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What is Compulsive Sexual Behavior? Causes, Diagnosis and Treatment

A person suffers from compulsive sexual behavior when they have recurrent and excessive sexual fantasies and anxiety regarding sex-related behaviors. This results in impulsiveness that the patient has a hard time controlling.

Although some mental health professionals are reluctant to accept this as a disorder in itself, most consider it to be an addiction. It’s also known as hypersexuality, hypersexuality disorder, or sex addiction.

Experts don’t know for sure how many people in the world suffer from compulsive sexual behavior. Some vague estimates in developed countries state that up to 5% of the general population suffers from it.

However, we should mention that this disorder is hard to quantify because the data is subjective. In other words, no laboratory test or diagnostic imaging can confirm that a person suffers from this condition.

Diagnostic criteria for compulsive sexual behavior or hypersexuality

Experts established a series of criteria to guide the diagnosis and establish the presence of this condition. Firstly, the patient must be over 18 years of age.

Secondly, the symptoms must be present for at least six months and consist of the recurrence of intense sexual fantasies and excessive sexual desire. This implies that the person spends a lot of their time immersed in fantasies, in addition to planning and executing them.

This isn’t just any sexual fantasy someone might have. The addiction criterion implies that the person starts neglecting important aspects of their life due to their sexual behavior. Their hypersexuality can affect their social and family relationships, as well as their job.

Another diagnostic criterium is that no drug the patient has taken can explain the fantasies. In addition, the person may have tried and failed to control their impulses.

Ultimately, a mental health professional will be the one to diagnose the patient. It’s not just about seeing if they “fall into the criteria”. The expert must evaluate the patient rigorously to determine the degree of severity.

The possible causes of compulsive sexual behavior

The etiology of compulsive sexual behavior remains unclear. Nevertheless, everything seems to indicate that the origin of the disorder lies in the brain and its neurotransmitters. A change in neurotransmitter amounts or an alteration in the neural pathways could be behind hypersexuality.

The first hypothesis posits that there’s an imbalance between dopamine, serotonin, and also norepinephrine in the brain. All three substances powerfully regulate mood at all times, and any minimal change could lead to this behavior.

Another theory is that sexual fantasies extremely stimulate the brain’s reward circuits. The daily reinforcement of this satisfaction would be channeled in the same way that other addictions develop, to the point of even producing tolerance. As such, increasingly more of the stimulus is needed to produce the same effect.

Some of the secondary causes are diseases that alter brain architecture. Epileptic, vascular dementia or Parkinson’s patients can suffer from compulsive sexual behavior.


This disorder isn’t easy to treat, as it usually requires a combination of drugs and psychotherapy. Mental health professionals guide the treatment protocols.

Depending on the specific case, they can resort to cognitive-behavioral or psychodynamic therapies. The mental health professional should try to provide the person with tools that help them manage their recurring fantasies so they don’t neglect other aspects of their daily life.

Cognitive-behavioral therapy emphasizes limiting access to sexual content and developing strategies to avoid risky situations. It may prove helpful for patients to go to support groups with other people who suffer from the same condition.

Regarding the drugs for compulsive sexual behavior, the therapeutic options are based on antidepressants and two other drugs:

  • Antiandrogens. These drugs are prescribed to men to block the action of androgens, which are natural male sex hormones.
  • Naltrexone. This substance is mostly used for alcohol and morphine addiction. However, due to its ability to act on reward circuits, it’s also used for other addictions.

Compulsive sexual behavior is an addiction

In short, although experts are still discussing and studying this, most consider compulsive sexual behavior addictive. Hypersexuality disrupts the daily lives of patients and puts their social fabric, including family, friends, and work, at risk. It’s essential for these patients to get professional help so their behavior doesn’t end up isolating them.

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