Front Matter

Contributors

Foreword

1 Compulsive Sexual Behavior Disorder From Myths to Reality

Richard Balon, M.D., and Peer Briken, M.D.

2 Sexual Addiction vs. CSBD

Mateusz Gola, Ph.D., and Shane W. Kraus, Ph.D.

3 Compulsive Sexual Behavior and Substance Use Disorders

Shane W. Kraus, Ph.D., Ami Popat-Jain, Ph.D., and Marc N. Potenza, M.D., Ph.D.

4 The Internet and CSBD

Cristina Giménez-García, Ph.D., Rafael Ballester-Arnal, Ph.D., and Kristian Daneback, Ph.D.

5 Diagnostic Aspects of CSBD DSM and Beyond

Richard B. Krueger, M.D.

6 Clinical Evaluation of CSBD

Kenneth Paul Rosenberg, M.D., Patrick J. Carnes, Ph.D., and Bianca P. Acevedo, Ph.D.

7 Pharmacotherapy for Patients With CSBD

Peer Briken, M.D., and Daniel Turner, M.D., Ph.D.

8 Psychotherapies in the Treatment of CSBD

Rosemary Munns, Psy.D., Janna Dickenson, Ph.D., Leonardo Candelario-Perez, Ph.D., Alex Kovic, Psy.D., G. Nic Rider, Ph.D., Dianne Berg, Ph.D., Eli Coleman, Ph.D., and Abby Girard, Psy.D.

9 CSBD in Women

Verena Klein, Ph.D., and Meg S. Kaplan, Ph.D.

10 Forensic Aspects of Hypersexuality

Brad D. Booth, M.D., FRCPC, Drew A. Kingston, C.Psych., Ph.D., and Joel Watts, M.D., FRCPC

11 Hypersexuality and Sexual Compulsivity Behavioral/Sexual Risks and Risks of Sexually Transmitted Diseases

Richard Balon, M.D.

12 Religious and Cultural Influences of CSBD

António Pacheco Palha, M.D., Ph.D. and Mário Ferreira Lourenço, M.D., Ph.D.

Index

Research Associate, Department of Psychological and Brain Sciences, University of California–Santa Barbara, Santa Barbara, California

Full Professor, Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón de la Plana, Spain

Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University School of Medicine, Detroit, Michigan

Assistant Professor, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Mental Health Centre; Associate Professor, Division of Forensic Psychiatry, Department of Psychiatry, University of Ottawa, Ontario, Canada

Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center, Hamburg-Eppendorf, Germany

Sexual Health Consultant, Health Partners, St Paul; Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Founder, International Institute for Trauma and Addiction Professionals and Gentle Path Press, Carefree, Arizona

Professor, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Full Professor, Department of Social Work, University of Gothenburg, Gothenburg, Sweden

Assistant Teaching Professor, Department of Psychology, University of California–San Diego, La Jolla, California; Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Associate Professor, Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castelló de la Plana, Spain

Assistant Professor, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Associate Researcher, Institute for Neural Computations, University of California–San Diego, La Jolla, California; Associate Research Professor, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland

Clinical Professor of Psychology in Psychiatry, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York

Adjunct Scientist, Integrated Forensic Program, Royal Ottawa Mental Health Centre, Ottawa, Ontario, Canada; Senior Clinical Director, HOPE program, San Diego, California

Postdoctoral Researcher, Institute for Sex Research and Forensic Psychiatry, University Medical Center, Hamburg, Germany

Psychologist, Natalis Counseling and Psychology Solutions; Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Assistant Professor, Department of Psychology, University of Nevada–Las Vegas, Las Vegas, Nevada

Department of Psychiatry, College of Physicians and Surgeons, Columbia University; Department of Psychiatry, New York-Presbyterian Hospital, New York State Psychiatric Institute, New York, New York

Former Professor of Medical Psychology at Dentistry Faculty, Oporto University, Porto; Head, Couple Clinic, Hospital da Senhora da Oliveira, Guimarães; Former President, Portuguese Society of Clinical Sexology, Lisbon; Member, International Academy of Medical Sexology, Porto, Portugal

