Blog 11: How Shame, Guilt, and Self-Criticism May Contribute to Compulsive Sexual Behavior Disorder

Fabiola Ngamaleu Teumeni

Fabiola (she/her) is a third-year undergraduate student in psychology at the University of Montreal. Since February 2023, she has been a research assistant in Dr. Bőthe's Sexuality, Technology, and Addictions Laboratory. She wishes to pursue her doctoral studies in clinical psychology, and her main research interests focus on the intersectional perspective of compulsive sexual behaviors in older adults.

​Compulsive sexual behavior disorder (CSBD) is characterized by a persistent difficulty to control intense, repetitive sexual urges that result in ongoing sexual behaviors lasting at least six months (World Health Organization, 2022). These urges and sexual behaviors persist and result in negative consequences and significant distress for the individual and/or their environment. Importantly, distress that is solely related to moral disapproval of one’s sexual impulses, urges, or behaviors is not sufficient for a CSBD diagnosis (World Health Organization, 2022). However, shame, guilt, and self-criticism can emerge alongside these behaviors and may contribute to cycles of distress and unwanted sexual activity, amplifying the challenges of managing CSBD (Sassover et al., 2023).

​Although often used interchangeably, shame and guilt are distinct emotional experiences with different consequences.

• Shame is self-directed, emerging when individuals view themselves as fundamentally flawed based on how they believe others perceive them. This often leads to internalized thoughts such as “I am bad” (Gilliland et al., 2011). Shame typically generates a strong urge to hide or withdraw and is often associated with feelings of sadness or being stuck (Gilliland et al., 2011).
• Guilt, on the other hand, is focused on the actions rather than the self (Gilliland et al., 2011). It emerges from the belief “I did something bad”, which may motivate responsibility-taking or attempts to repair harm (Gilliland et al., 2011).

​Shame and guilt are painful, but self-criticism often strikes first. We set unrealistically high standards, and when we fall short, we punish ourselves with harsh judgment (Sassover et al., 2023). This can lead to shame (“I am flawed”) or guilt (“I am a failure”), along with feelings of disgust (Sassover et al., 2023).

​The interaction between these emotions can be visualized as a cycle (Sassover et al., 2023):

1. Self-criticism may lead individuals to judge themselves harshly, creating emotional pain and lowering self-esteem.
2. This pain feeds into shame, reinforcing feelings of worthlessness.
3. CSBD behaviors (e.g., watching pornography, masturbating, sexual behaviors with others, uncontrolled use of paid sexual services) emerge as a coping mechanism. It provides a temporary escape or relief from these overwhelming emotions.
4. After acting out, individuals often experience renewed self-criticism (“I failed again”), which may result in even deeper shame. The cycle then restarts.

This cycle highlights that CSBD involves more than sexual urges. It reflects how difficult emotions like shame, guilt, and self-criticism can become entangled with sexual behavior, maintaining or intensifying patterns of distress.

​Guilt in CSBD is particularly complex. On the one hand, it can motivate change (Gilliand et al., 2011; Sassover et al. 2023). For example, when individuals step back from behaviors that conflict with their values.
On the other hand, guilt in CSBD often can become chronic, entangled with negative beliefs about sexuality itself (Gilliand et al., 2011; Sassover et al. 2023). In this context, instead of resolving distress, guilt can intensify urges, making the “forbidden” feel more tempting and reinforcing the compulsion to act (Gilliand et al., 2011; Sassover et al. 2023).

​Recognizing the roles of shame, guilt, and self-criticism in CSBD is essential for both clinical practice and self-understanding. These emotions highlight that CSBD is not simply about sexual excess but might also relate to the regulation of painful inner experiences (Briken et al., 2024; Lew-Starowicz et al. 2020). By addressing these emotional drivers, clinicians can provide judgment-free, personalized care, and individuals can begin to make sense of their struggles with greater self-compassion (Briken et al., 2024; Lew-Starowicz et al. 2020).

References
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Briken, P., Bőthe, B., Carvalho, J., Coleman, E., Giraldi, A., Kraus, S. W., Lew-Starowicz, M., & Pfaus, J. G. (2024). Assessment and treatment of compulsive sexual behavior disorder: A sexual medicine perspective. Sexual Medicine Reviews, 12(3), 355–370. https://doi.org/10.1093/sxmrev/qeae01
Gilliland, R., South, M., Carpenter, B. N., & Hardy, S. A. (2011). The Roles of Shame and Guilt in Hypersexual Behavior. Sexual Addiction & Compulsivity, 18(1), 12–29. https://doi.org/10.1080/10720162.2011.551182
Lew-Starowicz, M., Lewczuk, K., Nowakowska, I., Kraus, S., & Gola, M. (2020). Compulsive sexual behavior and dysregulation of emotion. Sexual Medicine Reviews, 8(2), 191–205. https://doi.org/10.1016/j.sxmr.2019.10.003
Sassover, E., Abrahamovitch, Z., Amsel, Y., & others. (2023). A study on the relationship between shame, guilt, self-criticism and compulsive sexual behaviour disorder. Current Psychology, 42(9), 8347–8355. https://doi.org/10.1007/s12144-021-02188-3
World Health Organization. (2022). International Classification of Diseases, 11th Revision (ICD-11): 6C72 Compulsive sexual behaviour disorder.