Sex Addiction: Causes, Signs, And Hypersexuality Treatment

Last Updated: January 21, 2021

Authored by Sharon Levy, MD, MPH

Reviewed by Michael Espelin APRN

The frequent destructive sexual activity is not emotionally fulfilling and results in problems in marriage, social relationships, health, employment, finances, and the law. The compulsive behavior interferes with the normal daily life and its responsibilities and can cause devastating results. Read along further to find out about what sexual addiction is, what are its signs and symptoms, its causes and risk factors, and how to deal with it by seeking sex addiction help.

Sexual Addiction is Real

Some therapists refer to sex addiction simply as Hypersexuality. However, sex can be an addiction of cyclical nature. This is when a person is highly obsessed with sexual thoughts and actions to the point that it interferes with their daily lives. It includes their inability to have meaningful relationships or work properly. Compulsive sexual behavior or hypersexuality disorder has been classified by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) as an addictive disorder. It has also been included in the ICD-11 (Impulse Control Disorders).

In a study conducted on 19 men who showed compulsive sexual behavior, their brains showed a similar activity to that of drug and alcohol addicts. This shows that hypersexuality is a real addiction that can have severe psychological, physical, and social consequences.

Causes of Hypersexuality

There could be several factors that can be considered to be the cause of compulsive sexual behavior. These factors can further be classified into the following categories:

Biological Causes

Some of the biological causes of this compulsive behavior include the following:

  • Some people may have the genes that cause them to seek sensation and impulsive behavior.
  • An increased level of hormones such as testosterone and estrogen can increase the libido, causing compulsive sexual behavior.

Psychological Causes

The psychological causes of this addiction include:

  • The mental health of certain individuals can make them more prone to compulsive acts such as anxiety, depression, and personality disorders.
  • Certain environmental factors such as early exposure to sexual content and poor parental control and supervision can also become a cause.

Social Causes

Certain social factors also contribute towards this behavior:

  • Social isolation can become the cause of inappropriate sexual acts.
  • Peer pressure can also make a person indulge in excessive sexual acts which can then become an addiction.
  • Social rejection can also cause a person to fall into this addiction.
Female underwear on the bedroom floor.

Hypersexuality Cycle

Hypersexuality like all other addictions can be considered a cyclical act with one stage leading towards the next. According to this study, an American psychologist Dr. Patrick Carnes, in his book “Out of the Shadows”, specifically developed the concept of sexual dependency and his model of its cycle. He breaks down the cycle of sex addiction into six stages, namely:

Triggers

The first stage is that of triggers which can create a need or desire for a person to act out sexually.

They Include:

  • Shame
  • Blame
  • Guilt
  • Emotional and physical discomfort are both ‘’pain agents’’ that act as triggers
  • Loneliness
  • Stress
  • Depression
  • Anxiety
  • Boredom
  • Some positive triggers could also occur. For instance, wanting to celebrate something by acting out sexually

Fantasy

After a trigger, a sex addict will repeatedly turn to their key coping mechanism. In this case, it is a sexual fantasy. This includes memories of how much they had enjoyed sexual encounters in the past. In addition, they will anticipate how enjoyable future sexual encounters will be.

At this point in the cycle, they view every person that they encounter as a sexual object.

Ritualization

Ritualization happens when fantasy heads toward reality. In Defining and Understanding the Cycle of Sexual Addiction, Carns explains this. In addiction terms, this stage is traditionally known as the bubble. This is when the addicts get lost in planning and preparation of his or her next encounter.

This stage includes watching porn excessively. Actually, they might plan a trip where they can act out without restraints. Otherwise, they may drive to a popular place where sex workers assemble. This is all preparation, not acting out.

Release (acting out)

This is the physical, sexual act, whether it be solo or with another person/people. This is also the stage where orgasm is not, like in normal circumstances, a good thing. It’s the point where they toss the addict back into the real world.

The release is where the ‘’high’’ ends. Of course, this is why individuals addicted to sex would typically try to stretch out the ritualization stage. Also, they will do this for as long as possible.

Numbing

After acting out, a sex addict will attempt to distance him- or herself emotionally. In addition, they will try to justify their behavior. This is the stage where denial sets in, as a protective measure against stage six.

Despair – shame, blame or guilt

Sometimes, a sex addict will realize how their behavior negatively affected themselves. This realization may include the lives of those around them. Later, they are flung back into reality. This is with all the discomforts that triggered the process in the first place. As a result, they will usually feel a form of shame or guilt.

