Skip to main content

Addictive Use of Online Sexual Activities and its Comorbidities: a Systematic Review


Purpose of the Review

This systematic review explores comorbidities related to the problematic use of online sexual activities (OSAs) in the absence of any published synthesis on the subject. These comorbidities are commonly confused with problems associated with offline addictive sexual disorders, even though it is not clear whether they are strictly similar.

Recent Findings

This is the first systematic review of the literature synthesizing data on the comorbidities of problematic OSA use. The pattern of comorbidities that was evidenced supports the hypothesis that problematic OSA use is part of a spectrum of related (yet distinct) disorders, Internet-related disorders.


A total of 23 studies were selected and analyzed. The systematic literature review conducted showed that various comorbidities occur with problematic OSA use as follows: (1) addictive behaviors (internet addiction, online gaming problem, substance use disorders), (2) other psychiatric disorders or psychopathological symptoms (mood disorders and suicidality, anxiety, post-traumatic stress disorder, borderline personality disorder, eating disorder, online dissociation), (3) psychological dimensions (insecure peer attachment, specific personality traits), and (4) sexual problems (sexual dysfunction, paraphilia, offline addictive sexual disorders).

This is a preview of subscription content, access via your institution.

Fig. 1


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

  1. 1.

    •• Castro Calvo. Motives to engage in online sexual activities and their links to excessive and problematic use: a systematic review - dimensions. This is important study documenting the motives behind OSAs. Authors noted that important motive related to the pathological use of OSAs was emotional coping and fantasizing motives.

  2. 2.

    •• Wery A, Billieux J. Online sexual activities: an exploratory study of problematic and non-problematic usage patterns in a sample of men. Comput. Hum. Behav. 2016;56:257–66 This study aimed to investigate the characteristics, usage patterns and motives for men to engage in OSAs. Results showed that sexual dysfunction, anonymous fantasying and mood regulation are associated with problematic OSA use.

    Article  Google Scholar 

  3. 3.

    Albright JM. Sex in America online: an exploration of sex, marital status, and sexual identity in internet sex seeking and its impacts. J Sex Res. 2008;45:175–86.

    PubMed  Article  Google Scholar 

  4. 4.

    Cooper A, Morahan-Martin J, Mathy RM, Maheu M. Toward an increased understanding of user demographics in online sexual activities. J. Sex Marital Ther. 2002;28:105–29.

    PubMed  Article  Google Scholar 

  5. 5.

    Shaughnessy K, Byers ES, Walsh L. Online sexual activity experience of heterosexual students: gender similarities and differences. Arch Sex Behav. 2011;40:419–27.

    PubMed  Article  Google Scholar 

  6. 6.

    Cooper A, Putnam DE, Planchon LA, Boies SC. Online sexual compulsivity: getting tangled in the net. Sex. Addict. Compulsivity. 1999;6:79–104.

    Article  Google Scholar 

  7. 7.

    Cooper A, Delmonico DL, Griffin-Shelley E, Mathy RM. Online sexual activity: an examination of potentially problematic behaviors. Sex Addict Compulsivity. 2004;11:129–43.

    Article  Google Scholar 

  8. 8.

    Potenza MN. Obesity, food, and addiction: emerging neuroscience and clinical and public health implications. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol. 2014;39:249–50.

    Article  Google Scholar 

  9. 9.

    Kafka MP. Hypersexual disorder: a proposed diagnosis for DSM-V. Arch Sex Behav. 2010;39:377–400.

    PubMed  Article  Google Scholar 

  10. 10.

    Kraus SW, et al. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry Off J World Psychiatr Assoc WPA. 2018;17:109–10.

    Google Scholar 

  11. 11.

    Moser C. Hypersexual disorder: searching for clarity. Sex. Addict. Compulsivity. 2013;20:48–58.

    Google Scholar 

  12. 12.

    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;9:348–60.

    PubMed  Article  Google Scholar 

  13. 13.

    Berberovic D. Sexual compulsivity comorbidity with depression, anxiety, and substance use in students from Serbia and Bosnia and Herzegovina. Eur. J. Psychol. 2013;9:517–30.

    Article  Google Scholar 

  14. 14.

    Garcia C. Conceptualization and measurement of coping during adolescence: a review of the literature. J Nurs Scholarsh. 2010;42:166–85.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Mick TM, Hollander E. Impulsive-compulsive sexual behavior. CNS Spectr. 2006;11:944–55.

