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Compulsive Sexual Behavior and Dysregulation of Emotion
Abstract
INTRODUCTION: Dysregulation of emotion (DE) is commonly seen in individuals suffering from compulsive sexual behavior (CSB), as well as represents a crucial element of its common comorbidities like mood, anxiety, and substance use disorders. AIM: To investigate the links between CSB and DE. METHODS: A review of pertinent literature on CSB and DE was performed using EBSCO, PubMed, and Google Scholar databases. MAIN OUTCOME MEASURE: Patterns of DE were evaluated as a common clinical feature, underlying mechanisms, as well as a target for psychological and pharmacological interventions in CSB. RESULTS: Across different conceptualizations of CSB, DE represents the core element of a failure to cope with sexual impulses, thoughts, urges, or resulting uncontrolled sexual behaviors. DE may contribute to the occurrence of CSB while for individuals affected by this condition, sexual arousal and release act as an easier/learned (yet uncontrolled and leading to negative consequences) way of coping with negative mood states. CSB may represent a delusive form of self-regulation. Experience of child sexual abuse and insecure attachment patterns are considered risk factors for CSB (likely to be mediated by DE) but require further investigation. DE is also positively associated with CSB symptom severity. Pharmacological treatments affecting mood regulation, anxiety, impulsivity, and regulation within the brain reward system have been reported to help people with CSB achieve better control over their sexual urges and behavior. However, the available data are scarce and well-powered randomized controlled trials are needed to support these observations. Although improvement in one's emotional self-regulation is considered as an important healing factor in treatment, its benefit in psychological therapies specific to CSB requires further investigation. CONCLUSION: DE represents a core symptom of compulsive sexual behavior disorder and related comorbidities as well as a predisposing factor to the development of compulsive sexual behavior disorder. Addressing DE may facilitate better treatment outcomes for patients with CSB. Lew-Starowicz M, Lewczuk K, Nowakowska I, et al. Compulsive Sexual Behavior and Dysregulation of Emotion. J Sex Med 2020;8:191-205.
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“and the relationship between emotional regulation and sexual behavior was described as an important aspect of treatment planning.2,36,37”
From Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective (2024) · cites this paper as [36]
In the citing paper
“Insecure attachment is often a feature of addictions (Starowicz et al., 2020)”
From A motivation model of sex addiction – Relevance to the controversy over the concept (2022) · cites this paper as Starowicz et al., 2020
In the citing paper
“The co-morbidity between (i) sexual addiction and (ii) anxiety and mood disorders is high, estimates being up to 66% (Black et al., 1997) or even 96% (Lew-Starowicz et al., 2020).”
From A motivation model of sex addiction – Relevance to the controversy over the concept (2022) · cites this paper as Lew-Starowicz et al., 2020
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“To the extent that CSBD patients tend to use sex as a coping mechanism (Kafka, 2010; Lew-Starowicz et al., 2019; Schultz et al., 2014), we also hypothesized that prevalence of disorders where emotional dysregulation plays an important role would be increased in CSBD participants.”
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“…the severity of psychotic symptoms (Cramer et al., 2016; Jansen et al., 2019), eating disorders (Prefit et al., 2019), compulsive sexual behavior (Lew-Starowicz et al., 2019), addictive behaviors (Bowen et al., 2011), suicidal ideation and self-harm (Tighe et al., 2018) as well as other…”
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“2,36,37 Several important limitations of CSBD research are pertinent.”
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“Previous studies have found that individuals with CSBD are more likely to have comorbid obsessive–compulsive disorder (OCD) [42], dysregulation of emotions [43], posttraumatic stress disorder [44], suicide risk [45], depression [46], anxiety disorder, substance use disorder, and impulse control disorder [47].”
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Aslan, I. H., Dorey, L., Grant, J. E., & Chamberlain, S. R. (2024) · CNS Spectrums · doi:10.1017/s1092852924000270 · Cited by 34
“15,34 Those affected by compulsive sexual behavior often struggle with managing emotional states, and sexual arousal and engagement may serve as maladaptive coping mechanisms to regulate negative mood states.”
