Compulsive Sexual Behavior: A Mental Health Perspective

Peeping at someone while they are bathing, sexual fantasies, and publicly masturbating in an alley?

Hello Doctor,
I have been troubled by a problem for many years and I don’t know what to do! I have been living with my boyfriend for ten years.
In the second year of our relationship, he began to cheat on me, and this has led to a series of infidelities and an obsession with women.
He often forgets my existence and openly watches adult films at home! He is attracted to any passerby regardless of their appearance or age, and he has a fixation on women in black stockings.
He tends to follow women on his bike and is captivated by women bending over, exposing themselves.
These behaviors happen every day.
He admits that he has loved lying since childhood.
Once, his lying led to a police incident that almost got his father in trouble, but he feels no remorse.
When he was in kindergarten, he brought a neighbor's child home to engage in sexual acts (including penetration).
As a teenager, he would hide in his room every day to watch adult films and masturbate, a habit that continued until a few years ago.
Before he met me, he had other girlfriends, and he claimed that he only wanted to sleep with them, even collecting their underwear or asking them to send him nude photos for his masturbation.
His mother mentioned that he saw a psychiatrist in high school due to being bullied, and the doctor diagnosed him with paranoid delusions, but he only took medication for a few months before stopping.

Throughout our ten years together, every word he says is filled with lies, and he cannot express even the simplest daily matters honestly.
In 2012-2013, I caught him climbing out of the window to sneak into the alley to watch someone shower, and he was masturbating while doing so! Before that, I had already suspected him of many strange behaviors and the continuous emotional pain from his infidelities, but that time, I saw it with my own eyes! At that moment, I truly broke down.
Since then, I have developed a strong aversion to women and to his words, and I can no longer go to crowded places.
This has been going on for many years! During this time, he has continued many of the same behaviors he exhibited before.
I have been trying to restrain myself from doubting him, but there is too much evidence for me to continue deceiving myself!
On April 10, 2016, he said he was going to walk to the corner to buy food (it was raining, and he took an umbrella), but it seems he went to the nearby alley to #watch someone shower and #masturbate! He left around 10 PM and didn’t return until almost 11 PM.
I just want to record the approximate time.
When he came home, there were many marks on his clothes from iron bars (this has happened before when he was unaccounted for while walking, and he would come back sweaty with evidence of ejaculation on his underwear).
We had an argument that day, and three days later, he confessed to me.
He admitted that he went to the alley to watch someone shower and masturbate! He said he saw a light on in a bathroom and went into the dark alley to masturbate, claiming that it was just a light on without curtains and the window closed, and he wasn’t sure if it was a man or a woman! He said that regardless of how someone looks, whether male or female, fat or thin, if he sees a light on in a bathroom or toilet, he will have sexual fantasies and will uncontrollably masturbate in public, but he wakes up halfway through! We talked for a long time, and I don’t know if what he said was fabricated or if he was hiding something! He also didn’t explain how the marks on his clothes from the iron bars came about.
I remain skeptical! An alley is still a public place! Isn’t this pathological? I asked him how I could help him, and he said he didn’t want to think about it! Don’t ask! I don’t want him to continue with this strange personality! He is also invading others' privacy! Seeing a psychologist costs a lot of money, and the person must be willing to face their issues to change, right? I have sought help from his mother, but she doesn’t want to deal with it! She even said he could just look through the door instead of climbing! I am even more hurt; what should I do? I don’t want him to keep falling into this state! Should I report him? I really want to report him! I also want to talk to his mother again! Doctor, can you help me? Can medical treatment effectively solve his problems, or does it depend on him? Can you recommend a doctor in Kaohsiung who specializes in this area? What is the process for seeking treatment? Is psychological counseling charged by the hour? If there is no psychological counseling and only medication, the effect is very limited, right?
On a personal note, this has been going on for ten years! I am probably the one who is most hurt! Although my mental state has changed! I no longer view many people and things as I did before; I live in fear and anxiety every day.
My body is also showing problems! Am I experiencing post-traumatic stress disorder, or is it just depression? I have also gone with him to a psychosomatic clinic, but when he described the incident of watching someone shower, the doctor told him that my situation was more serious (saying that my trauma has affected my daily life) and asked me to come into the consultation room, but I refused.
I was a bit angry at the time! I felt it was his fault; why was I the one who was more serious? It’s also possible that my boyfriend miscommunicated, making me feel that the doctor implied I had a problem!

