Compulsive Sexual Behaviour Disorder - Revision history

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← Older revision		Revision as of 21:14, 30 December 2020
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		+	Key points (based on presentation by Briken):
		+
		+	* Impulse control disorder, not behavioral addiction - no clear information on whether the processes involved are equivalent to substance use disorders, gambling and gaming.
		+	* Concerns about over pathologizing sexual behaviors are explicitly addressed
		+	* Individuals with high levels of sexual interest and behavior who do not exhibit '''impaired (sexual self-)control''' and '''significant distress''' or impairment in functioning should not be diagnosed.
		+	* Diagnosis should also not be assigned to describe high levels of sexual interest and behaviors (e.g. masturbation) that are common among adolescents
		+	* Should not be diagnosed based on psychological distress related to moral judgments.
		+
	== References ==		== References ==

@@ Line 8: / Line 8: @@
 Klein V, Rettenberger M, Briken P. Self-reported indicators of hypersexuality and its correlates in a female online sample. J Sex Med. 2014;11:1974–81.</ref>). ''Ibid.''
-*** In Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). What should be included in the criteria for compulsive sexual behavior disorder? Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki> he writes: In the absence of consistent definitions and community based epidemiological data, determining accurate prevalence rates of compulsive sexual behaviour disorder has been difficult. Epidemiological estimates have ranged up to 3-6% in adults [8]<ref>Kuzma JM, Black DW. Psychiatr Clin N Am 2008;31:603-11.</ref>, though recent studies have produced somewhat lower estimates of 1 to 3% [9]<ref>Klein V, Rettenberger M, Briken P. J Sex Med 2014;11:1974-81.</ref>. The more restrictive diagnostic requirements proposed for ICD-11 would be expected to produce lower prevalence rates.
+*** In the absence of consistent definitions and community based epidemiological data, determining accurate prevalence rates of compulsive sexual behaviour disorder has been difficult. Epidemiological estimates have ranged up to 3-6% in adults [8]<ref>Kuzma JM, Black DW. Psychiatr Clin N Am 2008;31:603-11.</ref>, though recent studies have produced somewhat lower estimates of 1 to 3% [9]<ref>Klein V, Rettenberger M, Briken P. J Sex Med 2014;11:1974-81.</ref>. The more restrictive diagnostic requirements proposed for ICD-11 would be expected to produce lower prevalence rates. ''In Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). What should be included in the criteria for compulsive sexual behavior disorder? Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki>''
 == Treatment ==

@@ Line 3: / Line 3: @@
 * Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>
 * Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]<ref>Leeman RF, Rowland BHP, Gebru NM, Potenza MN. Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans. Philos Trans R Soc Lond Ser B Biol Sci. 2019;374(1766):20180129. <nowiki>https://doi.org/10.1098/rstb.2018.0129</nowiki>.</ref>. '''Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors''' [107]<ref>Briken P, Basdekis-Jozsa R. Sexual addiction? When sexual behavior gets out of control. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010;53(4):313–8. <nowiki>https://doi.org/10.1007/s00103-010-1033-z</nowiki>.</ref>. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108]<ref>Bancroft J, Vukadinovic Z. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. J Sex Res. 2004;41:225–34.</ref>, according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109<ref>Rettenberger M, Klein V, Briken P. The relationship between hypersexual behavior, sexual excitation, sexual inhibition, and personality traits. Arch Sex Behav. 2016;45:219–33.</ref>, 110<ref>Walton MT, Bhullar N. Hypersexuality, higher rates of intercourse, masturbation, sexual fantasy, and early sexual interest relate to higher sexual excitation/arousal. Arch Sex Behav. 2018;47:2177–83.</ref>]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21.  p. 17.''
-** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]). ''Ibid.''
+** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]<ref>Dickenson JA, Gleason N, Coleman E, Miner MH. Prevalence of distress associated with difficulty controlling sexual urges, feelings, and behaviors in the United States. JAMA Netw Open. 2018;1(7):e184468.
 == Treatment ==

