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Compulsive sexual behavior - Diagnosis and treatment
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Diagnosis
Your doctor or other mental health professional can do a psychological evaluation, which may involve answering questions about your:
- Physical and mental health, as well as your overall emotional well-being
- Sexual thoughts, behaviors and compulsions that are hard to control
- Use of recreational drugs and alcohol
- Family, relationships and social situation
- Problems caused by your sexual behavior
With your permission, your mental health professional may also request input from family and friends.
Determining a diagnosis
There's an ongoing debate in the psychiatric community about exactly how to define compulsive sexual behavior because it's not always easy to determine when sexual behavior becomes problematic.
Many mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, as a guide for diagnosing mental health problems. Because compulsive sexual behavior doesn't have its own diagnostic category in the DSM-5, it may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder or a behavioral addiction.
Some mental health professionals consider compulsive sexual behaviors as sexual activities taken to an extreme with significant and negative consequences. Although more research is needed to clarify and classify all the criteria, diagnosis and treatment by a mental health professional who has expertise in addictions and compulsive sexual behaviors will likely yield the best results.
Treatment
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.
If you have compulsive sexual behavior, you may also need treatment for another mental health condition. People with compulsive sexual behavior often have alcohol or drug abuse problems or other mental health problems, such as anxiety or depression, which need treatment.
People with other addictions or 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.
Psychotherapy
Psychotherapy, also called talk therapy, can help you learn how to manage your compulsive sexual behavior. Types of psychotherapy include:
- Cognitive behavioral therapy (CBT), which helps you identify unhealthy, negative beliefs and behaviors and replace them with more adaptive ways of coping. You learn strategies to make these behaviors less private and interfere with being able to access sexual content so easily.
- Acceptance and commitment therapy, which is a form of CBT that emphasizes acceptance of thoughts and urges and a commitment to strategies to choose actions that are more consistent with important values.
- Psychodynamic psychotherapy, which is therapy that focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts.
These therapies can be provided in an individual, group, family or couples format.
Medications
In addition to psychotherapy, certain medications may help because they act on brain chemicals linked to obsessive thoughts and behaviors, reduce the chemical "rewards" these behaviors provide when you act on them, or reduce sexual urges. Which medication or medications are best for you depend on your situation and other mental health conditions you may have.
Medications used to treat compulsive sexual behavior are often prescribed primarily for other conditions. Examples include:
- Antidepressants. Certain types of antidepressants used to treat depression, anxiety or obsessive-compulsive disorder may help with compulsive sexual behavior.
- Naltrexone. Naltrexone (Vivitrol) is generally used to treat alcohol and opiate dependence and blocks the part of your brain that feels pleasure with certain addictive behaviors. It may help with behavioral addictions such as compulsive sexual behavior or gambling disorder.
- Mood stabilizers. These medications are generally used to treat bipolar disorder, but may reduce compulsive sexual urges.
- Anti-androgens. These medications reduce the biological effects of sex hormones (androgens) in men. Because they reduce sexual urges, anti-androgens are often used in men whose compulsive sexual behavior is dangerous to others.
Self-help groups
Self-help and support groups can be helpful for people with compulsive sexual behavior and for dealing with some of the issues it can cause. Many groups are modeled after the 12-step program of Alcoholics Anonymous (AA).
These groups can help you:
- Learn about your disorder
- Find support and understanding of your condition
- Identify additional treatment options, coping behaviors and resources
- Help with relapse prevention
These groups may be internet-based or have local in-person meetings, or both. If you're interested in a self-help group, look for one that has a good reputation and that makes you feel comfortable. Such groups don't suit everyone's taste. Ask your mental health professional for suggested groups or about alternatives to support groups.
Coping and support
You can take steps to care for yourself while getting professional treatment:
- Stick to your treatment plan. Attend scheduled therapy sessions and take medications as directed. Remember that it's hard work, and 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 behaviors. Set up boundaries to avoid your unique risk situations. For example, stay away from strip clubs, bars or other areas where it might be tempting to look for a new sexual partner or engage in risky sexual behavior. Or stay off the computer or install software that blocks pornographic websites. Making these behaviors less private and more difficult to engage in can be helpful in breaking the addictive cycle.
- 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. If you use sexual behavior as a way to cope with negative emotions, explore healthy ways to cope, such as through exercise and recreational activities.
- Practice relaxation and stress management. Try stress-reduction techniques such 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.
Preparing for your appointment
You can seek help for compulsive sexual behavior in several ways. To begin, you may:
- Talk to your primary care doctor. Your doctor can do a thorough physical exam to look for any health problems that may be linked to your sexual behavior. Your doctor may refer you to a psychiatrist, psychologist or other mental health professional for a more in-depth exam and treatment. Your doctor may also provide you with information about support groups, websites or other resources.
- Make an appointment with a mental health professional. If you don't have a doctor's recommendation, check with a local medical center or mental health services to find a psychiatrist, psychologist or other mental health professional with experience in sexual behavior issues. Or look at credible websites online, or check your phone book. Government websites and local agencies such as the Department of Health and Human Services or the Department of Veterans Affairs may be able to help you find a mental health professional.
- Look into reputable online or local support groups. These groups may be able to refer you to an appropriate mental health professional for diagnosis and treatment as well as provide other recommendations and support online or in person. Some groups are faith-based, and others are not.
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment, prepare the following information:
- Notes about your behavior, including when and how often it occurs, what seems to trigger it or make it worse, or what things have been helpful to resist the urges
- Legal, employment or relationship problems caused by your behavior
- Any other mental health issues you have, whether diagnosed or not, such as depression or anxiety, that may also need treatment
- An honest look at your substance use — be ready to discuss this with your doctor
- Key personal information, including any recent or past traumatic events, current stresses and recent life changes
- All medications, vitamins, herbs or other supplements that you're taking, and the dosages
- Questions to ask your doctor or mental health professional to help you make the most of your time together
Some questions to ask may include:
- Why am I doing these things even when it makes me feel bad?
- How can I better manage my persistent, intense sexual urges?
- What type of treatment might help in my case?
- Would a support group or a 12-step program be helpful for me?
What to expect from your doctor
Be ready to answer questions from your doctor, such as:
- When did you first begin noticing harmful sexual behavior or desires?
- Have your behaviors caused legal, relationship or employment problems, or major distress in your daily life?
- Does your behavior feel like it's getting more extreme or out of control?
- What, if anything, seems to lessen your sexual urges?
- What appears to increase your sexual urges?
- Have you ever caused or been the victim of physical, emotional or sexual abuse?
- Has your behavior hurt you or others in the past? Are you afraid it may hurt you or others in the future?
- What other mental health conditions do you have?
- Do you drink alcohol or use illegal drugs?
Credit: Mayo Clinic