Compulsive Sexual Behaviour Disorder

References

• Briken, P. (2020). An integrated model to assess and treat compulsive sexual behaviour disorder. Nature Reviews Urology, 17. https://doi.org/10.1038/s41585-020-0343-7
• 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.

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. https://doi.org/10.1038/s41585-020-0343-7
  • 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]. Ibid.