@@ Line 14: / Line 14: @@
 * Leonhardt, N. D., Busby, D. M., & Willoughby, B. J. (2020). Do You Feel in Control? Sexual Desire, Sexual Passion Expression, and Associations with Perceived Compulsivity to Pornography and Pornography (t sexual drive is associated with higher pornography use, providing some support for Prause et al. hypothesis, namely, sexual drive, rather then addiction, leads to compulsive sexual behavior. )
 * Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775124/ Compulsive sexual behaviour disorder in the ICD-11]. World Psychiatry, 17(1), 109–110. <nowiki>https://doi.org/https://doi.org/10.1002/wps.20499</nowiki>
 * Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). [https://www.researchgate.net/publication/347218359_What_should_be_included_in_the_criteria_for_compulsive_sexual_behavior_disorder What should be included in the criteria for compulsive sexual behavior disorder?] Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki>
 ** Furthermore, researchers have raised questions about whether models dichotomizing CSB involving the presence or absence of moral incongruence are as distinct as proposed (Brand, Antons, Wegmann, & Potenza, 2019)<ref>Brand, M., Antons, S., Wegmann, E., & Potenza, M. N. (2019) Theoretical assumptions on pornography problems due to moral incongruence and mechanisms of addictive or compulsive use of pornography: Are the two “conditions” as theoretically distinct as suggested?. Archives of Sexual Behavior, 48(2), 417–423.</ref>. Thus, although moral incongruence may have clinical relevance in what motivates individuals to seek treatment for CSB (Kraus & Sweeney, 2019)<ref>Kraus, S. W., & Sweeney, P. J. (2019). Hitting the target: Considerations for differential diagnosis when treating individuals for problematic use of pornography. Archives of Sexual Behavior, 48, 431–435.</ref>, its role in the etiology of and definition of CSBD warrants additional understanding.

← Older revision		Revision as of 14:36, 30 December 2020
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	* Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775124/ Compulsive sexual behaviour disorder in the ICD-11]. World Psychiatry, 17(1), 109–110. <nowiki>https://doi.org/https://doi.org/10.1002/wps.20499</nowiki>		* Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775124/ Compulsive sexual behaviour disorder in the ICD-11]. World Psychiatry, 17(1), 109–110. <nowiki>https://doi.org/https://doi.org/10.1002/wps.20499</nowiki>
	* Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). [https://www.researchgate.net/publication/347218359_What_should_be_included_in_the_criteria_for_compulsive_sexual_behavior_disorder What should be included in the criteria for compulsive sexual behavior disorder?] Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki>		* Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). [https://www.researchgate.net/publication/347218359_What_should_be_included_in_the_criteria_for_compulsive_sexual_behavior_disorder What should be included in the criteria for compulsive sexual behavior disorder?] Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki>
		+	** Furthermore, researchers have raised questions about whether models dichotomizing CSB involving the presence or absence of moral incongruence are as distinct as proposed (Brand, Antons, Wegmann, & Potenza, 2019)<ref>Brand, M., Antons, S., Wegmann, E., & Potenza, M. N. (2019) Theoretical assumptions on pornography problems due to moral incongruence and mechanisms of addictive or compulsive use of pornography: Are the two “conditions” as theoretically distinct as suggested?. Archives of Sexual Behavior, 48(2), 417–423.</ref>. Thus, although moral incongruence may have clinical relevance in what motivates individuals to seek treatment for CSB (Kraus & Sweeney, 2019)<ref>Kraus, S. W., & Sweeney, P. J. (2019). Hitting the target: Considerations for differential diagnosis when treating individuals for problematic use of pornography. Archives of Sexual Behavior, 48, 431–435.</ref>, its role in the etiology of and definition of CSBD warrants additional understanding.

← Older revision		Revision as of 14:32, 30 December 2020
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	* Leonhardt, N. D., Busby, D. M., & Willoughby, B. J. (2020). Do You Feel in Control? Sexual Desire, Sexual Passion Expression, and Associations with Perceived Compulsivity to Pornography and Pornography (t sexual drive is associated with higher pornography use, providing some support for Prause et al. hypothesis, namely, sexual drive, rather then addiction, leads to compulsive sexual behavior. )		* Leonhardt, N. D., Busby, D. M., & Willoughby, B. J. (2020). Do You Feel in Control? Sexual Desire, Sexual Passion Expression, and Associations with Perceived Compulsivity to Pornography and Pornography (t sexual drive is associated with higher pornography use, providing some support for Prause et al. hypothesis, namely, sexual drive, rather then addiction, leads to compulsive sexual behavior. )
		+	* Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Atalla, E., & Reed, G. M. (2018). [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775124/ Compulsive sexual behaviour disorder in the ICD-11]. World Psychiatry, 17(1), 109–110. <nowiki>https://doi.org/https://doi.org/10.1002/wps.20499</nowiki>
		+	* Gola, M., Lewczuk, K., Potenza, M., Kingston, D., Grubbs, J., Stark, R., & Reid, R. (2020). [https://www.researchgate.net/publication/347218359_What_should_be_included_in_the_criteria_for_compulsive_sexual_behavior_disorder What should be included in the criteria for compulsive sexual behavior disorder?] Journal of Behavioral Addictions. <nowiki>https://doi.org/10.1556/2006.2020.00090</nowiki>

