Understanding compulsive sexual behavior

A person often engages in risky sex, has a lot of sexual partners and often mixes sex with drugs or alcohol. The popular literature calls this behavior sexual addiction. But is it really addiction that propels people to behave in this way? Or is it an impulse control disorder? And how can psychologists help?

Experts in the field refer to such actions as compulsive sexual behavior. And two studies on sexual compulsivity presented during APA's 2003 Annual Convention shed some light on a subject that garners a lot of media attention, but about which little is really known. Presenting one of the studies, on the psychophysiological and neuroanatomical basis of compulsive sexual behavior, was Michael Miner, PhD, of the University of Minnesota.

Miner's study examined two groups--a cohort of male compulsive sexual behavior (CSB) patients and a male control group--in two types of tasks. In one task, participants responded to certain letters of the alphabet. In the other, they responded to sexual and neutral stimuli--designed to illustrate impulse control and attentional bias.

In both tasks, compulsive sexual behavior patients responded differently than controls, yet not in ways that researchers anticipated. For example, in the second task the CSB group showed less attentional bias than the controls.

"It's not consistent with an addiction model," said Miner. "Our controls are much more interested in naked people than are CSB people. And we have no indication of impulsivity." Though the data "might mean nothing" Miner said, it will be helpful in his next phase of research on CSB using fMRI.

And further research into CSB will hopefully lead to effective treatments, said psychologist Jeffrey Parsons, PhD, of Hunter College of the City University of New York. "We have a responsibility to get out there and find more types of treatments," said Parsons, "particularly because of HIV. Maybe an increase in sexual compulsivity is fueling an increase in HIV," he added.

His research compared gay and bisexual men who reported sexual-behavior problems with a control group of noncompulsive gay and bisexual men. Compulsive men averaged 39 sex partners in three months, whereas noncompulsive men had seven. And 60 percent of the sexually compulsive men reported having a sex-related infection, which is twice as many as the other sample, said Parsons. He also noted that the CSB patients wanted help managing their dangerous behavior: Some were more interested in individual therapy than a 12-step program.

"But effectiveness is still in question," said Parsons. Some studies suggest that SSRI antidepressants are effective, he said. And, he added, "cognitive behavioral therapy to deal with trigger situations" could be very helpful.

"One take home message is that sexual compulsivity is something that clearly exists but it has a lot of variation and variability in how it presents itself," said Parsons."

--J. DAW HOLLOWAY