Tests and diagnosis

By Mayo Clinic Staff

Your doctor, psychiatrist or other mental health provider will do a psychological evaluation, which may involve answering a number of questions about:

  • Your physical and mental health as well as your overall emotional well-being
  • Your sexual thoughts, behaviors and compulsions
  • Your use of drugs and alcohol
  • Your family, relationships and social situation

Your mental health provider may also request input from family and friends.

How compulsive sexual behavior is diagnosed

There's an ongoing debate in the psychiatric community about exactly how to define compulsive sexual behavior, because it's not always easy to determine when normal sexual behavior crosses the line into problem sexual behavior. Currently, mental health providers use the Diagnostic and Statistical Manual of Mental Disorders (DSM) — a manual published by the American Psychiatric Association — as a guide for diagnosing mental health problems.

Because compulsive sexual behavior doesn't have its own diagnostic category in the DSM, it's often diagnosed as a subcategory of another mental health condition. In many cases, compulsive sexual behaviors are generally accepted sexual activities taken to an extreme. These may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder or an obsessive-compulsive disorder.

Diagnosis of sexual behavior as a paraphilia

There are, however, diagnostic criteria for clearly unhealthy sexual behaviors called paraphilias. Paraphilias are behaviors that are generally considered harmful or socially unacceptable or are illegal. Diagnostic categories for paraphilias include:

  • Exhibitionism, sexually arousing fantasies, sexual urges or behaviors involving the exposure of your genitals to an unsuspecting stranger.
  • Fetishism, sexually arousing fantasies, sexual urges or behaviors involving the use of objects of some kind, such as women's underwear.
  • Frotteurism, sexual urges or behaviors involving touching and rubbing against a nonconsenting person.
  • Pedophilia, sexually arousing fantasies, sexual urges or behaviors involving sexual activity with a child or children.
  • Sexual masochism, sexually arousing fantasies, urges or behaviors involving being humiliated, beaten, bound or otherwise made to suffer.
  • Sexual sadism, sexually arousing fantasies, sexual urges or behaviors involving acts in which the psychological or physical suffering, including humiliation, of the victim is sexually exciting.
  • Transvestic fetishism, sexually arousing fantasies, sexual urges or behaviors involving cross-dressing in a heterosexual male. A person diagnosed with transvestic fetishism may also have gender dysphoria — discomfort with gender role or identity.
  • Voyeurism, sexually arousing fantasies, sexual urges or behaviors involving the act of observing unsuspecting persons who are naked, in the process of disrobing or engaging in sexual activity.
  • Paraphilia not otherwise specified, sexually arousing fantasies that don't meet the criteria for any of the specific categories. Examples include sexual behaviors involving obscene phone calls (telephone scatologia), obsession with dead bodies (necrophilia), exclusive focus on a body part (partialism), animals (zoophilia), feces (coprophilia), enemas (klismaphilia) and urine (urophilia).

Whatever the nature of your compulsive sexual behavior, push past your fear, shame or embarrassment and seek a professional evaluation. Getting the right diagnosis can be a relief and can guide treatment that will get your life back on track and save you and the people you care about a lot of anguish.

Sep. 15, 2011