@@ Line 2: / Line 2: @@
 * Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>
-* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]. Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors [107]. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108], according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109, 110]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21.  p. 17.''
+* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]<ref>Leeman RF, Rowland BHP, Gebru NM, Potenza MN. Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans. Philos Trans R Soc Lond Ser B Biol Sci. 2019;374(1766):20180129. <nowiki>https://doi.org/10.1098/rstb.2018.0129</nowiki>.</ref>. '''Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors''' [107]<ref>Briken P, Basdekis-Jozsa R. Sexual addiction? When sexual behavior gets out of control. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010;53(4):313–8. <nowiki>https://doi.org/10.1007/s00103-010-1033-z</nowiki>.</ref>. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108]<ref>Bancroft J, Vukadinovic Z. Sexual addiction, sexual compulsivity, sexual impulsivity, or what? Toward a theoretical model. J Sex Res. 2004;41:225–34.</ref>, according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109<ref>Rettenberger M, Klein V, Briken P. The relationship between hypersexual behavior, sexual excitation, sexual inhibition, and personality traits. Arch Sex Behav. 2016;45:219–33.</ref>, 110<ref>Walton MT, Bhullar N. Hypersexuality, higher rates of intercourse, masturbation, sexual fantasy, and early sexual interest relate to higher sexual excitation/arousal. Arch Sex Behav. 2018;47:2177–83.</ref>]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21.  p. 17.''
 ** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]). ''Ibid.''
@@ Line 9: / Line 9: @@
 * See First- step treatment goals and Second- step therapy goals in Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>
 ** The treatment goals and the development of a treatment plan vary but should consider the symptoms first and then the existing comorbidities and the under lying hypothesis for the development of the disorder. Thus, dividing the treatment goals and the treatment plan into different steps seems reasonable [38]<ref>Briken, P. & Basdekis- Jozsa, R. [Sexual addiction? When sexual behavior gets out of control]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 53, 313–318 (2010).</ref>. Ibid.

← Older revision		Revision as of 14:12, 30 December 2020
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	* See First- step treatment goals and Second- step therapy goals in Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>		* See First- step treatment goals and Second- step therapy goals in Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>
		+	** The treatment goals and the development of a treatment plan vary but should consider the symptoms first and then the existing comorbidities and the under lying hypothesis for the development of the disorder. Thus, dividing the treatment goals and the treatment plan into different steps seems reasonable [38]<ref>Briken, P. & Basdekis- Jozsa, R. [Sexual addiction? When sexual behavior gets out of control]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 53, 313–318 (2010).</ref>. Ibid.

← Older revision		Revision as of 14:09, 30 December 2020
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	* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]. Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors [107]. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108], according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109, 110]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. p. 17.''		* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]. Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors [107]. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108], according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109, 110]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. p. 17.''
	** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]). ''Ibid.''		** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]). ''Ibid.''
		+
		+	== Treatment ==
		+
		+	* See First- step treatment goals and Second- step therapy goals in Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>

← Older revision		Revision as of 13:32, 30 December 2020
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	* Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>		* Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. <nowiki>https://doi.org/10.1038/s41585-020-0343-7</nowiki>
−	* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]. Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors [107]. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108], according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109, 110]. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. p. 17.''	+	* Although the word ‘compulsive’ is included in the name because that is a very common way of referring to this phenomenon in the literature, sexual behaviour in CSBD is not considered a true compulsion that occurs in relation to intrusive, unwanted and typically anxiety provoking thoughts (obsessions) as in OCD. Rather, CSBD is a repetitive, typically initially rewarding behaviour pattern that the person feels unable to control, which appears to have both impulsive and compulsive elements [106]. Early in the development of the behaviour pattern, impulsivity and positive reinforcement (pleasure) are the most important elements. Later in the course of the disorder, compulsive aspects and negative reinforcement (e.g. temporary improvement of negative mood) are likely to become increasingly important in sustaining the behaviors [107]. The most thoroughly investigated theoretical model on the interplay between excitatory and inhibitory influences on sexual behaviour is the dual control model [108], according to which CS BD could be a problem when sexual self-control is relatively low and sexual responsiveness/excitability is relatively high [109, 110]. Clinically, the lack of self-control is often subjectively experienced as urgency, while sex in CSBD may fulfill a variety of different functions. Treatment therefore focuses on improvement of sexual self-control as well as coping with the underlying emotional states and motives. Briken in ''Stein, D. J., Szatmari, P., Gaebel, W., Berk, M., Vieta, E., Maj, M., de Vries, Y. A., Roest, A. M., de Jonge, P., Maercker, A., Brewin, C. R., Pike, K. M., Grilo, C. M., Fineberg, N. A., Briken, P., Cohen-Kettenis, P. T., & Reed, G. M. (2020). Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Medicine, 18(1), 21. p. 17.''
		+	** Available evidence suggests a prevalence of 10–12% for men and 7% for women for sexual compulsivity; however, the new CSBD guidelines are yet to be used in epidemiological studies (e.g. [111–113]). ''Ibid.''