Sex Addiction, Hypersexuality and Compulsive Sexual Behavior

What is sexual addiction?

Sexual addiction is an intense focus on sexual fantasies, urges or activities that can’t be controlled and cause distress or harm your health, relationships, career or other aspects of your life. Sexual addiction is the most commonly used lay term. You may hear healthcare professionals call this compulsive sexual behavior, problematic sexual behavior, hypersexuality, hypersexuality disorder, sexual compulsivity or sexual impulsivity.

Although sex addiction involves activities that can be common to a sex life — such as masturbation, pornography, phone sex, cybersex, multiple partners and more — it’s when your sexual thoughts and activities consume your life that you may be considered to have a sexual addiction.

Is a sex addiction similar to other addictions?

Yes. The “addiction feeling” is what makes it similar. The craving for sex is similar to cravings felt for alcohol or drugs by those who have addictions to these substances. It’s an overwhelming compulsion or temptation that’s so strong you feel that you have to have it. It’s an out-of-control feeling, never feeling satisfied feeling or a constant battle to take control of something that’s on autopilot. You return to the behavior — over and over again — despite the negative consequences.

How common is sexual addiction and who is most affected?

Hypersexuality appears to affect about 3% to 10% of the general U.S. population. It’s more common in men than women. For every two to five males with hypersexuality, one woman is affected. Sexual addiction begins, on average, at 18 years of age. Most individuals don’t reach out for professional help until age 37.

Many individuals (88%) have a history of other mental health conditions, too, including:

• Mood disorders, including bipolar disorder.
• Anxiety disorders.
• History of suicide attempts.
• Personality disorders.
• Other addictive disorders.
• Impulse control disorders.
• Obsessive-compulsive disorder (OCD).
• Attention deficit hyperactivity disorder (ADHD).

Is sex addiction or hypersexuality considered a mental health disorder?

Debate is ongoing if hypersexuality can be classified as a mental health disorder. The American Psychiatric Association rejected a proposal to include hypersexual disorder as a condition in DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition), their manual for assessing and diagnosing mental health conditions. Their reason was lack of evidence and the potential consequences of calling excessive sexual activity a “pathology” (calling it a disease or disorder).

What does a sexual addict think or feel about their sexual obsession?

A sex addict may feel:

• Guilt, shame or remorse.
• Hopelessness, powerless over the addictive behavior.
• Depressed, lonely.
• Fearful, anxious.
• Suicidal.

What are the signs and symptoms of sexual addiction or hypersexuality?

Although there’s no established criteria for hypersexuality, traits that are commonly seen in a hypersexual person or sexual addict include:

• You’re obsessed with sex. You spend a lot of time fantasizing about your sexual urges and engaging in sexual behavior.
• You masturbate often (once to several times daily).
• You frequently view pornography. Sources include videos, adult magazines, the internet (websites, webcams). You often masturbate while viewing pornography.
• You spend an excessive amount of time planning sexual activity. You spend a lot of time figuring out where and how you’ll get your next sexual “high.”
• You frequently use sexual services. This is a step up, in that your activities now involve human interaction. Behaviors could include phone sex, connections made through internet chat rooms, paying for sexual encounters, visits to strip clubs, having multiple partners or frequent one-night stands.
• Your behavior escalates to reckless sexual activity. You may add substance abuse to your sexual activity or add sexual aggression or dangerous sexual activity (such as autoerotic asphyxiation) to your behaviors.
• You engage in sexual behaviors that go against your personal values, religious beliefs or what society deems appropriate.
• You frequently engage in paraphilia. These are sexual behaviors that involve another person’s psychological distress, injury or death. Examples include exhibitionism (exposing genitals to strangers), voyeurism (watching or engaging in sexual activities with others), sadomasochism (sexual pleasure from inflicting pain or humiliation on others) and pedophilia (sexual feelings toward children).
• You can’t stop your sexual behavior despite negative consequences to your finances, relationships, health or emotions.

What are the complications of having a sexual addition or hypersexuality?

