An integrated model to assess and treat compulsive sexual behaviour disorder

The introduction of dedicated diagnostic guidelines for compulsive sexual behaviour disorder in the ICD-11 provides an opportunity to improve diagnosis and research into the disorder's aetiology, assessment and therapy. For patients who consider their sexual behaviour uncontrollable, the interplay between excitatory and inhibitory factors could be in dysbalance. In this Review, Briken describes the aetiology and background of this often misunderstood disorder and provides a comprehensive approach to diagnosis and treatment. Contrary to common belief, hypersexual or compulsive sexual behaviour disorder is not a current fashion diagnosis. Nevertheless, the introduction of dedicated diagnostic guidelines for International Classification of Diseases 11th Revision (ICD-11) brings an opportunity for more accurate diagnosis and, therefore, improved research into the disorder's aetiology, assessment and therapy. A considerable proportion of both men and women consider themselves to have a problem with pornography and an even greater proportion experience their sexual behaviour as insufficiently controllable. For these people, the interplay between excitatory and inhibitory factors could be in dysbalance. In this context, biological correlates are important, but social factors, such as negative attitudes towards pornography or hostile attitudes to sexuality, also have a role. In patients with compulsive sexual behaviour disorder, excessive pornography consumption, masturbation and/or promiscuity that are out of control and lead to distress and impairment are usually present. Differential diagnoses, such as neuropsychiatric syndromes that can exhibit hypersexuality as a symptom, such as frontal lobe lesions, should be investigated and treated, as should comorbid disorders such as depression. Therapeutic approaches can be based on the Dual-Control Model and the Sexual Tipping Point Model. In each patient, an individualized therapeutic approach is multimodal and includes psychopharmaceuticals such as selective serotonin reuptake inhibitors and naltrexone as well as specific psychotherapeutic approaches. The efficacy of some therapeutic approaches has now also been supported by initial randomized controlled trials in this patient population.