In contemporary society, we are quick to pathologize our behaviors. We jokingly call our fondness for cleaning “OCD,” sometimes argue that “we’re all a little autistic,” and haphazardly label our tumultuous on-and-off relationships with our toxic exes “Stockholm Syndrome.”

While popular culture may lead you to believe that love and sex addictions are not only accepted conditions but also quite prevalent—think Frank in season 3 of White Lotus; Elizabeth Gilbert’s latest memoir All the Way to the River: Love, Loss, and Liberation; and pretty much any cultural analysis of the actions of Sex and the City’s Carrie Bradshaw around Mr. Big—the scientific understanding of problematic behaviors related to love and sex is far more nuanced.

Researchers and clinicians hesitate to characterize obsessive love or serial, overly consuming relationships as love addiction, for fear of feeding misinformation or encouraging people to adopt untested treatment regimes. And consider the many varying characteristics. Think about the intensity of your first crush or your devastation after ending it with your three-month situationship. Sure, you might have demonstrated some very concerning behaviors, but would it be fair to call it an addiction? A 2025 systematic review of research noted the growing interest in understanding love addiction and found a significant relationship between love addiction and attachment styles, concluding that a broader lens than addiction is needed to understand and treat harmful relationship behaviors.

Sex addiction, on the other hand, has gained more traction in the scientific community, particularly in the last decade, although clinicians still urge caution as the field comes to consensus. The term itself, along with hypersexual disorder, was denied inclusion in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM-5), when the American Psychiatric Association published an update in 2013. But in 2019, a closely related diagnosis—Compulsive Sexual Behavior Disorder (CSBD)—was formally recognized in the International Classification of Diseases (ICD-11), which the World Health Organization publishes.

Compulsive sexual behaviors can cause very real distress, change brain pathways, and disrupt people’s entire lives, just as with behavioral disorders such as gambling and harmful Internet use. While many addictive behaviors can be addressed through abstinence, sex and love are important parts of many people’s healthy and fulfilling experiences of life, making recovery more complex than simply achieving sobriety. Individuals struggling to manage unhealthy behaviors must find a way to reintegrate love, intimacy, and sex into their lives without triggering the addiction cycle.

So as researchers work to gain clarity on how sex addiction fits into existing addiction frameworks, clinicians continue to work with clients to build their self-regulation skills, reduce harm, and support healthy intimacy. Seeking to understand harmful sexual behaviors encompasses addiction medicine, behavioral disorders, and a range of treatment options, including psychological, biological, and social. Ultimately, both diagnosis and treatment of sex addiction are complicated because of the unique role that sex and sexuality play in our lives, our deep need for connection to others, and our evolving understanding of sexuality. Whereas in a prior generation, you’d be pathologized simply for having multiple sexual partners, in modern times we understand polyamory, for example, as one expression of the vast range of normal sexual behavior and relationships.

“In reality, people vary widely in desire and behavior,” explains Kerry McCarthy, a Denver, Colorado-based licensed Mental health counselor, who warns against labeling “frequent masturbation, pornography use, or diverse sexual interests as unhealthy. . . . Those differences aren’t inherently problematic.”

What is addiction?

Addiction is understood as a “treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences,” according to the American Society of Addiction Medicine. In addiction, normal drives and desires become harmful, changing a person’s brain so they lose control of their behaviors, explains Margaret Jarvis, psychiatrist and chief of addiction services at Geisinger Addiction Medicine in Bloomsburg, Pennsylvania.

“They are pushed . . . by the disease to do things that really are contrary to their own values, contrary to their own interests,” Jarvis says. “It becomes very, very hard for that person to use their brains to do other things, to plan other activities, to engage in other work.”

Researchers first described addiction in the context of substance use, with early 20th century medical and psychological research focusing on behaviors of compulsion and loss of control in relation to alcohol and drugs. In 1960, physiologist and addiction researcher E. M. Jellinek framed alcoholism as a disease with identifiable stages—pre-alcoholic, early, middle, and chronic—marking a shift to viewing chronic substance abuse as a medical condition rather than a moral failure.

In subsequent decades, psychologists including William R. Miller and Mark Griffiths expanded the understanding of addiction to include behaviors such as gambling, overeating, and sexual acts. Griffiths characterized addiction with shared components of salience, tolerance, withdrawal, mood modification, conflict, and relapse. That means the substance or behavior becomes increasingly important, requires escalating intensity to achieve similar effects, causes distress when stopped, alters emotional states, causes interpersonal or functional conflict, and persists despite attempts to abstain, respectively.

