Compulsive Sexual Behavior and Problematic Pornography Use on the Impulsivity-Compulsivity Axis: A Systematic Review

Purpose of Review: Despite the recent inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the ICD-11, with problematic pornography use (PPU) as a common manifestation, its classification and impulsive-compulsive nature remain debated. This systematic review examined the associations of impulsivity and compulsivity with compulsive sexual behavior (CSB) and PPU, given their clinical and transdiagnostic significance. Recent Findings: A PRISMA-guided search across four databases yielded 5945 records, of which 71 studies (total N = 55,956) were analyzed. Impulsivity was examined in 82% of studies, most reporting weak to moderate positive associations with CSB (97%) and PPU (73%). Compulsivity was less frequently studied (29%) but showed small to moderate positive associations. Summary: Both traits appear relevant to CSB and PPU, though severe knowledge gaps are still present in the literature (e.g., lack of longitudinal studies and inclusion of diverse samples). The use of unified assessment tools in longitudinal study designs among diverse samples would be an essential next step for advancing classification, with significant treatment and policy implications.