The Problem
So, what is the actual issue?
Compulsive sexual behavior, problematic pornography use, and the betrayal they leave behind are among the most under-researched and under-recognized public health concerns of our time. Decades of peer-reviewed studies from respected institutions show that these patterns affect millions of individuals, wound the people closest to them, and strain the relationships that hold families and communities together. Yet the science remains thin, the funding remains scarce, and the people who suffer often have nowhere to turn. AFAR exists to close that gap.
A common condition that science has largely overlooked
Nearly 1 in 20 adults worldwide is at high risk for
compulsive sexual behavior disorder.
Prevalence
Nearly 1 in 20 adults worldwide is at high risk for compulsive sexual behavior disorder.
In the largest study of its kind, drawing on the International Sex Survey of more than 82,000 people across 42 countries, researchers found that roughly 5 percent of adults were at high risk of experiencing compulsive sexual behavior disorder (CSBD).1 That places it in the same range of occurrence as many far better-studied psychiatric conditions.
Between 3 and 6 percent of U.S. adults are estimated to live with compulsive sexual behavior.
Population estimates in the United States place the prevalence of compulsive sexual behavior at approximately 3 to 6 percent of adults, with onset typically in late adolescence or early adulthood and higher rates reported among men.2 A large national German sample found a lifetime prevalence consistent with ICD-11 criteria of 4.9 percent in men and 3.0 percent in women.3
Recognized by the world, still missing from U.S. diagnosis
CSBD is recognized by the World Health Organization, yet it is absent from the primary diagnostic manual used by U.S. clinicians.
The Diagnostic Gap
The World Health Organization formally recognized compulsive sexual behavior disorder as an impulse control disorder when the ICD-11 took effect in 2022. The condition does not appear as a standalone diagnosis in the DSM-5, the manual most U.S. clinicians rely on, which leaves providers without shared criteria, complicates insurance and treatment access, and slows the research the field urgently needs.4
Only about 14 percent of people at high risk for CSBD have ever sought treatment.
The Treatment Gap
Across the same 42-country study, only about 14 percent of individuals at high risk for CSBD had ever sought treatment, and roughly a third of those who needed help never pursued it, citing barriers such as cost, stigma, and shame.1 The absence of a clear diagnosis, accessible care, and public understanding leaves most who struggle to do so in silence.
When pornography use becomes compulsive
Problematic pornography use affects up to 11 percent of men and up to 3 percent of women.
Porn Addiction
Most people who view pornography report no negative consequences, but for a meaningful minority the use becomes persistent, distressing, and difficult to control. Prevalence estimates for problematic pornography use range from roughly 4 to 11 percent among men and 1 to 3 percent among women, and it is now widely understood as a common manifestation of compulsive sexual behavior disorder.5
Mental Health Impact
Problematic pornography use is consistently linked to higher anxiety and depression. A one-year longitudinal study of more than 4,300 U.S. adults tracked problematic pornography use alongside psychological distress and confirmed a persistent association with elevated anxiety and depression over time.6 The distress is not incidental. It travels with the behavior and often deepens the longer it goes unaddressed.
The Unseen Injury: Betrayal Trauma
Nearly 70 percent of betrayed partners meet the symptom criteria for PTSD.
Betrayal Trauma
Foundational research on partners of individuals with compulsive sexual behavior found that 69.6 percent of the women studied met every criterion for post-traumatic stress disorder except direct exposure to a physically life-threatening event.7 This work reframed the betrayed partner not as a codependent to be treated, but as a trauma survivor whose responses are a normal reaction to a genuine relational injury.
Between 34 and 60 percent of women who experience infidelity show significant PTSD symptomology.
Studies of women who have experienced intimate betrayal estimate that somewhere between 34 and 60 percent present with significant post-traumatic stress symptomology and could meet the threshold for a PTSD diagnosis.8 Common experiences include intrusive thoughts, hypervigilance, emotional numbing, sleep disruption, and a collapse of the sense of safety that once anchored the relationship.
Betrayal reaches far beyond the couple, disrupting work, parenting, identity, and daily functioning.
