On The World Health Organization's Recognition of Compulsive Sexual Behavior Disorder

This week brought news the World Health Organization has officially recognized in its newest diagnostic manual, ICD-11, the diagnosable condition known as Compulsive Sexual Behavior Disorder (“CSBD”). We are heartened by this development because it takes a meaningful step toward ensuring people struggling with what we refer to as “porn addiction” receive the help they need. It also serves as a long overdue validation for anyone who felt the pain and confusion of reading, over and over, that their agonizing, unceasing compulsion to consume porn wasn’t “real.”

Here is how ICD-11 describes the very real condition known as CSBD:

Compulsive sexual behavior disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behavior; and continued repetitive sexual behavior despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behavior is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviors is not sufficient to meet this requirement.

Critics of the new CSBD diagnosis hasten to point out that ICD-11 omits any mention of the word “addiction” in relation to CSBD and categorizes CSBD as an “impulse control disorder.” According to the critics, these features purportedly reflect the WHO having rejected the “addiction model” as an appropriate approach to treating CSBD. There also seems to be a vein of dismissiveness in these criticisms, as if an “impulse control disorder” is somehow less serious than diagnoses labeled “addiction” – which seems odd, considering “impulse control disorders” also encompass serious conditions like kleptomania and pyromania.

Still, clinicians who already have been treating patients suffering from “sex addiction” and “porn addiction” for years are celebrating. The lack of an “addiction” label on CSBD notwithstanding, it’s indisputable CSBD’s diagnostic criteria address the type of uncontrolled sex-related behaviors these clinicians have long been addressing, with at least some success, through addiction-related treatment modalities. Likewise, many, likely most, of those men and women who belong to sexual behavior-related 12-Step fellowships such as Sex Addicts Anonymous would easily recognize themselves and their fellow group members in the CSBD definition. 

The fact is, even though the word “addiction” remains a fixture in our society, the term long ago fell out of favor as a diagnostic descriptor. For instance, clinicians today refer to the condition everyone colloquially calls “drug addiction” as “substance use disorder.” The thinking among therapists and doctors goes that the label “addiction” stigmatizes patients (although, ironically, it’s not unusual for patients to take comfort from that word…but that’s a topic for another day). 

It’s also worth noting that the CSBD criteria flat out reject the tired canard that religiosity alone motivates people to seek help for “sex addiction” and “porn addiction”. According to the definition above, CSBD stands apart from merely wanting, and failing, to quit porn on moral grounds. (Which is not to denigrate anyone’s religious motives for wanting to quit porn – they’re just not what qualifies as CSBD without other factors present.) 

We look forward over the coming months and years to learning what percentage of prospective patients who seek help from therapists for uncontrolled sexual behaviors meet the diagnostic criteria for CSBD. We suspect the figure will be far higher than critics of the CSBD diagnosis predict. But, even if CSBD only affects 1% of the internet porn using population worldwide, that’s still tens of millions of people around the globe.