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The Biological Bases of Compulsive Sexual Behavior


Partner often misperceives the meaning of the situation ... known as: Hypersexuality, Erotomania, Nymphomania, Satyriasis, Hyperphilia, ... – PowerPoint PPT presentation

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Title: The Biological Bases of Compulsive Sexual Behavior

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Male Sexual Health
  • Male Erectile Disorder (Erectile Dysfunction)
  • Rapid Ejaculation (Premature Ejaculation)
  • Compulsive Sexual Behavior (CSB)
  • Hypoactive Sexual Desire
  • Sexual Aversion
  • Male Orgasmic Disorder
  • Dyspareunia
  • will be covered today

Male Erectile Disorder (ED)
  • More commonly known as erectile dysfunction
  • Often a strong biological component
  • Partner often misperceives the meaning of the
  • Psychogenic ED is almost always a function of
  • The events that created the ED may not maintain
    the ED

Sex at age 90 is like trying to shoot pool with
a rope. George Burns
ED Definition
  • Persistent or recurrent inability to attain or
    maintain an adequate erection
  • Prevalence By age 50, 50 of men feel they have
    at least mild ED (Feldman et al. 1994)
  • Lifelong vs. acquired
  • Generalized vs. situational
  • Differential Diagnosis
  • Sexual dysfunction due to a general medical
  • Substance-induced sexual dysfunction
  • Occasional difficulties with erections

  • P Occasional difficulties with erections is
  • Sex does not equal intercourse
  • LI Common ways psychogenic ED gets started
  • The link between anxiety and sexual function
  • The biology of erections (high risk categories)
  • Education for the partner
  • SS Challenge unrealistic sexual expectations
  • Physician referral
  • Vacuum pump, PDE5i, intracavernosal injections
  • Increase sexual communication skills
  • Help client explore non-coital sexuality

Premature (Rapid) Ejaculation
  • Often confused with unrealistic sexual
  • Partner often misperceives the meaning of the
  • Rapid ejaculation is almost always a function of
  • Usually perpetuated by a snowball dynamic,
    characterized by increasing levels of

A hard-on doesnt count as personal
growth. Evelyn Loeb Except in sex
Premature Ejaculation Definition
  • Persistent ejaculation with minimal stimulation,
    and before the person wishes it.
  • Differential Diagnosis
  • Normal range of sexual functioning
  • Occasional problems with rapid ejaculation
  • Substance induced sexual dysfunction

Myths that Perpetuate Rapid Ejaculation
  • Most men last for at least 10 minutes
  • A good lover lasts until his partner orgasms
  • Thrusting alone is enough for most women to have
    an orgasm during intercourse
  • Concentrating on something else delays orgasm
  • PE is a sign of selfishness
  • PE is a sign of a power struggle

Facts about Rapid Ejaculation
  • The average length of sexual intercourse is 2-7
    minutes (Leiblum and Rosen, 1989)
  • Expecting simultaneous orgasms is unrealistic
  • Most women require clitoral stimulation to
    achieve orgasm
  • Concentrating on something else encourages rapid
  • PE is a symptom of lack of familiarity and
    attentiveness to physical cues

Rapid Ejaculation PLISSIT
  • P Occasional difficulties with ejaculatory
    control is normal
  • Empower sexuality that works for client and
  • LI Statistics about realistic sexual
  • Contradicting rapid ejaculation myths
  • Providing statistics
  • Education for the partner
  • SS Start/stop method
  • Increasing sexual repertoire
  • Increase sexual communication skills

Compulsive Sexual Behavior (CSB)
  • Also known as Hypersexuality, Erotomania,
    Nymphomania, Satyriasis, Hyperphilia, Sexual
    Addiction, Paraphilia
  • No agreement in psychological community regarding
    definition, etiology or classification
  • Addiction? Impulse control disorder?
  • Mood disorder? Obsessive/compulsive disorder?
  • Psychosexual developmental disorder?

