Abstract Objectives Compulsive Sexual Behavior Disorder (CSBD) is categorized as an impulse control disorder in the ICD-11. CSBD is characterized by repetitive and intense sexual impulses or urges, leading to uncontrollable sexual behavior despite adverse consequences. There is an ongoing debate about the etiology of CSBD. Theories that classify CSBD an addictive behavior suggest that neuropsychological alterations such as deficits in emotion regulation are present in CSBD. Prior research indicates that individuals with CSBD may experience difficulties in regulating emotions, but the extent of these difficulties is still debated. Methods This study investigated the emotion regulation abilities of 42 men with CSBD and 33 matched healthy controls using a cognitive reappraisal task during functional magnetic resonance imaging (fMRI). Participants were presented with negative and neutral emotional stimuli and asked to either observe or actively regulate their emotional responses. Behavioral and neural measures were collected to evaluate emotion regulation performance. Results Contrary to our hypotheses, no significant differences were found in emotional valence ratings or neural activation patterns. However, men with CSBD reported higher (non-sexual) arousal during emotion regulation tasks, suggesting difficulties in managing emotions in specific situations. Conclusions The present study is the first to investigate emotion regulation difficulties in CSB employing an experimental design. Result highlight potential difficulties in arousal regulation for CSBD patients, but results differ from previous research, and further studies are needed to explore these findings. Conflicts of Interest The authors declare that they have no conflict of interest.