Assistant Professor, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Full Professor of Psychiatry, Retired, FMUP; Former President, Portuguese Society of Psychiatry and Mental Health, Lisbon; Clinical Director, Casa de Saúde Bom Jesus (Hospitaller Sisters), Braga; President, Portuguese Language Mental Health Association, Porto, Portugal; Honorary Member, World Psychiatry Association, Geneva, Switzerland

Adjunct Professor, Department of Applied Psychology, Northeastern University, Boston, Massachusetts

Professor of Psychiatry, Departments of Psychiatry and Neuroscience and Child Study Center, Yale University School of Medicine, New Haven; Director, Connecticut Mental Health Center, New Haven; Director, Connecticut Council on Problem Gambling, Wethersfield, Connecticut

Assistant Professor, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota

Clinical Associate Professor, Psychiatry, Weill Cornell University Medical Center and New York Presbyterian Hospital, New York

Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany

Clinical Director and Forensic Psychiatrist, Integrated Forensic Program, Royal Ottawa Mental Health Centre; Assistant Professor, Division of Forensic Psychiatry, Department of Psychiatry, University of Ottawa, Ontario, Canada

The diagnostic category of compulsive sexual behavior disorder (CSBD) has been included in the ICD-11 and thus is relatively new (Kraus et al. 2018). This construct replaces the older concept of excessive sexual drive, which was located in the chapter on sexual dysfunctions in the ICD-10 as the counterpart to hypoactive sexual desire disorder. The World Health Organization (WHO) has therefore taken a different approach from the American Psychiatric Association with regard to hypersexual disorder, which was not included in DSM-5 (American Psychiatric Association 2013; Kafka 2014). WHO included CSBD in its classification, listing it among impulse-control disorders.

For clinicians, patients with CSBD are a well-known group that has been described in the clinical literature for more than 100 years (Briken 2020). There has always been an accompanying risk that sexual behavior will be prematurely pathologized, and this applies to the current diagnosis of CSBD as well. However, this risk tends to decrease when an accurate description is available, which makes valid and reliable diagnosis much more likely than is possible with categories that are not described in detail, as was the case with the ICD-10 diagnosis. We believe that measurable progress has been made. In a Web-based field study comparing the diagnostic accuracy and clinical utility of some diagnoses using vignettes presented to health professionals from all WHO regions, the diagnostic accuracy of the ICD-11 was significantly higher for CSBD (89.3% correct diagnoses) than for the ICD-10’s excessive sexual drive diagnosis (48.7%; χ²[1] = 16.3; P < 0.001) (Gaebel et al. 2020).

This book is therefore being published at just the right time, and it aims to offer clinicians of various specialties and disciplines (e.g., psychiatrists, sexual medicine specialists, gynecologists, family practitioners, psychologists) a practical introduction to the topic and its various facets. Our guiding question was: What does the clinician need to know in order to examine, assess, and treat patients with CSBD? We believed that the book should be practical, scientifically sound, and not too extensive. We hope that we succeeded.

We can distinguish CSBD, on the one hand, as an autoerotic activity form of sexual behavior and, on the other hand, as a sexual behavior that includes other people. For the former, the current consumption of pornography through digital media plays a special role. For the latter, partner-related sexual activities, such as promiscuous behavior, have been discussed in the past in connection with sexual risk behavior and the danger of sexually transmitted diseases. Many studies have been done about men who have sex with men (MSM) in this context. We do not include separate chapters on MSM or people with nonheterosexual orientations, but we do cover sexual minorities in the different chapters when it makes sense to do so. There are also no separate chapters and no differentiated mentioning of trans, intersex, and asexuality, because no studies have yet investigated these or other spectrums of sex or gender (Nieder et al. 2020) more specifically. We believe that issues of gender and sexual orientation are not salient for establishing the diagnosis of CSBD.

We hope that readers of this book will be those who come into contact with patients with CSBD in counseling, psychotherapy, sex therapy, or psychiatry. The book can be the basis for therapeutic and drug treatment and can provide good support for theoretical and practical training. We welcome feedback, suggestions for improvement, or practical advice from interested readers. We hope not only that the research activities in this field will continue to increase but also that patients will be able to find appropriate professional care. If the book can contribute to this goal, we will be satisfied. Above all, the book should serve patients with CSBD, who should not be restricted with moralizing, negative attitudes about their sexual behaviors but should be supported in finding a form of sexual health that satisfies them and frees them from distress.