Compulsive Sexual Behaviour Disorder Research Articles

Spirituality and behavioural addictions: narrative review

The relationship between spirituality and behavioural addictions is complex. Although some studies have suggested spirituality to be a protective factor helping in recovery from addictive behaviours, others have found spirituality to be a potential risk factor. To better understand the relationship between spirituality and various behavioural addictions, this review summarises the literature on the association between spirituality and the following behavioural addictions: gaming disorder, gambling disorder, problematic internet use, problematic smartphone use, compulsive sexual behaviour disorder and compulsive buying/shopping disorder. Implications for clinical practice and future research are discussed.

(016) Pharmacological Treatment of Men with Compulsive Sexual Behaviour Disorder - Randomized, Double-blind, Placebo-controlled Trial of Paroxetine and Naltrexone

Abstract Introduction Psychotherapy is considered as first-line therapy for compulsive sexual behaviour disorder (CSBD). “Off-label” use of selective serotonin reuptake inhibitors and opioid antagonists was reported as effective but the evidence-based data on pharmacological interventions remains very scarce. Objective The purpose of the study was to compare safety and efficacy of naltrexone and paroxetine in the treatment of CSBD. Methods Double-blind, randomized study comparing naltrexone, paroxetine and placebo was performed in a group of 73 treatment-seeking, heterosexual males meeting the ICD-11 criteria of CSBD. During 5 months treatment, the safety and efficacy of the medication was assessed by clinical examinations and clinical scales including Sexual Addiction Screening Test (SAST), Hypersexual Behavior Inventory (HBI), the Brief Pornography Screen (BPS), as well as in the Ecological Momentary Assessment. Results Symptoms of CSBD significantly improved in all three treatment arms but receiving active treatment was related to better satisfaction with the therapy and self-reported decrease of problematic sexual behavior. Sexual and porn craving decrease was pronounced the most in the paroxetine group. Adverse effects were relatively seldom and mild. All-cause discontinuation rate was 15.1%. Conclusions The study has shown that paroxetine and naltrexone represent safe treatment options for CSBD male patients. However, due to mixed results, their clinical efficacy should be confirmed in future trials that should also include women and non-heterosexual groups of patients. Disclosure No

The World Federation of Societies of Biological Psychiatry guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder.

The current guidelines aim to evaluate the role of pharmacological agents in the treatment of patients with compulsive sexual behaviour disorder (CSBD). They are intended for use in clinical practice by clinicians who treat patients with CSBD. An extensive literature search was conducted using the English-language-literature indexed on PubMed and Google Scholar without time limit, supplemented by other sources, including published reviews. Each treatment recommendation was evaluated with respect to the strength of evidence for its efficacy, safety, tolerability, and feasibility. Psychoeducation and psychotherapy are first-choice treatments and should always be conducted. The type of medication recommended depended mainly on the intensity of CSBD and comorbid sexual and psychiatric disorders. There are few randomised controlled trials. Although no medications carry formal indications for CSBD, selective-serotonin-reuptake-inhibitors and naltrexone currently constitute the most relevant pharmacological treatments for the treatment of CSBD. In cases of CSBD with comorbid paraphilic disorders, hormonal agents may be indicated, and one should refer to previously published guidelines on the treatment of adults with paraphilic disorders. Specific recommendations are also proposed in case of chemsex behaviour associated with CSBD. An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

No significant effect of frequent online sexual behaviour on Pavlovian-to-instrumental transfer (PIT): Implications for compulsive sexual behaviour disorder.

Reward based learning is broadly acknowledged to underpin the development and maintenance of addictive behaviour although the mechanism in sexual compulsivity is less understood. Using a Pavlovian-to-Instrumental Transfer (PIT) task we tested whether the motivational aspect of conditioned Pavlovian conditioned stimulus invigorated instrumental responding in relation to specific compatible monetary rewards. Performance on the task was analysed between two groups of males based on Low (N = 38) and High (N = 41) self-report online sexual behaviour (OSB). Psychometric tests including sexual compulsivity scale and behavioural activation/behavioural inhibition (BIS/BAS) were also administered to determine the relationship between OSB and general reward sensitivity. We show clear evidence of acquisition in the Pavlovian and instrumental conditioning phases. Specific transfer effect was greater in the High-OSB group although the difference compared to the Low-OSB group was non-significant. OSB negatively correlated with both BIS and BAS indicative of introversion and low reward sensitivity. OSB positively correlated with sexual compulsivity although it is unclear whether individuals in the High-OSB group considered their behaviour either excessive or problematic. These findings contribute to the ongoing debate regarding the nature of problematic OSB. Fundamental differences in motivational characteristics and mechanism contributing to compulsive behaviour in relation to high-OSB might indicate incompatibility with behavioural addiction models. PIT was not enhanced in high-OSB by appetitive conditioning, although problematic OSB could stem from failure to inhibit actions. Further research should investigate whether aversive conditioning differentially affects responding in high-OSB individuals, potentially explaining perseverant behaviour despite negative consequences.

