| Compulsive sexual behaviour disorder | |
|---|---|
| Specialty | Psychiatry |
| Duration | ≥ 6 months |
Compulsive sexual behaviour disorder (CSBD), [1] 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. [1] [2] [3] This disorder can also cause impairment in social, occupational, personal, or other important functions. [1] [4] CSBD is not an addiction, [5] 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. [6] In contrast, the American Psychiatric Association's (APA) DSM-5 does not recognise CSBD as a standalone diagnosis. [1] CSBD was proposed as a diagnosis for inclusion in the DSM-5 in 2010, [4] but was ultimately rejected. [7]
Sexual behaviours such as chemsex and paraphilias are closely related with CSBD and frequently co-occur along with it. [1] Mental distress entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to diagnose CSBD. [1] 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. [8] The study also highlighted the need for more inclusive research and culturally-sensitive treatment options for CSBD.
ICD-11 includes a diagnosis for compulsive sexual behaviour disorder (CSBD). [6] CSBD is not an addiction. [9] [10]
CSBD is defined as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.[ citation needed ]
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 ]
Criteria: [6]
The United States of America will leave the World Health Organization in January 2026. [11] Meanwhile, the US ceased to cooperate with the WHO. [12]
DSM-5 [13] and DSM-5-TR have no such diagnosis. [9] [14] [15]
As of end of 2019, the US Food and Drug Administration (FDA) had approved no medications for it. [16]
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. [17] [18] [ medical citation needed ]
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". [19]
Hypersexual disorder was initially proposed as a diagnosis in 2010 [4] 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). [20] [21] It was ultimately rejected. [7] The term hypersexual disorder was reportedly chosen because it did not imply any specific theory for the causes of hypersexuality, which remain unknown. [4] 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. [22] [23] [24]
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. [25]
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) [...]
'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.
... 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
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).
"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.
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.
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.
