Standard clinical approach

1. Assessment by a psychiatrist, psychologist, or sexual-medicine clinician
   • Clarify the behaviours, triggers, loss of control, consequences, consent, and safety.
   • Screen for depression, anxiety, OCD symptoms, trauma, ADHD, substance-use disorders, bipolar mania/hypomania, and relationship problems.
   • Review medicines and neurological causes. For example, dopamine agonists used in Parkinson disease can cause hypersexuality or other impulse-control problems.
   • Assess sexual health and offer STI testing when indicated.
2. Psychotherapy: first-line treatment The best-supported standard approach is individual therapy, especially:
   • Cognitive behavioural therapy (CBT): identifies triggers, thoughts, routines, and high-risk settings; builds alternative coping behaviours and relapse-prevention plans.
   • Acceptance and commitment therapy (ACT): helps a person tolerate urges without acting on them and act according to personal values.
   • Motivational interviewing when ambivalence is high.
   • Treatment for trauma, mood, substance use, or OCD when these are present.
   • Couples or family therapy when appropriate and safe, particularly where trust, boundaries, or relationship effects need work.
   • Peer-support groups can help some people, but should complement rather than replace professional care.
   International biological-psychiatry guidance states that psychoeducation and psychotherapy should be offered to all patients and are first-choice treatments. WFSBP guideline
3. Practical behavioural measures
   • Identify predictable triggers such as loneliness, stress, alcohol/drug use, particular apps, pornography, unstructured time, or conflict.
   • Use an urge-management plan: delay acting, leave the triggering setting, contact a support person, exercise, grounding, or planned alternative activity.
   • Limit access to high-risk situations when needed, for example content filters, deleting apps, blocking sites, financial controls, avoiding alcohol/drugs, and clear relationship boundaries.
   • Keep a non-shaming record of urges, triggers, actions, and consequences to use in therapy.

Medicines

• SSRIs such as sertraline, fluoxetine, paroxetine, or citalopram may be considered off-label, particularly if depression, anxiety, OCD-like symptoms, or intrusive sexual thoughts coexist.
• Naltrexone may be considered off-label, especially when there is a compulsive reward-seeking pattern or co-occurring alcohol/substance or behavioural addiction.
• Medication should be monitored for adverse effects, interactions, suicidality, liver function for naltrexone, and other relevant risks.
• Hormonal or antiandrogen treatment is not routine treatment for ordinary CSBD. It is reserved for narrowly selected, high-risk situations such as some paraphilic disorders, under specialist care, with informed consent and careful medical and ethical oversight.

When urgent help is needed