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Compulsive sexual behaviour disorder

Mental disorder

Summary

Mental disorder

FieldValue
nameCompulsive sexual behaviour disorder
specialtyPsychiatry
duration≥ 6 months

Compulsive sexual behaviour disorder (CSBD) 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. This disorder can also cause impairment in social, occupational, personal, or other important functions. CSBD is not an addiction, 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.

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. 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.

DSM-5

DSM-5 and DSM-5-TR have no such diagnosis.

Treatment

Medications

As of end of 2019, the US Food and Drug Administration (FDA) had approved no medications 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 and a feeling of social pain and isolation, and it 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.

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".

Hypersexual disorder was initially proposed as a diagnosis in 2010 and was recommended for inclusion in the DSM-5 by the Sexual and Gender Identity Disorders Workgroup (Emerging Measures and Models, Conditions for Further Study). 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.

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.

References

References

  1. (November 2022). "The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder". [[Laboratoires Servier]].
  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. {{cite encyclopedia. (2023). [[Springer, Cham]]. link
  4. (April 2010). "Hypersexual Disorder: A Proposed Diagnosis for DSM-V". Archives of Sexual Behavior.
  5. (2024-02-15). "The ASAM Principles of Addiction Medicine". Lippincott Williams & Wilkins.
  6. "6C72 Compulsive sexual behaviour disorder".
  7. (June 2024). "Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective". Sexual Medicine Reviews.
  8. (2023). "Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools". Journal of Behavioral Addictions.
  9. a verified Counsellor or Therapist. (24 January 2018). "Compulsive sexual behavior disorder". Taylor & Francis.
  10. (April 2014). "Is pornography addictive?". Monitor on Psychology.
  11. Martinez-Gilliard, Erin. (2023). "Sex, Social Justice, and Intimacy in Mental Health Practice: Incorporating Sexual Health in Approaches to Wellness". Taylor & Francis.
  12. American Psychiatric Association. (2022). "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)". American Psychiatric Association Publishing.
  13. American Psychiatric Association. (2022). "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR)". American Psychiatric Association Publishing.
  14. 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. link. (2022-05-22 December 13, 2019. Quote: "Currently there are no medications with an approved Food and Drug Administration indication for CSBD.")
  15. Neves, Silva. (2021). "Compulsive Sexual Behaviours: A Psycho-Sexual Treatment Guide for Clinicians". Routledge.
  16. Birchard, Thaddeus. (2015). "CBT for Compulsive Sexual Behaviour : A Guide for Professionals". Routledge.
  17. American Psychiatric Association. (2000). ''Diagnostic and statistical manual of mental disorders'' (4th ed., text revision). Washington, DC: Author.
  18. "DSM-5 Development Page for Sexual Dysfunctions". American Psychiatric Association.
  19. (28 April 2012). "Hypersexual Disorder". American Psychiatric Association.
  20. "Psychiatry's bible: Autism, binge-eating updates proposed for 'DSM' - USATODAY.com".
  21. "Sex addiction, obesity, Internet addiction not included in proposed changes to APA diagnostic manual - New York Daily News".
  22. "New Diagnostic Guidelines for Mental Illnesses Proposed".
  23. (1 November 2012). "Report of Findings in a DSM-5 Field Trial for Hypersexual Disorder". The Journal of Sexual Medicine.
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