Sad unhappy couple having problem in bed.

Hypersexuality Signs

There are certain signs which can point towards hyperspexuality or compulsive sexual behavior. Some of the questions a person can be asked to see if a person needs sex addiction help and if there are any sex addiction signs include:

  • Does a person often find his/her mind preoccupied with (even decent) sexual thoughts?
  • Has a person ever at some point felt that sexual behavior is not normal?
  • Did one ever feel guilty about personal sexual behavior after doing the deed?
  • Has one sexual behavior ever caused problems for oneself or family?
  • Did one’s sexual obsession ever hurt someone emotionally?
  • Are any of his/her sexual activities against the law?
  • The age-old question: has a person ever tried to quit a certain sexual activity, but failed?
  • Does he/she ever hide sexual activities from others?
  • Has a person ever felt degraded because of a sexual act or activity?
  • Does one feel depressed after a sexual act?
  • Does he/she ever feel that sexual desire controls the mind?
  • Has a person neglected other parts of life because sex was consuming most of the time?
  • Are sexual thoughts almost all one can think about?
  • Has a person ever used sex to escape from the problems?
  • Has sex become the single most important factor in life?
  • Is he/she in crisis due to sexual matters?
  • Has the internet ever created sexual problems in relationships? On the other hand, has one been spending too much time online for sexual purposes? This includes subscribing to pornography, ‘’renting’’ someone to satisfy sexual desires?
  • Had sexual intercourse of any sort with a minor?
  • Stayed in an emotionally or physically abusive relationship. Did one do it just for the sex?
  • Traded sex for money or gifts?
  • Maintained multiple sexual relationships at a time?
  • Engaged in an unsafe sexual activity, knowing that it could cause harm?

Hypersexuality Symptoms

There are also certain symptoms that can present themselves in individuals with a compulsive sexual problem which can lead him to seek sex addiction help. These can be categorized below:

Emotional Symptoms

The emotional symptoms include the following:

  • Becoming involved with people easily
  • Staying in unhealthy relationships just for sex
  • Jumping between relationships
  • Sexualizing other feelings such as loneliness, guilt or fear

Physical Symptoms

The physical symptoms may include the following:

  • Feeling unable to move due to sexual obsessions
  • Repeated, compulsive seeking for sexual activity
  • Participating in dangerous sexual activity, which can be harmful to oneself and others
  • Withdrawal when going without sex for too long
  • Tolerance to sex, needing more sex to feel satisfied

When One Is In a Relationship With a Sex Addict?

If one is in a relationship with a sex addict, their life will be deeply affected by it. It is important to determine if the other person is a sex addict so something could be done about that. There are some tell-tale signs that a spouse or partner can notice.

These Include the Following:

  • Lies most of the time
  • Cheats on someone, not only once, consistently, probably maintaining multiple relationships at once
  • Masturbates too much, even after intercourse
  • The kinky stuff becomes all-encompassing and the person gets pushed out of comfort zone, never having ‘’normal’’ sex
  • Tries to be in control all the time. Whether one gets any pleasure from the sexual encounters or not, the partner doesn’t care
  • Flirts with others – all the time. For a sex addict, this is a way of ‘’getting off’’, or grooming potential victims
  • Blames the victim for being a sex addict. Especially when confronted, a sex addict will often manipulate the situation
Couple flirt in a bar.

Dangers of Compulsive Sexual Behavior

Hypersexulity can be quite dangerous or destructive not only for the person himself, but for his family and those closely related to him. This kind of behavior can have severe physical, mental, psychological, and social repercussions. Some of the most evident dangers of this behavior are discussed below.

Sexually Transmitted Diseases or Infections

Sexual health is a primary fear when it comes to dealing with compulsive sexual behavior. The risk of contracting STDs or STIs are much higher with risky sexual behavior.

Some of the Most Common STDs Include the Following:

  • Chlamydia
  • HPV (human papillomavirus)
  • Syphilis
  • HIV
  • Gonorrhea
  • Pubic Lice (Crabs)
  • Trichomoniasis
  • Herpes
  • Chancroid
  • Lymphogranuloma venereum
  • Granuloma inguinale
  • Molluscum contagiosum
  • Scabies

Self-Worth and Self Esteem

Many people addicted to sex have reported reduced feelings of self-worth and self-respect after doing the sexual acts. This low self-esteem can then become the cause of more compulsive sexual behavior and the cycle continues. Eventually, this leads to a complete loss of self-esteem.

