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Nosology of behavioral addictions: Intersections with philosophy of psychiatry •

Commentary to the debate: “Behavioral addictions in the ICD-11”

Journal of Behavioral Addictions
Authors:
Dan J. Stein
and
Christine Lochner

Abstract

Writing in this journal, Brand and colleagues have proposed criteria for other specified disorders due to addictive behaviors. Their proposal intersects with key debates in philosophy of psychiatry, including how best to define mental disorders, to validate them, and to optimize their meta-structure. Review of these debates in the context of behavioral addictions suggests several conclusions. First, these debates involve “essentially contested” constructs that require ongoing consideration and judgment. Second, the complexity of psychopathology suggests multiple legitimate approaches to delineating traits and explicating mechanisms. Third, in optimizing meta-structure, non-psychobiological considerations are crucial - the overlapping public mental health approach to addictive disorders is paramount.

Open access

Background and aims

Compulsive sexual behavior disorder (CSBD) will be included in ICD-11 as an impulse-control disorder. CSBD also shares clinical features with obsessive–compulsive spectrum disorders (OCSDs) and behavioral addictions. There has been relatively little systematic investigation of CSBD in obsessive–compulsive disorder (OCD), the paradigmatic compulsive disorder. We aimed to determine prevalence of CSBD in OCD, and its associated sociodemographic and clinical features, including associated comorbidity, to learn more about the nature of CSBD.

Methods

Adult outpatients with current OCD (N = 539) participated in this study. The Structured Clinical Interview for OCSDs was used to diagnose OCSDs (Tourette’s syndrome, compulsive shopping, pathological gambling, kleptomania, pyromania, intermittent explosive disorder, self-injurious behavior, and CSBD). Prevalence rates of OCSDs in male versus female patients as well as comorbid disorders in OCD patients with and without CSBD were compared.

Results

Lifetime prevalence of CSBD was 5.6% in patients with current OCD and significantly higher in men than women. OCD patients with and without CSBD were similar in terms of age, age of onset of OCD, present OCD illness severity, as well as educational background. Lifetime prevalence rates of several mood, obsessive–compulsive, and impulse-control disorders were considerably elevated in patients with lifetime CSBD.

Discussion and conclusions

A substantive number of OCD patients suffered from CSBD. CSBD in OCD was more likely comorbid with other mood, obsessive–compulsive, and impulse-control disorders, but not with disorders due to substance use or addictive behaviors. This finding supports conceptualization of CSBD as a compulsive–impulsive disorder.

Open access
Journal of Behavioral Addictions
Authors:
Johannes Fuss
,
Jared W. Keeley
,
Dan J. Stein
,
Tahilia J. Rebello
,
José Ángel García
,
Peer Briken
,
Rebeca Robles
,
Chihiro Matsumoto
,
Christoph Abé
,
Joël Billieux
,
Jon E. Grant
,
Shane W. Kraus
,
Christine Lochner
,
Marc N. Potenza
, and
Geoffrey M. Reed

Abstract

Background and aims

The ICD-11 chapter on mental, behavioral and neurodevelopmental disorders contains new controversial diagnoses including compulsive sexual behavior disorder (CSBD), intermittent explosive disorder (IED) and gaming disorder. Using a vignette-based methodology, this field study examined the ability of mental health professionals (MHPs) to apply the new ICD-11 diagnostic requirements for impulse control disorders, which include CSBD and IED, and disorders due to addictive behaviors, which include gaming disorder, compared to the previous ICD-10 guidelines.

Methods

Across eleven comparisons, members of the WHO's Global Clinical Practice Network (N = 1,090) evaluated standardized case descriptions that were designed to test key differences between the diagnostic guidelines of ICD-11 and ICD-10.

Results

The ICD-11 outperformed the ICD-10 in the accuracy of diagnosing impulse control disorders and behavioral addictions in most comparisons, while the ICD-10 was not superior in any. The superiority of the ICD-11 was particularly clear where new diagnoses had been added to the classification system or major revisions had been made. However, the ICD-11 outperformed the ICD-10 only in a minority of comparisons in which mental health professionals were asked to evaluate cases with non-pathological high involvement in rewarding behaviors.

Discussion and Conclusions

Overall, the present study indicates that the ICD-11 diagnostic requirements represent an improvement over the ICD-10 guidelines. However, additional efforts, such as training programs for MHPs and possible refinements of diagnostic guidance, are needed to avoid over-diagnosis of people who are highly engaged in a repetitive and rewarding behavior but below the threshold for a disorder.

Open access
Journal of Behavioral Addictions
Authors:
Beáta Bőthe
,
Mónika Koós
,
Léna Nagy
,
Shane W. Kraus
,
Zsolt Demetrovics
,
Marc N. Potenza
,
Aurélie Michaud
,
Rafael Ballester-Arnal
,
Dominik Batthyány
,
Sophie Bergeron
,
Joël Billieux
,
Peer Briken
,
Julius Burkauskas
,
Georgina Cárdenas-López
,
Joana Carvalho
,
Jesús Castro-Calvo
,
Lijun Chen
,
Giacomo Ciocca
,
Ornella Corazza
,
Rita Csako
,
David P. Fernandez
,
Elaine F. Fernandez
,
Loïs Fournier
,
Hironobu Fujiwara
,
Johannes Fuss
,
Roman Gabrhelík
,
Ateret Gewirtz-Meydan
,
Biljana Gjoneska
,
Mateusz Gola
,
Joshua B. Grubbs
,
Hashim T. Hashim
,
Md. Saiful Islam
,
Mustafa Ismail
,
Martha C. Jiménez-Martínez
,
Tanja Jurin
,
Ondrej Kalina
,
Verena Klein
,
András Költő
,
Chih-Ting Lee
,
Sang-Kyu Lee
,
Karol Lewczuk
,
Chung-Ying Lin
,
Liverpool John Moores University's research team † Liverpool John Moores University's research team
,
Christine Lochner
,
Silvia López-Alvarado
,
Kateřina Lukavská
,
Percy Mayta-Tristán
,
Ionut Milea
,
Dan J. Miller
,
Oľga Orosová
,
Gábor Orosz
,
Sungkyunkwan University's research team †† Sungkyunkwan University's research team
,
Fernando P. Ponce
,
Gonzalo R. Quintana
,
Gabriel C. Quintero Garzola
,
Jano Ramos-Diaz
,
Kévin Rigaud
,
Ann Rousseau
,
Marco De Tubino Scanavino
,
Marion K. Schulmeyer
,
Pratap Sharan
,
Mami Shibata
,
Sheikh Shoib
,
Vera L. Sigre Leirós
,
Luke Sniewski
,
Ognen Spasovski
,
Vesta Steibliene
,
Dan J. Stein
,
Julian Strizek
,
Aleksandar Štulhofer
,
Berk C. Ünsal
, and
Marie-Pier Vaillancourt-Morel

Abstract

Background and aims

Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice.

Method

Using data from the International Sex Survey (N = 82,243; M age = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD.

Results

A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability.

Discussion and conclusions

This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Open access