He Couldn't Stop — Then Psychiatrist Found the Real Cause
Following a detailed history and physical and mental examination, a diagnosis was established and treated with a combination of pharmacotherapy and psychotherapy.
The case report by Srishti Sharma, a resident doctor in psychiatry at the Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India, and colleagues shed light on an often taboo psychiatric illness.
The Patient and His History
The patient presented to a hospital in Chandigarh, India, with a 2-year history of progressively intensifying compulsive sexual urges. Apart from encounters with commercial sex workers, he also watched pornographic content available online for about 1-2 hours at night, followed by masturbation. His frequency of visits increased from three to four times per month initially to three to four times per week over 5-6 months. He would not use a condom or any protection during intercourse.
Although he reported an urge to watch pornographic content, the act did not give him as much sexual gratification as visiting commercial sex workers. He continued to experience initial excitement during the anticipation of sexual intercourse, which perpetuated the cycle, but soon followed by feelings of guilt and worthlessness following the encounters.
He reported not being in any romantic relationship at the time of presentation. Although he is a diploma holder in mechanical engineering, he works as a cab driver. Gradually, he felt that his desire for sexual gratification was excessive and beyond his control, as he was unable to focus on his academic and professional goals due to preoccupation with thoughts of acquiring sexual pleasure.
Other psychiatric disorders, including substance use, were ruled out, and he denied having any family history of psychiatric disorders.
Findings and Diagnosis
The patient's vital signs were measured at the time of admission. Blood pressure, oxygen saturation on room air, body temperature, respiratory rate, and heart rate were all within normal ranges. Physical examination revealed molluscum contagiosum. Auscultation, palpation, and percussion revealed no pathologic findings. Routine laboratory test results were unremarkable.
The patient scored 59/110 on the Compulsive Sexual Behaviour Inventory-13 (CSBI-13) and 36/40 on the Sexual Compulsivity Scale.
On the basis of the overall findings, hypersexuality was diagnosed.
Following the diagnosis, treatment was started on fluoxetine 20 mg once daily and tablet clonazepam 0.25 mg as needed. He was initially enrolled in supportive therapy sessions, which later proceeded to behavioural therapy and relaxation exercises. A dermatological consultation was arranged for the treatment of molluscum contagiosum.
Within 2 weeks of treatment initiation, the patient reported 20%-30% improvement. However, he still engaged in excessive viewing of pornographic content, followed by masturbation.
Tablet fluoxetine was increased to 40 mg/d, and after another 3 weeks, the patient reported an overall 60%-70% improvement. To achieve further progress, the focus of psychotherapy shifted to identifying the underlying causes.
In subsequent sessions, he was able to identify that the lack of a romantic partner made him feel inadequate and unworthy, and visiting commercial sex workers had become a sort of reassurance seeking.
Based on the clinical interview and therapy sessions, the patient had poor exposure to individuals of the opposite sex during his adulthood, including the absence of peer circles and women in his adolescence, which could have further led to communication deficits and anxiety in initiating conversations with them.
After 6 months of combined therapy, the patient achieved a CSBI-13 score of 31/110. The Sexual Compulsivity Scale was reduced to 13/40.
The patient reported increased confidence in his ability to attract partners as a result of therapy.
Discussion
'In the Indian context, where open conversations about sex itself are generally taboo, it is imperative to explore reasons for distress and encourage healthy discussions regarding sexual disorders so that people can seek help and not just continue to live in shame and guilt, thinking that there is something inherently wrong with them and there is no solution to their problems,' the authors wrote.
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Easing yourself in gradually, for example by meeting a trusted friend for a coffee before going to an exercise class full of strangers, can be helpful, as this gradually increases your exposure to the source of your fear. This goes for any kind of anxiety. 'Avoiding the source of your fear entirely will only make things worse.' Winding down with a glass of wine Alcohol makes you relax – it's a fact as true as the sky is blue. When you have a drink, it reduces your inhibitions and prompts the release of dopamine, the feel-good chemical in your brain. These effects are short-lived, however, and relying on them to soothe anxiety can come with the ugly side-effect of knocking the brain's hormonal balance out of whack, leading to worsened anxiety the next day (otherwise known as 'hangxiety'). Alcohol also interrupts sleep and worsens sleep quality, even if having a nightcap can help you to nod off. 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With over 50 offices globally, including 13 in Mainland China, the HKTDC promotes Hong Kong as a two-way global investment and business hub. The HKTDC organises international exhibitions, conferences and business missions to create business opportunities for companies, particularly small and medium-sized enterprises (SMEs), in the mainland and international markets. The HKTDC also provides up-to-date market insights and product information via research reports and digital news channels.
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Join top CEOs, founders and operators at the Level Up conference to unlock strategies for scaling your business, boosting revenue and building sustainable success. Mental health education is not a nice-to-have; it's a business imperative. Employees will engage proactively with support and seek help if they are able to recognize early warning signs like chronic exhaustion, irritability, declining performance or isolation from teammates. They are also more likely to do so if they simply know the right language to describe what they are experiencing, and if they trust that being open about their struggles will not cost them credibility within your company. You can support your employees by helping them develop the skills to recognize when they or their teammates are overloaded or when their teammates are, teaching them how to negotiate, discuss and hold boundaries when the scope of their work changes, and the skills to make clean hand-offs when they are tasked with too much. Brief, skills-based training fits perfectly here. Video-based mental health training has helped companies of all sizes and across industries better equip their employees to protect, nurture and openly discuss mental well-being. These brief, skills-based sessions can normalize tough conversations, build emotional literacy and create a more prepared — not reactive — work environment. Building trust through emotional literacy Trust is rooted in teams having clarity of roles, a shared understanding of their goals and objectives, and empathy for the challenges that each person is facing. At the heart of this is emotional literacy, which is the ability to notice, make sense of, and respond to one another's cues. When people are transparently communicating and listening to one another with compassion, collaboration becomes more seamless. 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Include mental health support skills in onboarding and leadership development so that they are learned just like any other job skill. Define the behaviors you expect and practice them regularly until they become second nature. Related: Thinking of Mental Health Therapy? Go Through This Checklist. Teach skills that protect engagement 17% percent of U.S. employees are actively disengaged at work. Disengagement often happens when people feel overwhelmed and alone, lowering their effort to just get through the week. Mental health education fills this gap by making well-being a clear, practical goal. Teach teams to set limits that protect quality but avoid perfectionism. Show how prolonged stress impairs judgment and how to reset priorities when high workloads lead to diminishing returns. Encourage peer support. Lending a hand to cover for teammates during crunch times should be normalized. 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With repetition of these first-line-of-defense support strategies for well-being, workplace confidence rises and teams feel steadier because everyone knows the playbook. There are easy ways to track your company's progress in these areas. Run brief pulse checks on stress, psychological safety and perceived support. Measure your trends on retention, absenteeism and new hire referrals, as well as employee output metrics around project completion and quality. Watch for adoption signals like training participation and early outreach. And put extra focus on areas where the data indicates you are falling short. Be clear and genuine that your goal is to support your people. It's important that measurement is used to take positive action and build trust, not create an uncomfortable sense of oversight. Related: How to Support Employees' Mental Health as You Return to the Office When education is used to build culture, performance follows Teams that understand stress and communicate clearly produce better work and mo re consistently. While it's unrealistic to eliminate pressure or the need to put in extra hours during crunch times, it is realistic to build skills and trust that prevent burnout. When targeted mental health education is added into the mix, benefits are used when needed, minor issues stay minor, and your reputation grows for performance and care. That's the kind of company high-potential people choose to join, stay with and recommend to others, which will make a difference as you grow your business.
