Diagnostic and Classification Considerations Related to Compulsive Sexual Behavior Disorder and Problematic Pornography Use

Abstract

Purpose of Review There are ongoing debates about specific features of compulsive sexual behavior disorder (CSBD) relating to classification and diagnoses. We aim to address current discussions relating to potential subtypes of CSBD, the aspect of compulsivity in CSBD, and the aspect of moral incongruence and CSBD. Recent Findings CSBD includes multiple specific sexual behaviors that might be related to specific psychological processes. Problematic pornography use may be considered a subtype of CSBD, which may have multiple parallels with addictive behaviors. The feature of compulsivity in CSBD may be different from compulsivity in other disorders and may be differently involved in early versus later stages of CSBD. Moral incongruence is important to consider in the context of CSBD, although moral disapproval is not a general exclusion criterion for diagnosing CSBD. Summary Considering the current debates of specific features of CSBD, future research and clinical practice may benefit from a trans-diagnostic approach to contribute to a more fine-grained understanding of the multiple facets of CSBD.

Neural and behavioral correlates of sexual stimuli anticipation point to addiction-like mechanisms in compulsive sexual behavior disorder

“…Fourth, the frequency of sexual encounters did not differ between groups. CSBD patients, however, showed more frequent pornography consumption often observed in CSBD ( Antons et al., 2021 ). In addition, we found a correlation between VS activity during anticipation and pornography consumption measures.…”

“…While both mechanisms may contribute, they cannot be disentangled in this study. However, it is well-known that depression and CSBD are highly correlated ( Antons et al., 2021 ), thus, our study cohort represented an ecologically valid clinical sample of patients with CSBD. Fourth, the frequency of sexual encounters did not differ between groups.…”

Compulsive sexual behavior, religiosity, and spirituality: A systematic review

“…The Pornography Problems due to Moral Incongruence model (PPMI; Grubbs, Perry, Wilt, & Reid, 2019 ) was developed to explain the contribution of both moral conflict and behavioral dysregulation to the development of problematic pornography use (PPU). In the present paper, PPU is conceptualized as a manifestation of CSB involving use of pornography that leads to distress and impairment ( Antons & Brand, 2021 ). The PPMI asserts that self-perceived PPU may arise from moral incongruence (MI), or a conflict between a person's moral or religious disapproval of pornography and their pornography use behavior.…”

“…Individuals suffering from CSBD experience significant impairment or distress due to failure to control sexual thoughts and impulses resulting in repetitive sexual behavior ( WHO, 2018 ). CSBD has several behavioral manifestations, including paid sexual services, pornography use, masturbation, and partnered sexual activities ( Antons & Brand, 2021 ).…”

Reward Responsiveness, Learning, and Valuation Implicated in Problematic Pornography Use — a Research Domain Criteria Perspective

“…PPU can be considered as a subtype of compulsive sexual behavior disorder (CSBD; [6]), and research has shown that the majority of patients seeking treatment for CSBD report PPU as their primary problematic sexual behavior [7]. Therefore, current opinions view PPU as a subtype of this construct [8,9] and also assume that many patients presenting with CSBD will show PPU as their primary problematic sexual behavior. Since the inclusion of CSBD in the International Classification of Disease (ICD-11; [10]) in 2019, CSBD Topical Collection on Sex Addiction.…”