Compulsive sexual behaviour disorder (CSBD), more commonly known as sexual addiction or sexual compulsivity, is similar to any other addiction, except the ‘substance of abuse‘ is sexual fantasy and behaviour rather than alcohol or drugs (or spending, video gaming, gambling, etc.)

For many years, CSBD has been diagnosed by Certified Sex Addiction Therapists (CSATs) based on three primary criteria:

• Preoccupation to the point of obsession. Sex addicts spend hours, sometimes even days, fantasising about, planning for, pursuing, and eventually engaging in sexual acts (with self or others). They often ‘lose time’ when floating around in their sexual obsession.
• Loss of control. Most sex addicts try, usually repeatedly, to either quit or cut back on their sexual behaviours. Sometimes they even succeed for a short while. But before they know it, they are back where they started, losing themselves in sexual obsession.
• Negative consequences. Sex addicts typically experience the same basic consequences as other addicts: problems at work or in school, relationship woes, financial issues, declining physical and/or emotional health, loss of interest in previously enjoyable activities, isolation, arrest, etc.

Stated simply, CSBD (sex addiction/compulsivity) is an ongoing, out-of-control pattern of sexual fantasies and behaviours that causes problems in a person’s life.

Recently, the World Health Organization (WHO) added CSBD to the latest version of its diagnostic manual, commonly referred to as the ICD-11. The WHO’s CSBD description reads as follows: ‘Compulsive sexual behaviour disorder is characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., six months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgements and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.’

So, again, CSBD is defined based on three primary criteria: preoccupation to the point of obsession with sexual fantasy/behaviour, loss of control over sexual fantasy/behaviour, and negative consequences that are linked either directly or indirectly to sexual fantasy/behaviour.

In today’s world, those who are sexually addicted typically engage in both online and real-world sexual activities, though for some addicts the sexual ‘acting out’ is purely online or in person. Generally, sexually addicted individuals engage in one or more of the following activities:

• An ongoing pattern of intense and highly sexualised affairs or brief ‘serial’ relationships.
• Consistently having casual and/or anonymous sex with people met online or in person.
• Constantly ‘hunting’ for sex
• Consistently visiting strip clubs, adult bookstores, adult theatres, and other sex-driven environments
• Paying for (or being paid for) sex, sensual massage, eroticised domination, etc.
• Hour after hour of porn and/or webcam use, with or without masturbation.
• Losing oneself in hookup apps and similar technologies such as dating sites, video chat, sexting, etc.
• A pattern of unsafe sex, such as unprotected sex, sex with strangers, sex in public, etc.
• Consistently seeking sex without regard to consequences, such as damaged relationships, financial issues, arrest, etc.

Without a doubt, this listing of common sex addict behaviours is extremely incomplete. That said, at least one or two of the activities listed above are nearly always among the behaviours that any sexually addicted/compulsive person struggles with.

Sex addiction is not about sex. It’s about ‘numbing out’ and escaping from stress and other forms of emotional discomfort, such as depression, anxiety, low self-esteem, the pain of unresolved early-life trauma, etc. This is always why alcoholics drink, drug addicts get high, compulsive gamblers hit the casino, etc.

So, sex addicts are hooked not on the sex act, they’re hooked on the emotional intensity and escape produced by their sexual fantasies and patterns of behaviour, including the endless search for the perfect video, the perfect sex partner, the perfect sexual encounter, etc. Often, sex addicts spend many hours, sometimes even days, in this elevated state – high on the goal/idea of having sex – without ever engaging in any concrete sexual act. They even have a name for this escapist, dissociated condition, referring to it as either ‘the bubble’ or ‘the trance’.

If you think you or someone you know might be sexually addicted but are still unsure, you can find an anonymous sex and porn addiction screening test here.

Robert Weiss, PhD is a relationship expert who has spent more than 25 years developing treatment programmes to help those who are challenged by digital-age infidelity, sexual addiction, and other addictive disorders.