By Dámaris Tenza – Sex Therapist Specialized in Compulsive Sexual Behavior Disorder (CSBD), CBT and Gestalt Therapy
Yes: the distress that many people describe as ‘sex addiction’ is real and recognised. The World Health Organization’s ICD-11, which came into effect in 2022, classifies compulsive sexual behaviour disorder (CSBD) under code 6C72. What is not an official diagnosis is the label ‘sex addiction’. That distinction matters, and here is why.
Perhaps you have found this article after clearing your browsing history yet again. You told yourself it would be the last time, and for a few days, it was. Now you are wondering whether what you are experiencing is a recognised problem or simply a lack of willpower. It is one of the most frequently searched questions on this subject. But there is another, more useful question that people rarely ask themselves. We will come back to it at the end.
Why is there so much debate about whether sex addiction is real?
The debate exists because two different questions are often rolled into one: whether the distress is real, and whether ‘addiction’ is the right word. The first has a fairly clear answer. The second is less straightforward.
For years, diagnostic manuals did not include this problem. The American Psychiatric Association considered including ‘hypersexual disorder’ in the DSM-5 but ultimately decided against it in 2013. Meanwhile, the term ‘sex addiction’ became popular in the media, often linked to celebrities accused of using it as an excuse. This fuelled scepticism and added to the shame felt by people who were genuinely struggling.
The turning point came with the ICD-11, the WHO’s International Classification of Diseases. Shane W. Kraus and colleagues outlined the proposed diagnostic category in World Psychiatry in 2018. The WHO chose a descriptive name, compulsive sexual behaviour disorder, and placed it among impulse control disorders rather than addictive disorders.
In other words, the current classification recognises a condition that warrants clinical attention. It does not establish that the condition is equivalent to an addiction to alcohol. As we will see, that careful distinction can work in your favour.
What are the ICD-11 criteria for compulsive sexual behaviour disorder?
The ICD-11 defines compulsive sexual behaviour disorder as a persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour.
For this pattern to qualify as a disorder, it must involve one or more of the first four features below, alongside the requirements concerning duration and significant distress or impairment. Here is what each criterion means in everyday life.
1. Sexual activity has become the central focus of your life
ICD-11 criterion, paraphrased: Repetitive sexual activity becomes so central to your life that you neglect your health, personal care, other interests, activities or responsibilities.
In everyday life: Hours disappear that you had not intended to spend this way. You arrive late, get less sleep or stop making time for things that used to matter to you.
2. You have repeatedly tried to cut down without success
ICD-11 criterion, paraphrased: You make numerous unsuccessful attempts to control or significantly reduce repetitive sexual behaviour.
In everyday life: You get caught in a cycle of promises. You install website blockers, then remove them. ‘Not this month.’ The harder you try, the more powerful it seems to become.
3. The behaviour continues despite negative consequences
ICD-11 criterion, paraphrased: You continue the behaviour despite its harmful consequences.
In everyday life: Relationship arguments. Risks to your job. Financial or health problems. You know what it is costing you, yet it happens again.
4. You continue even when it brings little or no satisfaction
ICD-11 criterion, paraphrased: You continue the behaviour even when you derive little or no satisfaction from it.
In everyday life: This is often the most surprising sign. It may no longer feel like pleasure, only relief, or not even that. It can become a way of avoiding another feeling.
5. The pattern persists over an extended period
ICD-11 criterion, paraphrased: The pattern continues over an extended period, for example, six months or more.
In everyday life: This is more than a brief difficult spell after a break-up. It is a pattern that has been part of your life for some time.
6. It causes significant distress or affects your ability to function
ICD-11 criterion, paraphrased: The pattern causes marked distress or significant impairment in personal, family, social, educational, occupational or other important areas of life.
In everyday life: It weighs on you. You hide it. You notice it affecting your relationship, your concentration or the way you see yourself.
These criteria come from the ICD-11 and are also discussed in the review by Zhu and colleagues published in Frontiers in Psychiatry on 3 July 2025.
There is one further clarification, and it may be the most important of all. We will explore it in the next section, but first, take a moment to reflect.
Do any of these experiences feel familiar?
- You have tried to cut down or stop, only to return to the behaviour more often than you would like to admit.
- You spend more time or energy on pornography or sexual activity than you want to.
- You continue even when it is affecting your relationship, work or sleep.
- You use it to escape feelings such as stress, loneliness, anxiety or boredom.
- You hide it or lie about it.
- Afterwards, you feel guilty, empty or unlike yourself.
Recognising yourself in these experiences does not mean you have a disorder, but it may be worth exploring what is happening in a calm, private setting.
A habit, a compulsion or something more? Explore your experience in a few minutes, without judgement. Our Sex Addiction Assessment draws on the criteria outlined above and offers personalised guidance.
