Hypersexuality & Compulsive Sexual Behavior: Symptoms and Treatment

Although societal attitudes have shifted to being more open about sex, it still remains a topic surrounded by stigma, shame, and taboo. As a result, you may be afraid to discuss your sexuality openly and confidently, or you might even wonder if your thoughts, desires, sensations and urges are normal.

Sex is a healthy part of the human experience. You shouldn’t feel ashamed for having strong sexual preferences or expressing your sexuality in different ways. Masturbation, having casual sexual partners, using sexual communication platforms, and watching pornography are all normal. However, if these activities begin to dominate your life and create problems in your daily routine, or if you struggle to control your thoughts and actions, you might be dealing with hypersexuality and sexual compulsions.

What is hypersexuality?

Being a sexual person is different from being hypersexual. Hypersexuality, also known as compulsive sexuality or sex addiction, is when sexual urges and behavior become an uncontrollable focus, create problems for you or others, and cause harm. Tracie Zinman-Ibrahim, LMFT, CST, and Chief Compliance Officer at NOCD explains, “Hypersexual disorder has to do with the level of sexual desire that is affecting the way that you are thinking. The fantasies and arousals and urges are very intense.” People experiencing hypersexuality are constantly trying to chase the level of pleasure and relief their urges bring.

When untreated, hypersexuality can negatively impact your self-esteem, relationships, and career, as well as the people around you.

What are sexual compulsions? 

To fully understand what sexual compulsions are, it’s important to understand how compulsions work in general. Compulsions are repeated actions or thoughts that a person feels they must perform, often driven by an overwhelming urge to follow strict personal rules or routines. For people with obsessive compulsive disorder (OCD), these behaviors can be physical, like hand washing, or mental, like counting or repeating phrases, and are done to relieve anxiety and discomfort, or prevent something bad from happening. Obsessions, which are repetitive intrusive thoughts, images, sensations, feelings, or images, are connected to these behaviors, as performing compulsions provides a temporary feeling of relief from unwanted thoughts.

Sexual compulsions are urges related to sex that become uncontrollable and harmful, although these are not always related to OCD.  Common examples include excessive masturbation at inappropriate times, an obsession with watching pornography no matter where you are (even in public), and frequent thoughts about sex that disrupt important parts of your life. People who are hypersexual may feel driven to act on these urges, despite wanting to stop or knowing the negative consequences. This leads to feelings of shame, guilt, or anxiety. 

Sexual compulsions vs. OCD

Due to the overlap in compulsions, hypersexuality is sometimes mistaken as a form of OCD. However, while people can have sexual compulsions and be hypersexual, others can separately have sexual compulsions and have OCD. 

Zinman-Ibrahim points out a key difference between the two. For hypersexuality, individuals feel a need to satiate their desires. “If you are hypersexual, you get a lot of arousal responses, you get urges and on top of that, you’re doing something to try to take care of them,” Zinman-Ibrahim explains. “And I don’t mean get rid of them because you’re scared, you get rid of them to get relief. And these are things you are enjoying.” 

Zinman-Ibrahim went on to emphasize that if you have sexual compulsions and OCD, you do not enjoy acting out on them. She gives an example where a person with OCD is engaging in sexual activities, and in the middle of it, they get a sexual intrusive thought and then orgasm at the same time. “That is a very slippery slope with OCD, when people are like, ‘did I enjoy that?’”  Zinman-Ibrahim explains that the answer here is no. “It sounds like it a little bit, but it’s not, that’s just something called arousal non-concordance and it’s a part of groinal response. It doesn’t mean you liked the thought or you enjoyed it. And that’s why you feel so horrified.” she explained.

Can mental health conditions cause hypersexuality? 

While the exact cause of hypersexuality is unknown, it can sometimes be related to mental health. That being said, just because you are an intensely sexual individual and have a mental health condition, it does not necessarily mean you are a sex addict. A person can only be diagnosed with hypersexuality if they are unable to control their sexual compulsions, leading to situations that harm their health, relationships, job, or self-image. It is very important to understand that embracing sexuality and extensively enjoying sexual activities is not a cause for concern. There are plenty of perfectly healthy kinks and fetishes, and your sexuality only becomes a concern when it impairs other aspects of your life, or you know that your actions are wrong but you enjoy doing them.

Zinman-Ibrahim explains that while mental illness being the cause of hypersexuality is not the most common, it is sometime seen in people who have experienced sexual abuse, especially as children or teenagers. “It’s not that in real life they actually have this extreme desire or try to do all these things,” she clarifies. “It’s usually that there’s some trauma and they learn things in a different way.”

While mental illness and hypersexuality can sometimes be related, they usually exist separately or are mistaken for one another. Some of these conditions include bipolar disorder, depression, anxiety, OCD, and PTSD.

Most commonly, people confuse their OCD for hypersexuality. Zinman-Ibrahim explains that people think that if they ruminate about something all the time, that must mean that they have hypersexual disorder. “No, it means that you’re ruminating a lot about what happens to be a sexual theme of OCD. Totally separate.” she states. So, even if you are struggling with something like compulsive masturbation, but you feel bad and guilty about your actions and mentally punish yourself for the act, it is not the same as being hypersexual.

For some individuals, hypersexuality can actually lead to other mental health issues, such as depression and anxiety. This stems from the hypersexual habits ruining one’s life, relationships, or job, despite the pleasure they receive from acting out on them. “For anxiety, it can come up because it’s now affecting your life in some way that’s negative. For depression, it’s maybe feeling like things are out of control,” Zinman-Ibrahim says.