Tolerability and efficacy of paroxetine and naltrexone for treatment of compulsive sexual behaviour disorder

Tolerability and efficacy of paroxetine and naltrexone for treatment of compulsive sexual behaviour disorder

Advances in problematic usage of the internet research – A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion.A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives.However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

A randomised controlled trial of fluoxetine versus naltrexone in compulsive sexual behaviour disorder: presentation of the study protocol

BackgroundCompulsive sexual behaviour disorder is a new disorder in the International Classification of Diseases (ICD-11), and is associated with negative consequences in different areas of life. Evidence for pharmacological treatment...

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder.

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

A new paradigm in the treatment of compulsive sexual behaviours

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.

A study on the relationship between shame, guilt, self-criticism and compulsive sexual behaviour disorder

A study on the relationship between shame, guilt, self-criticism and compulsive sexual behaviour disorder

The moral maze of sex & porn addiction

Sex addiction, a term first coined in the early 80s, has always been met with controversy. Some say the label of addiction is an excuse used by those who have lost their moral compass or refuse to accept responsibility for their sexual choices. Others claim the label is used to pass moral judgement on those whose sex lives or internet viewing habits do not fit societally prescribed norms. The acceptance by WHO of CSBD (Compulsive Sexual Behaviour Disorder) into ICD11 was heralded as a moral victory by the sex addiction naysayers who claimed WHO’s position ‘proved’ it wasn’t an addiction; conversely sex addiction professionals claimed victory saying that finally this was a step in the right direction. This paper will explore the divide and provide insight on how using a pure medical model of addiction has contributed and fueled the debate. An alternative model for conceptualization from a biopsychosocial perspective will be provided to suggest ways of moving forward that could ease the controversies as well as opening new areas for research and most importantly, greater understanding and empathy for clients.

BARONESS CHARLOTTA CASTELLI GLEMBAY - WAS SHE HYPERSEXUAL?

Hypersexuality disorder (or sexual addiction or excessive sexual drive or compulsive sexual behaviour disorder) is a controversial condition that is present in the International Classification of Disease but not in the Diagnostic and Statistical Manual for Mental Disorders. It is defined as a clinical syndrome characterised by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. The condition is more prevalent in men than in women. Some medical conditions were described in fictional literature before their formal recognition in medicine, like Huntington disease, Pickwick syndrome, and Munchausen syndrome. The aim of this article is to analyse the fictional character of Charlotta Castelli Glembay from Miroslav Krleža’s play Messrs Glembays from 1928. Krleža presented a woman with a sexual drive that could be described as uncontrollable, organic (physical) in origin, and different from love and affection (that she also experienced, but only with one particular man). The author gave a special name for her condition – erotic intelligence. This sexual behaviour has distressing and devastating consequences. This paper will argue that the play depicts hypersexuality disorder in a woman, with a designation of its aetiology. In concordance with the prevailing attitudes of the time (the early 20th century), hypersexuality in women had negative attributions.

A pilot study of mindfulness-based relapse prevention for compulsive sexual behaviour disorder.

