Compulsive sexual behavior (CSB) is a common disorder featuring repetitive, intrusive and distressing sexual thoughts, urges and behaviors that negatively affect many aspects of an individual’s life. This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options.
We reviewed the literature regarding the clinical aspects of CSB and treatment approaches.
The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm.
Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health. Further research needs to be completed to understand where CSB falls within the psychiatric nosology.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Arlington, VA: American Psychiatric Publishing
Augustine Fellowship. (1986). Sex and love addicts anonymous. The Augustine Fellowship
Barth, R. J. & Kinder, B. N. (1987). The mislabeling of sexual impulsivity. Journal of Sex & Marital Therapy, 13(1), 15–22
Benotsch, E. G., Kalichman, S. C. & Kelly, J. A. (1999). Sexual compulsivity and substance use in HIV-seropositive men who have sex with men: Prevalence and predictors of high-risk behaviors. Addictive Behaviors, 24(6), 857–868
Black, D. W., Kehrberg, L. L., Flumerfelt, D. L. & Schlosser, S. S. (1997). Characteristics of 36 subjects reporting compulsive sexual behavior. The American Journal of Psychiatry, 154(2), 243–249
Briken, P., Habermann, N., Berner, W. & Hill, A. (2007). Diagnosis and treatment of sexual addiction: A survey among German sex therapists. Sexual Addiction & Compulsivity: The Journalof Treatment & Prevention, 14(2), 131–143
Callesen, M. B., Weintraub, D., Damholdt, M. F. & Møller, A. (2014). Impulsive and compulsive behaviors among Danish patients with Parkinson’s disease: Prevalence, depression, and personality. Parkinsonism & Related Disorder, 20(1), 22–26
Carnes, P. J. (1989). Sexually addicted families: Clinical use of the circumplex model. In D. H. Olsen, C. S. Russell & D. H. Sprenkle (Eds.), Circumplex model: Systemic assessment andtreatment of families. Binghamton, NY: Haworth
Carnes, P. (1992). Don’t call it love: Recovery from sexual addiction. New York, NY: Bantam
Carnes, P. J. (2001). Out of the shadows: Understanding sexual addiction. 3 rded. Center City, MN: Hazelden
Chavasse, P. H. (1871). Physical life of men and women, or adviceto both sexes. New York, NY: Kessinger
Christenson, G. A., Faber, R. J., De Zwaan, M., Raymond, N. C., Specker, S. M. Ekern, M. D., Mackenzie, T. B., Crosby, R. D., Crow, S. J., Eckert, R. D., et al. (1994). Compulsive buying: Descriptive characteristics and psychiatric comorbidity. The Journal of Clinical Psychiatry, 55(1), 5–11
Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals, 22(6), 320–325
Coleman, E. (2011). Impulsive/compulsive sexual behavior: Assessment and treatment. In J. E. Grant & M. N. Potenza (Eds.), Oxford handbook of impulse control disorders. New York, NY: Oxford University Press
Coleman, E., Raymond, N. & McBean, A. (2003). Assessment and treatment of compulsive sexual behavior. Minnesota Medicine, 86(7), 42–48
Comer, S. D., Sullivan, M. A., Yu, E., Rothenberg, J. L., Kleber, H. D., Kampman, K., Dackis, C. & O’Brien, C. P. (2006). Injectable, sustained-release naltrexone for the treatment of opioid dependence: A randomized, placebo-controlled trial. JAMAPsychiatry, 63(2), 210–218
Cooper, C. A., Jadidian, A., Paggi, M., Romrell, J., Okun, M. S., Rodriguez, R. L. & Fernandez, H. H. (2009). Prevalence of hypersexual behavior in Parkinson’s disease patients: Not restricted to males and dopamine agonist use. International Journalof General Medicine, 2, 57–61
