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

Abstract

Objectives 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. Methods 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. Results 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. Conclusions An algorithm is proposed with different levels of treatment for different categories of patients with CSBD.

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“…Nevertheless, these represent rather limitations of the literature in the topic than limitations of our study and may be addressed in future investigations. In addition, PPU is also associated with other compulsive sexual behaviors, 42 which may make the separation between withdrawal-like states coming exclusively from PPU to those originating in other problematic sexual behaviors difficult, representing a confounding factor that must be better investigated in future studies. Lastly, it is important to consider the preliminary state of the data presented in this scoping review.…”

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