Compulsive Sexual Behaviour

Sex addiction and pornography addiction — often referred to as Hypersexuality Disorder — have  yet to be formally recognised as specific conditions. Nonetheless patterns of compulsive sexual behaviour causing serious problems and distress to individuals and families are very real. It will take time for evidence from research to catch up with the often harmful sexual behaviours reported by patients and observed by clinicians.  These patterns and the symptoms they produce appear to align, in many respects, with the diagnostic profile of addiction.

Emotional urgency and compulsion

In addiction, the ability of whatever substance (e.g., alcohol, cocaine or nicotine) or behaviour (e.g., gambling, shopping, exercise) to change the way a person feels, quickly and effectively, is pivotal. Their attraction lies in their ability to stimulate the reward centres of the brain. Sexual behaviour is one such activity.  For some people, the pleasurable effect is so powerful that they do not merely want to repeat the experience sometime in the future, they feel compelled to do so, and soon. There is an emotional urgency akin to craving, especially as they find positive effects on mood wear off too quickly. With the frequency of repetition increasing, the compulsive pursuit of short-term sexual gratification begins to preoccupy the mind, eventually taking over much of everyday life.

With others or alone

Sexual activity either involves the presence of another person or people or involves masturbation with or without viewing pornography while alone.  Disordered inter-personal sexual behaviour may encompass multiple short-term encounters with strangers where there is almost no emotional investment, in contrast to non-addictive relationships. Apart from short-term excitement or relief, it can ultimately feel unsatisfying. Repetitive visits to sex workers, cruising, or risky sex, sometimes with use of substances (“chem sex”), may feature.  Sexual behaviour indulged while alone may include obsessive consumption of pornography both offline or online (through web cams or other devices); broadly known as cybersex.

The role of the internet

The internet and the speed of access to it has significantly increased the range and availability of pornography.  Accessibility, affordability and anonymity drive problems; the last of these being particularly important for a stigmatised behaviour pattern.  Secrecy protects against any challenge or interference but it is also a way to manage the shame that many sex and pornography addicts feel about their compulsive behaviour. Unfortunately it increases isolation and disconnection from others, which in turn encourages the habit. It also explains why low self-esteem, anxiety and depression commonly co-exist with compulsive sexual behaviour.

When problems develop

The strong sense of losing or having lost control is often what leads people to seek help.  Trapped by a seeming inability to stop despite the distressing evidence of mounting harmful consequences, anxiety ramps up. The ingrained response to this distress is now predictably more of the same mood-altering behaviour. Harm may include sexually transmitted infection or conflict with people closest to the addicted person or with life more generally, especially when personal values or the achievement of life goals become threatened.  As more and more time is consumed by the activity as well as by thinking about it, the addicted person often finds the enjoyment of sexual experiences with their partner suffers. For men this may include the development of erectile dysfunction. Correspondingly, partners may feel intimacy diminishing and sense an emotional withdrawal from the relationship by the addicted individual. Faced with the damaging impact of hyper sexual behaviour, the person may try to stop or cut down yet find such self-denial impossible to sustain without help.

The benefits of time out from everyday life

Given the degree of secrecy, social isolation and breakdown in meaningful interpersonal relationships that often characterises compulsive sexual behaviour, it may be advisable to take advantage of therapeutic expertise offered in a residential setting with 24-hour care, especially if there are co-existing health problems.  Time out from everyday life in a safe, contained, supportive environment offers a period of abstinence and thus the opportunity to explore without pressure very sensitive issues, including the possible impact of past trauma on current behaviour patterns and mental health.