    PubMed  Article  Google Scholar 

  16. 16.

    Ferree MC. Women and the web: cybersex activity and implications. Sex Relatsh Ther. 2003;18:385–93.

    Article  Google Scholar 

  17. 17.

    Giugliano J. Out of control sexual behavior: a qualitative investigation: Ingenta Connect.

  18. 18.

    Carroll JJ. For lack of wanting: discourses of desire in Ukrainian opiate substitution therapy programs. Transcult Psychiatry. 2016;53:198–216.

    PubMed  Article  Google Scholar 

  19. 19.

    Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS. 2005;16:102–7.

    PubMed  Article  Google Scholar 

  20. 20.

    Kalichman SC, Cain D. The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. J. Sex Res. 2004;41:235–41.

    PubMed  Article  Google Scholar 

  21. 21.

    Moher D, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1.

    PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    Ballester-Arnal R, Castro Calvo J, Gil-Llario MD, Gil-Julia B. Cybersex addiction: a study on Spanish college students. J Sex Marital Ther. 2017;43:567–85.

    PubMed  Article  Google Scholar 

  23. 23.

    Barrault S, Hegbe KG, Bertsch I, Courtois R. Relationship between traumatic life events of childhood, borderline personality disorder and problematic cybersexual behavior. Psychotr Belg. 2017;22:65–81.

    Article  Google Scholar 

  24. 24.

    Beutel ME, et al. Prevalence and determinants of online-sex use in the German population. PLoS One. 2017;12:e0176449.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  25. 25.

    Blais-Lecours S, Vaillancourt-Morel M-P, Sabourin S, Godbout N. Cyberpornography: time use, perceived addiction, sexual functioning, and sexual satisfaction. Cyberpsychology Behav. Soc. Netw. 2016;19:649–55.

    Article  Google Scholar 

  26. 26.

    Bothe B, Tóth-Király I, Orosz G. Clarifying the links among online gaming, internet use, drinking motives, and online pornography use. Games Health J. 2015;4:107–12.

    PubMed  Article  Google Scholar 

  27. 27.

    Chaney, D. Online experiences of sexually compulsive men who have sex with men: sexual addiction & compulsivity: Vol 10, No 4.

    Article  Google Scholar 

  28. 28.

    Deborah Corley M, Hook J. Women, female sex and love addicts, and use of the internet. Sex. Addict. Compulsivity. 2012;19:53–76.

    Article  Google Scholar 

  29. 29.

    Daneback K, Ross MW, Månsson S-A. Characteristics and behaviors of sexual compulsives who use the internet for sexual purposes. Sex. Addict. Compulsivity. 2006;13:53–67.

    Article  Google Scholar 

  30. 30.

    Egan V, Parmar R. Dirty habits? Online pornography use, personality, obsessionality, and compulsivity. J. Sex Marital Ther. 2013;39:394–409.

    PubMed  Article  Google Scholar 

  31. 31.

    Greenfield DN. Psychological characteristics of compulsive internet use: a preliminary analysis. Cyberpsychology Behav Impact Internet Multimed Virtual Real Behav Soc. 1999;2:403–12.

    CAS  Google Scholar 

  32. 32.

    Grov C, et al. Exploring the internet’s role in sexual compulsivity and out of control sexual thoughts/behaviour: a qualitative study of gay and bisexual men in New York City. Cult Health Sex. 2008;10:107–25.

    PubMed  Article  Google Scholar 

  33. 33.

    Grubbs JB, Wilt JA, Exline JJ, Pargament KI, Kraus SW. Moral disapproval and perceived addiction to internet pornography: a longitudinal examination. Addiction. 2018;113:496–506.

    PubMed  Article  Google Scholar 

  34. 34.

    Levin ME, Lillis J, Hayes SC. When is online pornography viewing problematic among college males? Examining the Moderating Role of Experiential Avoidance. Sex Addict Compulsivity. 2012;19:168–80.

    Google Scholar 

  35. 35.

    Meerkerk G-J, Van Den Eijnden RJJM, Garretsen HFL. Predicting compulsive internet use: it’s all about sex! CyberPsychol Behav. 2006;9:95–103.

    PubMed  Article  Google Scholar 

  36. 36.

    Mitchell K, Becker-Blease K, Finkelhor D. Inventory of problematic internet experiences encountered in clinical practice. Prof Psychol-Res Pract. 2005;36:498–509.

    Article  Google Scholar 

  37. 37.

