Compulsive sexual behaviour disorder

Compulsive sexual behaviour disorder (CSBD),[1] otherwise known as hypersexual disorder,[1] is a pattern of behavior involving intense preoccupation with sexual fantasies and behaviours that cause significant levels of psychological distress, are inappropriately used to cope with stress, cannot be voluntarily curtailed, and risk or cause harm to oneself or others.[1][2] This disorder can also cause impairment in social, occupational, personal, or other important functions.[1][3]

CSBD is not a diagnosis found in ICD-10 or DSM-5.[1] It was proposed in 2010 for inclusion in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) of the American Psychiatric Association (APA), but was ultimately not approved. ICD-11 currently includes a diagnosis for "Compulsive Sexual Behaviour Disorder",[4] which is categorized under "Impulse Control Disorders". Abnormal sexual behaviours such as chemsex and paraphilias are closely related with CSBD and frequently co-occur along with it.[1] Psychological 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.[5] 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".[4] CSBD is not an addiction.[6][7][8][9][10][11][12][13]

"Compulsive Sexual Behaviour Disorder" is defined as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour.

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.

Criteria:

  1. Pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour
  2. Manifested over an extended period of time (e.g., 6 months or more)
  3. 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)

It has been argued that the CSBD diagnosis is not based upon sex research.[14]

DSM-5

DSM-5[15] and DSM-5-TR have no such diagnosis.[6][16][17]

Different literature descriptions

People with hypersexual disorder experience multiple, unsuccessful attempts to control or diminish the amount of time spent engaging in sexual fantasies, urges, and behaviors. Individuals may engage in sexual behaviors that they experience as compulsive, despite knowledge of adverse medical, legal, and/or interpersonal consequences, and may neglect social and recreational activities and role responsibilities.[2]

For a valid diagnosis of hypersexual disorder to be established, symptoms must persist for a period of at least 6 months and occur independently of mania or a medical condition.[18]

Treatment

Medicines

As of end of 2019, FDA had approved no medicines for it.[19]

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. And secondly, that 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.[20][21]

History

Hypersexual disorder 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). It was ultimately not approved.[22] The term hypersexual disorder was reportedly chosen because it did not imply any specific theory for the causes of hypersexuality, which remain unknown.[23] 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.[24][25][26]

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.[27]

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".[28]

