This article reviews the clinical characteristics of CSB, cognitive aspects of the behaviors, and treatment options. We reviewed the literature regarding the clinical aspects of CSB and treatment approaches.
The literature review of the clinical aspects of CSB demonstrates that there is likely a substantial heterogeneity within the disorder. In addition, the treatment literature lacks sufficient evidence-based approaches to develop a clear treatment algorithm. Although discussed in the psychological literature for years, CSB continues to defy easy categorization within mental health.
Further research needs to be completed to understand where CSB falls within the psychiatric nosology. Compulsive sexual behavior can generally be divided into two categories: Nonparaphilic CSB, which is characterized by more typical sexual desires, include compulsive sexual acts with multiple partners, constant fixation on a partner that may be considered unobtainable, compulsive masturbation, compulsive use of pornography, and compulsive sex and sexual acts within a consensual relationship Coleman, This article will review the clinical aspects of CSB and treatment approaches to the disorder.
Conceptualization of CSB will be examined. Although it is difficult to compare possible historical notions of CSB to what we currently think of as the behavior due to the ever changing characterizations and terminologies for problematic sex behaviorsome form of CSB appears to date back centuries. The concept of nymphomania demonstrates how our understanding of sexual behavior has been complicated by sociocultural Sexual dysfunction and paraphilias in the dsm-5 pathological heterogeneity and gender, morality and gender politics.
Henry Chavasse, in his book Physical Life of Men and Women, or Advice to Both Sexesargued that extreme sexual restraint in either men or women may result in nymphomania and satyriasis Chavasse, Jean-Etienne Dominique Esquirol asserted that nymphomania was not due to a lack of sexuality, but rather a physical disorder originating from the reproductive organs that affected the brain translated from French Esquirol, It was not until Richard von Krafft-Ebing wrote about sexual behavior in men that we had a description of sexual behavior that clearly mirrors our modern understanding of CSB: Another study of university students found that A third study of 1, university students screened specifically for the criteria of CSB and found a prevalence of 2.
Similar current rates 1. Other international studies have focused more on the severity of those with CSB, rather than the overall prevalence in the population Scanavino et al. As illustrated above, it has become a difficult task to try to solidify a prevalence rate for CSB across the world.
Without conducting a large epidemiological study, the exact prevalence rate may continue to be speculative. Based on small clinical samples, it appears that the majority of treatment-seeking individuals with CSB are males Black et al. Due to the sensitive nature of sex behavior, however, many have argued that the prevalence of CSB may be underreported in the general population and that females may be underrepresented in these clinical samples Grant, In fact, a study of adolescents hospitalized for psychiatric reasons found that CSB was more common in females 8.
A recent study found that 3. These studies highlight the importance of evaluating women for CSB and addressing issues of compulsive sexual behaviors or hypersexuality in women. Whether gender plays a role in treatment response in CSB, and whether treatment needs differ based on gender, necessitates further inquiry.
CSB can be subdivided into three clinical elements: Although a high percentage of people report gratification from the sexual behavior e. CSB may be understood as an extreme form of behavior along a continuum of sexual behavior and it may be important to recognize the symptoms, even if the patient does not meet the full clinical description. CSB does not appear to reflect just one type of problematic sexual behavior. It is important to note that though certain behaviors generally appear to be more common in those with CSB, there can be a wide range of behaviors that may co-occur and no list is exhaustive of these behaviors.
CSB can also be comorbid with impulse control disorders pathological gambling [9. In terms of family history, substance abuse is common in the relatives of individuals with CSB.
Research suggests that the majority of individuals with CSB come from dysfunctional families Sex therefore becomes a source of well-being to these individuals Carnes, Of this sample, Approximately half of those with CSB also reported that their thoughts, urges and behavior negatively affect other areas of their lives as well, such as marriage and important relationships, work, and social activities Black et al.
The high prevalence of comorbid health problems indicates a range of problems that crosses many fields of medicine and therefore involves more than those involved with psychiatric treatment of those with CSB. Two recent studies on hypersexuality suggest that there may be cognitive dysfunction in those who struggle with CSB.
Pachankis and colleagues found maladaptive cognitive processes and perceptions about sex in a population of homosexual and bisexual men i. The first step in treatment begins with accurate diagnosis.
To make an accurate diagnosis, it is important first to rule out medical causes of the hypersexuality. Certain neurological disorders can cause an individual to act inappropriately and possibly cause hypersexuality as a result. We could find only one randomized trial of psychotherapy for CSB in the literature.
McConaghy and colleagues randomized 20 individuals with CSB to receive either imaginal desensitization or covert sensitization, and found that both interventions reduced compulsive sexual behaviors at the one-month and one-year follow-up visits.
Group therapy has been recommended to be paired with individual therapy and family therapy to address concerns specific to the individual and to address issues surrounding the family of the individual with CSB Schreiber et al. For a more detailed description of treatment goals and approaches, please see Coleman, There is also limited research concerning pharmacotherapy for CSB.
In one week, double-blind, placebo-controlled study, citalopram resulted in significant reductions in the desire for sex, frequency of masturbation, and hours of pornography use per week in a sample of 28 gay and bisexual men compared to placebo. There was no significant effect, however, on the number of sexual partners that the subjects had Wainberg et al.
Another treatment option that has been explored is the use of naltrexone, which has been found to be effective in reducing other impulses in similar disorders such as pathological gambling and kleptomania and also reduced relapse in alcohol and opiate dependence Comer et al. Sex Addicts Anonymous SAA is one such example of a support group whose purpose is to help others with sex addiction find recovery. There is an ongoing discussion about the proper categorization of CSB.
Some believe that CSB should be treated with an addiction perspective while others consider CSB most properly fits within the category of sexual disorders or impulse control disorders. With the exclusion of CSB from Sexual dysfunction and paraphilias in the dsm-5 pathological heterogeneity and gender DSM-5 and the ongoing debate about its classification, new research will most likely begin to emerge in an attempt to find its correct position within psychiatric disorders.
The debate over what CSB should be characterized will most probably await more definitive pathophysiological research. What is known currently, however, is that CSB is a relatively common disorder that has significant personal and public health ramifications.
Although there are a variety of psychosocial and pharmacological treatments which have shown early promise in the treatment of CSB, more evidence-based treatment options are needed. Education regarding sexual compulsivity may advance the understanding of this often disabling disorder.
KD assisted with manuscript preparation and editing. JG assisted with study funding, and manuscript editing. Grant has received research grant support from Forest and Roche Pharmaceuticals. He has also received royalties from American Psychiatric Publishing Inc. Derbyshire reports no conflicts of interest. A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39 2— Jon Grant of the University of Chicago.
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Methods We reviewed the literature regarding the clinical aspects of CSB and treatment approaches.