Compulsive Sexual Behavior Disorder and Sexual Orientation
Research shows CSBD differs across orientations, but stigma clouds the picture.
Posted November 27, 2025 | Reviewed by Jessica Schrader
This post was written by Neil Gleason, Ph.D., and Todd Jennings, MA, researchers at the University of Washington and the University of Nevada, respectively. They are leading experts on the intersection of problematic sexual behaviors and LGBTQ+ health.
Mark is a deeply religious man who, in his own words, has “struggled with same-sex attraction ” for much of his life. He feels deep shame about his attractions to other men and has tried without success to ignore these feelings. After years of struggling, he decided to seek therapy .
Mark is told by his therapist, much to his relief, that he is not a homosexual, but actually struggling with “ sex addiction ” rooted in early life trauma . With intensive treatment, his therapist assures him he can get rid of his addictive same-sex attractions.
Mark’s story illustrates how “sex addiction ” has been (and unfortunately, still continues to be) used as a justification for “conversion therapy,” or treatment that attempts to change one’s sexual orientation (Jennings, Gleason, Pachankis, et al., 2024).
To be clear, conversion therapy doesn’t effectively get rid of same-sex attractions and can be deeply harmful to those subjected to it (APA, 2021). The diagnosis for compulsive sexual behavior disorder in the ICD -11 has language that specifically prohibits the diagnosis from being used in this way: it states CSBD should not be solely diagnosed “based on distress related to moral judgements and disapproval about sexual impulses, urges, or behaviors,… [for instance, in] a person who is distressed about his homosexual attraction or behavior” (WHO, 2021).
However, there are people of all sexual orientations who legitimately struggle with seemingly out-of-control sexual behavior. Research has started to explore how CSBD looks different across sexual orientations, but there is still a lot we don’t know.
Are Lesbian, Gay, and Bisexual (LGB) Individuals More or Less Likely to Have CSBD Than Heterosexuals?
This is a tricky question for a few reasons. First, several studies indicate that LGB individuals score higher on measures of CSBD than heterosexual individuals, but there are also studies that find no differences (Jennings, Gleason, Grubbs, et al., 2024). Second, LGB identity is stigmatized across the world, and like in Mark’s story above, many LGB individuals have had times in their lives where they experienced a lot of shame around their sexual attractions.
If you look at some of the measures we use to assess CSBD symptoms, many of the questions seem like they would pick up on this shame rather than CSBD symptoms; for instance, items like “I do things sexually that are against my values and beliefs” (Reid et al., 2011) or “How often have you concealed or hidden your sexual behavior from others?” (Miner et al., 2017). Mark would likely endorse these items even though he shouldn’t receive a diagnosis of CSBD.
Newer measures of CSBD symptoms are better at distinguishing between sexual shame and true CSBD symptoms (Bőthe et al., 2020; Rahm-Knigge et al., 2025), and one study using a newer measure found that among 82,243 people living across 42 countries, there were no differences in CSBD symptoms across sexual orientations (Bőthe et al., 2023).
Does CSBD Present Differently for LGB Individuals?
There is a lot more research exploring this question with gay and bisexual men (GBM), than with lesbian and bisexual women. In part, this is because sexual health research since the 1980s often focuses on HIV, which disproportionately impacts GBM (CDC, 2021). The subcultures that GBM have created around the world are known for their open attitudes toward casual sex, which has led some to speculate that CSBD is a particularly sticky issue for GBM (Weiss, 2013). However, as noted above, GBM don’t necessarily have a higher prevalence of CSBD. So what does the research actually say about how CSBD may present differently among GBM? One main difference may be the kinds of sexual behaviors GBM report problems around. One recent study found that GBM with CSBD symptoms were more likely to struggle with “cruising,” or meeting new partners in public places for anonymous sex compared to straight participants. The same study found that lesbian and bisexual women with CSBD symptoms didn’t differ that much from straight women in the types of sexual behaviors they were struggling with (Grubbs et al., 2024). Other studies have found that for GBM, CSBD is highly associated with using drugs with sex (sometimes referred to as “chemsex”; 2025; Rooney et al., 2018). In fact, one recent study found that a majority of GBM participants reporting chemsex also screened positive for CSBD (Jennings et al., 2025).
What Do I Do If I’m a LGB Person Struggling With CSBD?
The most important thing to do is find a therapist who is LGB-affirming and who you feel comfortable talking to about sexual issues. In general, it’s a good idea to start with lower-intensity treatment (like seeing a therapist once a week) and only get higher-level treatment (like going to residential treatment center or “rehab”) if it’s absolutely necessary. Therapy for CSBD is all about finding healthy and positive ways to enjoy sex and live authentically as an LGB person—avoid any treatment that tries to use fear and shame to make you change who you are.
To find a therapist, please visit the Psychology Today Therapy Directory.
American Psychological Association (2021). APA resolution on sexual orientation change efforts. American Psychological Association. https://www.apa.org/about/policy/resolution-sexual-orientation-change-e…
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Beata Bőthe, Ph.D., is an assistant professor at the Department of Psychology at the University of Montréal in Canada, and Mónika Koós, Ph.D., is a postdoctoral researcher at the Institute for Forensic Psychiatry and Sex Research in Essen, Germany.
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