See also

References
  1. Turner, D.; Thibaut, F.; Briken, P.; Grubbs, J.; Malandain, L.; Mestre-Bach, G.; Potenza, M. N. (November 2022). Thibaut, Florence (ed.). "The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder". Dialogues in Clinical Neuroscience. Laboratoires Servier. 24 (1): 10–69. doi:10.1080/19585969.2022.2134739. ISSN 1958-5969. OCLC 62869913. S2CID 253661994.
  2. 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.
  3. Kafka, Martin P. (2010-04-01). "Hypersexual Disorder: A Proposed Diagnosis for DSM-V". Archives of Sexual Behavior. 39 (2): 377–400. CiteSeerX 10.1.1.433.1948. doi:10.1007/s10508-009-9574-7. ISSN 0004-0002. PMID 19937105. S2CID 2190694.
  4. "Compulsive sexual behaviour disorder (ICD-11)", icd.who.int, retrieved 2023-04-27
  5. Bothe, Beata (2023-06-23). "Almost 5% of people may experience compulsive sexual behavior disorder worldwide". PsyPost. Retrieved 2023-06-23.
  6. Martinez-Gilliard, Erin (2023). Sex, Social Justice, and Intimacy in Mental Health Practice: Incorporating Sexual Health in Approaches to Wellness. Taylor & Francis. p. unpaginated. ISBN 978-1-000-84578-5. Retrieved 5 March 2023. '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.
  7. Neves, Silva (2021). Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians. Taylor & Francis. p. 14. ISBN 978-1-000-38710-0. Retrieved 26 March 2022. ... 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
  8. Dhuffar-Pottiwal, Manpreet (2022). Pontes, Halley M. (ed.). Behavioral Addictions: Conceptual, Clinical, Assessment, and Treatment Approaches. Studies in Neuroscience, Psychology and Behavioral Economics. Springer International Publishing. p. 163. ISBN 978-3-031-04772-5. Retrieved 27 July 2023. 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).
  9. Bowman, Todd (2022). Reclaiming Sexual Wholeness: An Integrative Christian Approach to Sexual Addiction Treatment. Zondervan Academic. p. 161. ISBN 978-0-310-09311-4. Retrieved 27 July 2023.
  10. Ley, David J. (24 January 2018). "Compulsive Sexual Behavior Disorder in ICD-11". Psychology Today. Retrieved 27 March 2021.
  11. Sassover, Eli; Weinstein, Aviv (29 September 2020). "Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view". Journal of Behavioral Addictions. Akademiai Kiado Zrt. 11 (2): 166–179. doi:10.1556/2006.2020.00055. ISSN 2062-5871. PMC 9295215. PMID 32997646. S2CID 222167039.
  12. "Compulsive sexual behavior disorder". World Health Organization (ICD-11). Retrieved 2022-03-25.
  13. a verified Counsellor or Therapist (18 January 2021). "Do I have compulsive sexual behaviour?". Counselling Directory. Retrieved 26 March 2022. "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 Organisation.
  14. Briken, Peer; Turner, Daniel (13 July 2022). "What does "Sexual" mean in compulsive sexual behavior disorder? •". Journal of Behavioral Addictions. Akademiai Kiado Zrt. 11 (2): 222–225. doi:10.1556/2006.2022.00026. ISSN 2062-5871. PMC 9295231. PMID 35895459.
  15. Weir, Kirsten (April 2014). "Is pornography addictive?". Monitor on Psychology. 45 (4): 46. ISSN 1529-4978. OCLC 612512821. Archived from the original on 2014-04-05.
  16. American Psychiatric Association (2022). "Conditions for Further Study". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)). G - Reference,Information and Interdisciplinary Subjects Series. American Psychiatric Association Publishing. p. 916. ISBN 978-0-89042-576-3. 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.
  17. American Psychiatric Association (2022). "Substance-Related and Addictive Disorders". Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR(tm)). G - Reference,Information and Interdisciplinary Subjects Series. American Psychiatric Association Publishing. p. 543. ISBN 978-0-89042-576-3. 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.
  18. "American Psychiatric Association DSM-5 Development Page for Hypersexual Disorder". Dsm5.com. Retrieved 28 August 2017.
  19. Matthias Brand, PhD, Gretchen R. Blycker, LMHC, Marc N. Potenza, MD, PhD When Pornography Becomes a Problem: Clinical Insights December 13, 2019. Quote: "Currently there are no medications with an approved Food and Drug Administration indication for CSBD."
  20. Neves, Silva (2021). Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians. ISBN 978-0367465483.
  21. Birchard, Thaddeus (2015). CBT for Compulsive Sexual Behaviour : A Guide for Professionals. ISBN 978-0415723800.
  22. "DSM-5 Development Page for Sexual Dysfunctions". Dsm5.org. Retrieved 28 August 2017.
  23. Kafka, M. P. (2010). Hypersexual Disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39, 377–400.
  24. "Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' - USATODAY.com". Usatoday.com. Retrieved 28 August 2017.
  25. "Sex addiction, obesity, Internet addiction not included in proposed changes to APA diagnostic manual - New York Daily News". Archived from the original on 2011-07-27. Retrieved 2011-03-06.
  26. "New Diagnostic Guidelines for Mental Illnesses Proposed". Health.usnews.com. Retrieved 2017-08-28.
  27. Reid, Rory C.; Carpenter, Bruce N.; Hook, Joshua N.; Garos, Sheila; Manning, Jill C.; Gilliland, Randy; Cooper, Erin B.; McKittrick, Heather; Davtian, Margarit; Fong, Timothy (1 November 2012). "Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder". The Journal of Sexual Medicine. 9 (11): 2868–2877. doi:10.1111/j.1743-6109.2012.02936.x. PMID 23035810.
  28. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

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