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What does “Sexual” mean in compulsive sexual behavior disorder? •
Commentary to the debate: “Behavioral addictions in the ICD-11”
Abstract
This paper comments three recent publications in the Journal of Behavioral Addictions (Brand et al., 2022; Gola et al., 2022; Sassover & Weinstein, 2022). It shortly discusses (1) the role of researcher biases and the significance of the naming of a disorder (here “sexual addiction” and “pornography use disorder”) for stigma and treatment, (2) the development and course of CSBD and its significance for research results, (3) the role of “Sexual” in CSBD. The paper concludes that the guidelines for CSBD give a precise description and the authors plea for an exchange between disciplines and a sex positive treatment approach.
We greatly appreciate the care and thought that is evident in the 10 commentaries that discuss our debate paper, the majority of which argued in favor of a formalized ICD-11 gaming disorder. We agree that there are some people whose play of video games is related to life problems. We believe that understanding this population and the nature and severity of the problems they experience should be a focus area for future research. However, moving from research construct to formal disorder requires a much stronger evidence base than we currently have. The burden of evidence and the clinical utility should be extremely high, because there is a genuine risk of abuse of diagnoses. We provide suggestions about the level of evidence that might be required: transparent and preregistered studies, a better demarcation of the subject area that includes a rationale for focusing on gaming particularly versus a more general behavioral addictions concept, the exploration of non-addiction approaches, and the unbiased exploration of clinical approaches that treat potentially underlying issues, such as depressive mood or social anxiety first. We acknowledge there could be benefits to formalizing gaming disorder, many of which were highlighted by colleagues in their commentaries, but we think they do not yet outweigh the wider societal and public health risks involved. Given the gravity of diagnostic classification and its wider societal impact, we urge our colleagues at the WHO to err on the side of caution for now and postpone the formalization.