Moral incongruence: when sexual distress comes from guilt alone
The ICD-11 includes a crucial clarification: distress arising entirely from moral judgements and disapproval of your sexual impulses, urges or behaviour is not sufficient for a diagnosis of CSBD. In research, a conflict between sexual behaviour and personal moral beliefs is often discussed in terms of moral incongruence.
Why does this matter? Someone might feel deeply distressed about watching pornography once a month because their upbringing or values condemn it, even when there is no loss of control. Their distress is real and deserves attention, but it does not, by itself, establish compulsive sexual behaviour.
Research supports this distinction. A study by Joshua B. Grubbs, Shane W. Kraus and Samuel L. Perry, published in the Journal of Behavioral Addictions in 2019, surveyed a representative sample of 2,075 adults in the United States. Around 11% of men and 3% of women agreed with the statement ‘I am addicted to pornography’. Religious commitment and moral incongruence were among the factors associated with this response, alongside frequency of use.
In other words, feeling addicted does not necessarily mean you meet the criteria for a recognised disorder.
Research involving Peer Briken’s team at the University Medical Center Hamburg-Eppendorf found a related association. In a representative German sample, people meeting indicators of CSBD more often reported a strict religious upbringing (Journal of Behavioral Addictions, 2022).
This distinction has two practical implications:
- If your distress mainly comes from guilt rather than a loss of control, the focus may be on understanding the relationship between your values and your sexuality. Therapy can help with this, too.
- If you experience both guilt and a loss of control, guilt does not explain the whole picture. Both deserve attention.
At IntimAddict, we begin by understanding where your distress comes from, before applying a label.
High sex drive vs compulsive sexual behaviour disorder: what is the difference?
Having a high sex drive is not a disorder. The difference between a high libido and CSBD is not how much sex you have. It is about control, distress and consequences.
| Area | High sex drive | Possible features of CSBD |
|---|---|---|
| Control | You can choose when and how often to engage in sexual activity. | You repeatedly try to cut down but struggle to do so. |
| How you feel afterwards | Sexual activity may leave you feeling satisfied and at ease. | You may experience brief relief followed by guilt or emptiness. |
| Role of sexual activity | Pleasure and connection can be part of a balanced sexual life. | Sexual behaviour may become a repeated way of managing stress, anxiety or loneliness. |
| Satisfaction | Sexual activity remains enjoyable. | You may continue despite getting little or no satisfaction from it. |
| Secrecy | Privacy does not necessarily involve deception. | You may hide the behaviour or lie about its extent or consequences. |
| Impact on everyday life | Sexual activity fits around your responsibilities. | Your health, work or relationships may be neglected. |
| Duration | A high libido alone is not a clinical problem. | The loss-of-control pattern persists over an extended period, for example, six months or more. |
| Distress | A high libido alone does not imply significant distress or impairment. | There is marked distress or significant impairment, not explained solely by moral disapproval. |
The experiences in this table are illustrative, not a diagnostic checklist. Guilt, secrecy or using sex to manage emotions do not, on their own, establish CSBD.
If the right-hand column feels familiar, the following sections may help you understand why trying to manage the problem alone can be difficult.
How common is compulsive sexual behaviour disorder?
Research suggests that difficulties with compulsive sexual behaviour affect a significant minority of adults. However, estimates vary according to the population studied and the screening measures used.
- The International Sex Survey, led by Beáta Bőthe and a consortium of researchers across 42 countries, analysed responses from 82,243 adults. It found that 4.8% were at high risk of CSBD (Journal of Behavioral Addictions, 2023).
- A University of Minnesota study, led by Janna Dickenson and published in JAMA Network Open on 9 November 2018, found that 8.6% of US adults screened positive for clinically relevant distress or impairment associated with difficulty controlling sexual feelings, urges and behaviour: just over 10% of men and 7% of women.
- A German study involving Briken’s team estimated lifetime prevalence indicators consistent with ICD-11 CSBD requirements at 4.9% among men and 3.0% among women (2022).
These figures measure related but different outcomes. Screening positive or being at high risk is not the same as receiving a clinical diagnosis.
One finding from the international study is particularly striking: among those at high risk, only 14% had sought treatment. A further 33% had not sought treatment for reasons including stigma or cost.
If you have not yet asked for support, you are not alone.
Why willpower alone may not be enough: the compulsive cycle
If you have repeatedly promised yourself you would stop, your struggle is not necessarily a lack of willpower. Compulsive sexual behaviour can form a self-reinforcing cycle, and willpower addresses only one part of it.
- Trigger: Stress, loneliness, boredom, an argument or simply having your phone in bed.
- Urge: The urge builds, and it becomes harder to think about anything else.
- Behaviour: Pornography, apps or seeking sexual encounters.
- Brief relief: The tension drops for a few minutes.
- Guilt and shame: ‘Not again.’
- Secrecy and isolation: You hide what happened and withdraw from other people.