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“Emotional dysregulation and dysfunctional coping have been suggested in CSBD [15, 16] and may act as predisposing and maintaining factors in the case of PPU as well.”
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“…PPU, in line with prior research that has identified links between emotion dysregulation and hypersexuality (Reid et al., 2014) and compulsive sexual behavior (Lew-Starowicz et al., 2020), as well as the relevance of emotion regulation difficulties as predictors of PPU (Cardoso et al., 2022).”
The Relation of Sexual Attitudes to Hypersexuality and Problematic Pornography Use
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Self-citationDysregulated Sexuality in Women with Eating Disorders: The Role of Childhood Traumatic Experiences
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A motivation model of sex addiction – Relevance to the controversy over the concept
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“The co-morbidity between (i) sexual addiction and (ii) anxiety and mood disorders is high, estimates being up to 66% (Black et al., 1997) or even 96% (Lew-Starowicz et al., 2020).”
BackgroundLew-Starowicz, M., & Coleman, E. (2022) · Journal of Behavioral Addictions · doi:10.1556/2006.2022.00032 · Cited by 28
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“Problematic pornography use can be, in turn, perceived as a mood regulation strategy (e.g., Lewczuk et al., 2020; Sniewski & Farvid, 2020; see: Lew-Starowicz et al., 2020); this could explain a greater prevalence of CSBs among sexually diverse individuals.”
Self-citationRahm-Knigge, R. L., Gleason, N., Mark, K. P., & Coleman, E. (2023) · Archives of Sexual Behavior · doi:10.1007/s10508-023-02690-8 · Cited by 23
“Common features across the proposed Hypersexual Disorder and many conceptual models of CSB include engaging in CSB in response to negative affect or stress (Kafka, 2010; Lew-Starowicz et al., 2020; Miner et al., 2019; Reid & Kafka, 2014).”
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“The importance of emotion regulation in minority stress theory dovetails with the emphasis on this construct in the broader CSB literature, which suggests that CSB may arise as a maladaptive coping response to negative affective states, such as depression and anxiety [62].”
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“Moreover, they corroborate the theoretical claim that ER difficulties may be a useful framework for explaining the impact of attachment insecurity on CSBD (see Lew-Starowicz et al., 2020).”
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“However, individuals in the hypersexual porn users and porn users groups seem to use sex to cope with dif fi cult emotions (e.g., sadness, shame, loneliness, boredom, or anger), stress, or painful experiences (Lew-Starowicz et al., 2020).”
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“Hence, preventing major negative consequences could represent an effective way to prevent the full-blown disorder (Lew-Starowicz et al., 2020).”
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“Our findings fit with others demonstrating that both boredom proneness and CSB are associated with impairment in social relationships and intimacy functioning (e.g., Braun-Harvey & Vigorito, 2015; Briken, 2020; Chaney & Blalock, 2006; Chaney & Chang, 2005; Coleman et al., 2018; Kafka, 2010; Klein, Jurin, Briken, & Štu…”
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“Although culture, gender, and sexual orientation are discussed in the ICD-11 as important features in diagnosing CSBD, previous studies were mostly conducted among heterosexual or gay men and in Western countries, signi fi cantly limiting the generalizability of fi ndings and knowledge of PPU and/or PPMI (L. Chen et al.…”
Self-citationLGBQ-affirming clinical recommendations for compulsive sexual behavior disorder
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Adicciones sin sustancia o adicciones comportamentales
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“Regarding the results for gay men, our findings are in contradiction with the results in the literature (Lew-Starowicz et al., 2020; Pachankis et al., 2015).”
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“The term “emotional dysregulation” defines several conditions for which the patient appears to be unable to be aware of the emotions, to control impulsive behaviors, and to behave in line with the emotional status [44, 45].”
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“Some authors have emphasized emotional dysregulation in individuals with CSBD (Lew-Starowicz et al., 2020).”