Background and aims Compulsive sexual behaviour disorder (CSBD) is a medical condition that can impair social and occupational functioning and lead to severe distress. To date, treatment effectiveness studies of CSBD are under-developed; typically, treatment for CSBD is based on guidelines for substance or other behavioural addictions. Mindfulness-based relapse prevention (MBRP) is an evidence-based treatment for substance addiction aimed at, among other things, reducing craving and negative affect—i.e. processes that are implicated in the maintenance of problematic sexual behaviours. However, to our knowledge no prior research has been published evaluating mindfulness-based intervention (MBI) in the treatment of CSBD, except two clinical case reports. Therefore, the aim of the current pilot study was to examine whether MBRP can lead to clinical improvement in CSBD.MethodsParticipants were 13 adult males with a diagnosis of CSBD. Before and after the eight-week MBRP intervention, participants completed a booklet of questionnaires including measurements of porn viewing, masturbation and emotional distress.ResultsAs expected, we found that after MBRP participants spent significantly less time engaging in problematic pornography use and exhibited a decrease in anxiety, depression and obsessive-compulsive (OC) symptoms.Discussion and ConclusionsThe findings indicate that MBRP could be beneficial for CSBD individuals. Further clinical effectiveness studies with bigger sample sizes, delayed post-training measurements and randomised control trial design are warranted. In conclusion, MBRP leads to a decrease in time spent watching porn and a decrease in emotional distress in CSBD patients.

An integrated model to assess and treat compulsive sexual behaviour disorder.

Contrary to common belief, hypersexual or compulsive sexual behaviour disorder is not a current fashion diagnosis. Nevertheless, the introduction of dedicated diagnostic guidelines for International Classification of Diseases 11th Revision (ICD-11) brings an opportunity for more accurate diagnosis and, therefore, improved research into the disorder's aetiology, assessment and therapy. A considerable proportion of both men and women consider themselves to have a problem with pornography and an even greater proportion experience their sexual behaviour as insufficiently controllable. For these people, the interplay between excitatory and inhibitory factors could be in dysbalance. In this context, biological correlates are important, but social factors, such as negative attitudes towards pornography or hostile attitudes to sexuality, also have a role. In patients with compulsive sexual behaviour disorder, excessive pornography consumption, masturbation and/or promiscuity that are out of control and lead to distress and impairment are usually present. Differential diagnoses, such as neuropsychiatric syndromes that can exhibit hypersexuality as a symptom, such as frontal lobe lesions, should be investigated and treated, as should comorbid disorders such as depression. Therapeutic approaches can be based on the Dual-Control Model and the Sexual Tipping Point Model. In each patient, an individualized therapeutic approach is multimodal and includes psychopharmaceuticals such as selective serotonin reuptake inhibitors and naltrexone as well as specific psychotherapeutic approaches. The efficacy of some therapeutic approaches has now also been supported by initial randomized controlled trials in this patient population.

Establishing Canadian metrics for self-report measures used to assess hypersexuality

We examined the prevalence of hypersexuality in two combined Canadian adult community samples totalling 1,857 respondents (female n = 960, male n = 835, other n = 60, missing n = 2). Participants were recruited from social media to complete an online sexual behaviour survey that included two measures of compulsive sexual behaviour disorder— the Sexual Compulsivity Scale (SCS) and Hypersexual Behaviour Inventory (HBI)—as well as sexual behaviour and interest items. Respondents also reported their total sexual outlets (TSO)—defined by number of orgasms experienced weekly—as a third potential indicator of hypersexuality. Canadian men and women reported multiple sexual outlets per week that tended to be higher than previous reports. Men tended to report a larger number and higher frequency of various sexual behaviour than women, including higher rates of compulsive sexual behaviour disorder, which varied depending on the measure employed. Implications for establishing sexuality norms and conceptualizing hypersexuality and compulsive sexual behaviour disorder are discussed.

Obsessive-Compulsive Disorder, Sexual Obsessions and Sexual (Dys) Function: A Narrative Review

Introduction: obsessions are common symptoms of Obsessive-Compulsive Disorder (OCD) that can cause great distress and can focus on various sexual themes: unwanted sexual thoughts, thoughts of violent sexual behaviour, obsessions about the fear of engaging in homosexual activity or sex with animals. Our aim is to discuss the findings from previous studies about sexual obsessions and sexual dysfunction in OCD, analyse compulsive sexual behaviour disorder and the sexual dysfunction associated with the pharmacological treatment of OCD. Material and Methods: A literature research was conducted using the “PubMed” database and the search equation was built using the terms: Obsessive Compulsive Disorder; Sexual Obsessions; “Compulsive Behaviour” and Sexual Function; 18 articles were selected for the discussion of this narrative review. Results and Discussion: Several studies have been conducted on sexual function in individuals with OCD. obsessions comprise intrusive, recurrent and persistent thoughts, images or concerns about sexual matters that do not usually prompt sexual behaviour. orientation obsessions and the related distress may be misunderstood as being the result of a sexual identity conflicts. obsessions and obsessive thoughts about self-impurity play a role in sexual dysfunction in OCD as well as relationship difficulties and pharmacological management of the disease. Some studies suggest an association between OCD and compulsive sexual behaviour disorder, however, repetitive sexual thoughts in compulsive sexual behaviour are egosyntonic, whereas the obsessions in OCD are egodystonic. Conclusions: The occurrence of sexual obsessions in OCD should be recognised and understood as an ordinary and non-threatening OCD symptom. The more specific neurobiological characteristics of OCD and its treatment seem to influence sexual function in unique ways. A better understanding of sexual function in OCD may help clinicians to choose treatments more suited to the specific needs of these patients.

