What is Compulsive Sexual Behaviour?

Compulsive sexual behaviour (CSB) is a pattern of repeatedly indulging in particular sexual activities that lead to a neglect of self, responsibilities and personal care. While the actual activities may range from innocuous through to illegal it is the compulsion to participate that causes distress (and in some cases a threat to the well-being) of the sufferer.

Is that Addiction?

CSB certainly has the hallmarks of addiction and shares some of the problems of activity escalation which might be related to the dopamine reward diminishment process in the brain. However, if we work using the definition of addiction offered by Dr Gabor Maté: “Addiction is manifested in any behaviour that a person craves, finds temporary relief or pleasure in, but suffers negative consequences as a result of, and yet has difficulty giving up”. The implication of this definition is that the behaviour is a maladaptive attempt to solve a problem which manifests as some kind of pain or distress. Tragically, the very attempt to solve the problem can lead to greater pain, distress and maybe threat to well-being. Dr Gabor Maté therefore prefers not to ask “why the addiction?” but “why the pain?”. This approach leads to a psychotherapeutic way of working with sufferers that is less focussed on the behaviour, in contrast to the classic 12 step addiction therapy model which is prevalent in the alcohol and narcotics arena. This is not to suggest that abstinence from dangerous activities may not be a key ground rule in the therapeutic process however. The key point is that the therapeutic project is non-judgemental, non-shaming and seeks to assist the client with a deeper transformation at the level of personhood, from which behavioural adjustments can flow.

A Definition of Sexual Health according to the World Health Organisation

Sexual health is a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination and violence.

What kind of sexual behaviour can we aspire to?

Implicit in this definition is that participants in healthy sexual acts are willing, have exchanged informed consent and are not exploiting or being exploited by each other. Also that they are capable of protecting themselves from unwanted pregnancy or disease transmission. Further implications are that an honest relationship exists between the participants so that communication is open and free, allowing a respectful exploration of values and motivations. Finally, that the encounter is based on the principle of mutual pleasure, both giving and receiving, partnered or solo.

Working with Compulsive Sexual Behaviour:

Working with CSB can be complex. The subject is loaded with shame and the moralistic views of partners, society, religious orthodoxy and untrained physicians. The client may be keen to keep their behaviours secret from close associates, employers and law enforcement officers. Client’s behaviours may have become known to others who are demanding change, but change really requires the client to be willing as well. This willingness is not just about stopping the behaviour but examining its role and meaning to the client. The bio-psycho-social approach of clinical sexology requires a multi-dimensional approach to address all the contributing factors affecting the client. These can include attachment injury, trauma, misunderstandings, lack of awareness, and poor relational conditioning.
There are many excellent resources, activities, and processes available to help the client begin to understand their erotic mind and motivations. They can help to provide alternative responses to old triggers and maybe mitigate them. They can instill the capacity for self compassion and restore hope, if needed.