As WHO member states begin the transition from using the ICD-10 to the ICD-11 in health care and data reporting systems, it is important for clinicians to gain an understanding of how new diagnostic categories in the ICD-11 Clinical Descriptions and Diagnostic Requirements for Mental, Behavioural, or Neurodevelopmental Disorders have the potential to improve both individual care and public health globally.
In an article published recently in World Psychiatry, an international team of experts and collaborators share insight on the following four new diagnoses in the ICD-11: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. As part of a series of GCP.Network Perspectives articles, key information on compulsive sexual behaviour disorder is highlighted here.
What is compulsive sexual behaviour disorder? In the ICD-11, compulsive sexual behaviour disorder is described as:
- A persistent pattern of failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour and distress.
- Continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it.
- Multiple unsuccessful efforts to control or significantly reduce repetitive sexual behaviour.
- Inability to control impulses and behaviour persists for six months or more.
- Causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
- To view the full version of the diagnostic requirements, the ICD-11 CDDR is available here.
Why was compulsive sexual behaviour disorder added as a new diagnostic category? Compulsive sexual behaviour disorder is associated with significant suffering and may have a substantial negative impact on the health and lives of individuals impacted. The inclusion of this category in the ICD-11 is a response to WHO member states that have reported a need to identify and develop relevant clinical services and policies for this population. For more than a quarter of a century, there has been research on symptoms and conditions related to repetitive sexual behaviours. Recent studies have found co-morbidity of compulsive sexual behaviour disorder with other mental disorders, as well as neurobiological and genetic characteristics that may be exhibited by and impact individuals with compulsive sexual behaviour disorder.
Notably, ICD-11 CDDR explicitly states that the diagnosis should not be assigned based on the intensity or frequency of sexual interest and behaviour, nor based on distress related to an individual’s (or others’) moral judgements and disapproval related to sexual impulses, urges, or behaviours. Rather than pathologizing high levels of sexual interest or behaviour, the central feature of this diagnosis is persistent, impaired control of intense, repetitive sexual impulses that result in repetitive sexual behaviours with a variety of negative consequences for the individual. The inclusion of this category in the ICD-11 recognizes the legitimate health needs of this group of individuals and makes it possible to collect more accurate data on national and global prevalence rates for this disorder.
How does this new diagnosis improve care provision and advance public health? This new category provides a standardized definition that researchers and clinicians can utilize to develop better assessment tools and treatment methods for compulsive sexual behaviour disorder. For example, an international group of researchers have already developed the Compulsive Sexual Behavior Disorder-19 Scale (CSBD-19) to assess for symptoms. The scale was tested in three countries initially and, in 2021, the group launched an international survey in 40 countries. After this study is completed, the CSBD-19 will be publicly available in over 30 languages for research and clinical practice. In terms of treatment, cognitive behavioral therapy and acceptance and commitment therapy have been shown to be effective in reducing symptoms compared to waitlist control groups; other interventions such as self-help groups, mindfulness-based intervention, and treatments to reduce sexual risk behaviors and minority stress have also shown to be beneficial. Additional research will facilitate improvement of clinical care and additional data recorded in public health systems can inform policy-level decisions around the availability and accessibility of health services.
To read more about the history, research evidence, and controversies around the inclusion of compulsive sexual behaviour disorder in the ICD-11, the full article is available online here. GCP.Network members can log in and download a PDF of the article on the Scholarly Output page.
Citation: Reed, G.M., First, M.B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C.R., King, D.L., Kraus, S.W. and Bryant, R.A. (2022). Emerging experience with selected new categories in the ICD-11: Complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. World Psychiatry, 21: 189-213. https://doi.org/10.1002/wps.20960