- Further distress: This becomes the next trigger.
The key point is that shame can reinforce the cycle by encouraging isolation, which may itself become a trigger. That is why blocking websites or promising ‘never again’ may not be enough. These strategies address the behaviour without necessarily addressing the feelings it helps you manage.
The evidence points towards a broader approach. The 2025 review in Frontiers in Psychiatry identifies psychotherapy, particularly cognitive behavioural therapy (CBT), as a central treatment approach and recommends considering biological, psychological and social factors. The aim is not simply to control behaviour, but to support a healthy, satisfying sexual life.
At IntimAddict, our approach brings together psychotherapy, somatic work, attention to trauma and attachment difficulties where relevant, and support with intimacy and relationships.
If you recognise yourself in this cycle, the next step can simply be to understand it better.
Addiction, compulsion or impulse control disorder: does the label matter?
Researchers continue to debate whether this problem is best understood as an addiction, a compulsion or an impulse control disorder. The WHO placed CSBD in the third category, taking a cautious approach because there was insufficient evidence to classify it alongside substance addictions.
The discussion remains open. In December 2025, the UK’s College of Sexual and Relationship Therapists (COSRT) reiterated that ‘sex addiction’ and CSBD should not be used interchangeably, and that clinical practice should refer to recognised diagnoses.
We use both terms because ‘sex addiction’ is the phrase many people use when searching for help. However, we want the distinction to be clear: you do not need to settle on a label before seeking support.
It is enough to recognise that the behaviour is costing you more than it gives you, and that you are struggling to change it on your own.
What to do if you recognise the signs of compulsive sexual behaviour
Asking for help with something you may have hidden for years can feel daunting. That is why we have created a gradual process, with you choosing each step.
1. Complete the free Sex Addiction Assessment
Take a few minutes in private. You will receive an indicative result by email and, if you choose, via WhatsApp.
2. Book a confidential online assessment
If you would like to explore things further, you can book an online assessment for €150.
This is a confidential conversation with a specialist therapist who will explore the diagnostic criteria with you, consider where your distress comes from, including any moral conflict, and explain the options available.
3. Leave with a plan tailored to your situation
Your plan may include individual therapy, couples work where appropriate, or reassurance that treatment is not needed.
You do not need to have everything worked out before taking the first step.
Frequently asked questions about sex addiction and CSBD
Is sex addiction an official diagnosis?
Not under that name. The WHO recognises compulsive sexual behaviour disorder under code 6C72 in the ICD-11, which came into effect on 1 January 2022. It is classified as an impulse control disorder. ‘Sex addiction’ is a popular term people may use to describe their difficulties, but it is not interchangeable with the formal diagnosis.
Is sex addiction in the DSM-5?
No. The American Psychiatric Association considered including ‘hypersexual disorder’ but did not add it to the DSM-5 in 2013. Compulsive sexual behaviour disorder is recognised in the WHO’s ICD-11.
How can I tell whether I have a high sex drive or a problem?
The difference is not the amount of sexual activity, but your ability to control it and its effects on your life. If you can choose when and how often to engage in sexual activity without significant distress or disruption, a high sex drive alone is not a disorder.
If you repeatedly try to cut down without success and the pattern has been affecting your life for months, a professional assessment may help.
Does feeling guilty about pornography mean I am addicted?
Not necessarily. The ICD-11 states that distress arising solely from moral judgements is not enough for a CSBD diagnosis.
A 2019 study in the Journal of Behavioral Addictions found that identifying as ‘addicted to pornography’ was associated with religious commitment and moral incongruence, as well as frequency of use. An assessment can help distinguish guilt from a persistent loss of control.
Can compulsive sexual behaviour disorder be treated?
Yes. A 2025 review in Frontiers in Psychiatry identifies psychotherapy, including cognitive behavioural therapy, as a central treatment approach, ideally within a broader, individualised plan.
Specialist support can help people develop greater control and work towards a more satisfying sexual life.
Can the IntimAddict assessment diagnose me?
No. The free Sex Addiction Assessment is an initial screening tool designed to help you understand your situation. A diagnosis requires a clinical assessment by a suitably qualified professional, such as the online assessment we offer.
Beyond ‘is sex addiction real?’: the question that matters to you
At the beginning, we mentioned a question that may be more useful than ‘Is sex addiction real?’
Is this costing me more than it gives me, and can I stop when I choose to?
The WHO recognises that a persistent loss of control over sexual behaviour can constitute a disorder, and treatment options are available. Understanding what is happening in your own life is the next step, and you do not have to take it alone.
Imagine leaving your phone in the sitting room without constantly thinking about it. Looking at your partner without an unspoken conversation hanging over you. No longer counting the days since it last happened.
These are some of the changes you may begin to work towards when you address the cycle.
The first step is to understand where you are now.
This article is for information only and does not replace a professional assessment.
