Compulsive Sexual Behaviour

Symptoms

In many cases, compulsive sexual behavior consists of generally acceptable sexual acts taken to an extreme. These behaviors become problems when they become an obsession that's disruptive or harmful to you or others.

Other compulsive sexual behaviors are outside the bounds of commonly accepted conduct. Called paraphilias, these behaviors range from compulsive cross-dressing to having sexual desires toward children (pedophilia).

Compulsive sexual behavior symptoms vary in type and severity. Some signs 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 engage in certain sexual behavior, 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 risky sexual behavior despite serious consequences, such as the potential for getting or giving someone else a sexually transmitted disease, 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.

There's a broad range of sexual activities that can be warning signs of compulsive sexual behavior. Examples include:

• Having multiple sexual partners or extramarital affairs
• Having sex with anonymous partners or prostitutes
• Avoiding emotional involvement in sexual relationships
• Using commercial sexually explicit phone and Internet services
• Engaging in excessive masturbation
• Frequently using pornographic materials
• Engaging in masochistic or sadistic sex
• Exhibitionism
• Having a fixation on an unattainable sex partner

Causes

It's unclear what causes compulsive sexual behavior. Causes may include:

• An imbalance of natural brain chemicals. High levels of certain chemicals in your brain (neurotransmitters) such as serotonin, dopamine and norepinephrine may be related to compulsive sexual behavior. These brain chemicals also help regulate your mood.
• Sex hormone levels. Androgens are sex hormones that occur naturally in both men and women. Although androgens also have a vital role in sexual desire, it's not clear exactly how they're 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. Multiple sclerosis, 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 is an addiction that over time might actually 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 most common in men. It can also affect anyone regardless of sexual preference — whether heterosexual, homosexual or bisexual.

Compulsive sexual behavior often occurs in people who have:

• Alcohol or drug abuse problems
• Another psychological condition, such as a mood disorder, impulse control disorder or other mental health problem
• 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, taxing or destroying meaningful relationships
• Accumulate financial debts purchasing pornography and sexual services
• Contract HIV, hepatitis or another sexually transmitted disease, or pass a sexually transmitted disease 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
• Face an unwanted pregnancy and its consequences

Diagnosis

To help make a diagnosis, you may start with a medical doctor and get a thorough physical exam to see whether there may be any underlying conditions linked to your sexual feelings and behavior.

Your doctor, psychiatrist or other mental health provider will do a psychological evaluation, which may involve answering a number of questions about:

• Your physical and mental health as well as your overall emotional well-being
• Your sexual thoughts, behaviors and compulsions
• Your use of drugs and alcohol
• Your family, relationships and social situation

Your mental health provider may also request input from family and friends.

How compulsive sexual behavior is diagnosed

To diagnose mental health problems, including compulsive sexual behavior, mental health providers refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health professionals to diagnose mental conditions and by insurance companies to reimburse for treatment.

Because compulsive sexual behavior doesn't have its own diagnostic category in the DSM, it's often diagnosed as a subcategory of another mental health condition. Your diagnosis depends on the type and severity of your behavior.

Diagnosis of sexual behavior as a subcategory

In many cases, compulsive sexual behaviors are common and generally accepted sexual activities taken to an extreme. These may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder or an obsessive-compulsive disorder.

Diagnosis of sexual behavior as a paraphilia

It's sometimes difficult to determine when normal sexual behavior crosses the line into problem sexual behavior. However, there are diagnostic criteria for clearly unhealthy sexual behaviors called paraphilias. Paraphilias are behaviors that are generally considered harmful or socially unacceptable or are illegal. Diagnostic categories for paraphilias include:

