Keywords
hypersexuality
sexual addiction
compulsive sexual behavior disorder
ICD-11
How to Cite
Abstract
In 2019 Compulsive Sexual Behavior Disorder (CSBD) has been officially included in the forthcoming 11th edition of the International Classification of Diseases published by the World Health Organization (WHO). The placement of CSBD as a new disease entity was preceded by a three-decade-long discussion on the conceptualization of these behaviors. Despite the potential benefits of WHO's decisions, the controversy around this topic has not ceased. Both clinicians and scientists are still debating on gaps in the current knowledge regarding the clinical picture of people with CSBD, and the neural and psychological mechanisms underlying this problem. This article provides an overview of the most important issues related to the formation of CSBD as a separate diagnostic unit in the classifications of mental disorders (such as DSM and ICD), as well as a summary of the major controversies related to the current classification of CSBD.
References
(1) Gola M, Wordecha M, Sescousse G, Lew-Starowicz M, Kossowski B, Wypych M, Marchewka A, et al. Can pornography be addictive? An fMRI study of men seeking treatment for problematic pornography use. Neuropsychopharmacology 2017; 42(10):2021-2031.
(2) Mechelmans DJ, Irvine M, Banca P, Porter L, Mitchell S, Mole TB, Voon V, et al. Enhanced Attentional Bias towards Sexually Explicit Cues in Individuals with and without Compulsive Sexual Behaviours. PloS One 2014; 9(8):e105476.
(3) Voon V, Mole TB, Banca P, Porter L, Morris L, Mitchell S, Irvine M, et al. Neural correlates of sexual cue reactivity in individuals with and without compulsive sexual behaviours. PLoS One 2014; 9(7):e102419.
(4) Carnes P. Out of the shadows: Understanding sexual addiction. Minneapolis 1983. MN: CompCare Publications.
(5) Deville de Periere D, Buys-Hillaire D, Favre de Thierrens C, Puech R, Elkaim G, Arancibia S. Somatostatin immune reactive concentrations in human saliva and in the submandibular salivary glands of the rat. Possible sexual dependence in the human. Journal de Biologie Buccale 1988; 16(3):191-196.
(6) Gold SN, Heffner CL. Sexual addiction: Many conceptions, minimal data. Clinical Psychology Review 1998; 18(3):367-381.
(7) Goodman A. Sexual addiction: An integrated approach. Madison, CT: International Universities Press 1998.
(8) Bostwick JM, Hecksel KA, Stevens SR, Bower JH, Ahlskog JE. Frequency of new-onset pathologic compulsive gambling or hypersexuality after drug treatment of idiopathic Parkinson disease. Mayo Clinic Proceedings 2009; 84(4):310-316.
(9) Kafka MP. Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior 2010; 39(2):377-400.
(10) Klos KJ, Bower JH, Josephs KA, Matsumoto JY, Ahlskog JE. Pathological hypersexuality predominantly linked to adjuvant dopamine agonist therapy in Parkinson's disease and multiple system atrophy. Parkinsonism & Related Disorders 2005; 11(6):381-386.
(11) Monga TN, Monga M, Raina MS, Hardjasudarma M. Hypersexuality in stroke. Archives of Physical Medicine and Rehabilitation 1986; 67(6):415.
(12) Orford, J. Hypersexuality: Implications for a theory of dependence. British Journal of Addiction to Alcohol & Other Drugs 1978; 73(3):299-310.
(13) Stein DJ, Hugo F, Oosthuizen P, Hawkridge SM, Van Heerden B. Neuropsychiatry of hypersexuality. CNS Spectrums 2000; 5(1):36-46.
(14) Bancroft J, Vukadinovic Z. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. The Journal of Sex Research 2004; 41(3):225-234.
(15) Erez G, Pilver CE, Potenza MN. Gender-related differences in the associations between sexual impulsivity and psychiatric disorders. Journal of Psychiatric Research 2014; 55:117-125.
(16) Cooper AJ. A placebo-controlled trial of the antiandrogen cyproterone acetate in deviant hypersexuality. Comprehensive Psychiatry 1981; 22(5):458-465.
(17) World Health Organization The ICD-10 Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.
(18) Cooper AJ, Ismail AAA, Phanjoo AL, Love DL. Antiandrogen (cyproterone acetate) therapy in deviant hypersexuality. British Journal of Psychiatry 1972; 120(554):59-63.
(19) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (2nd ed.). Washington, DC: American Psychiatric Association 1968.
(20) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington, DC: American Psychiatric Association 1980.
(21) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.). Washington, DC: American Psychiatric Association 1987.
