After introduction of compulsive sexual behavior disorder (CSBD) in the ICD-11, many questions regarding etiology, classification and diagnostic criteria remain unanswered, providing rationale for further research. In this commentary, we critically review the ongoing discussion reflected in some relevant articles, and try to point out the risks of oversimplification of the broad clinical phenomenon, as well as attract attention to the neglected aspects, such as psychosexual development, intimacy disorder and the role of sexological expertise in the assessment and treatment of individuals presenting with out-of-control sexual behaviors. We also advocate for multimodal, transtheoretical approach and suggest that CSBD may be reconsidered as a condition related to sexual health.
The addiction model of compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU) predicts the presence of withdrawal symptoms and increased tolerance for sexual stimuli in the disorder phenotype. However, clear empirical evidence supporting this claim has largely been lacking.
In the preregistered, nationally representative survey (n = 1,541, 51.2% women, age: M = 42.99, SD = 14.38), we investigated the role of self-reported withdrawal symptoms and tolerance with respect to CSBD and PPU severity.
Both withdrawal and tolerance were significantly associated with the severities of CSBD (β = 0.34; P < 0.001 and β = 0.38; P < 0.001, respectively) and PPU (β = 0.24; P < 0.001 and β = 0.27; P < 0.001, respectively). Of the 21 withdrawal symptom types investigated, the most often reported symptoms were frequent sexual thoughts that were difficult to stop (for participants with CSBD: 65.2% and with PPU: 43.3%), increased overall arousal (37.9%; 29.2%), difficult to control level of sexual desire (57.6%; 31.0%), irritability (37.9%; 25.4%), frequent mood changes (33.3%; 22.6%), and sleep problems (36.4%; 24.5%).
Changes related to mood and general arousal noted in the current study were similar to the cluster of symptoms in a withdrawal syndrome proposed for gambling disorder and internet gaming disorder in DSM-5. The study provides preliminary evidence on an understudied topic, and present findings can have significant implications for understanding the etiology and classification of CSBD and PPU. Simultaneously, drawing conclusions about clinical importance, diagnostic utility and detailed characteristics of withdrawal symptoms and tolerance as a part of CSBD and PPU, as well as other behavioral addictions, requires further research efforts.
To address current gaps around screening for problematic pornography use (PPU), we initially developed and tested a six-item Brief Pornography Screen (BPS) that asked about PPU in the past six months.
Methods and Participants
We recruited five independent samples from the U.S. and Poland to evaluate the psychometric properties of the BPS. In Study 1, we evaluated the factor structure, reliability, and elements of validity using a sample of 224 U.S. veterans. One item from the BPS was dropped in Study 1 due to low item endorsement. In Studies 2 and 3, we further investigated the five-item the factor structure of the BPS and evaluated its reliability and validity in two national U.S. representative samples (N = 1,466, N = 1,063, respectively). In Study 4, we confirmed the factor structure and evaluated its validity and reliability using a sample of 703 Polish adults. In Study 5, we calculated the suggested cut-off score for the screen using a sample of 105 male patients seeking treatment for compulsive sexual behavior disorder (CSBD).
Findings from a principal components analysis and confirmatory factor analysis supported a one-factor solution which yielded high internal consistency (α = 0.89–0.90), and analyses further supported elements of construct, convergent, criterion, and discriminant validity of the newly developed screen. Results from a Receiver Operating Characteristic (ROC) curve suggested a cut-off score of four or higher for detecting possible PPU.
The BPS appears to be psychometrically sound, short, and easy to use in various settings with high potential for use in populations across international jurisdictions.
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.
The present work details the development of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) across seven samples, four languages, and five countries.
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).
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.
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.