Lack of Intimacy

People addicted to sex are often unable to form and sustain relationships and close friendships. This is due to their lack of self-esteem and feeling of guilt and shame. In many cases, sex addicts report to being afraid that they will face judgement or rejection if someone were to find out who they are.

Inability to Nurture Healthy Relationships

Many respondents admitted to feeling lonely according to Patrick Carnes breakthrough study on sex addiction. In most cases, they were unable to foster healthy relationships. For this reason, they feel that they are lying to friends about living two separate lives; one of which they feel they must hide from the outside world.

Legal Issues

Of course, not all sexual behavior is natural and consensual. 58% of people with sexual addiction have participated in illegal sexual behavior according to a National Council on Sexual Addiction and Compulsivity study. This gives rise to various legal issues that one may not be able to cope up with.

Co-occurrence

More than 80% of people addicted to sex have simultaneous addictions to either substance, gambling, or eating disorders. These can have various types of psychological, physical, and emotional consequences for everyone involved.

Hypersxuality And Co-Occurring Substance Abuse

As previously mentioned, a high majority of people addicted to sex usually also suffer from another addiction. It can be substance abuse, alcohol addiction, an eating disorder, or a gambling addiction. Usually, the underlying conditions for all of these types of addiction are the same because of which hypersexuality and substance abuse are treated concurrently.

There are Several Reasons Sex Addicts are also Addicted to Other Substances Such as:

  • They may want to enhance their sexual experiences by using drugs
  • They may abuse drugs to cope with the pain and guilt caused by their sexual behaviors
  • One addiction could also be a mechanism to cope with the other so that it can mask the shame, guilt, or pain of the other addiction
  • Addictions often feed into one another
gay couple kissing each other.

Chemsex: What It Is?

A growing practice in recent years is chemsex, which is intercourse under the influence of psychoactive substances such as gamma-hydroxybutyrate (GHB), gamma-butyrolactone (GBL), mephedrone and crystal methamphetamine. These drugs heighten the sex arousal and allow the users to have longer sex sessions with multiple sex partners in these chemsex parties. This has become a public health concern as it can lead to the transmission to various STDs and HIV along with its physical and mental health effects. Usually, chemsex is associated with injecting substances which causes users to share needles thus making it a perfect opportunity for the transmission of HIV and Hepatitis C.

Dealing with Nymphomania

Three personal competencies should be properly developed by the addict. This will have to include his or her loved ones to overcome a sex addiction.

Identify the triggers. Then, stay away from them. No, this does not mean shutting down a laptop or giving up sexual fantasies forever.

Here are Some Tried and Tested Strategies that May Help:

  • Fall in a meaningful relation: A relation defined by the depth of intimacy is key to making one happy. No doubt, sex is indispensable to a healthy relation. Nevertheless, it should not rely on just physical attachments. Make sure not to put sex at the top of a priority list.
  • Treat the potential underlying causes: Does one have a history or a current mental health issue? Then, seek medical treatment right away. It will largely help to tame urges.
  • Give up another addiction (if any): Essentially, this is never as easy as said. But seeking timely help from an expert can turn things around.
  • Set limits for sex-related activities. As a matter of fact, no one knows one’s limits better than a person oneself. Others can just guess it. Therefore, delve in some soul-searching. Then work out a strategy to decide what’s normal.
  • Stay committed to the goal. A setback does not necessarily indicate failure of the treatment plan. Similarly, it does not mean one has problems with self-control or impulsivity. Do not lose the sight of the ultimate goal. Stick to the treatment and do not hold back when encountering any issue.

Honesty

It is imperative to be open and honest about hypersexuality. In fact, a person must do it for both partner and oneself. Furthermore, do not lie about sexual activities. First, don’t rationalize addictive behavior. Second, it is important not to lie about the place one is and what is doing there. Third, don’t lie about whether or not one has had sex with someone.

For example, a person needs to accept the fact of having an addiction in order to deal with it. Above all, don’t lie to a partner about sexual activity. It could place them in danger of contracting a STD or Infection or worse, HIV or AIDS.

Effort

To overcome excessive sexual behaviors, one must place effort into the exercise. Is someone helping a loved one overcome it? In this case, approaches based on scare, shame or guilt will not help. In fact, it will just make them back up even more.

Most individuals addicted to sex are already dealing with feelings of guilt and shame. Therefore, humiliating them will have the opposite effect from the target goals. As a result, one may need to adopt another approach.