Cooper, A., Putnam, D. E., Planchon, L. A. & Boies, S. C. (1999). Online sexual compulsivity: Getting tangled in the net. Sexual Addiction & Compulsivity : The Journal of Treatment & Prevention, 6(2), 79–104
De Bienville, D. T. (1775). Nymphomania, or a Dissertation concerning the furor uterinus. Translated by Edward Sloane Wilmot. London, England: J. Bew
Dhikav, V., Anand, K. & Aggarwal, N. (2007). Grossly disinhibited sexual behavior in dementia of Alzheimer’s type. Archivesof Sexual Behavior, 36(2), 133–134
Esquirol, E. (1845). Mental maladies; A treatise on insanity. Philadelphia, PA: Lea and Blanchard
Fong, T. W., Reid, R. C. & Parhami, I. (2012). Behavioral addictions: Where to draw the lines? Psychiatric Clinics of North America, 35(2), 279–296
Freimuth, M., Waddell, M., Stannard, J., Kelley, S., Kipper, A., Richardson, A. & Szuromi, I. (2008). Expanding the scope of dual diagnosis and co-addictions: Behavioral addictions. Journalof Groups in Addiction & Recovery, 3(3–4), 137–160
Gadoth, N., Kesler, A., Vainstein, G., Peled, R. & Lavie, P. (2001). Clinical and polysomnographic characteristics of 34 patients with Kleine–Levin syndrome. Journal of Sleep Research, 10(4), 337–341
Goodman, A. (1992). Sexual addiction: Designation and treatment. Journal of Sex & Marital Therapy, 18(4), 303–314
Goodman, A. (1998). Sexual addiction: Diagnosis and treatment. Psychiatric Times, 15(15), 1–9
Grant, J. E. (2008). Impulse control disorders: A clinician’s guide to understanding and treating behavioral addictions. New York, NY: WW Norton & Company
Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Janardhan Reddy, Y. C., Simpson, H. B., Thomsen, P. H., van den Heuvel, O. A., Veale, D., Woods, D. W. & Stein, D. J. (2014). Impulse control disorders and “behavioral addictions” in the ICD-11. World Psychiatry, 13(2), 125–127
Grant, J. E. & Kim, S. W. (2002). An open-label study of naltrexone in the treatment of kleptomania. Journal of Clinical Psychiatry, 63(4), 349–356
Grant, J. E. & Kim, S. W. (2003). Comorbidity of impulse control disorders in pathological gamblers. Acta Psychiatrica Scandinavica, 108(3), 203–207
Grant, J. E., Levine, L., Kim, D. & Potenza, M. N. (2005). Impulse control disorders in adult psychiatric inpatients. The American Journal of Psychiatry, 162(11), 2184–2188
Grant, J. E., Potenza, M. N., Weinstein, A. & Gorelick, D. A. (2010). Introduction to behavioral addictions. The American Journal of Drug and Alcohol Abuse, 36(5), 233–241
Grant, J. E. & Steinberg, M. A. (2005). Compulsive sexual behavior and pathological gambling. Sexual Addiction & Compulsivity:The Journal of Treatment & Prevention, 12(2–3), 235–244
Grant, J. E., Williams, K. A. & Potenza, M. N. (2007). Impulsecontrol disorders in adolescent psychiatric inpatients: Co-occurring disorders and sex differences. Journal of Clinical Psychiatry, 68(10), 1584–1592
Kafka, M. P. (1997). Hypersexual desire in males: An operational definition and clinical implications for males with paraphilias and paraphilia-related disorders. Archives of Sexual Behavior, 26(5), 505–526
Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400
Kafka, M. P. & Hennen, J. (1999). The paraphilia-related disorders: An empirical investigation of nonparaphilic hypersexuality disorders in outpatient males. Journal of Sex & Marital Therapy, 25(4), 305–319
Kalichman, S. C. & Cain, D. (2004). The relationship between indicators of sexual compulsivity and high risk sexual practices among men and women receiving services from a sexually transmitted infection clinic. The Journal of Sex Research, 41(3), 235–241
