Scholar 

  53. 53.

    Sadiza J, Varma R, Jena SPK, Singh TB. Group cognitive behaviour therapy in the management of compulsive sex behaviour. Int J Crime Justice Sci. 2011;6(1&2):309–25.

    Google Scholar 

  54. 54.

    Hardy SA, Ruchty J, Hull TD, Hyde R. A preliminary study of an online psychoeducational program for hypersexuality. Sex Addict Comp. 2010;17:247–69.

    Article  Google Scholar 

  55. 55.

    Twohig MP, Crosby JM. Acceptance and commitment therapy as a treatment for problematic internet pornography viewing. Behav Ther. 2010. doi:10.1016/j.beth.2009.06.002.

    PubMed  Google Scholar 

  56. 56.••

    Crosby JM, Twohig MP. Acceptance and commitment therapy for problematic internet pornography use: a randomized trial. Behav Ther. 2016;47:355–66. This study provides important support for the use of acceptance and commitment therapy to treat compulsive sexual behavior. There are few controlled studies on the treatment of this disorder, and this randomized trial provides useful insight into the utility of this therapy paradigm when treating compulsive sexual behavior.

    Article  PubMed  Google Scholar 

  57. 57.

    Sprenkle DH. Treating a sex addict through marital sex therapy. Fam Relat. 1987;36(1):11–4.

    Article  Google Scholar 

  58. 58.

    Zitzman ST, Butler MH. Attachment, addiction, and recovery: conjoint marital therapy for recovery from a sexual addiction. Sex Addict Comp. 2005;12:311–37.

    Article  Google Scholar 

  59. 59.

    Cox RP, Howard MD. Utilization of EMDR in the treatment of sexual addiction: a case study. Sex Addict Comp. 2007;14:1–20.

    Article  Google Scholar 

  60. 60.

    Klontz BT, Garos S, Klontz PT. The effectiveness of brief multimodal experiential therapy in the treatment of sexual addiction. Sex Addict Comp. 2005;12:275–94.

    Article  Google Scholar 

  61. 61.

    Quadland MC. Compulsive sexual behavior: definition of a problem and an approach to treatment. J Sex Marital Ther. 1985;11(2):121–32.

    CAS  Article  PubMed  Google Scholar 

  62. 62.

    Schwartz MF, Masters WH. Integration of trauma-based, cognitive, behavioral, systemic and addiction approaches for treatment of hypersexual pair-bonding disorder. Sex Addict Comp. 1994;1(1):57–76.

    Article  Google Scholar 

  63. 63.

    Wan M, Finlayson R, Rowles A. Sexual dependency treatment outcome study. Sex Addict Comp. 2000;7:177–96.

    Article  Google Scholar 

  64. 64.

    Öst LG, Havnen A, Hansen B, Kvale G. Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clin Psychol Rev. 2015;40:156–69.

    Article  PubMed  Google Scholar 

  65. 65.

    Cowlishaw S, Merkouris S, Dowling N, Anderson C, Jackson A, Thomas S. Psychological therapies for pathological and problem gambling. Cochrane Database Syst Rev. 2012;11:CD008937.

    PubMed  Google Scholar 

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Correspondence to Eric W. Leppink.

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Conflict of Interest

Eric W. Leppink declares no conflict of interest. Jon E. Grant reports grants from Brainsway, grants from Forest, grants from Roche, grants from Trichotillomania Learning Center, and grants from NIMH, outside of the submitted work.

Human and Animal Rights and Informed Consent

All studies conducted with human or animal subjects by the authors and referenced in this manuscript were completed in accordance with the Declaration of Helsinki and with the approval of the Institutional Review Board of the relevant Institution.

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This article is part of the Topical Collection on Sex Addiction

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Leppink, E.W., Grant, J.E. Behavioral and Pharmacological Treatment of Compulsive Sexual Behavior/Problematic Hypersexuality. Curr Addict Rep 3, 406–413 (2016). https://doi.org/10.1007/s40429-016-0122-y

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Keywords

  • Compulsive sexual behavior
  • Treatment
  • Hypersexuality
  • Pharmacology
  • Psychotherapy