Today, the DSM-5 identifies substance use disorder through patterns of impaired control, physical dependence, social problems, and risky use. People diagnosed with the disorder often struggle to cut back or stop using the substance, require ever-higher doses, and continue using it despite negative repercussions in their life or to their health. This diagnosis is made via an 11-question yes-or-no checklist that assesses the prevalence of these symptoms in a patient for the past 12 months. Two or more “yes” answers point to a possible substance use disorder. It’s then up to the clinician to assess the severity. About 48.5 million Americans received a diagnosis of substance use disorder in 2023, according to the United States National Survey on Drug Use and Health.

The one behavioral disorder that is included in the DSM-5—gambling disorder—follows the framework of substance use disorder. However, tolerance and withdrawal are not included. This is because you don’t develop a tolerance to gambling, just as you don’t necessarily display withdrawal symptoms when you stop. Bottom line: Addictive behaviors are not going to impact your brain in the way alcohol or drugs do.

In the 1980s, psychologist Patrick Carnes was among the first to conceive of sex addiction as a behavioral disorder, describing it as a pathological relationship to sex. He defined sex addiction as a person persistently failing to control a specific sexual behavior, continuing that behavior in spite of its harmful consequences, giving up other activities, and distress if unable to engage in sex. He described this specifically in relation to marriages, and the harmful effects of sex addiction on spouses and family.  Carnes and his colleagues urged caution in diagnosing sexual addiction based on frequency of sex, promiscuity, or novel expressions of sexuality, because of the range of normal human behavior.

Only in the most recent 15 or 20 years have researchers begun to understand behavioral addictions, Jarvis says. “The evidence base for substance addictions is really still pretty poor compared to cardiology, cancer treatment, etc. We just don’t have the volume and the depth of research that helps guide clinical decision making,” she says.

How love and sex addiction fit in

The claim of love addiction crops up in pop culture more than in research. Gilbert’s memoir follows her relationship with Rayya Elias, a woman who suffered from drug and alcohol addiction. After Elias develops pancreatic cancer, Gilbert uproots her entire life to take care of her, resulting in compulsive behaviors, codependence, and grief—symptoms she compares to Elias’s substance use addiction.

Science and research have yet to define the contours of love addiction, although the 2025 systematic review noted growing interest in the most recent six years. The researchers conducted a meta-analysis of 15 studies with 3,628 participants and found a positive correlation between love addiction and anxious attachment, as well as a negative correlation between love addiction and avoidant attachment. They concluded that it would be too narrow to view problematic behavior around love solely through the addiction lens. By including frameworks and therapies from the attachment literature, clinicians might more effectively diagnose and treat addictive behaviors around love, they suggest.

People with personality disorders might appear to be addicted to love because they passionately fall into new relationships, only to disrupt them or end them abruptly, says Michigan-based therapist Taryn Sinclaire. But actually, that’s part of the unhealthy attachment pattern characteristic of a number of personality disorders, which Sinclaire treats. “I frequently see clients who are swept away at the beginning of a relationship only to end up chasing this initial high for the rest of the relationship, or rapidly devaluing the partner and moving on to someone new in order to feel this yet again,” she says.

University of Nevada associate professor and clinical psychologist Shane Kraus published research that informed the diagnostic criteria for CSBD. His work found that compulsive sexual behavior mirrors addiction in key ways: impaired control, continued engagement in spite of negative consequences, and the development of hard-to-break patterns.

“If you do a behavior over and over and over, your brain will form patterns and habits, and some of those can become compulsive or problematic, and that’s what happens with gambling,” he says. “Same thing for sex. Originally, it’s fun, you’re enjoying it, but now you’re having sex when you don’t want to. You’re having sex when you’re stressed.”

To be sure, high levels of sexual activity alone don’t qualify as problematic. A 2018 paper Kraus coauthored for World Psychiatry states: “Individuals with high levels of sexual interest and behaviour (e.g., due to a high sex drive) who do not exhibit impaired control over their sexual behaviour and significant distress or impairment in functioning should not be diagnosed with compulsive sexual behaviour disorder. The diagnosis should also not be assigned to describe high levels of sexual interest and behaviour (e.g., masturbation) that are common among adolescents, even when this is associated with distress.”

