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Just because someone is hypersexual does not mean he or she has CSB (compulsive sexual behavior). Other problems may result in a person becoming hypersexual. The first thing to keep in mind is that not all excessive sexual behavior equals CSB. As we mentioned above, sexual behaviors that are in conflict with someone’s own value system or someone else’s value system may feel problematic, but they are not compulsive. Similarly, just because someone has more sex than someone else does not mean that CSB is involved. The value system of the patient and the family may get confused with CSB. CSB must also be distinguished from the excessive sexual behavior that is often seen in new relationships. In those situations, the excessive sexual behavior is usually time limited and does not typically cause distress or result in impairment.
Extreme cases of sexual behavior (for example, masturbating six times a day and being unable to get to work on time due to the masturbation) are the easy cases to diagnose. It is more difficult to assess and diagnose behaviors that fall into the gray area. Take the example of a young man who is not working and spends hours each day looking at pornography. Is his behavior due to CSB or simply to excess free time? It is also a simple question of how much control the young man has over his behavior. If a job comes up, and he can stop his behavior and function at a high level, then he probably does not have CSB.
Excessive sexual behavior can occur as part of a manic episode in a person who has bipolar disorder. A manic episode is when a person is out of control, feeling too euphoric (or extremely irritable), and doing multiple impulsive behaviors that are getting her into trouble. Sexual behavior may be one of those impulsive behaviors. If the problematic sexual behavior also occurs when the person’s mood is stable, the individual may have CSB in addition to bipolar disorder. This distinction is important because the treatment for bipolar disorder is very different from that for CSB.
Excessive sexual behavior can occur when a person is high on drugs. In particular, stimulants (such as cocaine, amphetamines) as well as gamma hydroxyl butyrate (GHB) have resulted in excessive sexual behavior. If the sexual behavior does not occur when the person is not taking drugs, then the appropriate diagnosis would likely not be CSB.
Finally, it is important to find out whether the person started being hypersexual after beginning any medications. Some patients taking certain medications (for example, medications for Parkinson’s disease or restless leg syndrome, or aripiprazole to treat depression or psychosis) may engage in hypersexual behavior. These medications may increase dopamine in a specific part of the brain that controls our urges and our need for rewarding stimulation. If the sexual behavior decreases or stops when the medication is reduced in dosage or stopped, then a diagnosis of CSB would not be indicated.
How common is compulsive sexual behavior?
Evaluating the prevalence of CSB is difficult because of the embarrassment and shame frequently reported by those with CSB as well as society’s (at times) judgmental position toward the expression of sexuality. Although no large epidemiological studies have been performed, the estimated prevalence rate of CSB is approximately 3 to 6 percent. One recent study of public university students found that 2 percent (3 percent of men, 1.2 percent of women) met the diagnostic criteria for CSB.
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"