Niming, 30~39 year old female. Ask Date: 2016/04/15

Dr. Ding Shuyan reply Psychiatry

Hello, having an excessively strong libido may simply be a matter of personal disposition; however, it is often influenced by other mental health conditions that affect judgment and impulse control, leading to more direct expressions of sexual desire.
The content mentions that during high school, the individual consulted a psychiatrist who diagnosed them with paranoia.
Such manifestations due to mental illness are not uncommon in clinical practice and can be considered part of the symptoms of the disorder, necessitating a comprehensive treatment approach.
Therefore, if you can see a doctor and receive medication, it is possible that this situation may improve as the overall condition stabilizes.
The significant stress you have been under has likely contributed to a certain degree of depression and anxiety, which is a common human experience.
The closer the person is to you, the more emotional attachment you feel, leading to constant worry.
As the saying goes, "If they are not crazy, we are the ones who go crazy first!" Many individuals with mental health issues or family members and caregivers of those with substance use disorders often experience depressive symptoms.
The psychiatrist you consulted may have been concerned about the psychological impact and harm you have endured and wanted to help you; this is not a matter of right or wrong.
I encourage you to accept the doctor's assistance without hesitation.
Some healthcare institutions or clinics offer psychological counseling covered by health insurance, which can alleviate the financial burden, although there may be long wait times.
You can inquire at the medical facility about whether they accept health insurance.

Another issue is that if your boyfriend's behaviors are part of a mental health symptomatology, medication treatment may yield more immediate results.
Without comprehensive treatment, relying solely on psychological counseling may be less effective, especially if the individual is not willing to engage in therapy.
Resistance to change and lack of motivation can render counseling ineffective.
I am not familiar with the physicians in the Kaohsiung area, but I believe that any qualified psychiatrist should be able to assist you.
Wishing you all the best.

Sincerely,
Dr.
Ding Shuo-Yan

Reply Date: 2016/04/15

More Info

Compulsive sexual behavior, often referred to as hypersexuality, can significantly impact both the individual exhibiting these behaviors and their partners. In your case, it appears that your boyfriend's compulsive sexual behavior has not only affected his life but has also deeply impacted your mental health and well-being over the years. Understanding this condition from a mental health perspective is crucial for both of you.

Firstly, it’s important to recognize that compulsive sexual behavior can manifest in various ways, including excessive pornography consumption, infidelity, and public sexual acts, as you've described. These behaviors often stem from underlying psychological issues, such as anxiety, depression, or past trauma. In your boyfriend's case, his history of lying, early sexual experiences, and possible mental health issues, as indicated by his mother's account of his childhood behavior, suggest that he may be struggling with deeper psychological challenges.

From a mental health perspective, compulsive sexual behavior can be seen as a coping mechanism for dealing with emotional distress or unresolved issues. It may provide temporary relief or pleasure but ultimately leads to negative consequences, such as relationship problems, feelings of guilt or shame, and potential legal issues, especially if it involves public indecency or harassment. Your boyfriend's actions, such as peeping and public masturbation, are not only harmful to himself but also infringe on the rights and privacy of others, which can lead to serious legal repercussions.

In terms of treatment, it is essential for your boyfriend to seek professional help. Therapy, particularly cognitive-behavioral therapy (CBT), has been shown to be effective in treating compulsive sexual behavior. A mental health professional can help him explore the underlying issues contributing to his behavior, develop healthier coping mechanisms, and work on rebuilding trust in your relationship. However, as you noted, he must be willing to engage in this process, which can be a significant barrier if he is resistant to acknowledging his problems.

You mentioned the financial aspect of seeking therapy, which can be a concern for many. It's important to explore different options, such as community mental health services, sliding scale therapists, or support groups that may offer more affordable resources. In some cases, medication may also be prescribed to help manage underlying conditions like anxiety or depression, but this should be combined with therapy for the best outcomes.

As for your own mental health, it’s crucial to prioritize your well-being. Living in a state of constant fear and anxiety can lead to symptoms of post-traumatic stress disorder (PTSD) or depression. Seeking your own therapy can provide you with the support you need to process your experiences and develop coping strategies. It’s understandable to feel angry and hurt, especially after years of betrayal and emotional turmoil. A therapist can help you navigate these feelings and work towards healing.

Regarding your question about reporting his behavior, it’s a complex decision. If you believe that his actions pose a risk to others or if he continues to engage in illegal activities, reporting him may be necessary. However, this could also escalate the situation and further strain your relationship. It may be beneficial to discuss this with a mental health professional who can provide guidance based on your specific circumstances.

In conclusion, addressing compulsive sexual behavior requires a multifaceted approach involving both the individual exhibiting the behavior and their partner. Encouraging your boyfriend to seek help, while also taking care of your own mental health, is essential. Remember, you are not alone in this, and there are resources available to support both of you through this challenging time.

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