An analysis of 1,191 responses from partners of individuals with compulsive sexual behavior identified seven distinct patterns of disruption following discovery, including impaired functioning, difficulty fulfilling roles such as parenting and employment, preoccupation, loss of identity, and shame.9 The wound does not stay contained to the marriage. It radiates outward into every relationship the betrayed partner holds.
The Cost to Relationships
Beginning pornography use nearly doubles a married person's likelihood of divorce.
Harm to Relationships
Analyzing nationally representative panel data from thousands of American adults, researchers found that a married person who began using pornography between survey waves roughly doubled their likelihood of being divorced by the next interview, rising from about 6 percent to 11 percent.10
56 percent of contested divorces involve one partner's heightened internet pornography use.
Harm to Relationships
A survey of divorce attorneys reported that heightened internet pornography use by one partner was a factor in 56 percent of the divorce cases they handled.11 Alongside this, a large body of research links pornography use to lower relationship and sexual satisfaction, reduced commitment, and greater acceptance of infidelity.12
Why AFAR
The evidence is consistent across institutions and across decades: compulsive sexual behavior and problematic pornography use are common, they cause measurable harm, and they wound partners and families in ways that mirror recognized trauma. Yet the research base remains fragmented, the condition remains absent from U.S. diagnostic standards, and the overwhelming majority of those affected never receive care. AFAR is committed to advancing rigorous research, supporting formal diagnostic recognition, and building the evidence base that individuals, partners, and clinicians need. Understanding the problem is the first step toward solving it.
References
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Bőthe, B., Koós, M., Nagy, L., et al. (2023). Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools. Journal of Behavioral Addictions. https://pmc.ncbi.nlm.nih.gov/articles/PMC10316175/
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Kuzma, J. M., & Black, D. W. (2008). Epidemiology, Prevalence, and Natural History of Compulsive Sexual Behavior. Psychiatric Clinics of North America. https://www.sciencedirect.com/science/article/abs/pii/S0193953X08000725
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Klein, V., et al. (2023). Who feels affected by "out of control" sexual behavior? Prevalence and correlates of indicators for ICD-11 Compulsive Sexual Behavior Disorder in the German Health and Sexuality Survey (GeSiD). https://pmc.ncbi.nlm.nih.gov/articles/PMC9872532/
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American Psychiatric Association Publishing. Compulsive Sexual Behavior Disorder: Understanding, Assessment, and Treatment (on ICD-11 recognition and DSM-5 exclusion). https://www.appi.org/Products/Sexuality/Compulsive-Sexual-Behavior-Disorder
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Antons, S., et al. (2024). Reducing problematic pornography use with imaginal retraining: A randomized controlled trial (citing Grubbs et al. prevalence estimates). https://pmc.ncbi.nlm.nih.gov/articles/PMC11220800/
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Problematic pornography use and psychological distress: A longitudinal study in a large US sample (2025). https://pubmed.ncbi.nlm.nih.gov/40483829/
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Steffens, B., & Rennie, R. (2006), as cited in the Australian phenomenological study on female partners of individuals with compulsive sexual behavior (2024). https://link.springer.com/article/10.1007/s13178-024-01043-x
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Özgün (2010) and Laaser et al. (2017), as summarized in the validation of the Weiss Partner Betrayal Trauma Scale. https://partnerbetrayaltrauma.org/partner-betrayal-trauma-journal-article/
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Williams, L. K. (2019). The Experience of Sexual Betrayal Trauma: A Qualitative Analysis of Responses from the Trauma Inventory for Partners of Sex Addicts (TIPSA). Brigham Young University. https://scholarsarchive.byu.edu/etd/8557/
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Perry, S. L., & Schleifer, C. Beginning Pornography Use Associated With Increase in Probability of Divorce. American Sociological Association. https://www.asanet.org/beginning-pornography-use-associated-increase-probability-divorce/
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Dedmon (2002) divorce attorney survey, as cited in Willoughby et al., A Dyadic Approach to Pornography Use and Relationship Satisfaction. https://pmc.ncbi.nlm.nih.gov/articles/PMC6155976/
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Rasmussen, K., as summarized by the Institute for Family Studies, on pornography use and reduced satisfaction, commitment, and acceptance of infidelity. https://ifstudies.org/blog/millennials-infidelity-and-porn/