a disorder that seeks serenity through lack of control

For years we have heard words and expressions such as “nymphomania”, “sex addiction” or “hypersexuality”, among others, to talk about those people who suffered from an “excessive or exacerbated” sexual desire or a lack of control in their sexual behavior . While it is true that these words have had some history, today they are outdated terms.

The World Health Organization (WHO) included after much work in 2018 the label “Compulsive Sexual Behavior Disorder (CSCD)” to name the disease of those patients who come to the consultation with a lack of control in their sexual behavior that they cannot stop.

How are these people?

Criteria for this classification include people who:

  • They have lost control of their behaviors.

  • They strive to give up sexual behaviors and cannot give them up.

  • They derive no pleasure from these experiences.

  • They have serious consequences in the different areas of your life for more than 6 months.

The OMS refers to the fact that this problem would not be explained by a moral judgement, that is to say, that the simple fact that something does not seem appropriate or morally good to a person would not explain that there is a clinical pathology and susceptible to diagnosis.

“Sex has become an anxiolytic for me. Every time I suffer and I can’t take it anymore, sexuality becomes my refuge”, a 45-year-old patient told me. It is common to observe how patients use sexual behaviors (pornography, prostitution, chats or webcam sexual) to regulate their affective world. When patients with these difficulties do not know how to manage their emotions, they go to sex to find their serenity.

Although more research is still needed, CSCD affects about 10.3% of men and 7% of women in the general population, according to the book Compulsive sexual behavior: A comprehensive look. Guide for professionals. Around 87% of patients have difficulties controlling the use of pornography and between 15-20% sexual behaviors such as paid sex or infidelity.

How does it affect those who suffer from it?

People who suffer from these difficulties can see different areas affected:

  • Personal: the way of thinking and understanding sexuality is distorted and loss of self-esteem and self-confidence appears, feelings of incapacity, alteration of spiritual well-being, personal discomfort, humiliation or contempt, shame, guilt and lack of identity development staff.

  • Economic: job losses, excessive or inappropriate spending of money, blackmail and fraud.

  • Interpersonal: sentimental breakups, loss of trust of others, alteration or difficulties in interpersonal relationships, emotional damage to others, social isolation, failures in the care of a loved one, marital or partner breakups and loss of friendships.

  • Medical: sexually transmitted diseases, physically unhealthy sexual relations, cognitive dysfunctions, psychopathologies, sexual dysfunctions and worsening of health.

  • Others: legal problems (complaints, arrests), irresponsible behavior, renunciation of important goals or objectives, expulsion from organizations, associations, etc. and deterioration of the public image.

The neurobiological studies The most prominent have observed that compulsive sexual behavior disorder shows similar alterations in the brain to those caused by other addictions to substances and/or behaviors. The brain centers related to reward and dopamine can be impaired due to this lack of sexual control. Also, brain areas that regulate self-control, planning, attention, and empathy they can be altered as observed in the most recent studies.

How to recognize the disorder

Some clues that can help us suspect that a person suffers from this disorder are:

  • It presents features of impulsiveness, inability to delay gratification or lack of inhibitory control.

  • Changes in mood such as irritability, depressive symptoms, anxiety or instability.

  • Presence of sexually transmitted diseases.

  • Technology dependency.

  • Low academic or work performance and frequent absenteeism.

  • Drug use (alcohol, tobacco, cannabis and other substances).

  • Difficulties in emotional regulation.

  • Strong inclination to seek novelty or new sensations.

  • Difficulties in emotional expression.

  • Overly sexualized language.

  • Stability problems in the couple, infidelities, etc.

  • Little interest in sexual relations with one’s partner.

  • Low or no sexual training or great guilt regarding their sexual acts.

But there is a way out. Although the road is long and requires awareness, motivation, strength, support, patience, affection, help and dedication, the way out does exist. In recent years, different effective treatments have been shown to help these people, including individual therapy (from different currents, although the efficacy of cognitive behavioral therapy), group therapies and, sometimes, pharmacological therapy. These treatments help regulate behavior and control impulses, as well as relearn a healthy sexuality and live a freer life.

Also exist some formations that can help guide on how to make an adequate approach to this great unknown still for many health professionals.

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