A new study conducted in 42 countries suggests that almost 5% of people may be at high risk of experiencing compulsive sexual behavior disorder (CSBD). However, only 14% of them ever sought treatment for this behavior, according to the study, which was recently published in Journal of Behavioral Addictions.
CSBD (sometimes also called sex addiction or hypersexuality) is included in the 11th revision of International disease classification (ICB-11). According to these new diagnostic guidelinesa diagnosis of CSBD can be applied when someone engages in sexual impulses and repetitive behaviors with little or no control over them, and these behaviors subsequently lead to significant stress and negative consequences (eg, job loss, relationship conflict).
However, this diagnosis is still relatively new and some potential problems have not yet been examined in scientific research. One of these issues relates to the relative lack of data on CSBD outside of Western, educated, industrialized, wealthy and democratic (WEIRD) countries, among women and gender diverse individuals (eg, non-binary people) and sexually diverse individuals (eg, bisexual people). This is despite preliminary studies showing important differences based on gender, sexual orientation, and culture in sexual behavior in general and in CSBD specifically.
Therefore, to provide a picture of CSBD across cultures, genders and sexual orientations, we conducted a large-scale survey in 42 countries on five continents – International Sexuality Survey. First, we took the necessary step of verifying that the scales currently used to assess CSBD were valid and reliable across all the different groups we wanted to compare. We then compared CSBD in the aforementioned groups and examined differences in various sexual behaviors between individuals at low versus high risk of experiencing CSBD.
More than 82,000 adults completed our anonymous online survey, including nearly 47,000 women, 2,800 gender diverse individuals, and more than 25,000 sexually diverse individuals (ie, those who report a sexual orientation other than heterosexual, such as lesbians or gays). Our findings suggest that 4.8% of people may experience CSBD worldwide, although a wide range of rates is observed among different countries, genders, and sexual orientations.
The highest rates of CSBD were reported in Turkey, followed by China and Peru. These findings highlight the importance of researching CSBD in diverse populations beyond the realm of WEIRD countries, such as sexuality and related values can be connected with one cultural background and norms.
Regarding gender differences as shown in previous studies, males reported the highest levels of CSBD, followed by individuals of different genders and then females. Previous studies have not extensively examined sexual orientation-based differences in CSBD without pooling groups of individuals with different sexual orientations. This is quite problematic since e.g enough evidence that bisexual individuals face more mental health challenges than lesbian/gay or same-sex attracted people.
So we compared rates of CSBD in eight sexual orientation-based groups (ie, heterosexual, gay or lesbian, bisexual, queer and pansexual, homo- and heteroflexible, asexual, questioning, and individuals identifying with other sexual orientations) and no we saw any significant differences between their levels of CSBD.
Finally, we examined the frequency of different sexual behaviors among individuals who were at high risk of experiencing CSBD versus those who were not. As expected, the high-risk CSBD group used pornography more often, masturbated more often, had more sexual partners in their lifetime, had more casual sexual partners in the past year, and engaged in sexual activities with casual sexual partners more often by people in the low-risk CSBD group.
However, they had sex with their romantic partners as often as their peers in the low-risk group. Importantly, only 14% of individuals in the CSBD high-risk group ever sought treatment for CSBD, with an additional 33% not seeking treatment for various structural and personal reasons (eg, stigma, cost of treatment).
One of the main take-home messages from our study is that, with a worldwide incidence rate of almost 5%, CSBD appears to be as common as other, more extensively studied psychiatric disorders, with a wide range of estimates across countries, genders and sexual orientations. These differences in CSBD ratings provide evidence for the need for more comprehensive research in this area. Also, given the low rates of treatment seeking for CSBD among high-risk individuals, there is a need to increase awareness of CSBD, including affordable, accessible, evidence-based treatment options, in a culturally sensitive manner.
Like all research, our study includes some limitations. For example, although we were able to collect data from diverse populations (eg, sexually diverse individuals) in 42 countries, findings are not representative of all populations in each country, limiting broader generalizability of findings, especially in countries with relatively small sample sizes. Future studies are needed to further investigate CSBD in other populations, including nationally representative, longitudinal, and clinical samples.
However, the present study was the first step in a more in-depth study of CSBD and other sexual behaviors using data collected in the International Study of Sex.
Learning, “Compulsive sexual behavior disorder in 42 countries: Insights from the International Study of Sex and implementation of standardized assessment tools”, is authored by Beáta Bőthe, Mónika Koós, Léna Nagy, Shane Kraus, Marc Potenza, Zsolt Demetrovics and other contributors.