The Sage Handbook of Addiction Psychology presents a comprehensive overview of the state of the science behind the psychology of addiction, offering a crucial resource for psychologists engaged in both research and practice. Below is an excerpt of the section on CSBD (“Compulsive Sexual Behavior Disorder”).
Compulsive Sexual Behavior Disorder
Compulsive sexual behavior disorder (CSBD), also known as sex addiction or hypersexual disorder, was included in the ICD-11 as an impulse control disorder (WHO, 2019). According to the ICD-11 diagnostic guidelines, CSBD is characterized by repetitive, poorly controlled engagement in sexual impulses, urges, and behaviors, such as sexual activities with consenting partners or pornography use. These behaviors result in clinically significant distress and severe negative consequences (e.g., job loss). Importantly, it should be noted that distress arising solely from moral disapproval of sexual impulses, urges, and behaviors is not sufficient to diagnose CSBD
To date, four studies have examined CSBD among nationally representative samples and showed that 3%–10% of men, and 2%–7% of women might experience CSBD (Bőthe et al., 2020; Briken et al., 2022; Dickenson et al., 2018; Lewczuk et al., 2022). The prevalence estimates of CSBD among men and women were also corroborated in a large-scale, cross-cultural study with more than 80,000 participants from 42 countries, and an estimate of 6% of CSBD was reported for gender-diverse individuals (Bőthe et al., 2023). Regarding sexual orientation, only two of the nationally representative studies examined CSBD by sexual orientation, with one reporting that CSBD might be more common among sexually diverse individuals (e.g., gay and lesbian- or bi-sexual), while the other reported no significant differences between individuals with different sexual orientations (Briken et al., 2022; Dickenson et al., 2018). The findings from the latter study were corroborated in the aforementioned large, cross-cultural study, suggesting that no sexual-orientation-based differences were present in experiencing CSBD (Bőthe et al., 2023). No nationally representative study has examined the prevalence of CSBD among adolescents (Efrati, 2020).
Problematic pornography use (PPU) is one of the most common manifestations of CSBD. PPU may be diagnosed using the criteria for CSBD, with these applied to pornography use (Kraus & Sweeney, 2019; WHO, 2019).
Although most individuals view pornography in their lifetime, approximately 1%–38% may experience PPU (Grubbs et al., 2018; Grubbs et al., 2019; Grubbs, et al., 2020a; Grubbs, et al., 2020b; Lewczuk et al., 2020; Rissel et al., 2017). Men versus women tend be more likely to experience PPU, with prevalence estimates ranging between 3% and 38% among men, and 1% and 23% among women (Grubbs et al., 2019; Grubbs, et al., 2020b; Lewczuk et al., 2020; Lewczuk et al., 2022; Rissel et al., 2017). However, prevalence estimates may be inflated due to the use of measures with high false positive rates in some studies or high levels of self-perceived PPU due to moral incongruence (Kraus & Sweeney, 2019; WHO, 2019). No data are available on PPU in gender-diverse individuals. Most prior studies did not report participants’ sexual orientation, and only one of the nationally representative studies documented PPU across sexual orientations. Specifically, bisexual individuals had the highest estimates of PPU (5%), followed by heterosexual (3%) and gay and lesbian (2%) individuals (Rissel et al., 2017). No nationally representative study has examined the prevalence of PPU among adolescents, but it is estimated that 5%–14% of 14- to 19-year-old adolescents may experience excessive, compulsive, or problematic use of pornography (Bőthe et al., 2019; Bőthe et al., 2020; Efrati, 2020; Efrati & Gola, 2018; Štulhofer et al., 2020).