Kalichman, S. C., Greenberg, J. & Abel, G. G. (1997). HIV-seropositive men who engage in high-risk sexual behaviour: Psychological characteristics and implications for prevention. AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 9(4), 441–450
Kalichman, S. C. & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65(3), 586–601
Kausch, O. (2003). Patterns of substance abuse among treatmentseeking pathological gamblers. Journal of Substance Abuse Treatment, 25(4), 263–270
Kelly, B. C., Bimbi, D. S., Nanin, J. E., Izienicki, H. & Parsons, J. T. (2009). Sexual compulsivity and sexual behaviors among gay and bisexual men and lesbian and bisexual women. Journalof Sex Research, 46(4), 301–308
Kessler, R. C., Borges, G. & Walters, E. E. (1999). Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. JAMA Psychiatry, 56(7), 617–626
Kim, S. W., Grant, J. E., Adson, D. E. & Shin, Y. (2001). Doubleblind naltrexone and placebo comparison study in the treatment of pathological gambling. Biological Psychiatry, 49(11), 914–921
Klein, V., Rettenberger, M. & Briken, P. (in press). Self-reported indicators of hypersexuality and its correlates in a female online sample. The Journal of Sexual Medicine
Kor, A., Fogel, Y. A., Reid, R. C. & Potenza, M. N. (2013). Should hypersexual disorder be classified as an addiction? Sexual Addiction& Compulsivity : The Journal of Treatment & Prevention, 20(1–2), 27–47
Krafft-Ebing, R. (1886). Psychopathia sexualis. Translated by F. J. Rebman. New York, NY: Physicians and Surgeons Book Co.
Levine, M. P. & Troiden, R. R. (1988). The myth of sexual compulsivity. Journal of Sex Research, 25(3), 347–363
McConaghy, N., Armstrong, M. S. & Blaszczynski, A. (1985). Expectancy, covert sensitization and imaginal desensitization in compulsive sexuality. Acta Psychiatrica Scandinavica, 72(2), 176–187
Mendez, M. F., Selwood, A., Mastri, A. R. & Frey, W. H. (1993). Pick’s disease versus Alzheimer’s disease: A comparison of clinical characteristics. Neurology, 43(2), 289
Miner, M. H. & Coleman, E. (2013). Compulsive sexual behavior and its relationship to risky sexual behavior. Sexual Addiction& Compulsivity : The Journal of Treatment & Prevention, 20(1–2), 127–138
Müller, A., Rein, K., Kollei, I., Jacobi, A., Rotter, A., Schütz, P., Hillemacher, T. & De Zwaan, M. (2011). Impulse control disorders in psychiatric inpatients. Psychiatry Research, 188(3), 434–438
Odlaug, B. L. & Grant, J. E. (2010). Impulse-control disorders in a college sample: Results from the self-administered Minnesota Impulse Disorders Interview (MIDI). Primary Care Companionto the Journal of Clinical Psychiatry, 12(2)
Odlaug, B. L., Lust, K., Schreiber, L. R., Christenson, G., Derbyshire, K., Harvanko, A., Golden, D. & Grant, J. E. (2013). Compulsive sexual behavior in young adults. Annals of Clinical Psychiatry, 25(3), 193–200
Pachankis, J. E., Rendina, H. J., Ventuneac, A., Grov, C. & Parsons, J. T. (2014). The role of maladaptive cognitions in hypersexuality among highly sexually active gay and bisexual men. Archivesof Sexual Behavior, 43(4), 669–683
Raymond, N. C., Coleman, E. & Miner, M. H. (2003). Psychiatric comorbidity and compulsive/impulsive traits in compulsive sexual behavior. Comprehensive Psychiatry, 44(5), 370–380
Raymond, N. C., Grant, J. E. & Coleman, E. (2010). Augmentation with naltrexone to treat compulsive sexual behavior: A case series. Annals of Clinical Psychiatry. 22(1), 55–62
