Compulsive sexual behaviour disorder
{{Short description|Mental disorder}}
{{infobox medical condition
| name = Compulsive sexual behaviour disorder
| specialty = Psychiatry
| duration = ≥ 6 months
}}
Compulsive sexual behaviour disorder (CSBD),{{cite journal |author1-last=Turner |author1-first=D. |author2-last=Thibaut |author2-first=F. |author3-last=Briken |author3-first=P. |author4-last=Grubbs |author4-first=J. |author5-last=Malandain |author5-first=L. |author6-last=Mestre-Bach |author6-first=G. |author7-last=Potenza |author7-first=M. N. |date=November 2022 |title=The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder |editor-last=Thibaut |editor-first=Florence |journal=Dialogues in Clinical Neuroscience |publisher=Laboratoires Servier |volume=24 |issue=1 |pages=10–69 |doi=10.1080/19585969.2022.2134739 |doi-access=free |pmid=37522807 |issn=1958-5969 |oclc=62869913 |s2cid=253661994|pmc=10408697 }} is a psychiatric disorder which manifests as a pattern of behavior involving intense preoccupation with sexual fantasies and behaviours that cause significant levels of mental distress, cannot be voluntarily curtailed, and risk or cause harm to oneself or others.Herron, Abigail J., Brennan, Tim K. eds. ASAM Essentials of Addiction Medicine, The. 3rd Edition. Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103 USA:Lippincott Williams & Wilkins; 2020.{{cite book |last1=Das |first1=Shrayasi |last2=Singh |first2=Lokesh Kumar |last3=Somani |first3=Aditya |title=Encyclopedia of Sexual Psychology and Behavior |date=2023 |publisher=Springer, Cham |isbn=978-3-031-08956-5 |pages=1–5 |url=https://link.springer.com/referenceworkentry/10.1007/978-3-031-08956-5_28-1 |language=en |chapter=Compulsive Sexual Behavior |doi=10.1007/978-3-031-08956-5_28-1 |archive-date=2024-12-25 |access-date=2024-12-25 |archive-url=https://web.archive.org/web/20241225154545/https://link.springer.com/referenceworkentry/10.1007/978-3-031-08956-5_28-1 |url-status=live }} This disorder can also cause impairment in social, occupational, personal, or other important functions.{{Cite journal |vauthors=Kafka MP|date=April 2010|title=Hypersexual Disorder: A Proposed Diagnosis for DSM-V|journal=Archives of Sexual Behavior|language=en|volume=39|issue=2|pages=377–400|doi=10.1007/s10508-009-9574-7|pmid=19937105|citeseerx=10.1.1.433.1948|s2cid=2190694|issn=0004-0002}} CSBD is not an addiction,{{cite book | last1=Hall | first1=Timothy M. | last2=Bershad | first2=Anya | last3=Shoptaw | first3=Steven | editor-last1=Miller | editor-first1=Shannon C. | editor-last2=Rosenthal | editor-first2=Richard N. | editor-last3=Levy | editor-first3=Sharon | editor-last4=Saxon | editor-first4=Andrew J. | editor-last5=Tetrault | editor-first5=Jeanette M. | editor-last6=Wakeman | editor-first6=Sarah E. | title=The ASAM Principles of Addiction Medicine | publisher=Lippincott Williams & Wilkins | publication-place=Philadelphia, PA | date=2024-02-15 | isbn=978-1-9752-0157-9 | page=unpaginated | quote=Proposals for two constructs related to compulsive sexual behaviors , sexual addiction and hypersexual disorder, have been repeatedly rejected from inclusion in recent editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) for lack of empirical support and lack of consensus as to definition. [...] (CSBD), has been included in the International Classification of Diseases, 11th edition (ICD-11), under impulse control disorders rather than as an addiction disorder. CSBD has significant differences from substance use disorders (SUD) [...] | chapter=53. Compulsive Sexual Behaviors | chapter-url=https://books.google.com/books?id=vWf1EAAAQBAJ&pg=PT1931}} and is typically used to describe behaviour, rather than "sexual addiction".