How do I know if I have a problem?

People often misdiagnose themselves with hypersexuality or sex addiction when they may simply be very sexual beings.  According to Zinman-Ibrahim, these are some signs that indicate you may be experiencing hypersexuality:

• A good deal of your time is taken up with sexual activity or sexual fantasies in your head
• You find yourself looking at sexual content at work or school and cannot resist the urge to act out
• You give in to urges for relief, not out of fear
• You are enjoying acting out on the inappropriate or troubling arousal responses and urges

To know if you have hypersexuality, or any other mental health condition, it’s important to seek the opinion of a licensed clinician. Your clinician will evaluate your tendencies, feelings, and mental health history to determine if you have a persistent inability to control repetitive sexual urges or impulses that lead to repetitive sexual behavior. According to the ICD-11, one of the official manuals for diagnosing mental illnesses, the necessary criteria for diagnosis is as follows:

• Sexual behavior becomes such a central part of someone’s life that they start neglecting their health, personal care, and other important activities or responsibilities
• The person has tried many times to cut back or stop the behavior but hasn’t found success
• The person keeps engaging in these behaviors even when it causes problems, like relationship conflicts, financial trouble, legal issues, or health problems
• The person continues these behaviors even if they no longer get satisfaction from them
• The pattern of behavior goes on for a long time, usually six months or more

What if it’s just a phase?

Individuals with hypersexuality can find themselves wondering if the sexual addiction they are struggling with is a phase, or something that they don’t need to focus on fixing because it will run its course. While this is a possibility, it’s still important to seek help for issues that are causing problems for you.

Zinman-Ibrahim recommends speaking to a healthcare provider about hypersexuality and taking an assessment to see if you need treatment, especially if your compulsions are adversely affecting your daily life.

How can I gain control over my sexual compulsions?

It’s important to remember that, despite how isolating it may feel, hypersexuality is more common than you might think. You are not alone—many people face similar struggles and successfully overcome their sexual compulsions. Recovery often involves a balance of lifestyle changes and professional help. Simple daily habits like setting boundaries, finding healthy outlets, and practicing mindfulness can make managing compulsions easier. If your hypersexuality is tied to a mental health condition or becomes difficult to handle on your own, professional treatment is key. 

“If it’s been going on a while and it’s disrupted some parts of your life,” Zinman-Ibrahim stated, “it’s probably time to seek treatment. I always say going to a certified sex therapist is a good idea.” Another resource Zinman-Ibrahim recommends is The American Academy of Sexual Educators, Counselors and Therapists (AASECT), which allows one access to numerous professionals and platforms that can help address their problems. Zinman-Ibrahim also recommends first getting a medical assessment to rule out any hormone-related issues. 

Addressing underlying mental health conditions

If your hypersexuality is linked to other mental health conditions, such as bipolar disorder, anxiety, depression, OCD, or PTSD, it’s essential to address these underlying issues. 

• The standard treatment for OCD is Exposure and Response Prevention (ERP). This evidence-based therapy involves gradually facing your triggers while learning strategies to tolerate your distress and prevent compulsive responses. ERP is also used to treat anxiety.
• Bipolar disorder is often treated with a combination of talk therapy, medication to manage manic or hypomanic episodes and depressive periods, and peer support groups. 
• Depression is often treated through antidepressant medication and therapy, such as behavioral activation (BA). This is a therapeutic approach that encourages individuals to participate in positive and meaningful activities, even if they do not want to at the moment. Over time, this involvement helps reduce the symptoms of depression. 
• For PTSD, Prolonged Exposure Therapy (PE) is recommended. PE helps individuals slowly face and work through the traumatic memories and situations they have been avoiding. By slowly confronting these fears in a safe setting, and addressing the distress tied to their traumas, people can learn to take back control of their lives.  

Lifestyle changes

In addition to therapy, making lifestyle changes can help you regain control over your sexual compulsions. Putting in your own work is equally as important as seeking professional help, and this will support the progress you make in therapy. Here are a few strategies to look into:

• Set boundaries: Create clear limits around your sexual activities. Try to focus on setting time limits, controlling frequency, and choosing specific instances where the activity is allowed. This can help you steer clear of triggers and keep things under control. For example, if you are struggling with compulsively watching pornography, you can set boundaries by deciding how many times a week you will allow yourself to engage in the act, decide that you will only do it at home when alone, and set a time limit for viewing. This will help you get on the right track to reducing the frequency of acting out on your compulsions.
• Find healthy outlets: When you find yourself beginning to focus on a compulsion, try directing your energy into positive activities such as exercise, hobbies, or creative endeavors. These can offer a satisfying alternative to compulsive behaviors and help shift your focus away from the habits you are trying to gain control over.
• Practice mindfulness: Techniques like meditation and mindful breathing can help you stay grounded and manage urges when they come up. By bringing intention and awareness to your thoughts and feelings, you can gradually weaken the hold compulsions have on you. 
• Support groups: Joining communities, either in person or online, can connect you with others who are facing similar challenges. Sharing experiences and strategies with peers can provide encouragement and reduce feelings of isolation. Ask your therapist if they can recommend a support group for people with hypersexuality. 

Finding the right balance

Having hypersexuality can produce simultaneous feelings of guilt and pleasure, creating a very confusing mental landscape. Though compulsions can have a negative effect on yourself and those around you, it’s possible to treat them with therapy, lifestyle changes, and external support. With the right resources, you can regain control and lead a positive, fulfilling life while enjoying sex in a healthy way.