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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
Journal of Behavioral Addictions
Authors:
Maja Finkenstaedt
,
Daniel Biedermann
,
Johanna Schröder
,
Rose Gholami Mazinan
,
Johannes Fuss
, and
Sarah V. Biedermann

Abstract

Background and aims

Borderline personality disorder (BPD) is a complex mental health condition characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. Some individuals with BPD regularly engage in sexual risk behavior such as unprotected sex and are at higher risk of contracting sexually transmitted infections. This study investigates discounting of condom- or dental dam-protected sex in women with BPD compared with a control group.

Methods

Data were collected from 40 women diagnosed with BPD and 40 healthy controls with an average age of 27.28 years (SD = 6.14) using the Sexual Delay Discounting Task (SDT), the Borderline Symptom List-23 (BSL-23), and the Compulsive Sexual Behavior Disorder Scale-19 (CSBD-19).

Results

Women with BPD were less likely to use an immediately available condom or dental dam and more likely to discount safer sex than controls. Partner desirability and the perceived STI risk influenced the participants' likelihood of having protected sex. Women with BPD showed more symptoms of compulsive sexual behavior (CSB) than controls. However, sexual delay discounting was not significantly correlated with borderline symptoms or CSB in the BPD group.

Discussion and conclusions

These findings contribute to our understanding of sexual impulsivity in women with BPD and highlight the omission and delayed availability of safety measures as important contributors to sexual risk behavior and STI risk in women. Impulsive sexual behavior, as well as the accompanying sexual health concerns, should receive special attention in the treatment of women with BPD.

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

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:
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
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:
Joshua B. Grubbs
,
Rory C. Reid
,
Beáta Bőthe
,
Zsolt Demetrovics
,
Eli Coleman
,
Neil Gleason
,
Michael H. Miner
,
Johannes Fuss
,
Verena Klein
,
Karol Lewczuk
,
Mateusz Gola
,
David P. Fernandez
,
Elaine F. Fernandez
,
Stefanie Carnes
,
Michal Lew-Starowicz
,
Drew Kingston
, and
Shane W. Kraus

Abstract

Background and aims

The World Health Organization's International Classification of Diseases (ICD-11) includes Compulsive Sexual Behavior Disorder (CSBD), a new diagnosis that is both controversial and groundbreaking, as it is the first diagnosis to codify a disorder related to excessive, compulsive, and out-of-control sexual behavior. The inclusion of this novel diagnosis demonstrates a clear need for valid assessments of this disorder that may be quickly administered in both clinical and research settings.

Design

The present work details the development of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) across seven samples, four languages, and five countries.

Setting

In the first study, data were collected in community samples drawn from Malaysia (N = 375), the U.S. (N = 877), Hungary (N = 7,279), and Germany (N = 449). In the second study, data were collected from nationally representative samples in the U.S. (N = 1,601), Poland (N = 1,036), and Hungary (N = 473).

Findings

Across both studies and all samples, results revealed strong psychometric qualities for the 7-item CSBD-DI, demonstrating evidence of validity via correlations with key behavioral indicators and longer measures of compulsive sexual behavior. Analyses from nationally representative samples revealed residual metric invariance across languages, scalar invariance across gender, strong evidence of validity, and utility in classifying individuals who self-identified as having problematic and excessive sexual behavior, as evidenced by ROC analyses revealing suitable cutoffs for a screening instrument.

Conclusion

Collectively, these findings demonstrate the cross-cultural utility of the CSBD-DI as a novel measure for CSBD and provide a brief, easily administrable instrument for screening for this novel 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