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Is compulsive sexual behavior a new disorder?
Because of the continually changing characterizations and terminologies for problematic sexual behavior, it is difficult to compare historical notions of CSB (compulsive sexual behavior) to what we currently think of as the behavior. Some forms of compulsive sexual behavior appear to date back centuries. The first medical accounts that we have found date to 1775, and the concept was later refined in 1845, when the term nymphomania was coined.
Multiple behaviors are encompassed by the term compulsive sexual behavior. There are at least seven common behaviors: compulsive cruising for multiple partners, compulsive fixation on an unattainable partner, compulsive autoeroticism (masturbation), compulsive use of erotica, compulsive use of the Internet for sexual purposes, compulsive multiple love relationships, and compulsive sexuality in a relationship.
Most people who struggle with CSB are reluctant to mention it to their health care providers, and most physicians are generally uncomfortable talking about sex with their patients, in part because of a lack of training. People are more likely to bring up the topic when they are being treated for a sexually transmitted infection, an unwanted pregnancy, or marital or relationship problems. Other patients might seek treatment for anxiety, depression, or alcohol or drug abuse. There is a high rate of comorbidity between CSB and mental health problems, particularly anxiety disorders, depression, and substance abuse disorders. Therefore, when patients present with these types of problems, their health care providers must consider that sexual behavior might be associated as a coping mechanism, distressing outcome, or comorbid condition.
The essential feature of CSB is persistent and recurrent maladaptive sexual behavior that results in problems with work, school, or family life. To receive the diagnosis of CSB, an individual must have recurrent and intense sexual fantasies, sexual urges, and sexual behavior that result in some impairment in functioning as well as at least four of the following five symptoms during the same six-month period:
1) Spending excessive time consumed by sexual fantasies and urges as well as planning for and engaging in sexual behavior
2) Repetitively engaging in these sexual fantasies, urges, and behavior as a response to anxiety, depression, boredom, or irritability
3) Habitually engaging in sexual fantasies, urges, and behavior in response to stressful life events
4) Repeatedly but unsuccessfully attempting to control or significantly reduce these sexual fantasies, urges, and behavior
5) Continually engaging in sexual behavior without regard for the risk of physical or emotional harm to self or others
Jon E. Grant, JD, MD, MPH, Brian L. Odlaug, PhD, MPH, and Samuel R. Chamberlain, MD, PhD are the co-authors of "Why Can't I Stop?: Reclaiming Your Life from a Behavioral Addiction"