CSB Definition
  • 1) Recurrent and intense sexually arousing
    fantasies, sexual urges, and behaviors that cause
    clinically significant distress in social,
    occupational, or other important areas of
  • 2) Not due to another medical condition,
    substance use disorder, or developmental
    disorder. E. Coleman (2003)

CSB Definition (Cont.)
  • Prevelance Approximately 5 of the U.S.
    population Coleman (1992) and Barth Kinder
  • Paraphilic vs. Nonparaphilic (Normophilic)
  • Paraphilic CSB Pedophilia, Exibitionism,
    Voyerism, Sexual Masochism, Sexual Sadism,
    Fetishism, Transvestic Fetishism, Frotteurism
  • Nonparaphilic CSB Conventional sexual behaviors
    taken to an extreme, resulting in clinically
    significant impairment

CSB DSM Classification
  • Paraphilias
  • Sexual Disorder NOS
  • Differential Diagnosis
  • Developmentally normal compulsive sexuality
  • Sexual problems and experimentation
  • Moral conflicts
  • Compulsivity exclusively within a mood disorder
  • Persistent genital arousal disorder

CSB Comorbidity
  • Lifetime prevalence
  • 70 positive for mood disorders
    Raymond (2003)
  • 50-90 positive for anxiety disorders Raymond (2003
  • 50 positive for substance use disorders
  • Raymond (2003)
  • High incidence of adult ADHD
  • Other sexual compulsivity
    Carnes (1992)
  • Higher incidents of child abuse/neglect Coleman

Carnes Level of Addiction
  • Level I Behaviors have general cultural
    acceptance, generally victimless (masturbation,
    pornography, prostitution, anonymous sexual
  • Level II Behaviors which are sufficiently
    intrusive as to warrant legal sanctions, but seen
    as nuisance crimes(voyeurism, exhibitionism,
    indecent phone calls)
  • Level III Behaviors that break significant
    boundaries designed to defend the vulnerable.
    There is typically little compassion or
    understanding for offenders at this level (child
    molestation, rape, incest)
  • Carnes (1992)

Treatment of CSB
  • A continuum of care is available
  • self help -gt outpatient care -gt residential
    treatment (forensic facilities)
  • Medical treatment
  • 12 step programs (Sexual Addicts Anonymous, Sex
    and Love Anonymous, Sexaholics Anonymous)
  • Controversial
  • Psychotherapy
  • Cognitive behavioral therapy
  • Psychoeducation regarding healthy sexuality
  • Individual, family and group modalities

Treatment of CSBPLISSIT
  • P Giving permission for client to be
  • Bond with positive sexuality
  • LI Definition of CSB (interference in a major
    life role)
  • Discussion of the range of sexual expression
  • Explanation of sexually compulsive dynamic
  • Differentiation between one partners lack of
    comfort and the others pathology
  • SS Techniques for increasing intentional
  • Increase advocacy for core needs met by
  • Techniques for increasing sexual communication
  • Technologies for limiting access
  • Educate/empower the partner

  • Barth, R. J. Kinder, B. N. (1987). The
    mislabeling of sexual impulsivity. Journal of
    Sex Marital Therapy, 13(1), 15-23.
  • Carnes, P. (1992). Out of the Shadows. Center
    City, MN Hazelden.
  • Coleman, E. (2005). Neuroanatomical and
    neurotransmitter dysfunction and compulsive
    sexual behavior. In J. S. Hyde (Eds.), Biological
    Substrates of Human Sexual Behavior (pp.
    147-169). New York, NY American Psychological
  • Coleman, E. (2003). Compulsive Sexual Behavior
    What to call it, how to treat it? SIECUS Report,
    31(5), 12-16.
  • Feldman, H., Goldstein, I., Hatzichristou, D.,
    Krane, R., McKinlay, J. (1994). Impotence and
    its medical and psychological coorelates Results
    of the Massachusetts Male Aging Study. Journal of
    Urology, 151, 54-61.
  • Leiblum, S., Rosen, R., eds. (1989). Principles
    and Practice of Sex Therapy Update for the
    1990s. New York, NY Guilford Publications.
  • Raymond, N. C. (2003). An approach to
    pharmacotherapy of compulsive sexual behavior.
    SIECUS Report, 31(5), 17-18.

Recommended Reading
  • Carnes, P. (1992). Out of the Shadows. Center
    City, Minnesota Hazelden.
  • Kaplan, H. S. (1989). How to Overcome Premature
    Ejaculation. New York ,NT Brunner/Mazel, Inc.
  • Metz, M. E., McCarthy, B. W. (2003). Coping With
    Premature Ejaculation. Oakland, CA New Harbinger
  • Metz, M. E., McCarthy, B. W. (2004). Coping With
    Erectile Dysfunction. Oakland, CA New Harbinger
  • Zilbergeld, B. (1999). The New Male Sexuality.
    New York, NY Bantam Books.