Future Considerations for Classifying Compulsive Sexual Behavior Essay

Future Considerations for Classifying Compulsive Sexual Behavior Essay

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Future Considerations for Classifying Compulsive Sexual Behavior Essay

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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 [1]. 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 [2]. More research should examine which proposed criteria – whether those relatingmore closely to sexual addiction [3] or hypersexual disorder [4] – 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 [5]. More research is needed to better understand in csb how central features of addiction (e.g. Tolerance, withdrawal) relate to csb and its treatment.

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Additional concerns included improving research method- ologies and minimizing possible confounds that may limit generalizability of studies [2]. 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 [8].

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 [8]. 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 [9], particularly as frequency of sexual behaviors may not be a strong predictor of csb [10].

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 [11]. 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 [12]. 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 [4] from dsm-5, a diagnosis of csb (excessive sex drive) can be made using icd-10 [13]. Csb is also being considered by icd-11 [14], 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.

Funding sources

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

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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

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© 2016 society for the study of addiction addiction, 111, 2107–2114

Problem gambling services program; has performed grant reviews for the national institutes of health and other agencies; has edited journals or journal sections; has given academic lectures in grand rounds, cme events and other clinical or scientific venues; and has generated books or book chapters for publishers of mental health texts

Shane w. Kraus1, valerie voon2, ariel kor3 &

Marc n. Potenza4,5

Visn 1 new england mirecc, edith nourse rogers memorial

Veterans hospital, massachusetts, usa,1 department of psychiatry,

University of cambridge, cambridge, uk,2 department of psychology,

Teachers college, columbia university, new york, usa,3 department

Of psychiatry, yale university school of medicine, new haven,

Connecticut, usa4 and department of neurobiology, child study

Center, the national center on addiction and substance abuse and

Connecticut mental health center, yale university school of medicine,

New haven, connecticut, usa5

E-mail: shane.kraus@va.gov

References

1. Kraus s. W., voon v., potenza m. N. Should compulsive sexual behavior be considered an addiction? Addiction 2016; 111: 2097–106.
2. Reid r. C. Additional challenges and issues in classifying compulsive sexual behavior as an addiction. Addiction 2016; 111: 2111–3.
3. Carnes p. J., hopkins t. A., green b. A. Clinical relevance of the proposed sexual addiction diagnostic criteria: relation to the screening test-revised. J addict med 2014; 8: 450–61.
4. Kafka m. P. Hypersexual disorder: a proposed diagnosis for dsm-v. Arch sex behav 2010; 39: 377–400.
5. Koob g. F. Neurobiology of addiction. Focus: the journal of lifelong learning in psychiatry 2011; 9: 55–65.
6. Farre j. M., fernandez-aranda f., granero r., aragay n., mallorqui-bague n., ferrer v. Et al. Sex addiction and gam- bling disorder: similarities and differences. Compr psychiatry 2015; 56: 59–68.
7. Kraus s. W., potenza m. N., martino s., grant j. E. Examining the psychometric properties of the yale-brown obsessive– compulsive scale in a sample of compulsive pornography users. Compr psychiatry 2015; 59: 117–22.
8. Griffiths m. D. Compulsive sexual behaviour as a behavioural addiction: the impact of the internet and other issues. Addiction 2016; 111: 2107–8.
9. Kraus s. W., martino s., potenza m. N. Clinical characteristics of men interested in seeking treatment for use of pornography. J behav addic 2016; 5: 169–78.
10. Gola m., lewczuk k., skorko m. What matters: quantity or quality of pornography use? Psychological and behavioral factors of seeking treatment for problematic pornography use. J sex med 2016; 13: 815–24.
11. Keane h. Technological change and sexual disorder. Addiction 2016; 111: 2108–9.
12. Luscombe b. Porn and the threat of virility. Time 2016; 40–47.
13. Krueger r. B. Diagnosis of hypersexual or compulsive sexual behavior can be made using icd-10 and dsm-5 despite rejec- tion of this diagnosis by the american psychiatric association. Addiction 2016; 111: 2110–1.
14. Organization w. H. Icd-11 beta draft (joint linearization for mortality and morbidity statistics); 2015.

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This document is a scanned copy of a printed document. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material.

Future Considerations for Classifying Compulsive Sexual Behavior Essay

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