(22) Wise TN, Schmidt CW. Paraphilias. [w:] Widiger TA, Frances AJ, Pincus HA, Ross R, First MB, Davis WW [red.]: DSM‑IV sourcebook (tom 2). Washington, DC: American Psychiatric Association 1997; 1133-1147.
(23) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association 1994.
(24) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association 2000.
(25) World Health Organization. History of the development of the ICD-6. Geneva: World Health Organization; 1949. http://www.who.int/classifications/icd/en/HistoryOfICD.pdf [retrieved on: September 2020].
(26) World Health Organization ICD-6. Geneva, Switzerland: World Health Organization; 1948.
(27) World Health Organization ICD-7. Geneva, Switzerland: World Health Organization; 1955.
(28) World Health Organization ICD-8. Geneva, Switzerland: World Health Organization; 1965.
(29) World Health Organization ICD-9. Geneva, Switzerland; 1975.
(30) World Health Organization The International Classification of Diseases, 9th Revision, Clinical Modification ICD-9-CM. Washington, DC: US Department of Health and Human Services; 1989.
(31) Manley G, Koehler J. Sexual behavior disorders: Proposed new classification in the DSM‑V. Sexual Addiction & Compulsivity 2001; 8:253-265.
(32) Mick TM, Hollander E. Impulsive‑compulsive sexual behavior. CNS Spectrums 2006; 11:944-955.
(33) American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Association 2013.
(34) Kafka MP. What Happened to Hypersexual Disorder? Arch Sex Behav 2014; 43:1259-1261.
(35) Winters J, Christoff K, Gorzalka B. Dysregulated sexuality and high sexual desire: Distinct constructs? Archives of Sexual Behavior 2010; 39:1029-1043.
(36) Wakefield JC. The DSM-5's proposed new categories of sexual disorder: The problem of false positives in sexual diagnosis. Clinical Social Work Journal 2012; 40:213-223.
(37) Winters J. Hypersexual Disorder: A more cautious approach [letter to the editor]. Archives of Sexual Behavior 2010; 39:594-596.
(38) Kraus SW, Voon V, Potenza MN. Should compulsive sexual behavior be considered an addiction? Addiction 2016; 111:2097-2106.
(39) Womack SD, Hook JN, Ramos M, et al. Measuring hypersexual behavior. Sex Addict Compulsivity 2013; 20:65-78.
(40) Reid RC, Carpenter BN, Hook JN, et al. Report of findings in a dsm-5 field trial for hypersexual disorder. J Sex Med 2012; 9:2868-2877.
(41) World Health Organization (2020). International Classification of Diseases 11th Revision. https://icd.who.int/dev11/l-m/en [retrieved on: September 2020].
(42) Kraus SW, Krueger RB, Briken P, First MB, Stein DJ, Kaplan MS, Voon V, Abdo CH, Grant JE, Atalla E, Reed GM. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry 2018; 17(1):109-110.
(43) Kowalewska E, Grubbs JB, Potenza MN, Gola M, Draps M, Kraus SW. Neurocognitive mechanisms in Compulsive Sexual Behavior Disorder. Current Sexual Health Reports 2018; 10(4):255-264.
(44) Gola M, Potenza MN. The proof of the pudding is in the tasting: Data are needed to test models and hypotheses related to compulsive sexual behaviors. Archives of Sexual Behavior 2018; 47(5):1323-1325.
(45) Gola M, Draps M. Ventral striatal reactivity in Compulsive Sexual Behaviors. Frontiers in Psychiatry 2018; 9:546.
(46) Lew-Starowicz M, Lewczuk K, Nowakowska I, et al. Compulsive Sexual Behavior and Dysregulation of Emotion. J Sex Med 2020, 8:191-205.
(47) Reid RC, Carpenter BN, Spackman M, Willes DL. Alexithymia, emotional instability, and vulnerability to stress proneness in patients seeking help for hypersexual behavior. Journal of Sex & Marital Therapy 2008, 34(2):133-149.
(48) Miner MH, Dickenson J, Coleman E. Effects of Emotions on Sexual Behavior in Men with and without Hypersexuality. Sexual Addiction Compulsivity (2019), 26(1-2):24-41.
(49) Gola M, Lewczuk K, Potenza MN, Kingston DA, Grubbs JB, Stark R, Reid RC. What should be included in the criteria for compulsive sexual behaviour disorder? Journal of Behavioral Addiction 2020. https://akjournals.com/view/journals/ 2006/aop/article-10.1556-2006.2020.00090/article-10. 1556-2006.2020.00090.xml [retrieved on: Mar 14, 2021].
(50) Klucken T, Wehrum-Osinsky S, Schweckendiek J, Kruse O, Stark R. Altered appetitive conditioning and neural connectivity in subjects with compulsive sexual behavior. J Sex Med 2016; 13(4):627-636.