• Exhibitionism, sexually arousing fantasies, sexual urges or behaviors involving the exposure of your genitals to an unsuspecting stranger.
• Fetishism, sexually arousing fantasies, sexual urges or behaviors involving the use of objects of some kind, such as women's underwear.
• Frotteurism, sexual urges or behaviors involving touching and rubbing against a nonconsenting person.
• Pedophilia, sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a child or children.
• Sexual masochism, sexually arousing fantasies, urges, or behaviors involving being humiliated, beaten, bound or otherwise made to suffer.
• Sexual sadism, sexually arousing fantasies, sexual urges or behaviors involving acts in which the psychological or physical suffering, including humiliation, of the victim is sexually exciting.
• Transvestic fetishism, sexually arousing fantasies, sexual urges or behaviors involving cross-dressing in a heterosexual male. A person diagnosed with transvestic fetishism may also have gender dysphoria — discomfort with gender role or identity.
• Voyeurism, sexually arousing fantasies, sexual urges or behaviors involving the act of observing unsuspecting persons who are naked, in the process of disrobing or engaging in sexual activity.
• Paraphilia not otherwise specified, sexually arousing fantasies that don't meet the criteria for any of the specific categories. Examples include sexual behaviors involving obscene phone calls (telephone scatologia), obsession with dead bodies (necrophilia), exclusive focus on part of body (partialism), animals (zoophilia), feces (coprophilia), enemas ( klismaphilia) and urine (urophilia).

Whatever the nature of your compulsive sexual behavior, push past your fear, shame or embarrassment and seek a professional evaluation. 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.

People with other addictions, 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.

Finding the right kind of help

Look for a mental health provider, such as a psychiatrist or psychologist, who has experience in treating sexual behavior disorders. Your family doctor may be able to give you the name of a specialist, or you can contact a medical center and ask for a referral.

If you have compulsive sexual behavior, you may also need treatment for another mental health condition as well. People with compulsive sexual behavior often have alcohol or drug abuse problems or other mental health problems that need treatment — especially obsessive-compulsive behaviors, anxiety or a mood disorder such as depression.

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 sexual urges that are extremely powerful and difficult to manage. Mental health providers understand this and are trained to be understanding, discreet and helpful. Keep in mind, what you say to a doctor or mental health counselor is kept confidential except in cases where you admit to planning or committing a crime or harming yourself or someone else.

Psychotherapy

Several forms of psychotherapy may help compulsive sexual behavior. These include:

• Psychodynamic psychotherapy. This form of psychotherapy focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts.
• Cognitive behavioral therapy. This form of therapy helps you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
• Group therapy. You meet regularly with a group, under guidance of a mental health professional, to explore emotions and relationships.
• Family therapy or marriage counseling. Compulsive sexual behavior affects the entire family, so it's often helpful to involve your partner or children in joint therapy sessions.

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 depends on your overall situation and other mental health conditions or addictions you may have.

You may have to try several medications, or a combination of medications, to find what works best for you with the fewest side effects. Medications used to treat compulsive sexual behavior are often used 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 (seroxat), sertraline (Lustral) and others.
• Mood stabilizers. Examples include lithium.These medications are generally used to treat bipolar disorder (manic depression), but may reduce uncontrolled sexual urges.
• Naltrexone. This medication 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 (med-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 (LHRH). This medication may reduce obsessive sexual thoughts by reducing the production of testosterone.
• Anti-anxiety medications. Examples include clonazepam (Rivotril), lorazepam (Ativan), chlordiazepoxide (Librium), diazepam (Valium) and alprazolam (Xanax). These medications are used to reduce serious anxiety and aggression in emergency situations, but are generally avoided, as they may worsen compulsive behavior in the long run.

Coping and support

Although it may be difficult to overcome compulsive sexual behavior on your own, you can take steps to care for yourself with healthy coping skills while getting professional treatment.

• Stick to your treatment plan. Take medications as directed and attend scheduled therapy sessions. Remember that it can be hard work and that 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 situations. Don't jeopardize your health or that of others or by putting yourself into situations where you'll be tempted to engage in risky sexual practices.
• 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. Explore healthy ways to rechannel your sexual compulsions through exercise and recreational activities.
• Practice relaxation and stress management. Try such stress-reduction techniques 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

It's not clear how compulsive sexual behavior might be prevented, but a few things may help keep it 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. As with mental health disorders, substance abuse can cause a loss of control and unhappiness that impairs your judgment and may push you toward unhealthy sexual behaviors.
• Seek treatment for childhood sexual abuse. Many people with compulsive sexual behavior were sexually abused as children. Appropriate professional treatment may help heal those emotional scars.

References:

http://healthland.time.com/2013/07/23/my-name-is-john-and-i-am-a-sex-addict-or-maybe-not/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945841/

http://www.sca-recovery.org/compulsive.htm

https://www.psychologytoday.com/blog/sex-lies-trauma/201103/5-tips-survive-your-partners-sexually-compulsive-behavior

http://wwwoutage.apa.org.s3-website-us-east-1.amazonaws.com/