When Sexual Behaviour Feels Compulsive
Some people find themselves repeating sexual behaviours even when they genuinely want to change. It might be repeated affairs, problematic pornography use or cam sex, visiting sex workers, or patterns of masturbation that feel like they have become more frequent or more important than they would like.
Sometimes there is a strong pull towards the behaviour that can be difficult to understand. You may find yourself doing something sexually even though you know it conflicts with your values, your relationships, or the person you want to be. Afterwards there might be regret, shame or a sense that you have let yourself, or somebody else, down.
For some people, there is also a lot of secrecy involved. You may be trying to keep your sexual behaviour hidden from a partner or other people in your life, while at the same time feeling increasingly preoccupied with it yourself. Over time, this can create difficulties in relationships and leave you feeling quite distressed about what is happening.
Understanding Compulsive Sexual Behaviour
Compulsive Sexual Behaviour Disorder (CSBD) is the clinical term used to describe patterns of sexual behaviour that feel difficult to control. The World Health Organisation classifies CSBD as an impulse control disorder in the ICD-11, rather than an addiction.
However, most people who come to therapy aren't particularly concerned about whether they meet a diagnostic category. They are usually more interested in understanding why they keep doing something that they don't really want to be doing, and in finding a way of changing it.
It's also worth saying that not everybody who feels that their sexual behaviour is out of control will meet the full diagnostic criteria for CSBD. Sexual behaviour can become problematic for a number of different reasons, and part of my role is to understand what is happening for you rather than trying to fit your experience into a particular label.
I’m interested in what the behaviour means for you and what purpose it might be serving. Sexual behaviour can sometimes become a way of coping with difficult emotions or situations. It might provide comfort, excitement or relief from stress, or it might be something you turn to when you are bored, lonely, anxious or feeling disconnected from other people.
Understanding this doesn't mean excusing behaviour that has caused difficulties or hurt other people. Rather, it gives us a better understanding of what is happening and creates an opportunity to do something different.
Why the Behaviour Persists
In therapy, we can explore where your sexual behaviours come from and what is happening around them. We can look at what tends to happen before you engage in the behaviour, what you get from it in the moment, and what happens afterwards. This might include exploring things like boredom, loneliness, stress or anxiety, as well as your relationships, your emotional life and the ways in which you have learned to manage difficult feelings.
We can also look at the pattern of the behaviour itself. Perhaps you can manage not to do something for a while, but then find that once you start you have difficulty stopping. Or perhaps you keep returning to a particular behaviour even though you know that it is having consequences that you don't want.
For me, understanding the function of the behaviour is an important part of therapy. If we can begin to understand what the behaviour is doing for you, rather than simply trying to suppress it, there is more opportunity to find other ways of meeting those needs.
Common Experiences
People who come to see me about compulsive sexual behaviour often describe feeling that they have difficulty stopping once they begin. They might experience shame or regret afterwards, particularly when the behaviour conflicts with their personal values or affects somebody they care about.
There can also be a significant amount of secrecy, particularly where there has been an affair, pornography use or other sexual behaviour that a partner doesn't know about. This can have an impact on trust and intimacy within a relationship, as well as creating a lot of emotional distress for both partners.
You may recognise some of this in your own experience, or your situation may be quite different. There isn't one particular way that compulsive sexual behaviour looks, and I think it's important that we take the time to understand your particular circumstances rather than making assumptions about what is going on.
My Therapeutic Approach
My approach is focused on understanding and integration rather than shame or suppression. I don't see therapy as being about simply telling you to stop having sexual thoughts, urges or desires. Instead, I want to understand your sexual and relational life and help you make sense of what is happening. This includes exploring your sexual urges and desires, your needs, wants and longings, and the values that are important to you.
We can look at which behaviours feel healthy and right for you and which ones feel unwanted, harmful or out of keeping with the person you want to be. We can also explore your erotic mind, including your sexual desires and fantasies, and how these fit with your wider sense of yourself and your relationships.
Where stress, anxiety, loneliness, boredom or other difficult emotions are contributing to the behaviour, we can look at different ways of managing these experiences. We can also work on developing a greater ability to manage urges and interrupt repetitive patterns when they are not serving you well.
Where there are underlying emotional or relational difficulties, these can be explored too. Sometimes the sexual behaviour is only part of a much bigger picture, and understanding that picture can be important in making meaningful and sustainable changes.
If there has been an affair or secrecy within a relationship, we can also look at what has happened and what needs to happen next. This might involve thinking about trust, communication, intimacy and the kind of relationship you want to have going forward.
Ultimately, I want to help you develop a more integrated and fulfilling relationship with your sexuality, one that supports your wellbeing and your relationships rather than working against them. My approach is grounded in respect and sex-positivity. I don't have a particular idea about what your sex life should look like, and therapy isn't about imposing my own values on you. Instead, we'll work together to understand what is important to you and how you want your sexual and relational life to fit into the wider life you want to live.
You Don't Have to Deal With This Alone
Talking about sexual behaviour can be difficult, particularly if you have been carrying feelings of shame or secrecy for some time. You may not be sure whether what is happening is something you should be concerned about, or you may simply know that things don't feel right and that you would like some help making sense of them.
Therapy provides a confidential, non-judgmental space where we can explore what is happening without you having to pretend that everything is fine. You don't need to have worked out exactly what the problem is before you come to therapy. That's something we can explore together.