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“…negative affect (Reid, 2010; Reid et al., 2008), and sexual reactivity associated with changes in affective states (Coleman et al., 2018; Kafka, 2010; Lew-Starowicz et al., 2020; Miner et al., 2016; Miner, Dickenson, & Coleman, 2019; Reid et al., 2008) In line with the associations between…”
BackgroundInfluentialIncreased sensitivity for negative emotional images in individuals with problematic pornography use
Qu, S., Li, R., & Wang, J. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1287455 · Cited by 9
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“Accordingly, prior studies have already suggested a relationship between hypersexuality and poor emotional regulation strategies and have stated compulsive sexual behavior may represent a delusive form of self-regulation and coping with distressing emotions (Goodman, 2001; Guigliamo, 2006; Cashwell et al., 2017; Lew-S…”
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“This is surprising, given that the literature suggests that men tend to endorse CSB at a much higher rate than women in the general population (Kowalewska, Gola, Kraus, & Lew-Starowicz, 2020), as well as treatment-seeking populations (Stavro et al., 2013).”
BackgroundBőthe, B., Michaud, A., Beaulieu, V., Houle, S. A., Nagy, L., Koós, M., Kraus, S. W., Potenza, M. N., Demetrovics, Z., Költő, A., et al. (2026) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00540 · Cited by 7
“In conclusion, even at the lowest ends of available prevalence estimates about pornography-use-related problems, such results suggest that millions of individuals may struggle with PPU and/or PPMI worldwide (B ő the, Nagy, et al., 2024; Grubbs, Kraus, et al., 2019; Lewczuk et al., 2020).”
InfluentialSelf-citationGarner, A. R., Brem, M. J., Shorey, R. C., Hamlin, J. S., & Stuart, G. L. (2022) · Computers in Human Behavior · doi:10.1016/j.chb.2022.107385 · Cited by 7
Impulsivity in the context of pornography use and compulsive sexual behavior
Testa, G., Mestre‐Bach, G., Montejo, A. L., & Actis, C. C. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13437-1.00007-0 · Cited by 7
dos Reis, S. C., Park, K., Dionne, M. M., Kim, H. S. A., & Scanavino, M. D. T. (2022) · Brazilian Journal of Psychiatry · doi:10.47626/1516-4446-2022-2584 · Cited by 9
Hypersexuality in mixed-sex couples: a dyadic longitudinal study
Bőthe, B., Vaillancourt-Morel, M.-P., & Bergeron, S. (2021) · Archives of Sexual Behavior · doi:10.1007/s10508-021-01959-0 · Cited by 6
Yang, X., Wang, Y., Tang, S., Li, L., & Wang, J. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00030 · Cited by 7
Efrati, Y., Goldman, K., Levin, K., & Rosca, P. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00964-1 · Cited by 6
“…difficult emotions (e.g., sadness, shame, loneliness, bore-dom, or anger), and/or painful experiences (Efrati & Mikulincer, 2018; Gola et al., 2020; Lew-Starowicz et al., 2020; Reid et al., 2008, 2011a, 2011b), we may speculate that women with SUDs could turn to CSBD and risky sexual behavior in…”
Manão, A. A., Martins, E. M., & Pascoal, P. M. (2023) · Healthcare · doi:10.3390/healthcare11212856 · Cited by 6
“According to a study [66], engaging in compulsive sexual behaviours may be a way to regulate emotions.”
BackgroundDefining a Framework for Those with Compulsive Sexual Behavior Disorder: A Narrative Synthesis
Whelan, T., Cunnane, E., Clifford, D., & Davoren, M. P. (2023) · Sexual Health & Compulsivity · doi:10.1080/26929953.2023.2236607 · Cited by 5
Cruz, D. M., Ávila-Chauvet, L., Villalobos-Gallegos, L., & Toledo-Lozano, C. G. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1265822 · Cited by 5
“In this regard, further research is warranted to identify the effect of the specific dimensions in the clinical presentation, course, severity of impairment, and comorbidities of sexual addiction, as previous studies suggest (30).”
