Sex Addiction: What Are Compulsive Sexual Behaviours and When Do They Require Treatment?

The term “sex addiction” is widely used in the media and is intuitively understandable, but it is not the official name of a diagnosis in current psychiatric classifications. In ICD-11, the World Health Organization recognizes Compulsive Sexual Behaviour Disorder (CSBD), coded as 6C72. Importantly, it is classified as an impulse control disorder rather than a disorder due to addictive behaviours. The term “sex addiction” should therefore be used with caution, as it may suggest a disease mechanism that current scientific evidence does not allow us to establish conclusively.

The defining feature of CSBD is not an exceptionally strong sex drive, but a persistent difficulty controlling intense, repetitive sexual impulses and behaviours. Sexual activity may gradually become increasingly central to a person’s life, leading them to neglect their health, work, relationships, interests, or everyday responsibilities. The person repeatedly tries to reduce the behaviour but is unsuccessful. They may continue despite relationship breakdown, occupational, financial, or health problems, and sometimes even when the behaviour itself provides little satisfaction. The pattern should persist over an extended period. Diagnostic guidelines generally refer to a period of at least approximately six months, and it should cause significant distress or impairment in functioning.

There is no specific number of sexual encounters or episodes of masturbation above which the disorder can be diagnosed. One person may want sex several times a month, another several times a week, and someone else every day. All of these patterns can fall within the range of healthy sexuality. Similarly, daily masturbation does not automatically indicate CSBD. In diagnosis, a much more important question than “How often do I do it?” is “Am I still able to control it?” People with a high libido who remain in control of their behaviour and do not experience significant harm or impairment as a result should not be diagnosed with CSBD.

The same applies to pornography. Viewing pornographic material is not in itself a mental disorder, and even regular pornography use is not sufficient to diagnose CSBD. A problem may arise when a person repeatedly tries to reduce the behaviour but is unable to do so, spends increasing amounts of time on it, neglects other activities, or continues despite clear negative consequences. Problematic pornography use is currently one of the most frequently studied manifestations of compulsive sexual behaviour, but here too, loss of control and negative consequences are more important than the frequency of pornography use itself.

Particularly interesting data concern the prevalence of these problems in Poland. A study conducted on a representative sample of Polish adults estimated the prevalence of CSBD at approximately 4.7% of participants, 6.3% among men and 3.2% among women. Screening results, however, are not equivalent to a diagnosis established during a clinical assessment, and estimates of CSBD prevalence vary depending on the tools and criteria used. Nevertheless, these findings show that the problem does not affect men exclusively. A more recent review of research involving women also indicates that CSBD and problematic pornography use occur among women, although on average less frequently and with lower severity than among men.

Sexuality is also an area particularly susceptible to shame and guilt. A person may consider their own behaviour “abnormal” because it conflicts with their upbringing, religion, personal beliefs, or social norms. For example, someone may masturbate without losing control over the behaviour but experience intense guilt afterwards and believe that they are “addicted.” ICD-11 explicitly states that distress resulting solely from moral disapproval of one’s own sexual impulses or behaviours is not sufficient for a diagnosis of CSBD. This distinction is important because the role of psychiatry and sexology is not to determine what frequency of sexual activity is “appropriate,” but to identify situations in which there is a genuine impairment of control and functioning.

For the same reason, online tests for “sex addiction” or “porn addiction” should be interpreted with considerable caution. A questionnaire may indicate that it would be useful to examine one’s behaviour more closely, but it cannot replace a clinical diagnosis. Clinical assessment should take into account the frequency and nature of the behaviours, the person’s ability to control them, the duration of the problem, its consequences, and the role that sexual activity plays in that person’s life.

For some people, sex, masturbation, or pornography becomes a way of regulating emotions. These behaviours may occur particularly often during periods of loneliness, stress, boredom, tension, frustration, or low mood. Sexual activity may then provide short-term relief, followed by shame, guilt, or the consequences of the earlier behaviour. Increasing tension may once again lead the person to seek rapid relief, reinforcing a repetitive cycle. This does not mean that everyone who uses sex to improve their mood has CSBD. Sexuality can be one of the natural ways of experiencing pleasure and reducing tension. What matters most is whether the behaviour remains under the person’s control.

A sudden change in libido or sexual behaviour is particularly important. If someone who previously functioned in a certain way begins, within a relatively short period, to show markedly increased sexual activity, engage in risky sexual encounters, or behave very differently from before, other causes should be considered. One possible explanation is mania or hypomania in the course of bipolar disorder. Increased libido may then be accompanied by a reduced need for sleep, a marked increase in energy, increased talkativeness, racing thoughts, excessive self-confidence, impulsive spending, and other risky behaviours. In such cases, increased sexual activity is part of a broader change in mental state rather than an isolated sexual problem.

Diagnostic assessment should also consider the effects of psychoactive substances and medications. A particularly well-described example involves dopaminergic medications, especially dopamine agonists used, among other conditions, in Parkinson’s disease. In some people, these medications may lead to impulse control disorders that can also involve sexual behaviour. ADHD, substance use disorders, depression, anxiety disorders, and other mental health problems may also be relevant. However, the mere presence of one of these conditions does not mean that a person has CSBD. The purpose of diagnosis is to determine what is actually driving the behaviour, because similar symptoms may require very different forms of treatment.

Compulsive sexual behaviours can be treated. Appropriate diagnosis of the underlying problem is essential. The goal of treatment should not be to eliminate a person’s sexuality or automatically aim for complete sexual abstinence. The primary objectives are to regain control over behaviour, reduce its negative consequences, and enable the person to have a safe and satisfying sex life. Current evidence primarily supports the role of psychotherapy, including interventions incorporating elements of cognitive behavioural therapy. Treatment may involve identifying situations that trigger the behaviour, improving emotional regulation and impulse control, and developing alternative ways of coping with stress and tension. A systematic review found promising results particularly for interventions containing CBT components, although the authors emphasized that the number of high-quality studies remains limited.

Pharmacological treatment may be considered in selected cases, particularly when other mental health disorders coexist, but there is currently no single approved, universal “medication for sex addiction.” SSRIs and naltrexone, among other medications, have been studied, but the evidence base remains considerably weaker than for many other psychiatric disorders. A review of pharmacological treatment published in 2024 included only 13 studies involving 141 participants, and its authors emphasized the limited quality of the available evidence. Publications from 2025 and 2026 also indicate that pharmacological treatment of CSBD remains an area requiring further research.

Professional help should be considered when sexual behaviours begin to feel out of control, repeated attempts to reduce them are unsuccessful, sexuality starts to dominate other areas of life, or serious consequences arise in relationships, work, finances, or health. A high sex drive alone is not an illness. The problem begins when a person increasingly loses the ability to make a genuine choice about whether to engage in a particular behaviour.

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