Sexual Health

Signs of Sex Addiction and How to Treat It

Sex addiction is defined as the compulsive need to engage in sexual behaviors. It leads to relationship problems, mental health issues, risk-taking behaviors, a compulsive need to masturbate, view pornography, and engage in both partnered and unpartnered sex.

Sex Addiction: A Challenging Diagnosis

The diagnosis of sex addiction is controversial since it has been excluded from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). However, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) has a diagnostic category, “other sexual dysfunction not due to a substance or known physiological condition,” that includes sex addiction and related disorders.

More recently, the ICD-11 published by the World Health Organization (WHO) officially added “compulsive sexual behavior disorder.” The ICD-11 is scheduled to take effect in the U.S. in January 2022. ICD has traditionally been used as an administrative tool for resource allocation, not a diagnostic aid. However, research funding depends on the classifications within it.

The WHO put compulsive sexual behavior disorder in the category “impulse control disorder” instead of mental health disorder. The classification is controversial. Addiction is a term that is applied for other behavioral disorders such as eating disorders, internet gaming, and pathological gambling. In these disorders, there are also no clear diagnostic criteria.

Gambling disorder is classified under both addictive behaviors and Impulse control disorders. This classification has led many to believe that the classification of sexual behavior disorder will evolve over time.

When defining obsessive sexual behavior disorder, experts are referring to non-paraphilic behaviors (excessive engagement in common sexual activities), which include activities such as attending strip clubs, dependence on phone and chat-room sex, compulsive masturbation, paying for sex through prostitution, excessive use of pornography, and repeated engagement in extramarital affairs.

A lack of clarity on the diagnosis of sex addiction makes it harder to define its potential, causes, symptoms, and treatment.

Causes of Sex Addiction

The American Psychiatric Association describes addiction as a condition that causes “changes in the areas of the brain that relate to judgment, decision making, learning, memory, and behavior control.” There is still much controversy about whether sex addiction can properly be labeled an addiction. The wide range of potential sexual behaviors that can become compulsive makes it difficult to define compulsive sexual behavior disorder. ICD-11 is a first step towards that definition and can lead to research that will help determine the causes of compulsive sexual behavior disorder.

Symptoms of Sex Addiction

According to the WHO ICD-11 definition of compulsive sexual behavior disorder, symptoms include:

“A persistent pattern of failure to control intense, repetitive impulses or urges resulting in repetitive sexual behavior.”
“Repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities.”
Engaging in “numerous unsuccessful efforts to significantly reduce repetitive sexual behavior.”
Engaging in “repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it.”
“The failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., six months or more) and causes marked distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

According to Dr. Patrick Carnes, other symptoms associated with sex addiction include:

An increased incidence of anxiety or depression
Relationship problems
Preoccupation or obsessive thoughts about one’s sexual behavior
Inability to stop sexual behaviors even at the expense of relationships and other costs
Failure to resist impulses to engage in a specific sexual behavior
Has a long-standing desire or history of attempts to stop or control sexual behavior
Sexual behavior precludes fulfilling occupational, academic, domestic, or social obligations

It is important to note that people with high sexual interest and behavior who do not have impaired control over their behavior, significant distress, or impairment in functioning should not be assigned this diagnosis.

Other Exclusions:

Bipolar Disorder

Individuals with compulsive sex addiction commonly have a coexisting diagnosis of bipolar disorder. Sexual behaviors must be persistent and occur independently of hypomanic or manic episodes to meet the criteria for obsessive sexual behavior disorder.

Moral Distress

To meet the “significant distress” criterion for compulsive sexual behavior, distress cannot be from perceived moral judgment or disapproval about sexual impulses. This criterion excludes labeling people as having compulsive sexual behavior disorder because their sexual identity is different than the person labeling them.

Self-identification

Self-identifying as a porn addict or engaging in an excessive frequency of masturbation behavior does not meet the criteria for this disorder. Many people who self-identify as “sex addicts” may have symptoms of anxiety or depression.