Reid, R. C., Bramen, J. E., Anderson, A. & Cohen, M. S. (2014). Mindfulness, emotional dysregulation, impulsivity, and stress proneness among hypersexual patients. Journal of Clinical Psychology, 70(4), 313–321
Reid, R. C., Carpenter, B. N., Hook, J. N., Garos, S., Manning, J. C., Gilliand, R., Cooper, E. B., McKittrick, H., Davtian, M. & Fong, T. (2012). Report of findings in a DSM-5 field trial for hypersexual disorder. The Journal of Sexual Medicine, 9(11), 2868–2877
Reid, R. C., Carpenter, B. N. & Lloyd, T. Q. (2009). Assessing psychological symptom patterns of patients seeking help for hypersexual behavior. Sexual and Relationship Therapy, 24(1), 47–63
Reid, R. C., Dhuffar, M. K., Parhami, I. & Fong, T. W. (2012). Exploring facets of personality in a patient sample of hypersexual women compared with hypersexual men. Journal of Psychiatric Practice, 18(4), 262–268
Reid, R. C., Garos, S. & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the hypersexual behavior inventory in an outpatient sample of men. Sexual Addiction &Compulsivity: The Journal of Treatment & Prevention, 18(1), 30–51
Ross, M. W., Månsson, S. A. & Daneback, K. (2012). Prevalence, severity, and correlates of problematic sexual internet use in Swedish men and women. Archives of Sexual Behavior, 41(2), 459–466
Sbraga, T. P. & O’Donohue, W. T. (2003). The sex addiction workbook. Proven strategies to help you regain control of your life. Oakland, Canada: New Harbinger
Scanavino, M. D. T., Ventuneac, A., Abdo, C. H. N., Tavares, H., Amaral, M. L. S. A. D., Messina, B., dos Reis, S. C., Martins, J. P. & Parsons, J. T. (2013). Compulsive sexual behavior and psychopathology among treatment-seeking men in São Paulo, Brazil. Psychiatry Research, 209(3), 518–524
Schneider, J. P. & Schneider, B. H. (1996). Couple recovery from sexual addiction/co addiction: Results of a survey of 88 marriages. Sexual Addiction & Compulsivity: The Journal of Treatment& Prevention, 3(2), 111–126
Schreiber, L. R. N., Odlaug, B. L. & Grant, J. E. (2011). Compulsive Sexual Behavior: Phenomenology and Epidemiology. In J. E. Grant & M. N. Potenza (Eds.), The Oxford handbook ofimpulse control disorders. New York: Oxford University Press
Seegers, J. A. (2003). The prevalence of sexual addiction symptoms on the college campus. Sexual Addiction & Compulsivity:The Journal of Treatment & Prevention, 10(4), 247–258
Showalter, E. (1980). Victorian women and insanity. Victorian Studies, 23(2), 157–181
Smith, S. (2007). Drugs that cause sexual dysfunction. Psychiatry, 6(3), 111–114
US Department of Health and Human Services. (2013). Child Maltreatment 2012
Valleroy, L. A., MacKellar, D. A., Karon, M., Rosen, D. H., McFarland, W., Shehan, D. A., Stoyanoff, S. R., LaLota, M., Celentano, D. D., Koblin, B. A., Thiede, H., Katz, M. H., Torian, L. V. & Janssen, R. S. (2000). HIV prevalence and associated risks in young men who have sex with men. The Journal of the American Medical Association, 284(2), 198–204
Volpicelli, J. R., Alterman, A. I., Hayashida, M. & O’Brien, C. P. (1992). Naltrexone in the treatment of alcohol dependence. JAMA Psychiatry, 49(11), 876–880
Wainberg, M. L., Muench, F., Morgenstern, J., Hollander, E., Irwin, T. W., Parsons, J. T., Allen, A. & O’Leary, A. (2006). A double-blind study of citalopram versus placebo in the treatment of compulsive sexual behaviors in gay and bisexual men. The Journal of Clinical Psychiatry, 67(12), 1968–1973
Wines, D. (1997). Exploring the applicability of criteria for substance dependence to sexual addiction. Sexual Addiction &Compulsivity: The Journal of Treatment & Prevention, 4(3), 195–220