Out-of-Control Sexual Behavior: A Comprehensive Overview

Out-of-control sexual behavior (OCSB) is a complex issue that has been the focus of much debate and discussion within the fields of psychology and sexual health. It encompasses a range of behaviors where individuals experience a perceived loss of control over their sexual urges, thoughts, or activities.

Unlike more structured pathology-based models such as “sex addiction” or “compulsive sexual behavior disorder,” the OCSB model uses a more integrative and descriptive approach to understand and address sexual dysregulation. This article will provide a comprehensive overview of OCSB by exploring the conceptual differences between different models and identifying precise language that can be used to describe this situation.

Defining Out-of-Control Sexual Behavior

Out-of-control sexual behavior is defined as a sexual health problem where an individual’s consensual sexual urges, thoughts, or behaviors feel out of control (Braun-Harvey & Vigorito, 2016). Importantly, this definition does not imply that the person is truly out of control but rather emphasizes their subjective experience of feeling unable to manage their sexual desires. This approach intentionally avoids labeling or diagnostic language, such as “addiction” or “disorder,” which can pathologize the experience and limit the understanding of its origins.

The OCSB model considers that just because someone feels out of control doesn’t mean they are. The analogy of the “elephant and the rider” is often used to illustrate this phenomenon. Imagine the rider (representing rational thought and control) trying to steer an elephant (representing emotional impulses). When they are aligned, the rider can guide the elephant with ease, but if they are in conflict, it can feel like the elephant is running wild. In this sense, the experience of feeling “out of control” may stem from an internal struggle between conscious goals and underlying emotional or psychological states.

Conceptual Models of Sexual Dysregulation

Sexual dysregulation, which includes feelings of being unable to control one’s sexual behaviors, can be understood through multiple conceptual lenses:

1. Pathology-Based Models:
   This category includes conceptualizations like sex addiction, hypersexual behavior disorder, and compulsive sexual behavior disorder. Each of these models implies a distinct psychological disorder, similar to substance use disorders, where a person experiences compulsive engagement in sexual activities, loss of control, and distress. However, these models have been criticized for lacking consensus on diagnostic criteria and for applying addiction-like frameworks to sexual behavior, which may not fit the unique dynamics of sexual dysregulation (Grubbs et al., 2020).
2. Sexual Dysregulation as a Symptom of Pre-Existing Conditions:
   Rather than being a standalone issue, sexual dysregulation is often a symptom of other medical or psychiatric conditions such as bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), or Parkinson’s disease and its treatments. Misidentifying sexual dysregulation as the primary condition rather than addressing the underlying health issues can lead to ineffective treatment and even psychological harm by inserting a “disease narrative” that might not apply.
3. Moral Incongruence:
   Moral incongruence occurs when a person’s sexual behaviors are at odds with their personal values or beliefs, creating internal conflict and distress. This model is not necessarily linked to the frequency or type of behavior but rather the subjective interpretation of these actions as morally wrong. Research shows that individuals who view themselves as “addicted” to pornography or sexual activities often experience more distress due to this moral incongruence than from the behaviors themselves (Grubbs et al., 2020).
4. Psychosexual Problem:
   The psychosexual model recognizes that sexual dysregulation exists on a spectrum between sexual worry and sexual disorder. It accounts for the varied origins and presentations of OCSB without requiring a diagnosis of addiction or compulsive behavior. This perspective allows for more individualized treatment approaches and acknowledges that people can benefit from support even if their experiences do not meet strict diagnostic criteria (Braun-Harvey & Vigorito, 2016).

Treatment Approaches in the OCSB Model

The OCSB model focuses on treating underlying vulnerabilities and addressing self-regulation, attachment, and erotic conflict issues rather than framing the behavior itself as the problem. The goal is to improve overall sexual health and well-being rather than eliminate specific sexual behaviors. Recommended strategies include:

• Cognitive-Behavioral Therapy (CBT) for addressing maladaptive thought patterns and building healthier coping mechanisms.
• Emotion Regulation Training to enhance self-regulation skills.
• Attachment-Based Therapy to address unresolved relational conflicts that may manifest as sexual dysregulation.
• Psychosexual Education to help individuals develop a healthier relationship with their sexuality.

Seeking support from an AASECT-certified sex therapist who is experienced in OCSB is crucial. Unlike 12-step programs, which apply addiction frameworks, OCSB treatment should focus on helping individuals gain insight into the psychological and relational dynamics contributing to their perceived lack of control.

References:

Braun-Harvey, D., & Vigorito, M. A. (2016). Treating out of control sexual behavior: Rethinking sex addiction. Springer Publishing Company. https://doi.org/10.1891/9780826196767

Grubbs, J. B., Perry, S. L., Wilt, J. A., & Reid, R. C. (2019). Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis. Archives of sexual behavior, 48(2), 397–415. https://doi.org/10.1007/s10508-018-1248-x