COMPULSIVE SEXUAL BEHAVIOUR AS A RISK FACTOR FOR HIV

In recent years, the number of newly detected cases of HIV infection in Russia has been increasing every year. Risky behaviour and mental disorders (not only disorders caused by HIV infection, but also premorbid mental disorders leading to HIV infection are well-known risk factors for HIV infection. One of the mental disorders associated with risky sexual behaviour is compulsive sexual behaviour, which was recommended for inclusion in the International Classification of Diseases of the 11-th revision under the diagnosis of Compulsive sexual behaviour disorder. This review article is devoted to the problem of compulsive sexual behaviour and its connection with the HIV infection. Current data on epidemiology and clinical characteristics of compulsive sexual behaviour are presented. Special attention is paid to the theoretical substantiation of the impact of compulsive sexual behaviour on the implementation of risky sexual behaviour in the aspect of increasing the risk of HIV infection.

Insights from outside BJOG

Insights from outside BJOG

Relationships among impulsive, addictive and sexual tendencies and behaviours: a systematic review of experimental and prospective studies in humans.

Impulsivity's relationships to addictive and sexual behaviours raise questions regarding the extent impulsivity may constitute a vulnerability factor for subsequent addictive and sexual behaviours and/or results from each of these. Here, we systematically reviewed empirical support for impulsivity as a precipitating factor or a consequence of addictive or sexual behaviours. We restricted ourselves to recent, human studies with assessments over time, including at least one measure of impulsivity, addictive and sexual behaviours, yielding a review including 29 published reports from 28 studies. Findings point to generalized, self-reported impulsivity as a predictor of addictive and sexual behaviours at a wide range of severity, with elements of both impulsivity and compulsivity to these acts. Alcohol consumption often increases impulsive behaviour, including inclinations towards impulsive and potentially compulsive sexual acts. Research using the Sexual Delay Discounting Task has yielded findings linking impulsivity, addictive and sexual behaviour and as such is a valuable research tool that should be used more extensively. The present review identified gaps to be addressed in further research that concurrently examines facets of impulsivity, addictive and sexual behaviours, especially because criteria for compulsive sexual behaviour disorder have been included in the eleventh edition of the International Classification of Diseases. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Relationships between Behavioural Addictions and Psychiatric Disorders: What Is Known and What Is Yet to Be Learned?

This article provides a narrative review of the relationships between several behavioural addictions [pathological gambling, problematic Internet use (PIU), problematic online gaming, compulsive sexual behaviour disorder, compulsive buying, and exercise addiction] and psychiatric disorders. Associations between most behavioural addictions and depressive and anxiety disorders are strong and seem relatively non-specific. Strong links with substance use disorders may support the notion that some people are more prone to addictive behaviours, regardless of whether these involve substances or problematic activities. Other associations seem relatively specific, for example, those between PIU/online gaming and attention-deficit/hyperactivity disorder, between compulsive buying on the one hand and eating disorders and hoarding on the other hand and between exercise addiction and eating disorders. The quality of the research varies, but most studies suffer from methodological limitations, including a cross-sectional or correlational design, non-representative study populations, small sample sizes, reliance on self-report assessment instruments, diverse diagnostic criteria, and conceptual heterogeneity of most behavioural addictions. Due to these limitations, generalisability of the findings is questionable and the direction of causality, if any, is unknown in the relationships between behavioural addictions and psychiatric disorders. Regardless of the aetiological uncertainty, these relationships often call for a modified treatment approach. Prospective studies are needed to clarify the longitudinal relationships between behavioural addictions and psychiatric disorders.