Paraphilic Disorders

All paraphilic disorders (behaviors that deviate from the norm) such as pedophilia, exhibitionism, sexual masochism, sexual sadism, fetishism, and voyeurism are excluded from the diagnosis.

Other Explanations

The diagnosis of compulsive sexual behavior disorder should not be made if there are other potential explanations for sexual behavior, including medical conditions such as dementia or the effects of medications or drugs, whether being used to treat conditions such as Parkinson’s disease or use of illicit substances.

The Effects of Sex Addiction

Compulsive sexual behavior by definition means engaging in behavior that causes distress, that you want to stop and feel unable to control. Sexual addiction and compulsive sexual thought can have both physical and mental health impacts.

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Physical Health

When people struggle with behaviors they cannot control and that cause them distress, in addition to the toll on mental health, there is typically an impact on physical health as well. Drug and alcohol use to self-treat mental health disorders can lead to an increase in suicidal and risk-taking behaviors.

Risk-taking behaviors can increase the incidence of sexually transmitted infections such as HIV, genital herpes, HPV, syphilis, gonorrhea, and chlamydia.

Mental Health

Compulsive behavior that causes distress and is difficult to control can cause chronic low self-esteem, shame, self-hatred, hopelessness, despair, anxiety, loneliness, and moral conflict.

Shame and moral conflict can lead to relationship problems. Compulsive sexual behavior can lead to engaging in multiple affairs and having multiple sexual partners, which can cause significant relationship issues, including a lack of intimacy.

Read More: Acts of Intimacy Outside of Sex

Treatments for Sex Addiction

As you can imagine, when there is not a well-defined diagnosis for a disorder, it isn’t easy to research the condition and develop evidence-based treatment options. With that said, many inpatient and outpatient programs offer programs for people attempting to recover from sex addiction.

Therapy

Cognitive-behavioral therapy is one of the most frequently used forms of psychotherapy. It is used to treat many mental health conditions. Cognitive-behavioral therapists help people living with sex addiction learn more about their triggers for their behavior, and better control them.

Behaviors that potentially trigger the reward circuitry in the brain can lead to a loss of control and other symptoms of addiction. Sex Addicts Anonymous, Sex and Love Addicts Anonymous, and Sexaholics Anonymous are modeled after the 12-step therapy and practice.

Medication

Selective serotonin reuptake inhibitors (SSRIs) have been tried to treat compulsive behavior in both paraphilic and non-paraphilic disorders. SSRIs may decrease urges and preoccupation with sexual addiction. People with anxiety or depression as a comorbid disorder tend to respond best to these medications.

Mood stabilizers are used to treat symptoms of bipolar disorder, another common comorbid condition. These medications may also help reduce compulsive sexual urges.

Naltrexone, an opiate antagonist, has also been tried for its effect on the reward pathway. It is commonly used to treat substance abuse and pathological gambling.

Anti-androgen medications such as medroxyprogesterone or cyproterone acetate lower testosterone levels and have also been used to reduce sexual urges, sex drive, and aggressive sexual behavior. Though these medications have been used off-label to treat obsessive sexual behavior disorder, no medication has been approved by the Food and Drug Administration (FDA) to treat sex addiction.

Lifestyle Changes

As internet gaming, eating disorders, and other behavioral disorders are becoming better defined, sex addiction is likely to as well. In the meantime, like most medical conditions, the first step towards effective treatment is recognizing the problem and trying to optimize your overall health. Diet and exercise will not cure compulsive sexual behavior, but they may be a healthy distraction that can help you cope.

Before the more explicit definition in ICD-11, patterns of sexual behavior consistent with compulsive sexual behavior disorder were estimated to affect 3% to 6% of adults. More recent studies have put the number closer to 1% to 3%. The more restrictive definition in ICD-11 is expected to produce lower prevalence numbers.

While a better definition can lead to more research and a better understanding of sex addiction, it is not helpful to people who live with this condition or other compulsive behavioral disorders. The underlying problem in all of these disorders is a continued engagement in activities despite the negative consequences of these actions.

DISCLAIMER

While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.

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