ResultCompulsive sexual behavior disorder and impulsivity
Sassover, E., & Weinstein, A. M. (2024) · Elsevier eBooks · doi:10.1016/b978-0-443-13437-1.00009-4 · Cited by 5
Prantner, S., Espino‐Payá, A., Pastor, M. C., Giménez‐García, C., Kroker, T., Ballester‐Arnal, R., & Junghoefer, M. (2024) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2024.100524 · Cited by 5
The Association Between Sexual Violence, Compulsive Sexual Behavior and Problematic Pornography Use
Shegedin, M., Scoglio, A. A. J., Kraus, S. W., & Borgogna, N. C. (2024) · Sexual Health & Compulsivity · doi:10.1080/26929953.2024.2432679 · Cited by 5
“There are likely other important risk factors for male CSBD which could include other addiction-related struggles and internalized mental health symptoms, or factors such as trait impulsivity, compulsivity, or emotional dysregulation (Bőthe et al., 2022; Lew-Starowicz et al., 2020).”
Self-citationAndrovičová, R., Jahn, K., Engel, J., Sun, S., Veit, M., Frieling, H., Lew‐Starowicz, M., Kneer, J., Sinke, C., & Krüger, T. H. C. (2025) · Behavioural Brain Research · doi:10.1016/j.bbr.2025.115872 · Cited by 5
Self-citationHuțul, T., Huțul, A., Karner‐Huțuleac, A., Holman, A. C., & Grubbs, J. B. (2026) · Archives of Sexual Behavior · doi:10.1007/s10508-026-03493-3 · Cited by 5
“In this regard, it is important to mention that emotional dysregulation is one of the factors in the literature that has been noted to influence self-perceived addiction to pornography (Lew-Starowicz et al., 2020; Wal-ton et al., 2017).”
Shahbazian, S., Amirfakhraei, A., & Sanjari, S. (2025) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs-152425 · Cited by 4
Development of a structure-validated hypersexuality scale in Chinese university students
Jia, Y., Shao, X., Shen, C., & Wang, W. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03362-4 · Cited by 4
“Moreover, the emotional dysregulation was positively correlated with the compulsive sexual behavior, which might lead to the onset of compulsive sexual behavior [46].”
Background(2020) · doi:10.1007/978-3-030-52298-8_30 · Cited by 4
Self-citationAdamus, S., Bielski, K., Szatkowska, I., Gola, M. K., & Draps, M. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00014 · Cited by 4
Self-citationKhatcherian, E., Arroyave, S. A., ZULLINO, D. F., & Achab, S. (2025) · Journal of Medical Case Reports · doi:10.1186/s13256-025-05492-9 · Cited by 3
Efrati, Y., Shmulewitz, D., Skvirsky, V., Vider, M., Kor, A., Lev‐Ran, S., & Mikulincer, M. (2025) · Addictive Behaviors · doi:10.1016/j.addbeh.2025.108589 · Cited by 3
Alckmin-Carvalho, F., Bú, E. A. D., Silva, W. A. D., Teixeira, I. D. N., Wendt, G. W., Oliveira, A., Oliveira, A., & Pereira, H. (2026) · Healthcare · doi:10.3390/healthcare14020138 · Cited by 3
Slavin, M. N., Hewage, S., Roy, S., & Kraus, S. W. (2025) · Current Addiction Reports · doi:10.1007/s40429-025-00658-3 · Cited by 4
“Emotional numbing and avoidance were hypothesized as key mechanisms driving maladaptive sexual behaviors [74].”
Self-citationAmbrosini, F., Özal, Z., Mancini, G., & Biolcati, R. (2025) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2025.100798 · Cited by 3
Vulnerability to risky sexual behavior among patients with severe mental illness in Uganda
Birungi, C., Ssebunnya, J., Kiwanuka, N., Nakasujja, N., & Kinyanda, E. (2024) · Discover Social Science and Health · doi:10.1007/s44155-024-00071-7 · Cited by 3
“Mental disorders like mania, characterized by an increased libido and tendencies towards risky sexual behavior [47, 48], portray the intricate pathways that intertwine mental health and precarious sexual behavior [49].”
