'What used to be hardcore is now white vanilla sex' says Sex Therapist

(dpa) - Compulsive sexual behavior disorder (CSBD) is being listed in the 11th revision of the International Classification of Diseases by the decision-making body of the World Health Organization.

"This will make it easier for sufferers to find therapists" and also facilitate research on the condition, neurologist and sex therapist Dr Heike Melzer, 54, told us in an interview. Nine in 10 sufferers are male, she says. We asked her to shed some light on CSBD.

Q. What is compulsive sexual behavior disorder?

A. As in other addictions, it involves obsessive preoccupation with the object of addiction, in this case sexual fantasies and/or the initiation of predominantly casual or paid sexual contacts. This is accompanied over time by greater tolerance and an increase in dosage - that is, what was effective at first becomes dull. You need stronger material, younger performers, video sequences in rapid succession, and you keep expanding your consumption.

And then there's the loss of control. Despite negative consequences in your relationship, at your job, for your health, financial straits or trouble with the law, you can't stop your behavior.

Q. How can you tell you're slipping into compulsive behavior?

A. There's the so-called SAFE formula. S stands for "secret." A stands for "abusive." This can be self-abuse, for example if you constantly masturbate while watching porn and can't stop. Or if you consume sexual abuse material [eg child pornography]. In the paid sex segment, it's if your partner isn't acting voluntarily, but under pressure.

F stands for "feeling." The typical sufferer consumes to get rid of bad feelings, the causes of which have to be investigated. E stands for "empty," in other words sex detached from emotions and relationships.

Q. When do sufferers seek help?

A. Some read about the disorder and realize they've got a problem. But most need a wake-up call via conflicts with their partner when their double life comes to light. Others can no longer concentrate at work, which is no wonder if you devote up to 40 hours a week to your obsession.

Or health problems arise - young men with erectile dysfunction, a lack of sexual desire for their partner, delayed orgasm or none at all, or sexually transmitted diseases. And, obviously, when their financial resources are depleted and they can't pay for their consumption anymore.

Q. How does therapy proceed?

A. First I bolster the sufferer, strengthen their self-confidence, foster candor and trust. Then it's important to impart knowledge. When you know how your brain's reward system works and how overconsumption deadens you and makes you ill, it's easier to change your behavior. Addiction is accompanied by defense mechanisms, so it helps to look closely and analyze triggers or underlying feelings, for instance. Sufferers are often isolated, so attending support groups can be quite helpful. The sheer willingness to change, and conventional behavioral therapy, often have little effect.

Q. Is the problem linked to societal developments?

A. Yes. Sexual stimuli are getting ever stronger and can be consumed to excess. Moreover, what we watch changes our sexual fantasies. What used to be hardcore is now vanilla sex. Voyeurism, fetishism and exhibitionism have become part of our culture. Who isn't a voyeur in the era of Instagram and Pornhub?