Compulsive Sexual Behaviour Disorder in the newly adopted ICD-11 of World Health Organization
“Compulsive sexual behaviour disorder” in the eleventh revision of the International Classification of Diseases (ICD-11) has now been officially adopted by the 194 Member States of the World Health Organization. Member States noted that ICD-11 has been produced in a transparent and collaborative manner.
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This new "Compulsive Sexual Behaviour Disorder" (CSBD) diagnosis is vitally important. In addition to offering caregivers a suitable diagnosis for those who require treatment for compulsive sexual behavior (including problematic pornography use, excessive preoccupation with sexual fantasies, compulsive use of prostitutes or strip clubs) the existence of a formal diagnosis in the world’s premier medical manual will facilitate future research. Lack of a formal diagnosis has hindered mainstream recognition of the risks of this disorder. According to recent research, more than 80% of people presenting to healthcare professionals with compulsive sexual behavior have reported problematic use of pornography.
This CSBD diagnosis will be used for disorders that many health caregivers have long been treating by one name or another (as out-of-control sexual behavior, hypersexuality, sex addiction, sexual compulsivity, etc.). It is hoped that treatment for CSBD will be covered by medical insurance in due course.
So, has the ICD-11 “rejected” sexual behavior addictions? Not for now. The new diagnosis was the subject of intense debate. Here is a recent paper by various members of the WHO team that put together and recommended the new diagnosis. It appears in the prestigious World Psychiatry journal. Innovations and changes in the ICD‐11 classification of mental, behavioural and neurodevelopmental disorders.
The lead author is Geoffrey Reed who headed up the mental disorders section of the new ICD-11. This paper describes CSBD as resembling a dependence but located in the “impulse control disorder” category until more definitive information becomes available. Its purposes are to help treatment-seeking patients and reduce shame and guilt.
The ICD-11 has adopted a conservative, wait-and-see approach while further research is published. This was the same approach adopted for gambling disorder. When gambling was first given a medical diagnosis it too was characterized as an “impulse control disorder” while it was further investigated. Many hundreds of studies later, gambling disorder has now been characterized in the ICD-11 as a 'disorder due to addictive behavior'. Gaming disorder is also classified under that new category. Some experts suggest that CSBD will follow the same trajectory as more research is published.
The ICD-11 was ratified on May 25th 2019 in Geneva and will come into effect on January 1st 2022. This will permit Member States the necessary time for training and the integration of the new categories into healthcare practice.
Dr. Matthew Hedelius, President of the Society for the Advancement of Sexual Health says, “We are delighted to see this important new diagnostic category of Compulsive Sexual Behavior officially adopted. So many people are suffering without realizing that there is a label for their distressing symptoms and that professional help is available. Our SASH members are well qualified to deal with issues that an increasing number of people face in our digital age.”