(51) Seok JW, Sohn JH. Neural substrates of sexual desire in individuals with problematic hypersexual behavior. Front Behav Neurosci 2015; 9:321.
(52) Brand M, Snagowski J, Laier C, Maderwald S. Ventral striatum activity when watching preferred pornographic pictures is correlated with symptoms of internet pornography addiction. NeuroImage 2016; 129:224-232.
(53) Noori HR, Cosa Linan A, Spanagel R. Largely overlapping neuronal substrates of reactivity to drug, gambling, food and sexual cues: a comprehensive meta-analysis. Eur Neuropsychopharmacol 2016; 26:1419-30.
(54) Robinson TE, Berridge KC. The neural basis of drug craving: an incentive-sensitization theory of addiction. Brain Res Rev 1993; 18:247-91.
(55) Gola M, Potenza MN. Paroxetine treatment of problematic pornography use: a case series. J Behav Addict 2016; 5(3):529-32.
(56) Wordecha M, Wilk M, Kowalewska E, Skorko M, Łapiński A, Gola M. "Pornographic binges" as a key characteristic of males seeking treatment for compulsive sexual behaviors: qualitative and quantitative 10-week-long diary assessment. J Behav Addict 2018; 7(2):433-44.
(57) Gola M, Miyakoshi M, Sescousse G. Sex, impulsivity and anxiety: interplay between ventral striatum and amygdala reactivity in sexual behaviors. J Neurosci 2015; 35:15227-9.
(58) Griffiths M. A "components" model of addiction within a biopsychosocial framework. Journal of Substance Use 2005; 10:191-197.
(59) Sassover E, Weinstein A. Should compulsive sexual behavior (CSB) be considered as a behavioral addiction? A debate paper presenting the opposing view. Journal of Behavioral Addictions JBA 2020. https://akjournals.com/view/journals /2006/aop /article-10.1556-2006.2020.00055/article-10. 1556-2006.2020.00055.xml [retrieved on Mar 14, 2021].
(60) Carnes P. Don't call it love. New York 1991. NY: Bantam.
(61) Wéry A, Billieux J. Online sexual activities: An exploratory study of problematic and non-problematic usage patterns in a sample of men. Computers in Human Behavior 2016; 56:257-266.
(62) Kingston DA, Firestone P. Problematic hypersexuality: A review of conceptualization and diagnosis. Sexual Addiction and Compulsivity: The Journal of Treatment and Prevention 2008; 15:284-310.
(63) Reid RC, Woolley SR. Using emotionally focused therapy for couples to resolve attachment ruptures created by hypersexual behavior. Sexual Addiction & Compulsivity 2006; 13(2-3): 219-239.
(64) Reid RC, Garos S, Carpenter BN. Reliability, Validity, and Psychometric Development of the Hypersexual Behavior Inventory in an Outpatient Sample of Men. Sexual Addiction & Compulsivity 2011; 18(1):30-51.
(65) Grubbs JB, Perry SL, Wilt JA, Reid RC. Pornography problems due to moral incongruence: An integrative model with a systematic review and meta-analysis. Archives of Sexual Behavior 2018; 48(2):397-415.
(66) Walton MT, Cantor JM, Bhullar N, Lykins AD. Hypersexuality: A critical review and introduction to the "sexhavior cycle". Archives of Sexual Behavior 2017; 46(8):2231-2251.
(67) Lewczuk K, Glica A, Nowakowska I, Gola M, Grubbs JB. Evaluating Pornography Problems Due to Moral Incongruence Model. The Journal of Sexual Medicine 2020; 17(2):300-311.
(68) Kraus SW, Sweeney PJ. Hitting the target: considerations for differential diagnosis when treating individuals for problematic use of pornography. Archives of Sexual Behavior 2019; 48(2):431-435.
(69) Lew-Starowicz M, Gola M. Compulsive – and Other Out-of-Control Sexual Behaviors. [In:] Lew-Starowicz, M., Giraldi, A., Krueger, T. [Eds.] Psychiatry and Sexual Medicine. A comprehensive guide for clinical practitioners. Springer 2021; 457-469.
(70) Kowalewska E, Gola M, Kraus SW, Lew-Starowicz M. Spotlight on Compulsive Sexual Behavior Disorder: A Systematic Review of Research on Women. Neuropsychiatric Disease and Treatment 2020; 16:2025-2043.
(71) Savard J, Öberg KG, Chatzittofis A, Dhejne C, Arver S, Jokinen J. Naltrexone in Compulsive Sexual Behavior Disorder: A Feasibility Study of Twenty Men. The Journal of Sexual Medicine 2020; 17(8):1544-1552.