Future Contemplations for Classifying Compulsive Sexual Behaviors
Future, Contemplations, Classifying, Compulsive, Sexual, Behaviors
The debate about whether to classify compulsive sexual behavior as an addiction continues to evolve. Additional research is needed to clarify the terminology and diagnostic criteria used for classification purposes. Data assessing prevalence and other comorbidities are needed to further policy, prevention, diagnosis, and treatment efforts.
We recently considered evidence for classifying compulsive sexual behavior (csb) as a non-substance (behavioral) addiction . Our review found that csb shared clinical, neurobiological and phenomenological parallels with substance-use disorders; however, we concluded that more research is needed in order to address current shortcomings.
The responding commentaries highlight important issues regarding classification efforts including the lack of a consensus definition for csb and disagreement about proposed criteria central to defining csb . More research should examine which proposed criteria – whether those relating more closely to sexual addiction  or hypersexual disorder  – accurately reflect csb in clinical contexts.
Although the two diagnostic categories may conceptually differentiate between addiction and excessive drive, the criteria overlap and stress and negative emotionality as triggers apply to both . More research is needed to better understand in csb how central features of addiction (e.g. Tolerance, withdrawal) relate to csb and its treatment.
Additional concerns included improving research method- ologies and minimizing possible confounds that may limit generalizability of studies . Although data suggest that other behavioral addictions are comorbid with other psychiatric disorders [6,7], additional research is needed to determine the prevalence of co-occurring disorders with csb .
Co-occurring behavioral addictions with csb should be considered, particularly if the behaviors are intertwined (e.g. Traveling to resort casinos to engage in sex and gamble). Further, additional research is needed to better understand the prevalence of csb among the general population.
Additional points were raised regarding the language used to describe csb, with ‘risky’ or ‘excessive’ terminology being potentially misleading. ‘excessive’ sex may not be problematic . Instead, sexual behavior leading to significant functional impairment or psychological distress maymore likely reflect important clinical hallmarks of csb.
Applying a more objective approach to developing a diagnostic framework for csb may promote advancement. Objective indicators of distress (e.g. Repeated attempts to quit, craving, etc.) Rather than frequency of sexual behav- iors should be a focus , particularly as frequency of sexual behaviors may not be a strong predictor of csb .
The pathologizing of sexual behaviors falling outside normative standards or ranges and the evolution of sexual practices and societal values over time were also discussed . Notably, changes in usage of digital technologies have altered sexual behaviors, particularly amongst youth and young adults.
Internet pornography is thriving, casual sex (‘hook-up’) websites are widely popular, and social me- diamay act as a sexual conduit formany individuals. These developments are accompanied by many unanswered questions . Future longitudinal research is needed to examine how digital technologies are related to the devel- opment and maintenance of csb over the lifespan.
Although the american psychiatric association rejected hypersexual disorder  from dsm-5, a diagnosis of csb (excessive sex drive) can be made using icd-10 . Csb is also being considered by icd-11 , al- though its ultimate inclusion is not certain.
Future re- search should continue to build knowledge and strengthen a framework for better understanding csb and translating this information into improved policy, pre- vention, diagnosis, and treatment efforts to minimize the negative impacts of csb.
This study was funded by support from the department of veterans affairs, visn1mental illness research education and clinical center, the national center for responsible gaming, and the national center on addiction and substance abuse. Swk is a full-time employee of the department of veterans affairs. The content of this manuscript does not necessarily reflect the views of the funding agencies and reflects the views of the authors.
Declaration of interests
The authors report no conflicts of interest with respect to the content of this manuscript. Dr. Potenza has consulted for and advised ironwood, lundbeck, insys, shire, rivermend health and opiant/lakelight therapuetics;
has received research support from mohegan sun casino, the national center for responsible gaming, and pfizer; has participated in surveys, mailings or telephone consul- tations related to drug addiction, impulse-control disorders or other health topics; has consulted for gambling and legal entities on issues related to impulse-control and addictive disorders; provides clinical care in the connecticut department of mental health and addiction services