    Morelli M, Bianchi D, Baiocco R, Pezzuti L, Chirumbolo A. Sexting behaviors and cyber pornography addiction among adolescents: the moderating role of alcohol consumption. Sex Res Soc Policy. 2017;14:113–21.

    Article  Google Scholar 

  38. 38.

    Reiner I, Tibubos AN, Hardt J, Müller K, Wölfling K, Beutel ME. Peer attachment, specific patterns of internet use and problematic internet use in male and female adolescents. Eur Child Adolesc Psychiatry. 2017;26:1257–68.

    PubMed  Article  Google Scholar 

  39. 39.

    Schneider, J. P. Effects of cybersex addiction on the family: results of a survey: Sexual Addiction & Compulsivity: Vol 7, No 1–2.

    Article  Google Scholar 

  40. 40.

    Schneider JP. A qualitative study of cybersex participants: gender differences, recovery issues, and implications for therapists. Sex. Addict. Compulsivity. 2000;7:249–78.

    Article  Google Scholar 

  41. 41.

    Schwartz M. Compulsive cybersex: the new tea room. Sex. Addict. Compulsivity. 2000;7:127–44.

    Article  Google Scholar 

  42. 42.

    Stockdale, L. Video game addiction in emerging adulthood: cross-sectional evidence of pathology in video game addicts as compared to matched healthy controls. - PubMed - NCBI.

  43. 43.

    Wéry A, Karila L, De Sutter P, Billieux J. Conceptualisation, évaluation et traitement de la dépendance cybersexuelle : une revue de la littérature. Can Psychol. 2014;55:266.

    Article  Google Scholar 

  44. 44.

    Griffiths MD. The use of online methodologies in studying paraphilias - a review. J Behav Addict. 2012;1:143–50.

    PubMed  Article  Google Scholar 

  45. 45.

    Cooper A, McLoughlin IP, Campbell KM. Sexuality in cyberspace: update for the 21st century. CyberPsychol Behav. 2000;3:521–36.

    Article  Google Scholar 

  46. 46.

    Hayes. Experimental avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. - PubMed - NCBI.

  47. 47.

    Adams RE, Urosevich TG, Hoffman SN, Kirchner HL, Hyacinthe JC, Figley CR, et al. Social support, help-seeking, and mental health outcomes among veterans in non-VA facilities: results from the veterans’ health study. Mil Behav Health. 2017;5:393–405.

    PubMed  PubMed Central  Article  Google Scholar 

  48. 48.

    Schimmenti A, Passanisi A, Caretti V, la Marca L, Granieri A, Iacolino C, et al. Traumatic experiences, alexithymia, and internet addiction symptoms among late adolescents: a moderated mediation analysis. Addict Behav. 2017;64:314–20.

    PubMed  Article  Google Scholar 

  49. 49.

    Dervaux A, Laqueille X. Troubles de personnalité borderline et addictions. Inf Psychiatr. 2016;92:38–44.

    Google Scholar 

  50. 50.

    Carnes, P. Out of the shadows: understanding sexual addiction. (Hazelden Publishing, 2001).

  51. 51.

    •• Wéry A, Billieux J. Problematic cybersex: conceptualization, assessment, and treatment. Addict. Behav. 2017;64:238–46 This systematic examination of the literature showed that problematic OSA use is an umbrella construct that regroups various types of distinct dysfunctional online behaviors. The authors summarized data on epidemiology, profiles, risks factors, assessment and treatment of problematic OSA users.

    PubMed  Article  Google Scholar 

  52. 52.

    Brand M, et al. Watching pornographic pictures on the internet: role of sexual arousal ratings and psychological-psychiatric symptoms for using internet sex sites excessively. Cyberpsychology Behav Soc Netw. 2011;14:371–7.

    Article  Google Scholar 

  53. 53.

    Laier C, Pekal J, Brand M. Sexual excitability and dysfunctional coping determine cybersex addiction in homosexual males. Cyberpsychology Behav. Soc. Netw. 2015;18:575–80.

    Article  Google Scholar 

  54. 54.

    Ross MW, Månsson S-A, Daneback K. Prevalence, severity, and correlates of problematic sexual internet use in Swedish men and women. Arch Sex Behav. 2012;41:459–66.

    PubMed  Article  Google Scholar 

  55. 55.

    Abramowitz JS, Tolin DF, Street GP. Paradoxical effects of thought suppression: a meta-analysis of controlled studies. Clin Psychol Rev. 2001;21:683–703.

