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UI psychiatry researcher studies compulsive sexual behavior

IOWA CITY, Iowa -- Try telling someone that you, or a person you know, have a compulsive sexual behavior disorder, and your words might be met with an unbelieving smirk and a wink.

But for the estimated three to five percent of Americans with compulsive sexual behavior, it is a serious condition that can lead to personal or family distress, problems at work, and legal or financial consequences. A University of Iowa College of Medicine researcher has studied people with this condition to better describe its features and understand any links to other behavioral disorders.

In an article published in the February issue of the American Journal of Psychiatry, Dr. Donald Black, UI professor of psychiatry, and his colleagues report that compulsive sexual behavior may be a clinically useful concept, but it actually describes a diverse group of individuals with a range of behavioral problems.

Although there is no universally accepted definition of compulsive sexual behavior, the term is generally used to describe an excessive urge to engage in sexual activities. It has been characterized as a failure to control one's sexual behavior and the continuation of this behavior despite potentially harmful repercussions.

"The main thing is that compulsive sexual behavior exists. People describe this behavior and it's quite problematic for them," Black says. "This condition has received little attention in professional psychiatric literature, although it is probably given a disproportionate amount of coverage in the media."

In the study, UI researchers interviewed 36 people (28 men and eight women) who responded to advertisements for persons who have a problem with compulsive sexual behavior. Participants completed psychiatric assessments for personality and other behavioral disorders. The researchers found that the "typical" person with compulsive sexual behavior is a 27-year-old male who has experienced this condition for nearly nine years. "The behavior is essentially chronic for a number of years," Black says. "It generally involves normal sexual behavior that is taken to extremes."

The most often-reported compulsive sexual activities were "cruising," or seeking repeated sexual experience, and having multiple sexual partners. Compulsive sex within a relationship and compulsive masturbation were also frequently reported among study subjects.

Nearly two-thirds of the study participants met criteria for a current mental disorder, most commonly substance abuse, anxiety disorder or mood disorder. "There does seem to be some relationship between compulsive sexual behavior and substance abuse," Black says. "Using drugs or alcohol may disinhibit some of these people enough to carry out the behavior, or to numb their sense of shame."

He notes, however, that no good evidence exists to link compulsive sexual behavior to other psychiatric conditions, such as obsessive-compulsive disorder (OCD). "The main distinction is that OCD is characterized by repetitive thoughts or behavior that the person intensely dislikes. Certainly with compulsive sexual behavior there is a repetitive quality, but these are behaviors that are generally viewed as pleasurable. These people like what they're doing -- at least at first. After a while, they may start to feel remorse, because it can lead to trouble at home or at work, but they still enjoy the behavior."

Although compulsive sexual behavior's relationship to other psychiatric disorders is unclear, Black believes it is not a single phenomenon. "It probably describes a heterogeneous group of disorders that have repetitive sexual behavior in common. What links a pedophile who engages in such acts repeatedly and someone who masturbates compulsively is that both behaviors are repetitive, indulgent and each person enjoys doing it. But we're talking about two totally different conditions, really. That's part of the problem with the term used to describe this behavior. People read or hear about this and think it only describes a specific set of individuals."

Treatment options for people with compulsive sexual behavior vary, although few studies of the treatments' effectiveness have been conducted, Black says. Some of the newer medications for psychiatric disorders or depression may reduce sex drive and dampen this kind of behavior. For some individuals, psychotherapy may be helpful. Counseling groups, 12-step programs and hospital inpatient treatment programs also are available. "It is still unclear, however, whether these treatments have any proven benefit," Black says.