FAQ On the New Compulsive Sexual Behavior Disorder Diagnosis

The World Health Organization (WHO) recently announced a new diagnosis: Compulsive Sexual Behavior Disorder (CSBD). This is major news, and it directly impacts countless thousands of individuals — especially users of SexandRelationshipHealing.com. We have already received countless media inquiries about what the CSBD diagnosis means and how it affects men and women afflicted by and recovering from sex, porn, and love addiction/compulsivity. In response, we have prepared the following FAQ, which you may find enlightening.

How, exactly, do we define sex addiction/compulsivity? Is there a difference between that and how the World Health Organization is defining Compulsive Sexual Behavior Disorder? And do we really care what the WHO and others call this issue?

  • Certified Sex Addiction Therapists define sex addiction/compulsivity using three basic criteria: (1) Preoccupation to the point of obsession with sexual fantasy and behavior; (2) Loss of control over sexual fantasy and behavior, typically evidenced by failed attempts to quit or cut back; (3) Directly related negative life consequences.
  • The WHO’s CSBD diagnosis is wordier but essentially covers the same three points.
  • We do not care what this issue is called, as long as therapists and other clincians can accurately and effectively identify, diagnose, and treat it.

Is the “debate” about the existence or non-existence of sex addiction/compulsivity (Compulsive Sexual Behavior Disorder) finally over? Why was the issue so polarizing in the first place?

  • We are sure some folks will want to keep fighting, but the war is won. With the diagnosis in place in the WHO’s diagnostic manual (the ICD-11), the next revision of the American Psychiatric Association’s diagnostic manual (the DSM-5) will likely follow suit.
  • The primary arguments against a diagnosis centered on dislike of the word “addiction” and fear that sex addiction therapists want to be the sex police, imposing moral and religious judgments about “healthy sex” on their clients. The new CSBD diagnosis addresses both of these concerns.

How important is the new Compulsive Sexual Behavior Disorder diagnosis? What does it mean for people who are sexually addicted/compulsive? What does it mean for clinicians who treat this population?

  • It’s massively important.
    • For people who are sexually addicted/compulsive, having an official diagnosis will help to reduce shame while making it easier to get useful treatment (just as official diagnoses for alcoholism and drug addiction did in the 1970s).
    • For clinicians, it makes it easier to identify and diagnose the issue.
    • For everyone, it removes morality and religion and personal judgment from the equation, eliminating many of the misdiagnoses we’ve seen, along with many of the naysayer concerns we’ve seen. The CSBD diagnosis is based on scientific research, not opinion and conjecture.

Is there a fear that having a Compulsive Sexual Behavior Disorder diagnosis will normalize or serve as an excuse for illegal and/or abusive sexual behavior?

  • A sex addiction/compulsivity/CSBD diagnosis does not ever let people off the hook for bad behavior.
  • We don’t excuse a drunk driver because he’s alcoholic. In the same way, we won’t excuse a philanderer or harasser because he’s sexually addicted/compulsive.
  • Addicts are responsible for their behavior. Always. A significant part of addiction recovery is admitting what you’ve done, taking responsibility, and accepting the consequences.

The Compulsive Sexual Behavior Disorder diagnosis lists “Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors” as a rule-out. How important is this, and why?

  • This is very important. This concern was the most vocal and meaningful argument against a sex addiction/compulsivity diagnosis, and rightfully so.
    • In the past, some therapists have applied value judgments to what they (wrongly) called sex addiction treatment. Usually, these therapists were trying to change a person’s sexual orientation or interest in a fetish or kink.
      • Not only are such misguided treatments proven to not work, they can be harmful to the client. Some states have gone so far as to outlaw these practices when working with minors.

Related to the previous question, the Compulsive Sexual Behavior Disorder diagnosis does not appear to specifically address people who are hypersexual as a symptom of another mental health disorder or people who are behaving sexually in ego-dystonic ways (ways that cause them distress) such as, depending on the person, same-sex behavior, fetish, and kink. Is this a shortcoming? How do clinicians in the US deal with these issues? 

  • Being hypersexual as a symptom of another mental health disorder is not specifically addressed in the CSBD diagnosis, and that’s an oversight. It is clear, however, that if hypersexual behavior abates when another mental health disorder abates, the person is not sexually addicted/compulsive. (We see this, for example, with people who are only hypersexual in the manic phase of bipolar disorder.)
  • People with ego-dystonia surrounding their sexual desires and behavior are actually covered, and covered well, by the “distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors” language. That distress can be internally generated as well as externally generated.
  • At the end of the day, the tenet we must all remember is: Sexual addiction/compulsivity/CSBD is not in any way related to who or what it is that turns a person on.