Internet-Based CBT Benefits Men with Hypersexual Disorder

Internet-administered cognitive behavioral therapy (ICBT) can be helpful for men with hypersexual disorder with or without paraphilia(s) or paraphilic disorder(s), according to a recent Journal of Sexual Medicine pilot study.

Hypersexual disorder is characterized by sexual urges and behaviors that a person has difficulty controlling. The situation can interfere with the person’s ability to work, maintain relationships, and engage in day-to-day activities. It can become quite distressing.

People with paraphilias are sexually aroused by objects and situations that aren’t usually arousing for others. Fetishes, exhibitionism, and voyeurism are examples of paraphilias.

Many people with hypersexuality and paraphilias feel ashamed and embarrassed, making them less likely to seek help. The internet could provide a convenient, private way for patients to receive therapy.

Pilot Study Journal of Sexual Medicine

  • The study involved 36 men in Sweden (average age 39 years) who met proposed diagnostic criteria for hypersexual disorder. Twenty-five of the men had at least one paraphilia. Each man was in touch with a therapist who communicated with them regularly through email or telephone.
  • The intervention was a 10-module internet-based program taking place over 12 weeks. Modules included information on cognitive behavioral therapy, understanding hypersexual behavior, coping with emotions, and building communication skills, among other topics.
  • Each week, and again 3 months after the end of therapy, the men completed a series of questionnaires to evaluate their hypersexual behaviors, sexual compulsivity, psychological distress, depression, and satisfaction with the treatment. They also self-rated the severity of their paraphilias or paraphilic disorders. The men were interviewed two weeks following treatment.
  • Overall, the men completed about two-thirds of the modules. Just over a third finished all 10. Most of the men (88%) rated the program favorably.
  • Assessment scores suggested “large, significant decreases” in hypersexual symptoms and sexual compulsivity and “moderate improvements in psychiatric well-being and paraphilic symptoms.”
  • These results were still maintained at the 3-month follow-up point. Men who completed more modules tended to have better results.
  • Twenty-six men participated in interviews afterward. Based on these conversations, the researchers deemed 19 men to be “improved,” 6 to be “unchanged,” and 1 to be “deteriorated.”

The authors explained that about a third of the men lived outside Stockholm County, which could make it more difficult for them to receive in-person treatment. “Treatment accessibility independent of time and location and with frequent access to therapist support may have contributed to high treatment motivation,” they wrote.

Several limitations were noted, however. For example, hypersexual disorder was not included in the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), so researchers used a “tentative” diagnosis. Also, there was no control group.

Still, the authors encouraged clinicians to incorporate ICBT into their practices. They also recommended longer-term studies with larger cohorts (including women) and control groups.



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