Debates on Compulsive Sexual Behavior Disorder: A Call for Global and Interdisciplinary Perspectives

In 2018, the World Health Organization released the planned 11th revision of the International Statistical Classification of Diseases (ICD-11), which was introduced for jurisdictional use in January 2022 (Kraus et al., 2018; Reed et al., 2022; World Health Organization, 2022). Among other changes, the ICD-11 introduced a new diagnostic entity, Compulsive Sexual Behavior Disorder (CSBD, 6C72), that has been present in the clinical literature and has been researched for more than four decades under different names and conceptualizations, including sex addiction, hypersexuality, hypersexual disorder (HD), sexual compulsivity, sexual impulsivity, or out-of-control sexual behaviors (Grubbs et al., 2020; Reed et al., 2022). According to the ICD-11 diagnostic guidelines, CSBD is characterized by poorly controlled engagement in sexual urges and behaviors that result in clinically significant distress and cause significant impairment in different areas of functioning (World Health Organization, 2022). Individuals with CSBD derive diminished satisfaction from their sexual activities and often make unsuccessful efforts to reduce or stop their behavior over an extended period (i.e., at least six months). Distress that is entirely related to moral disapproval of sexual urges and behaviors is not sufficient to diagnose CSBD. Notably, CSBD (operationalized as HD) was proposed for inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but was ultimately rejected due to insufficient empirical evidence and the potential misuse of the proposed diagnosis, among other criticisms (American Psychiatric Association, 2013, 2022; Kafka, 2010, 2014; Reid & Kafka, 2014). Importantly, according to the World Health Organization’s latest reports, 64 member states are in different stages of implementing the ICD-11 (World Health Organization, 2023), meaning that even though CSBD is a new diagnostic entity, it may not be diagnosable in all counties yet (e.g., the ICD-10-CM is currently in use in the USA, which does not include CSBD as a diagnosis) (Centers for Disease Control & Prevention, 2023).