    CAS  PubMed  Article  Google Scholar 

  56. 56.

    Birchard, T. Sexual addiction and the paraphilias: sexual addiction & compulsivity, 18:3, 157-187DOI:

    Article  Google Scholar 

  57. 57.

    Davis JL, Petretic-Jackson PA, Ting L. Intimacy dysfunction and trauma symptomatology: long-term correlates of different types of child abuse. J Trauma Stress. 2001;14:63–79.

    Article  Google Scholar 

  58. 58.

    Maniglio R. The impact of child sexual abuse on health: A systematic review. Clinical Psychology Review. 2009;29:647–57.

    PubMed  Article  Google Scholar 

  59. 59.

    • Wéry, A., Schimmenti, A., Karila, L. & Billieux, J. Where the mind cannot dare: a case of addictive use of online pornography and its relationship with childhood trauma. J. Sex Marital Ther. 1–14 (2018) doi: This case report aimed to identify psychological processes and risk factors that may foster thedevelopment of addictive use of online pornography and critically consider the clinical utility of current diagnostic criteria proposed in the literature. In particular, this study documenting the impact of trauma-related dissociation.

    Article  Google Scholar 

  60. 60.

    Compas BE, Jaser SS, Bettis AH, Watson KH, Gruhn MA, Dunbar JP, et al. Coping, emotion regulation, and psychopathology in childhood and adolescence: a meta-analysis and narrative review. Psychol Bull. 2017;143:939–91.

    PubMed  PubMed Central  Article  Google Scholar 

  61. 61.

    Dalal PK, Basu D. Twenty years of internet addiction … quo Vadis? Indian J Psychiatry. 2016;58:6–11.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  62. 62.

    Cash H, Rae CD, Steel AH, Winkler A. Internet addiction: a brief summary of research and practice. Curr Psychiatr Rev. 2012;8:292–8.

    Article  Google Scholar 

  63. 63.

    Rehbein F, Mößle T, Arnaud N, Rumpf H-J. Video game and internet addiction. The current state of research. Nervenarzt. 2013;84:569–75.

    CAS  PubMed  Article  Google Scholar 

  64. 64.

    • Baggio S, et al. Technology-mediated addictive behaviors constitute a spectrum of related yet distinct conditions: a network perspective. Psychol. Addict. Behav. J. Soc. Psychol. Addict. Behav. 2018;32:564–72 This article supports the notion that Internet addiction is a spectrum of Internet-related disorders, which pertain to addictive online behaviours, such as gaming and sexual activities.

    Article  Google Scholar 

  65. 65.

    Pawlikowski M, Nader IW, Burger C, Stieger S, Brand M. Pathological internet use - it is a multidimensional and not a unidimensional construct. Addict Res Theory. 2014;22:166–75.

    Article  Google Scholar 

  66. 66.

    Pontes HM, Szabo A, Griffiths MD. The impact of internet-based specific activities on the perceptions of internet addiction, quality of life, and excessive usage: a cross-sectional study. Addict Behav Rep. 2015;1:19–25.

    PubMed  PubMed Central  Google Scholar 

  67. 67.

    Griffiths MD, Szabo A. Is excessive online usage a function of medium or activity? An empirical pilot study. J Behav Addict. 2014;3:74–7.

    PubMed  Article  Google Scholar 

  68. 68.

    Weinstein AM, Zolek R, Babkin A, Cohen K, Lejoyeux M. Factors predicting cybersex use and difficulties in forming intimate relationships among male and female users of cybersex. Front Psychiatry. 2015;6:54.

    PubMed  PubMed Central  Article  Google Scholar 

  69. 69.

    Wang C-W, Ho RTH, Chan CLW, Tse S. Exploring personality characteristics of Chinese adolescents with internet-related addictive behaviors: trait differences for gaming addiction and social networking addiction. Addict Behav. 2015;42:32–5.

    CAS  PubMed  Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Marianne Hermand.

Ethics declarations

Conflict of Interest

Dr. Laurent Karila has received consulting fees from Gillead, Recordati, indivior, Ethypharm Pharmaceuticals.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Technology Addiction

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Hermand, M., Benyamina, A., Donnadieu-Rigole, H. et al. Addictive Use of Online Sexual Activities and its Comorbidities: a Systematic Review. Curr Addict Rep 7, 194–209 (2020).

Download citation


  • Online sexual activities.
  • Systematic review
  • Comorbidities