Proper Advice

Telling someone with sex addiction to “just stop behave in that way” is like telling someone with depression to stop being sad. It can’t be ‘treated’ by simple repression. Therefore, addicts need proper guidance and advice from a professional to be overcome.

Compulsive Sexual Behavior Treatment: Things To Know

The exact cause is still not clear. However, they suggest a complex association between abnormal brain functions. Also, it could be some exposure to the risk factors. A person with a history of sex or substance abuse or problems with handling stress may be at a greater risk. Similarly, emotional instability, impulsivity, and introverted nature are some personality traits. As a result, they may lead to abnormal sexual involvement.

For these reasons, there is no specific sex addiction treatment or medical approach to treating it. Unfortunately, a “cure” may not always be possible.

Nonetheless, Available Treatment Approaches Aim to:

  • Lower the urges and sex drive
  • Reduce the levels of testosterone in the body. It is a male sex hormone that enhances sexual arousal
  • Identify the triggers. Then, change their response to any of them
  • Save them from legal charges and make them more sociable

Choosing the Rehab For Sex Addicts

In many cases, early and effective sexual addiction treatment results in a full recovery. However, success depends on a few underlying factors. They include co-occurrence of other mental illnesses. It can include the degree and type of addiction, and specific addiction-related behaviors.

The Determinants of the Success May Also Include:

  • Exposure to the tempting situation: It can be a workplace. Higher the exposure, lower the degree of treatment success.
  • Personality traits: There are some factors that may negatively impact treatment outcomes. They include a lack of empathy, strong sexual fantasies, and violent sexual behavior

Sometimes, hypersexuality is likely to be concurrent with other addictions. Therefore, it is important to do proper research about rehabilitation centers. Also, find out the method they apply when it comes to its treatment.

Also, they should have a staff educated to treat the following disorders:

  • Intimacy Disorders
  • Serial infidelity
  • Compulsive masturbation
  • Pornography addiction
  • Cyberporn abuse
  • Love addiction
  • Voyeurism
  • Anonymous sex
  • Problems with sexual boundaries
  • Exhibitionism

Therapists must be ready to deal with the deeper underlying issues as part of sex addiction treatment. That way, they may find out what has caused the addiction in the first place. Also, they can discover the embarrassing sexual secrets, and unblock the shame associated with them. Also, they can heal the harm caused to family and wounded relationships.

Couple Having Consultation With Male Doctor.

Therapies

Here are some therapeutic approaches in sex addiction treatment.

  • Cognitive Behavioral Therapy (CBT) to change the response to a trigger. CBT therapist teaches the patient ways to identify the triggers first. Then, they help him take a practical approach to change the attitude towards the problem by transforming negative thoughts to positive ones. As a result, the person becomes more inclined towards solving the problems.
  • Emotional Therapy to help the patients adapt to the urges. The therapist teaches the patient to identify any connection between the emotions and the resultant behavior. Once the connection is identified, it is easier for the patient to cope up with those emotions.
  • Psychodynamic Therapy to uncover early childhood influencers or unconscious memories that contribute to the current compulsive sexual behaviors. Once the factors are identified, it is easier to develop strategies to cope with them.
  • Dialectical Behavioral Therapy (DBT) to teach the skills of mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation which all help the patient to cope with triggers and deal with them in a positive manner.
  • Mindfulness to help recognize the patient’s present connections that exist between external stimuli and internal feelings so he can cope with them and act in a productive and healthy manner.
  • Group Therapy to help replace the negative and detrimental behaviors with prosocial and positive ones. Through group therapy, the patient is assured that he is not alone in this battle and he can take motivation and guidance from people similar to him.
  • Couples Therapy or Marriage Counseling to help both partners improve their communication skills and foster trust and honesty among themselves. This helps the patient in increasing his motivation to recover and lead a normal and healthy life.
  • 12-Step Recovery Programs help patients acknowledge their powerlessness and make them willing to live a life free from addiction in a group-based approach. Sex Addicts Anonymous is a similar support group that mimics the teachings and ways of Alcoholics Anonymous to help addicts regain control of their lives.
  • Inpatient Treatment Programs help the advanced cases of sex addiction to live in a safe and conducive facility where they can be away from all types of triggers and distractions and focus solely on their treatment and recovery.

What Medications May Be Used as Sex Addiction Treatment?

Currently, the FDA does not approve any medication specifically to treat it. However, a doctor may still prescribe some medications as part of sex addiction treatment. In fact, this approach relies largely on their experience and clinical judgment.  Currently, there are many medications that might help to treat sex addiction. This is in addition to alternative therapies.

