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Compulsive sexual behavior
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What Causes CSB?

Disagreement exists as to whether CSB is an addiction, a psychosexual development disorder, an impulse control disorder, a mood disorder, or an obsessive-compulsive disorder. Patrick Carnes (4) popularized the concept of CSB as & addiction. He believes that people become addicted to sex in the same way they become addicted to substances or behaviors. However, many dispute the idea that you can become addicted to sex in the same way that someone becomes addicted to alcohol or sex. Despite this criticism, sexual addiction has become a poplar metaphor similar to "workaholism." Twelve-step programs of spiritual recovery (similar to Alcoholics Anonymous) have become popular solutions to those who view CSB as an addiction. However, the "abstinence model" useful for alcoholics, cannot be applied to sexuality since sexual expression is a basic need of life. Critics view the abstinence solution as an oversimplification of CSB & potentially dangerous when proper medical & psychological treatment is not provided. Different explanations have been given as causes of CSB. Robert Stoller (5) was a strong advocate of psychodynamic factors. His theories have been helpful to our understanding of inner conflicts which fuel obsessive & compulsive drives. Others have suggested factors of anxiety, mood & personality disorders. In some cases, CSB can result from a bipolar mood disorder. In other cases, CSB can be caused by a neurological disorder such as epilepsy or Alzheimer's. John Money has assisted us to understand the complex interplay of biological, psychological & environmental factors in CSB. CSB in some cases may be caused by irregular chemical functions in the brain which produce repetitious nature of the self-defeating behavior. In this model, CSB is driven by anxiety where certain sexual behaviors provide temporary relief of the anxiety but is followed by further anxiety & distress - creating a self-perpetuating cycle.(6) Since CSB is such a complex disorder involving biological, psychological & social factors, a careful assessment by a well trained professional is necessary. Because of disagreements in theoretical approaches, the lay person should ask the professional about his/her own theories on CSB & consider other professional opinions.

Treatment of CSB

While disagreement exists about the nature of CSB, treatment professionals have generally found a combination of psychotherapy & prescription drugs to be effective in treating CSB. While medications which suppress the production of male hormones (anti-androgens) are used to treat a variety of paraphilic disorders, newer anti-depressants such as Prozac (®), Zoloft(®) or Paxil(®) which selectively act on serotonin levels in the brain are also effective in reducing sexual obsessions & compulsions & their associated levels of anxiety & depression. These newer medications interrupt the obsessive-compulsive cycle of CSB & help patients use therapy more effectively. The advantages of these anti-depressants over older anti-depressants or anti-androgens are their broad efficacy & relatively few known side effects.

How Does One Know if He/She Needs Help Regarding CSB?

The following questions are examples of those used in assessing & treating CSB:

1. Do you, or others who know you, find that you are overly preoccupied or obsessed with sexual activity?

2. Do you find yourself compelled to engage in sexual activity in response to stress, anxiety, or depression?

3. Have serious problems developed as a result of your sexual behavior (e.g., loss of a job or relationship, sexually transmitted diseases, injuries or illnesses, or sexual offenses)?

How Does Someone Find a Professional Who Has the Expertise in Assessment & Treatment of CSB?

There are several ways to find qualified professionals.

  • Call your state licensing boards for psychologists, psychiatrists, social workers, or marriage & family therapists who have a specialized competence in treating compulsive sexual behavior.

  • Inquire through college or university psychology, psychiatric or counseling departments.

  • Ask professionals for their credentials in treating compulsive sexual behavior (e.g., certified sex therapist).


Compulsive sexual behavior is a serious psychosexual disorder which can be identified & treated successfully. CSB does not always involve strange & unusual sexual practices. Many conventional behaviors can become the focus of an individual's obsessions & compulsions. The exact mechanism of CSB is still under debate & various treatment approaches have been developed. Research is needed to further clarify the nature of the disorder, the mechanisms involved & to test the most effective treatment approach. In the meantime, individuals suffering from CSB should not hesitate to seek professional guidance to properly assess their problem & to find help through counseling & treatment.


1. Money, J. (1996). Lovemaps: Clinical Concepts of Sexual/Erotic Health & Pathology, Paraphilia & Gender Transpositions in Childhood, Adolescence & Maturity.  New York, NY: Irvington Publishers.

2. American Psychiatric Association. (1994). Diagnostic & Statistical Manual of Mental Disorders. 4th ed. Washington, D.C.: American Psychiatric Association.

3. Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals, 22(6), 320-425.

4. Carnes, P. (1983). Out of the Shadows: Understanding Sexual Addiction. Minneapolis, MN: CompCare Publishers.

5. Stoller, R. (1975). Perversion: The Erotic Form of Hatred. New York: Pantheon.

6. Coleman, E. (1991). Compulsive sexual behavior: New concepts & treatments. Journal of Psychology & Human Sexuality. 4(2), 37-52.

Written by Eli Coleman, Ph.D. Professor & Director of the Program in Human Sexuality, Department of Family Practice & Community Health, University of Minnesota Medical School, University of Minnesota.

© 2001 Society for the Scientific Study of Sexuality


Compulsive sexual behavior > 1 > 2 > 3 > 4

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