The New York Times (NYT) recently ran an article on sex and love addiction, which attempted to give the sheen of science to a fluffy book review for Elizabeth Gilbert’s new memoir, All The Way To The River.

The first problem is the grouping together of love addiction and sex addiction. The former involves the compulsive need to feel in love or be in love or be in a relationship with someone. The second most often involves no other person, and includes very different syndromes such as compulsive masturbation, compulsive sexual engagements, and compulsive viewing of pornography.

The word “pornography” never appears in the NYT article. “Masturbation” only once.

Despite citing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the NYT article shows no real interest in getting to the bottom of compulsive sexual behaviors.

Let’s take a look at the science, then, behind the tantalizing headlines teasing stories of sexual compulsion. We’ll start with last year’s report on the assessment and treatment of compulsive sexual behavior disorder from the International Society for Sexual Medicine (ISSM).

One of the key findings of the review committee assembled by ISSM are the problems caused by mis-labeling and self-labeling compulsive sexual behavior, of which the NYT piece is guilty. For example:

[…] pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent ‘unhealthy’ sexual behavior.

Part of the reason that clinical hypersexuality is not included in DSM-5 is because of the number of completely different conditions lumped under the “sex addiction” heading by “current social media, periodicals, and online self-help forums […] especially in North America.” That means you, NYT.

Compulsive sexual behavior disorder (CSBD) is defined as “difficulties with sexual self-control over a prolonged time that are associated with distress.” Symptoms of CSBD may include:

[…] repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities, and responsibilities.

Similar to other true addictions, CSBD must be something that the sufferer wants to control, has tried to control, but feels incapable of controlling. It is a behavior they continue to engage in, despite adverse consequences. They no longer derive pleasure from the behavior except for the relief of cravings.

Behavior that appears excessive, immoral, or culturally inappropriate does not meet the threshold of “illness” or CSBD. Much like teens self-reporting being “addicted” to their phones, most fail to meet the criteria of true addiction and are, at most, dependent upon their devices. So, too, most self-reported “sex addicts” and “love addicts” in no way evidence the kind of compulsive self-harm that would qualify as CSBD.

It turns out we know quite a bit about CSBD because many actual cases cross the line into illegal behavior. Offenders go to court, case workers are assigned, and psychiatrists perform evaluations. A case worker must make some determination on the sources of the behavior, the consequences of the behavior, the triggers for the behavior, and “maintenance factors,” such as lifestyle, routines, and relationships.

The major non-criminal way that CSBD is treated is in couples counseling. True CSBD, the ISSM committee writes, “deeply affects sexual well-being and the ability to form and maintain satisfactory emotional and sexual relationships.” 

Treatment involves first assessing any risks, such as the potential for self-harm or partner injury. Second, multiple disorders need to be investigated. CSBD is often accompanied in children by attention-deficit hyperactivity disorder (ADHD). In adults, it often manifests with generalized anxiety disorder, depressive disorder, and/or substance use disorders.

Sex therapists should consider referral to other experts in the presence of multiple disorders. The authors point out the lack of training in sexual disorders received by most therapists, including psychologists, psychotherapists, and clinical psychologists.

Each case is unique and often complex. Sex therapists start with an initial phase that seeks stabilization of the behavior and self-management tools. A systematic review of 24 studies found an agreement on these interventions for CSBD:

• motivational interviewing
• goal identification
• awareness of thoughts, emotions, and beliefs
• mindfulness
• urge management
• problem-solving, conflict management, and coping strategies

The researchers were surprised at the lack of pharmacological interventions. They recommend greater consideration of the use of serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil and Celexa, and opioid receptor antagonists, such as naloxone and buprenorphine. There’s no reason to believe that CSBD might not also respond well to GLP-1 receptor agonists, such as Ozempic and Wegovy, that have been shown to reduce cravings for other behavioral compulsions.

There’s a lot more to the story of compulsive sexual behavior than first-person accounts from high-sex-drive celebrities looking to sell books. The real story requires some sympathy, some empathy, and a little more maturity than the superficial treatment it received in the NYT.

Written by Steve O’Keefe. First published September 15, 2025.

Sources:

“‘Sex and Love Addiction’ Isn’t a Diagnosis, but It Can Be Debilitating,” The New York Times, September 9, 2025.

“Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective,” Sexual Medicine Reviews, July 2024.

“Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review,” Journal of Behavioral Addictions, September 9, 2022.

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