They Include Antidepressants, Mood Stabilizers, and Hormonal Medication:

  • Depression-treatment medications: Selective serotonin reuptake inhibitors (SSRIs) to reduce certain conditions. They include the temptations and control obsessive thoughts. For example, fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa), fluvoxamine (Luvox), and escitalopram (Lexapro).
  • Mood-stabilizing agents to manage the symptoms. In fact, they might be beneficial. This is if the addiction has some connections with a mental disorder. In this case, they call it a manic-depressive disorder. Examples include carbamazepine (Tegretol), divalproex sodium (Depakote), and lamotrigine (Lamictal).
  • Naltrexone to reduce sex drive or compulsions. Indeed, it may be more effective in treating internet addiction. This is according to a study published in Mayo Clinic Proceedings.
  • Hormonal therapy to lower testosterone levels in the blood. That way, they help to lower sex drive and desire. However, this is a temporary treatment. Once a person stops the medication, it will restore testosterone levels — for example, cyproterone acetate.

Before using any of the medications, learn enough about them. Know the expectations and potential side effects. Severe cases of this addiction require inpatient treatment.

The success of treatment has a very high variability. For this reason, what works for others may bring little relief.

Regarding the medications, a doctor should implement a trial and error strategy. It is because no single medication has an evident advantage over another.

Any medication use should be under doctor’s supervision. The only doctor can prescribe drugs; patients should not do it by themself. Self-prescription can damage one’s health and lead to unpredictable reactions.

Support Groups

There are certain support groups that help patients interact with individuals with similar problems so they can all learn from each other and move towards recovery together.

Some of the Support Groups Include:

  • Sex Addicts Anonymous
  • Sex and Love Addicts Anonymous
  • Sexaholics Anonymous
  • SMART Recovery
  • NoFap
  • The Society for the Advancement of Sexual Health
  • Relativity at Elements Behavioral Health

Literature

Some of the most prominent and helpful books that can help a patient in his journey against sexual addiction include:

  • Out of the Shadows: Understanding Sexual Addiction by Patrick J. Carnes
  • Erotic Intelligence – Igniting Hot Healthy Sex After Recovery from Sex Addiction by Alexandra Katehakis
  • In the Shadows of the Net: Breaking Free of Compulsive Online Sexual Behavior by Patrick J. Carnes
  • Cruise Control: Understanding Sex Addiction in Gay Men by Robert Weiss

Hypersexuality Relapse

Hypersexuality relapse refers to a situation when the addicts have a moment of weakness and they fall back into the previous stages of addiction. This may occur after a period of voluntary abstinence. Some patients may leave the treatment altogether after a relapse while others may make a comeback and seek sex addiction help again.

People Attending Self Help Therapy Group Meeting.

Signs Of Relapse

The signs of compulsive sexual behavior relapse may not always be easy to catch. Some of the signs of relapse might include:

  • Negative thinking
  • Easily angered or annoyed
  • Overconfidence
  • Increased stress
  • Skipping support meetings or therapy sessions
  • Being in denial
  • Self isolation
  • Loss of interest in family affairs and activities
  • Hopelessness

Seeking Professional Sex Addiction Help

The journey from relapse to a full-blown addiction takes no more than a few weeks or months. Therefore, watch the symptoms. Are they getting worse or do not respond to the current medical interventions? Then, talk to a doctor immediately to seek sex addiction help.

Revealing sexual health problems may be tough to vocalize. However, seeking help and sex addiction treatment is indispensable to obtaining better outcomes.

No one is alone in the war against addiction. Family members, doctors, and addiction experts are always by a patient’s side.

In some cases, sexually addictive behavior spirals beyond hours of sex acts. These include pornography phone sex, compulsive masturbation, and online sex services. This does not mean all people addicted to sex become sex offenders. In this case, they may not take part in illegal activities. These include voyeurism, obscene phone calls, molestation, exhibitionism, or rape.

It is also important to remember this. Just because someone has a high libido, doesn’t mean that they are sex addicts.

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Page Sources

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Published on: April 20th, 2017

Updated on: January 21st, 2021

About Author

Sharon Levy, MD, MPH

After successful graduation from Boston University, MA, Sharon gained a Master’s degree in Public Health. Since then, Sharon devoted herself entirely to the medical niche. Sharon Levy is also a certified addiction recovery coach.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.