A new paradigm in the treatment of compulsive sexual behaviours

Abstract

ABSTRACT Introduction Compulsive sexual behaviours have been misunderstood for years using the controversial conceptualisation of ‘sex addiction’, a disorder that had not been clinically endorsed. In 2018, the ICD-11 has agreed on a clinical definition of compulsive sexual behaviour disorder (CSBD) with diagnostic criteria. Objective Thanks to the ICD-11 diagnostic criteria for CSBD, it is now possible to formulate a treatment protocol that is in line with the clinical understanding of sexual compulsivity, and not based on addiction-thinking. This presentation will summarise the definition of compulsive sexual behaviours disorder (CSBD) and highlight the difference between the disorder and the various patient clinical presentations of sexual compulsivity that may not reach the disorder criteria. Based on the various clinical materials of case studies from different populations, this presentation will propose a treatment protocol based on the three-phase model according to the speaker's clinical experience, explaining the relevance of each phase, including expected outcomes. Methods The three-phase treatment protocol takes into account the more recent and evidence-based understanding of sexual compulsivity to address different aspects of the problems: addressing impulse control, treating compulsivity and re-integrating the meaning of sexual behaviours and eroticism. It is a treatment protocol that is flexible and compatible with established psychotherapeutic modalities and interventions. Results Based on the speaker's own clinical work and various case studies, a sex-positive, evidence-based treatment provides much better and permanent behavioural change than an addiction-focused treatment (or a 12-step programme mindset). Conclusion The conceptualisation of ‘sex addiction’ and its addiction-focused treatments are no longer appropriate with the new understanding of compulsive sexual behaviours. The ICD-11 diagnostic criteria have precipitated a paradigm shift bringing the field of sexual compulsivity into the 21st century. The contemporary clinical understanding of sexual compulsivity opens the discussion for better, less dogmatic treatments. The success of the three-phase protocol rests upon the treatment being congruent with compulsivity and well-established therapeutic modalities, rather than addiction, offering patients more choices with a pluralistic approach. Disclosure Work supported by industry: no.