Compulsive Sexual Behavior

Characteristics

Compulsive sexual behavior is not listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), although many of its manifestations would fit criteria for various paraphilias such as pedophilia, voyeurism, exhibitionism, or transvestic fetishism. German psychiatrist Krafft-Ebbing described “pathological sexuality” over 100 years ago and wrote of a condition not unlike today's CSB, in which a person's sexual drive is abnormally increased. Various terms have been used to describe this condition, most pejorative, such as nymphomania and satyriasis in women and men, respectively, while men with this condition are frequently referred to as a “Don Juan” or “Casanova.” More neutral terms include compulsive sexual behavior, sexual addiction, or hypersexual disorder. It is unresolved whether this condition falls within an obsessive-compulsive spectrum of disorders, is related to addictive disorders, or represents an impulse control disorder.

The prevalence of CSB in adults is estimated to range from 3% to 6% and is thought to predominately affect men. Onset appears to be in the late teens or early 20s. Gender differences include its symptom presentation: Among men, the disorder predominately involves promiscuous sexual behavior, compulsive masturbation, or a paraphilia. Among women, the disorder is thought to involve cognitive or emotional states resulting in dangerous sexual encounters or multiple unsuccessful love relationships. CSB has been described as involving nonparaphilic behaviors (i.e., conventional sexual behaviors carried to an extreme) or paraphilias (i.e., abnormal or dangerous patterns of sexual arousal or behavior); some persons with CSB have both types of behaviors.

Psychiatric comorbidity is frequent, particularly of mood and anxiety disorders, substance misuse, and the impulse control disorders, including compulsive buying, kleptomania, and pathological gambling. Axis II (personality) disorders are also frequent, and in at least one study, 83% of persons with CSB met criteria for one DSM-IV personality disorder. No particular personality type predominated, though it has been observed that persons with CSB often exhibit narcissistic, borderline, dependent, or antisocial traits.

The natural history of CSB has not been well characterized, but it is likely chronic or recurrent. It has been described as beginning in adolescence with sexual preoccupations. The next stage, often referred to as ritualization, occurs when the person develops an idiosyncratic routine that prompts the sexual behavior. The third stage consists of the uncontrollable sexual behavior itself. The fourth stage is characterized by feelings of despair and hopelessness.

...