Compulsive sexual behavior (CSB), also known as hypersexual disorder, is of emerging interest in the psychiatric research community. But data are shallow in terms of fully understanding CSB – often defined as difficulties in controlling inappropriate or excessive sexual fantasies, urges, or behaviors that interfere with key areas of daily life – as well as its relation to other mental health problems.

Researchers believe that CSB may be tied in some cases to PTSD, suicide risk, and other psychiatric concerns in the Veteran population. But not enough is known about the relationship. Even explaining why CSB is more prevalent among Veterans compared with non–Veterans, or diagnosing Vets with the disorder and figuring out how best to treat them, has been a challenge.

Dr. Shane Kraus, a clinical psychologist at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, Massachusetts, led a team of researchers that conducted the most thorough Veteran study on compulsive sexual behavior to date. In the study, almost 14 percent of men and more than 4 percent of women acknowledged CSB–related symptoms. The study, published in March 2017 in the journal Military Psychology, also indicates that gambling, suicidality, and sexually transmitted infections were associated with male CSB.

The results suggest "CSB may be prevalent among U.S. military Veterans post–deployment and associated with significant negative health indices in men," the researchers write. "Some Veterans may be having difficulty managing their sexual behavior, raising concerns about possible unmet treatment needs for soldiers after they transition back to civilian life. CSB warrants attention regarding screening and intervention."

At the Bedford VA, Kraus sees Veterans suffering from behavioral addictions such as compulsive sexual behavior, excessive gambling, and binge eating. He says a lack of research and training has led to uncertainty in the medical community about how to best treat Veterans with CSB.

"It even took me a while to learn," he says. "Our Veterans have so many complex problems that sometimes when we see them we're not always thinking right away about these other behaviors. We might be thinking about someone who's having difficulty with alcohol use or PTSD or something else. So you're more focused on that. These other areas kind of get ignored or pushed to the side, not intentionally. It just happens when you're working with someone who has a lot going on." The average age in Kraus' sample was 35, and nearly 80 percent of the participants were white. The researchers conducted phone interviews with the Veterans, who were guaranteed their names wouldn't be used in the study. The Vets screened positive for CSB by responding "yes" to either of two items in the Minnesota Compulsive Disorders Interview, which includes questions on compulsive gambling and sexual behavior:

• "Do you or others that you know think that you have a problem with being overly preoccupied with some aspect of your sexuality or being overly sexually active?"
• "Do you have frequent sexual fantasies, urges, or repetitive behaviors which you feel are out of your control or cause you distress?"

Sixty–eight of the 493 male Veterans (13.8 percent) reported CSB symptoms, compared with 14 of the 327 women (4.3 percent). Kraus is unsure whether the percentage was much smaller for the women because they were perhaps more reluctant to speak out on a very sensitive subject.

He says he finds it interesting, though, that 4.3 percent of the women screened positive for CSB, compared with 1.2 percent of women in a 2013 non–VA survey of college–age people. The rate was 3 percent for men in the same survey.