CSBD is recognised by the World Health Organization (WHO) as an impulse-control disorder in the ICD-11. In contrast, the American Psychiatric Association's (APA) DSM-5 does not recognise CSBD as a standalone diagnosis. CSBD was proposed as a diagnosis for inclusion in the DSM-5 in 2010, but was ultimately rejected.{{cite journal |vauthors=Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, Lew-Starowicz M, Pfaus JG |title=Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective |journal=Sexual Medicine Reviews |volume=12 |issue=3 |pages=355–370 |date=June 2024 |pmid=38529667 |pmc=11214846 |doi=10.1093/sxmrev/qeae014}}
Sexual behaviours such as chemsex and paraphilias are closely related with CSBD and frequently co-occur along with it. Mental distress entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to diagnose CSBD. A study conducted in 42 countries found that almost 5% of people may be at high risk of CSBD, but only 14% of them have sought treatment.{{Cite web |last=Bothe |first=Beata |date=2023-06-23 |title=Almost 5% of people may experience compulsive sexual behavior disorder worldwide |url=https://www.psypost.org/2023/06/almost-5-of-people-may-experience-compulsive-sexual-behavior-disorder-worldwide-165970 |access-date=2023-06-23 |website=PsyPost |language=en-US |archive-date=2023-06-23 |archive-url=https://web.archive.org/web/20230623193040/https://www.psypost.org/2023/06/almost-5-of-people-may-experience-compulsive-sexual-behavior-disorder-worldwide-165970 |url-status=live }} The study also highlighted the need for more inclusive research and culturally-sensitive treatment options for CSBD.
Diagnosis
=ICD-11=
ICD-11 includes a diagnosis for compulsive sexual behaviour disorder (CSBD). CSBD is not an addiction.{{Bulleted list|{{harvnb|Hall|Bershad|Shoptaw|2024}}|{{cite book | last=Neves | first=Silva | title=Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians | publisher=Taylor & Francis | year=2021 | isbn=978-1-000-38710-0 | url=https://books.google.com/books?id=31olEAAAQBAJ&pg=PT14 | access-date=26 March 2022 | page=unpaginated | quote=... materials in ICD-11 make very clear that CSBD is not intended to be interchangeable with sex addiction, but rather is a substantially different diagnostic framework }}|{{cite book | editor-last=Pontes | editor-first=Halley M. | last=Dhuffar-Pottiwal | first=Manpreet | title=Behavioral Addictions: Conceptual, Clinical, Assessment, and Treatment Approaches | publisher=Springer International Publishing | series=Studies in Neuroscience, Psychology and Behavioral Economics | year=2022 | isbn=978-3-031-04772-5 | url=https://books.google.com/books?id=chuKEAAAQBAJ&pg=PA163 | access-date=27 July 2023 | page=163 | quote=Given that we do not yet have definitive information on whether the processes involved in the onset and maintenance of the disorder are equivalent to substance abuse disorders, gambling, and gaming (Kraus et al. 2016), CSBD is not included in the grouping of disorders due to substance and addictive behaviors, but rather in that of impulse control disorders (Kraus et al. 2018). }}|{{cite book | last=Bowman | first=Todd | title=Reclaiming Sexual Wholeness: An Integrative Christian Approach to Sexual Addiction Treatment | publisher=Zondervan Academic | year=2022 | isbn=978-0-310-09311-4 | url=https://books.google.com/books?id=9NFTEAAAQBAJ&pg=PA161 | access-date=27 July 2023 | page=161 }}|{{cite web | first=David J. | last=Ley | author-link=David J. Ley | title=Compulsive Sexual Behavior Disorder in ICD-11 | website=Psychology Today | date=24 January 2018 | url=https://www.psychologytoday.com/blog/women-who-stray/201801/compulsive-sexual-behavior-disorder-in-icd-11 | access-date=27 March 2021 | archive-date=19 April 2023 | archive-url=https://web.archive.org/web/20230419164441/https://www.psychologytoday.com/intl/blog/women-who-stray/201801/compulsive-sexual-behavior-disorder-in-icd-11 | url-status=live }}|{{cite journal | last1=Sassover | first1=Eli | last2=Weinstein | first2=Aviv | title=Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view | journal=Journal of Behavioral Addictions | publisher=Akademiai Kiado Zrt. | date=29 September 2020 | volume=11 | issue=2 | pages=166–179 | issn=2062-5871 | doi=10.1556/2006.2020.00055 | pmid=32997646 | pmc=9295215 | s2cid=222167039 }}|{{Cite web |title=Compulsive sexual behavior disorder |url=https://icd.who.int/browse11/l-m/en#/http%253A%252F%252Fid.who.int%252Ficd%252Fentity%252F1630268048 |access-date=2022-03-25 |website=World Health Organization (ICD-11) |archive-date=2023-10-15 |archive-url=https://web.archive.org/web/20231015122454/https://icd.who.int/browse11/l-m/en#/http%253A%252F%252Fid.who.int%252Ficd%252Fentity%252F1630268048 |url-status=live }}|{{cite web | author=a verified Counsellor or Therapist | title=Do I have compulsive sexual behaviour? | website=Counselling Directory | date=18 January 2021 | url=https://www.counselling-directory.org.uk/memberarticles/do-i-have-compulsive-sexual-behaviour | access-date=26 March 2022 | quote="Materials related to the ICD-11 make very clear that CSBD is not intended to be interchangeable with 'sex addiction', but rather is a substantially different diagnostic framework." ICD-11. World Health Organization. | archive-date=16 May 2022 | archive-url=https://web.archive.org/web/20220516102946/https://www.counselling-directory.org.uk/memberarticles/do-i-have-compulsive-sexual-behaviour | url-status=live }}}}
