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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

Abstract

Background and aims

The purpose of this study was to examine the prevalence and correlates of indicators consistent with Compulsive Sexual Behavior Disorder (CSBD)—defined and operationalized according to the ICD-11 guidelines—in a large (n = 4,633; 50.5% male; 49,5% female) probability-based German national sample.

Methods

Participants were asked if they had ever experienced “intense and recurring sexual impulses or sexual urges that I had difficulty controlling and resulted in sexual behavior” over a period of several months. Those who reported this experience were queried about the associated distress.

Results

Overall, 4.9% of men [95% CI = 3.9–6.1] and 3.0% of women [95% CI = 2.3–3.9] reported experiences consistent with ICD-11 diagnostic requirements for lifetime diagnosis. In the 12 months preceding the study, 3.2% of men [95% CI = 2.4–4.2] and 1.8% of women [95% CI = 1.2–2.5] reported experiences consistent with CSBD requirements. Compared to controls and participants who reported elements of compulsive sexuality but without accompanying distress, strict religious upbringing was most prevalent in the CSBD group. The CSBD group was more likely to view sexual practices like men having sex with men as unacceptable and to report the belief that pornography has negative impacts on their sex life and life in general. Compared to the other two groups, the CSBD group was significantly more likely to have received psychiatric treatment for depression or another mental health problem during the past 12 months.

Discussion and conclusions

The current study provides novel and important insights into the prevalence and characteristics of CSBD in the general population.

Open access
Journal of Behavioral Addictions
Authors:
Beáta Bőthe
,
Marc N. Potenza
,
Mark D. Griffiths
,
Shane W. Kraus
,
Verena Klein
,
Johannes Fuss
, and
Zsolt Demetrovics

Abstract

Background

Compulsive Sexual Behavior Disorder (CSBD) is included in the eleventh edition of The International Classification of Diseases (ICD-11) as an impulse-control disorder.

Aims

The aim of the present work was to develop a scale (Compulsive Sexual Behavior Disorder Scale–CSBD-19) that can reliably and validly assess CSBD based on ICD-11 diagnostic guidelines.

Method

Four independent samples of 9,325 individuals completed self-reported measures from three countries (the United States, Hungary, and Germany). The psychometric properties of the CSBD-19 were examined in terms of factor structure, reliability, measurement invariance, and theoretically relevant correlates. A potential threshold was determined to identify individuals with an elevated risk of CSBD.

Results

The five-factor model of the CSBD-19 (i.e., control, salience, relapse, dissatisfaction, and negative consequences) had an excellent fit to the data and demonstrated appropriate associations with the correlates. Measurement invariance suggested that the CSBD-19 functions similarly across languages. Men had higher means than women. A score of 50 points was found as an optimal threshold to identify individuals at high-risk of CSBD.

Conclusions

The CSBD-19 is a short, valid, and reliable measure of potential CSBD based on ICD-11 diagnostic guidelines. Its use in large-scale, cross-cultural studies may promote the identification and understanding of individuals with a high risk of CSBD.

Open access
Journal of Behavioral Addictions
Authors:
Benny Liberg
,
Katarina Görts-Öberg
,
Jussi Jokinen
,
Josephine Savard
,
Cecilia Dhejne
,
Stefan Arver
,
Johannes Fuss
,
Martin Ingvar
, and
Christoph Abé

Abstract

Background and aims

Compulsive sexual behavior disorder (CSBD) is characterized by persistent patterns of failure to control sexual impulses resulting in repetitive sexual behavior, pursued despite adverse consequences. Despite previous indications of addiction-like mechanisms and the recent impulse-control disorder classification in the International Classification of Diseases (ICD-11), the neurobiological processes underlying CSBD are unknown.

Methods

We designed and applied a behavioral paradigm aimed at disentangling processes related to anticipation and viewing of erotic stimuli. In 22 male CSBD patients (age: M = 38.7, SD = 11.7) and 20 healthy male controls (HC, age: M = 37.6, SD = 8.5), we measured behavioral responses and neural activity during functional magnetic resonance imaging (fMRI). The main outcomes were response time differences between erotic and non-erotic trials and ventral striatum (VS) activity during anticipation of visual stimuli. We related these outcomes with each other, to CSBD diagnosis, and symptom severity.

Results

We found robust case-control differences on behavioral level, where CSBD patients showed larger response time differences between erotic and non-erotic trials than HC. The task induced reliable main activations within each group. While we did not observe significant group differences in VS activity, VS activity during anticipation correlated with response time differences and self-ratings for anticipation of erotic stimuli.

Discussion and Conclusions

Our results support the validity and applicability of the developed task and suggest that CSBD is associated with altered behavioral correlates of anticipation, which were associated with ventral striatum activity during anticipation of erotic stimuli. This supports the idea that addiction-like mechanisms play a role in CSBD.

Open access