Brett Brian Cushing, MA, LMFT

Dialectical behavior therapy was developed when therapists attempting to use CBT techniques on the most seriously ill patients ran into a problem. When they suggested that a patient change their thoughts, these very vulnerable patients would become overwhelmed and turn aggressive or suicidal. DBT was developed to support these patients with acceptance and validation while still guiding them towards changing problematic thoughts. Although also used for suicidal and self-harming patients today, these days, DBT is mainly used to treat borderline personality disorder. It is one of the few effective interventions for this serious illness.

DBT has been shown to be very effective at reducing self-destructive behavior. It can also be used to teach new coping skills and increase a patient's self-esteem and motivation to become healthier.

Therapy can treat patients who self-harm. Therapists ask people to explore current and past experiences and emotions that may contribute to the desire to self-harm. Cognitive behavioral therapy, a specialized form of therapy, can also reduce self-harm by encouraging patients to identify negative patterns of thought and to develop coping strategies that do not involve self-inflicted injury. Those suffering from more severe self-harm may require in-patient hospitalization to recover mentally and physically.

• Frequent intense sexual fantasies, urges, and behaviors that feel involuntary or beyond an individual's control
• Numerous unsuccessful attempts to stop or reduce sexual behaviors
• The use of sexual behaviors as an attempt to deal with other problems, such as loneliness or depression
• Feeling guilt or remorse after engaging in repeated sexual behaviors
• The inability to stop engaging in sexual behaviors despite negative consequences such as contracting a sexually transmitted infection, damaging important relationships, losing a job, or developing financial or legal problems
• Continuing to engage in repeated sexual behaviors despite receiving little or no satisfaction from them

Compulsive sexual behavior can occur regardless of an individual's gender or sexual orientation, though it may be more common in men. The risk of compulsive sexual behavior may also be higher for people who have alcohol or drug use disorders, other mental health disorders, or childhood traumas, including sexual abuse.

While the causes of compulsive sexual behavior remain unknown, theories of possible causes include:

• Imbalance of brain chemicals affecting mood: certain chemicals in the brain, such as serotonin, dopamine, and norepinephrine, help control mood. When these chemicals are out of balance, sexual desire and behavior could be affected.
• Altered brain pathways: over time, compulsive sexual behavior might cause changes in the brain's pathways, especially in areas of the brain related to reinforcement. Eventually, more intense sexual content and stimulation are usually needed to obtain satisfaction or relief.
• Conditions that affect the brain: some health conditions, such as dementia, epilepsy, or bipolar disorder, may cause damage to parts of the brain that affect sexual behavior. Also, certain medications used to treat Parkinson's disease may cause compulsive sexual behavior.

There is ongoing debate among mental health experts over how to classify compulsive sexual behavior. The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, serves as the predominant guide for diagnosing mental health conditions in the United States and does not include compulsive sexual behavior as a diagnosis. However, the condition may sometimes be diagnosed as part of another mental health condition, such as an impulse control disorder or a behavioral addiction. In contrast, the World Health Organization recently identified compulsive sexual behavior disorder as a diagnosis, which it includes among impulse control disorders.

Determining if sexual behaviors have become a problem is not always straightforward, and more research is required to establish standard guidelines for diagnosis. Nevertheless, whether hypersexual behavior is a compulsion or an addiction, there are individuals engaging in these behaviors who would like to receive help with managing their behavior. There are mental health professionals who specialize in treating addictions, including and compulsive sexual behaviors. Compulsive sexual behavior may be treated with:

• Psychotherapy: essentially, a mental health professional will help individuals identify and manage factors that might trigger compulsive sexual behaviors. Psychotherapy may be provided in individual sessions, as well as sessions with families or couples. These sessions may take place in person or online.
• Medications: while there is currently no medication specifically approved to treat compulsive sexual behavior, some medications used to treat other conditions may be prescribed, such as antidepressants, anti-anxiety medications, or mood stabilizers. These medications act on brain chemicals linked to urges and behaviors. They can lessen sexual urges and brain-chemical rewards that certain behaviors might provide. The medications that are most appropriate for an individual depends on that individual's circumstances, including any other mental health conditions.
• Support groups: these groups can help individuals learn about compulsive sexual behavior, receive support and understanding, identify treatment options and coping techniques, and prevent relapse. Support groups are often modeled after the 12-step program of Alcoholics Anonymous. Mental health professionals may be able to recommend particular groups that meet locally or online.

The principal goal of treatment for compulsive sexual behavior is to help individuals manage urges and reduce problematic behaviors while still enjoying healthy relationships.