Jamali, S., Shoorehdeli, M. A., Daliri, M. R., & Haghparast, A. (2021) · Basic and Clinical Neuroscience Journal · doi:10.32598/bcn.2021.3071.1 · Cited by 3
Asadi, M. M., Akbari, M., Mohammadkhani, S., & Hasani, J. (2021) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-021-00410-6 · Cited by 3
Gonçalves, P. D. E. S., & Scanavino, M. D. T. (2024) · Sexual Medicine · doi:10.1093/sexmed/qfae050 · Cited by 2
“Items 2, 9, and 21 were not retained in this study.”
BackgroundInfluentialNagy, L., Bőthe, B., Kraus, S. W., Demetrovics, Z., & Grubbs, J. B. (2025) · Sexual Health & Compulsivity · doi:10.1080/10720162.2025.2511324 · Cited by 2
“…(CSB), including problematic pornography use (PPU) have gained international attention as important clinical phenomena, particularly due to their associations with impaired functioning, emotional distress, and adverse psychosocial consequences (Lew-Starowicz et al., 2020; McGraw et al., 2024).”
Self-citationAsian cultural values and help-seeking: a cross-sectional study on compulsive sexual behavior
Pham, H.-L., Nguyen, V. H. A., Le, C. M., Truong-Thai, T.-H., Vu-Thi, Q.-A., Phan, X., Nguyen-Vo, H.-N., Hua, T. D., Nguyen-Duong, B.-T., Ho, C. S. H., et al. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1633160 · Cited by 3
“These include satisfying physiological needs, strengthening interpersonal bonds, and regulating emotional states such as pleasure, satisfaction, stress relief, and feelings of loneliness (2, 3).”
Onu, D. U., Adangozi, C. P., Nnadozie, E. E., Ajah, A. C., & Igwe, E. J. (2026) · Current Psychology · doi:10.1007/s12144-025-08526-z · Cited by 2
“Youth who expe - rienced emotional or physical abuse may be more prone to using pornography as a maladaptive coping mechanism for unresolved trauma or negative affect (refer to Khouani, 2025 ; Lew-Starowicz et al., 2020 ; Testa et al., 2024 ).”
InfluentialHorváth, Z., Bőthe, B., Potenza, M. N., Stein, D. J., Demirgül, S. A., Paksi, B., Czakó, A., & Demetrovics, Z. (2026) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00419 · Cited by 3
Khayambashi, S., & Zarafshan, H. (2020) · International Serious Games Symposium (ISGS) · doi:10.1109/isgs51981.2020.9375446 · Cited by 2
Metadata
- Authors
- Lew-Starowicz, M., Lewczuk, K., Nowakowska, I., Kraus, S., & Gola, M.
- Affiliations
- Cardinal Stefan Wyszynski University in Warsaw (PL)
- The Maria Grzegorzewska University (PL)
- University of Nevada, Las Vegas (US)
- University of California San Diego (US)
- Venue
- Sexual Medicine Reviews
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-04
- Volume
- 8
- Issue
- 2
- Pages
- 191-205
- ISSN
- 2050-0513 (ISSN-L)
- 2050-0521
- OpenAlex
- W2992514771
- Cited by
- 163
- References
- 163
- Citations by year
- 2026: 38 · 2025: 29 · 2024: 27 · 2023: 21 · 2022: 23 · 2021: 12 · 2020: 12
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Sexual Medicine Reviews (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centre of Postgraduate Medical Education
- National Science Center (2016/21/N/HS6/02678)
- Swartz Foundation
- SAA
- Topics
- Social Sciences › Psychology › Clinical Psychology › Sexuality, Behavior, and Technology
- Social Sciences › Psychology › Clinical Psychology › Gambling Behavior and Treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Keywords
- compulsive sexual behavior, emotional dysregulation, sexual impulse control, mood regulation, anxiety comorbidity, substance use comorbidity, child sexual abuse, insecure attachment, risk factors, pharmacotherapy, psychotherapy, brain reward system, impulsivity
- MeSH terms
- Emotional Regulation, Compulsive Behavior, Humans, Psychotherapy, Mood Disorders, Sexual Dysfunctions, Psychological
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