CSBD is defined as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.{{Citation needed|date=April 2025}}
Symptoms may include repetitive sexual activities becoming a central focus of the person's life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.{{Citation needed|date=April 2025}}
- Pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour
- Manifested over an extended period of time (i.e., 6 months or more)
- Causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning (distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement)
=DSM-5=
DSM-5{{cite journal|last1=Weir|first1=Kirsten |title=Is pornography addictive? |url=http://www.apa.org/monitor/2014/04/pornography.aspx|url-status=dead|journal=Monitor on Psychology |date=April 2014 |volume=45 |issue=4 |page=46 |issn=1529-4978 |oclc=612512821 |archive-url=https://web.archive.org/web/20140405232028/http://www.apa.org/monitor/2014/04/pornography.aspx |archive-date=2014-04-05}} and DSM-5-TR have no such diagnosis.{{cite book | last=Martinez-Gilliard | first=Erin | title=Sex, Social Justice, and Intimacy in Mental Health Practice: Incorporating Sexual Health in Approaches to Wellness | publisher=Taylor & Francis | year=2023 | isbn=978-1-000-84578-5 | url=https://books.google.com/books?id=Y1yqEAAAQBAJ&pg=PT113 | access-date=5 March 2023 | page=unpaginated | quote='Sex addiction' is also referred to as a diagnosis or presenting problem. Sex addiction is not a diagnosis in the DSM-5-TR and identified as Compulsive Sexual Behavior in the ICD-11 rather than an issue of addiction.}}{{cite book | author=American Psychiatric Association | title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)) | publisher=American Psychiatric Association Publishing | series=G - Reference,Information and Interdisciplinary Subjects Series | year=2022 | isbn=978-0-89042-576-3 | url=https://books.google.com/books?id=PIGizgEACAAJ | chapter=Conditions for Further Study | page=916 | quote=Excessive use of the Internet not involving playing of online games (e.g., excessive use of social media, such as Facebook; viewing pornography online) is not considered analogous to Internet gaming disorder, and future research on other excessive uses of the Internet would need to follow similar guidelines as suggested herein. Excessive gambling online may qualify for a separate diagnosis of gambling disorder.}}{{cite book | author=American Psychiatric Association | title=Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)) | publisher=American Psychiatric Association Publishing | series=G - Reference,Information and Interdisciplinary Subjects Series | year=2022 | isbn=978-0-89042-576-3 | url=https://books.google.com/books?id=PIGizgEACAAJ | chapter=Substance-Related and Addictive Disorders | page=543 | quote=In addition to the substance-related disorders, this chapter also includes gambling disorder, reflecting evidence that gambling behaviors activate reward systems similar to those activated by drugs of abuse and that produce some behavioral symptoms that appear comparable to those produced by the substance use disorders. Other excessive behavioral patterns, such as Internet gaming (see “Conditions for Further Study”), have also been described, but the research on these and other behavioral syndromes is less clear. Thus, groups of repetitive behaviors, sometimes termed behavioral addictions (with subcategories such as “sex addiction,” “exercise addiction,” and “shopping addiction”), are not included because there is insufficient peer-reviewed evidence to establish the diagnostic criteria and course descriptions needed to identify these behaviors as mental disorders.}}
Treatment
=Medications=
As of end of 2019, the US Food and Drug Administration (FDA) had approved no medications for it.Matthias Brand, PhD, Gretchen R. Blycker, LMHC, Marc N. Potenza, MD, PhD [https://www.psychiatrictimes.com/view/when-pornography-becomes-problem-clinical-insights When Pornography Becomes a Problem: Clinical Insights] {{Webarchive|url=https://web.archive.org/web/20220522162114/https://www.psychiatrictimes.com/view/when-pornography-becomes-problem-clinical-insights |date=2022-05-22 }} December 13, 2019. Quote: "Currently there are no medications with an approved Food and Drug Administration indication for CSBD."
