TY - JOUR

T1 - Assessment and treatment of compulsive sexual behavior disorder

T2 - a sexual medicine perspective

AU - Briken, Peer

AU - Bőthe, Beáta

AU - Carvalho, Joana

AU - Coleman, Eli

AU - Giraldi, Annamaria

AU - Kraus, Shane W.

AU - Lew-Starowicz, Michał

AU - Pfaus, James G.

N1 - Publisher Copyright: © The Author(s) 2024. Published by Oxford University Press on behalf of The International Society of Sexual Medicine.

PY - 2024

Y1 - 2024

N2 - Introduction: The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed “hypersexual disorder,” “sexual addiction,” “porn addiction,” “sexual compulsivity,” and “out-of-control sexual behavior.” Objectives: To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. Methods: A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. Results: CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent “unhealthy” sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. Conclusions: Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related “out-of-control sexual behaviors” on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine–informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

AB - Introduction: The addition of compulsive sexual behavior disorder (CSBD) into the ICD-11 chapter on mental, behavioral, or neurodevelopmental disorders has greatly stimulated research and controversy around compulsive sexual behavior, or what has been termed “hypersexual disorder,” “sexual addiction,” “porn addiction,” “sexual compulsivity,” and “out-of-control sexual behavior.” Objectives: To identify where concerns exist from the perspective of sexual medicine and what can be done to resolve them. Methods: A scientific review committee convened by the International Society for Sexual Medicine reviewed pertinent literature and discussed clinical research and experience related to CSBD diagnoses and misdiagnoses, pathologizing nonheteronormative sexual behavior, basic research on potential underlying causes of CSBD, its relationship to paraphilic disorder, and its potential sexual health consequences. The panel used a modified Delphi method to reach consensus on these issues. Results: CSBD was differentiated from other sexual activity on the basis of the ICD-11 diagnostic criteria, and issues regarding sexual medicine and sexual health were identified. Concerns were raised about self-labeling processes, attitudes hostile to sexual pleasure, pathologizing of nonheteronormative sexual behavior and high sexual desire, mixing of normative attitudes with clinical distress, and the belief that masturbation and pornography use represent “unhealthy” sexual behavior. A guide to CSBD case formulation and care/treatment recommendations was proposed. Conclusions: Clinical sexologic and sexual medicine expertise for the diagnosis and treatment of CSBD in the psychiatric-psychotherapeutic context is imperative to differentiate and understand the determinants and impact of CSBD and related “out-of-control sexual behaviors” on mental and sexual well-being, to detect forensically relevant and nonrelevant forms, and to refine best practices in care and treatment. Evidence-based, sexual medicine–informed therapies should be offered to achieve a positive and respectful approach to sexuality and the possibility of having pleasurable and safe sexual experiences.

KW - assessment

KW - comorbidity

KW - compulsive sexual behavior

KW - diagnosis

KW - hypersexuality

KW - ICD-11

KW - impulse control disorder

KW - paraphilias

KW - sex/porn “addiction”

KW - treatment

U2 - 10.1093/sxmrev/qeae014

DO - 10.1093/sxmrev/qeae014

M3 - Review

C2 - 38529667

AN - SCOPUS:85197592816

VL - 12

SP - 355

EP - 370

JO - Sexual Medicine Reviews

JF - Sexual Medicine Reviews

SN - 2050-0521

IS - 3

ER -