Complications of sexual addiction include:

• Lack of a normal, healthy relationship with your sexual partner and your family.
• Downward work performance and career loss from an inability to focus on work or watching pornography at work.
• Money problems stemming from paying for sexual activities.
• Health consequences, including pregnancy and sexually transmitted infections (STIs), such as HIV, hepatitis B and C, syphilis or gonorrhea.
• Use of recreational drugs or drinking an excessive amount of alcohol.
• Development of mental health conditions, such as stress and anxiety, depression or thoughts of suicide.
• Potential jail or prison time for sexual offenses.
• Emotional costs including guilt, shame and hopelessness.

What causes sexual addiction or hypersexuality?

Scientists aren’t totally sure what causes hypersexuality. Possible theories include:

• Imbalance of mood chemicals in your brain. High levels or overactivity of certain chemicals in your brain called neurotransmitters (dopamine, norepinephrine and serotonin) might result in increased sexual desire and behavior.
• Conditions that affect or damage areas of your brain that control sexual behavior. Conditions such as dementia, epilepsy, bipolar disorder and damage to your frontal lobe, amygdala or prefrontal cortex areas of your brain may contribute to hypersexuality.
• Altered brain function that creates new nerve pathways of addictive behavior.
• Substance abuse, particularly cocaine and amphetamine use and alcohol.
• Adverse effect of medication. One example is levodopa, a common medication used in Parkinson’s disease.

How is hypersexuality diagnosed?

Your healthcare professional or mental health professional may ask you about your:

• Current health, existing health conditions, family medical history, current medications, supplements and herbal products.
• Use of recreational drugs and alcohol.
• Sexual thoughts, urges and behaviors, and level of control you feel you have over them, as well as other sexual symptoms (see Symptoms and Causes section).

Your healthcare provider may ask for your permission to talk with your family and friends to gain more input.

Your healthcare provider may also want to rule out other conditions for which hypersexuality may be a symptom, such as bipolar disorder (manic episode), hyperandrogenism, anxiety, personality disorder, obsessive-compulsive disorder and Tourette’s disorder.

At present, there isn’t an agreed diagnostic criteria for hypersexuality. Despite this, mental health professionals skilled in addiction disorders will recognize life-consuming sexual behaviors and can offer appropriate treatment options.

How is sexual addiction, hypersexuality, treated?

Sexual addiction, or hypersexuality, is treated with a combination of medications, psychotherapy and self-help group therapy.

Medications

No medication is specifically approved to treat sexual addiction. However, medications that act on your brain’s “urge and behavior” hormones and chemicals and that are prescribed for similar medical conditions can be tried. Your healthcare provider will prescribe medications that are best suited for you, considering any other mental health conditions you may have.

• Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatment for sexual addiction.
• Anti-androgens. These medications target male sex hormones. They’re useful in reducing obsessive thoughts. They might be tried in extreme cases of sexual acting out, when behaviors are dangerous to others.
• Naltrexone (Vivitrol®, Revia®). This drug, used to treat alcohol and opioid addiction, has been shown to be helpful in treating gambling addiction and may be helpful for sex addiction.
• Mood stabilizers. These drugs may be useful if you have bipolar disorder with manic or impulsive features and when hypersexuality is a feature. Some examples include lithium, valproate (Depakote®) and carbamazepine (Tegretol®).
• Anti-anxiety medications. These drugs may be tried if sexual behavior is triggered by anxiety. Buspirone is one example that may be helpful.
• Other medications. Antipsychotics may be considered when thought disorders or severe agitation are prominent features. These medications can reduce sexual desire, arousal and orgasm. If you have attention deficit hyperactivity disorder (which is linked to sexual risk taking), methylphenidate and dextroamphetamine may be a useful choice.

Psychotherapy

Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who’ll help you identify and manage factors that might be triggering your hypersexuality behaviors. Psychotherapy is provided to individuals, as well as to families and couples, since all are affected by an individual’s sexual addiction.

• Cognitive behavioral therapy. This type of psychotherapy focuses on replacing negative thoughts and behaviors with other ways to better cope and reduce the impulse to have sex.
• Acceptance and commitment therapy. This psychotherapy uses acceptance and mindfulness strategies. Its goal is for individuals to accept distress and to change the relationship with their thoughts rather than changing the thoughts themselves.
• Motivational interviewing. This psychotherapy guides individuals through the process of exploring their sexual addiction in the context of your personal goals and values.