= Cognitive-behavioural perspective =
Some treatment guides suggest shame at the core of CSBD mechanism. The shame is associated with the cognitive schema of self-defectiveness, a feeling of social pain and isolation and functions in two ways. Firstly, chronic shame derived from social stigma or early traumatic experiences augments the soothing function of sexual behaviour. That makes sexual behaviour compulsive. Secondly, excessive or inappropriate sexual behaviour, as it is considered socially unacceptable, causes extra shame and forms a self-sustaining cycle of CSBD. Therefore, treatment is primarily aimed at shame reduction and social reintegration.{{Cite book |last=Neves |first=Silva |title=Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians |year=2021 |publisher=Routledge |isbn=978-0367465483}}{{Cite book |last=Birchard |first=Thaddeus |title=CBT for Compulsive Sexual Behaviour : A Guide for Professionals |year=2015 |publisher=Routledge |isbn=978-0415723800}}{{Medical citation needed|date=April 2025}}
History
The DSM-IV-TR, published in 2000, includes an entry called "Sexual Disorder—Not Otherwise Specified" (Sexual Disorder NOS), for disorders that are clinically significant but do not have code. The DSM-IV-TR notes that Sexual Disorder NOS would apply to, among other conditions, "distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual only as things to be used".American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
Hypersexual disorder was initially proposed as a diagnosis in 2010 and was recommended for inclusion in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) by the Sexual and Gender Identity Disorders Workgroup (Emerging Measures and Models, Conditions for Further Study).{{cite web|url=http://www.dsm5.org/ProposedRevision/Pages/SexualDysfunctions.aspx|title=DSM-5 Development Page for Sexual Dysfunctions|website=dsm5.org|publisher=American Psychiatric Association|accessdate=28 August 2017|archive-date=6 November 2012|archive-url=https://web.archive.org/web/20121106151502/http://www.dsm5.org/ProposedRevision/Pages/SexualDysfunctions.aspx|url-status=dead}}{{cite web |title=Hypersexual Disorder |url=http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=415 |website=dsm5.org |publisher=American Psychiatric Association |archive-url=https://web.archive.org/web/20121031093418/http://www.dsm5.org/proposedrevision/Pages/proposedrevision.aspx?rid=415 |archive-date=31 October 2012 |date=28 April 2012 |url-status=dead}} It was ultimately rejected. The term hypersexual disorder was reportedly chosen because it did not imply any specific theory for the causes of hypersexuality, which remain unknown. A proposal to add sexual addiction to the DSM system had been previously rejected by the APA, as not enough evidence suggested to them that the condition is analogous to substance addictions, as that name would imply.{{cite web|url=https://www.usatoday.com/news/health/2010-02-10-dsm10_ST_N.htm|title=Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' - USATODAY.com|website=Usatoday.com|accessdate=28 August 2017|archive-date=2011-06-28|archive-url=https://web.archive.org/web/20110628215628/http://www.usatoday.com/news/health/2010-02-10-dsm10_ST_N.htm|url-status=live}}{{cite web |url=http://articles.nydailynews.com/2010-02-10/entertainment/27055937_1_autism-mental-disorders-mental-illness |title=Sex addiction, obesity, Internet addiction not included in proposed changes to APA diagnostic manual - New York Daily News |accessdate=2011-03-06 |url-status=dead |archiveurl=https://web.archive.org/web/20110727055212/http://articles.nydailynews.com/2010-02-10/entertainment/27055937_1_autism-mental-disorders-mental-illness |archivedate=2011-07-27 }}{{cite web|url=http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/02/10/new-diagnostic-guidelines-for-mental-illnesses-proposed|title=New Diagnostic Guidelines for Mental Illnesses Proposed|website=Health.usnews.com|accessdate=2017-08-28|archive-date=2012-05-27|archive-url=https://web.archive.org/web/20120527144851/http://health.usnews.com/health-news/family-health/brain-and-behavior/articles/2010/02/10/new-diagnostic-guidelines-for-mental-illnesses-proposed|url-status=live}}
Rory Reid, a research psychologist in the Department of Psychiatry at the University of California Los Angeles (UCLA), led a team of researchers to investigate the proposed criteria for Hypersexual Disorder. Their findings were published in the Journal of Sexual Medicine where they concluded that the given criteria are valid and the disorder could be reliably diagnosed.{{cite journal|title=Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder|first1=Rory C.|last1=Reid|first2=Bruce N.|last2=Carpenter|first3=Joshua N.|last3=Hook|first4=Sheila|last4=Garos|first5=Jill C.|last5=Manning|first6=Randy|last6=Gilliland|first7=Erin B.|last7=Cooper|first8=Heather|last8=McKittrick|first9=Margarit|last9=Davtian|first10=Timothy|last10=Fong|date=1 November 2012|journal=The Journal of Sexual Medicine|volume=9|issue=11|pages=2868–2877|doi=10.1111/j.1743-6109.2012.02936.x|pmid = 23035810}}
See also
{{Portal|Psychology|Human sexuality}}
References
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External links
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{{Wiktionary|Wikisaurus:libidinist}}
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