Kraus helped create the 19-item CSBD scale that clinicians now use to diagnose the disorder. Rather than answer yes-or-no questions, patients assess statements based on how much they agree with them (totally disagree, somewhat disagree, somewhat agree, totally agree). Scoring 50 or more points indicates a high risk of CSBD. Like substance abuse disorder, it’s up to the clinician to diagnose.

“In real clinical work, people rarely present exactly as diagnostic manuals describe, and diagnoses always need to be understood in context,” says Martha Koo, a psychiatrist and chief medical officer at Your Behavioral Health, a clinic in Torrance, California. “Loss of control, failure to change on one’s own, and functional impairment are important to arrive at a diagnosis and determine the need for treatment.”

A scientific review committee convened by the International Society for Sexual Medicine in 2024 concluded that clinical expertise is crucial to differentiate “out-of-control sexual behaviors,” understand their impact on mental and sexual well-being, and refine best practices in care and treatment. “Treatment centers have profited from it being labeled an ‘addiction,’ and current social media, periodicals, and online self-help forums have provided a venue for an enormous spread of misinformation,” the committee wrote. “Evidence-based, sexual medicine–informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.”

Treatment

Treatment for compulsive sexual behavior focuses on working with patients to reduce distress, create coping mechanisms around problematic sexual urges, and find a way back to healthy intimacy that aligns with a patient’s own values.

Clinicians support patients in learning to regulate their problematic sexual behaviors. For some, this means a temporary break from certain sexual behaviors to help clients interrupt compulsive patterns. Melissa Febos, in her memoir The Dry Season, writes about voluntarily abstaining from sex and romantic attachment after a breakup because she believed it would be a way to reconnect with her own desires and intimacy. Similarly, Jessica Steinman, a Los Angeles–based certified sex addiction therapist, recommends short-term abstinence from behaviors such as dating apps, masturbation, hookups, or sex altogether, paired with cognitive behavioral therapy (CBT).

“Abstaining from sexual acting-out behaviors can help reset those pathways and allow the brain to rewire, which takes time,” Steinman explains. This approach draws from research that shows that compulsive sexual behaviors are reinforced through repeated exposure and habit formation. Some clinicians, like Steinman, use abstinence as a way to reduce reinforcement—though studies measuring the effectiveness of this method are still sparse.

Other clinicians focus more on helping clients regulate behavior while still engaging in sexual expression. “The goal is not abstinence but helping clients manage urges, reduce problematic patterns, and engage in healthy sexual and relational experiences,” says Denver counselor McCarthy.

Michigan therapist Sinclaire finds that clients using regulation strategies may fare better than those pursuing strict abstinence, especially when their sexual behaviors are otherwise healthy and consensual. This may involve identifying triggers, planning for relapse, and setting personal boundaries. The main goal is to reduce harm related to these sexual behaviors.

Koo emphasizes that compulsive sexual behavior resembles other addictions in the way repetitive behaviors can dominate a person’s life. “All addictions, whether involving substances or behaviors, are most effectively treated when treatment includes psychological, social, and biological interventions,” Koo says.

Psychological interventions include CBT, eye movement desensitization and reprocessing (EMDR), and narrative therapy, while social interventions include 12-step programs and academic or occupational support to help patients advance their careers, which may have been disrupted by a pattern of sexual acting out. Biological interventions vary depending on the severity of the behaviors and whatever Mental health comorbidities exist. Some patients grappling with CSBD may consider medications for depression, anxiety, or insomnia.

“There is not one cookie-cutter combination of bio-psycho-social interventions I would recommend. Rather, it is important to understand that an eclectic, comprehensive treatment approach that addresses the individual’s needs in all three of these areas leads to best outcomes,” she said.

Research suggests that treatment for compulsive sexual behaviors can be effective. A systematic review of 24 studies found moderate to large reductions in symptom severity—particularly with CBT, though much of this work focuses on problematic pornography use. In a randomized controlled trial of group CBT for men with hypersexual disorder, researchers observed significant drops in compulsive behavior and psychiatric distress that persisted over time. In hypersexual disorder, an individual loses control over sexual behaviors, leading to distress and negative impacts on key life areas.

If you’re concerned about your own or a loved one’s sexual behavior, it’s worth taking a step back. Are you worried because the behavior challenges social norms—or because it has truly become disruptive, consuming, or uncontrollable? Care should focus on helping you regain control, not labels.

“What you do, what kind of sex you have, and how you sexually express yourself, is important,” Kraus says. “For engaging in something that doesn’t make you feel good about yourself, how do we shift you to do something that makes you align with your values?”