Self-help support groups

These are modeled after the 12-step program of Alcoholics Anonymous. A few of these groups include: Sex Anonymous, Sexaholics Anonymous, Sex Addicts Anonymous, Sex and Love Addicts Anonymous, and Sexual Compulsives Anonymous. Check the websites of these organizations to find local chapters near you.

Can sexual addiction or hypersexuality be prevented?

Whether or not sexual addiction can be prevented depends on the underlying cause(s). Sometimes, there’s a chemical imbalance in your brain. Or, another health condition’s side effect or symptom is hypersexuality. There are many factors that come into play in the development or appearance of a sexual addiction.

But even if you can’t control all the factors, you can take some control of some things that might escalate your thoughts, urges, desires and actions. These include:

• Learn about sexual addiction or hypersexuality. You’re taking your first step now by reading this article! See your healthcare professional or mental healthcare professional. They’re here to help you, beginning with education.
• Change triggers that you know tempt you. Block pornography internet sites and other sex sites on your computer. Drive a different route to avoid strip clubs. Think about other changes you can make.
• Get help for substance abuse problems. If you abuse alcohol or recreational drugs, you reduce your chance of resisting your sexual urges. Ask your healthcare provider for help in quitting these substances.
• Make sure other mental health conditions are well managed. If you have other mental health conditions, such as depression, anxiety or bipolar disorder, make sure you’re following all of your doctor’s instructions for managing these conditions. If you think your condition has changed, make an appointment and see your healthcare provider.
• Channel your energy to healthy choices. Redirecting your body can redirect and distract your mind. Get busy. Engage in sports, join clubs, take up a hobby, become a volunteer for organizations that help others, exercise, try meditation or yoga or other stress-reduction methods.
• Be patient and stay focused on your goal. Managing sexual addiction is a life-long commitment. It’s up to you to stay focused on the most important things in your life and to maintain or repair damaged relationships. You can do this. Your entire healthcare team is ready to help you. Choose to let them.

What outcome can I expect if I’m a sex addict?

Although there isn’t a cure for sex addiction, if you recognize it and want to end your excessive thoughts, desires, urges and behaviors, it can be effectively managed. It requires your life-long commitment, just as it would for other types of addictions.

How might I know if I have a sexual addiction?

Does your sexual behavior cause you distress or interfere with important areas of functioning? Do you:

• Lose sleep due to sexual thoughts or actions?
• Arrive late to work?
• Ignore obligations?
• Lie or keep secrets from family?
• Need more or more extreme sexual activities to achieve the same level of excitement or sexual relief?
• Does your sexual desire cause you to do sexual activities that involve people or places you wouldn’t ordinarily choose?
• Does pornography take up a great deal of your awake time?
• Does your sexual behavior cause you or could cause you legal problems or financial loss?
• Do your sexual fantasies, urges or behaviors consume you mentally, emotionally and/or physically?
• Does your sexual behavior conflict with your personal values, religious or moral beliefs?
• Do you feel shame, regret, hopelessness, guilt, loneliness or suicidal after your sexual behavior?

If you answer YES to any of these questions, you may want to make an appointment with your healthcare provider. They might refer you to a psychologist or psychiatrist for additional help. If you have suicidal thoughts, call your healthcare provider right away or call the Suicide and Crisis Lifeline at 988.

Is there a link between sexual addiction and depression?

There may be. There may be an increase in hypersexual behavior during periods of depressed moods. Symptoms of depression may respond to antidepressant medications.

A note from Cleveland Clinic

If your sexual appetite and activities are causing you distress, consuming your life and causing harm to your personal, professional and/or family life, it’s time to talk with your healthcare professional. Many people don’t seek care because they’re ashamed or feel guilty. Your healthcare team makes no judgment about your sexual behavior. They’re here to help you. The best outcome will be reached if you’re honest and open with everyone — your family, your partner, your medical team and most importantly, yourself. Many treatment options are available to help you.