Researchers from the University of Minnesota Program in Human Sexuality reported this month on research into the prevalence of Compulsive Sexual Behavior Disorder((Dickenson JA, Gleason N, Coleman E, Miner MH. Prevalence of Distress Associated With Difficulty Controlling Sexual Urges, Feelings, and Behaviors in the United States. JAMA Netw Open. 2018;1(7):e184468. doi:10.1001/jamanetworkopen.2018.4468)). They used data from the nationally representative National Survey of Sexual Health and Behavior (NSSHB) to “assess the prevalence of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors”. The NSSHB contains the Compulsive Sexual Behavior Inventory–13 (CSBI-13) which has a clinical cut off score allowing researchers to categorize the 2325 research participants as meeting CSBD criteria or not. Subjects were 18-50 year olds (x̅=34) from all 50 US States and DC with almost even split of male/female (50.5% female).
NOTE: This is not a report of sexual addiction. See below for comment.
In this survey study, we found that 8.6% of the nationally representative sample (7.0% of women and 10.3% of men) endorsed clinically relevant levels of distress and/or impairment associated with difficulty controlling sexual feelings, urges, and behaviors.
Researchers pointed out that the “gender differences were smaller than previously theorized” as earlier estimates put a male to female ratio at 2:1 to 5:1. An actual ratio of about 1.5:1 was not expected.
Summary from JAMA Network
Prevalence of Distress Associated With Difficulty Controlling Sexual Urges, Feelings, and Behaviors in the United States
Meaning The high prevalence of such symptoms has major public health relevance as a sociocultural problem and indicates a significant clinical problem that should be recognized by health care professionals.
Of special note was the sociodemographic differences noted in the report. Statistically significant differences were found with sexual orientation, ethnicity, education, and income level as shown in the graphs below. Age was not reported as a significantly different variable.
Relative to heterosexual individuals, gay or lesbian individuals were 2.92 times more likely, bisexual individuals were 3.02 times more likely, and individuals who identified as other were 4.33 times more likely to endorse distress associated with difficulty controlling sexual feelings, urges, and behaviors.
Individuals who identified as black, other, and Hispanic were respectively 2.50, 2.02, and 1.84 times more likely than white individuals to endorse clinically relevant levels of distress and impairment associated with difficulty controlling sexual feelings, urges, and behaviors.
While not a straight curve, higher education and higher income reported generally lower levels of distress associated with difficulty controlling sexual feelings, urges, and behaviors.
Does this mean that 10% of men and 7% of women meet criteria for CSBD? Likely not suggest the researchers.
A more plausible explanation is that the individuals who met the clinical cut point of the CSBI-13 capture the entire range of CSB, ranging from problematic but nonclinical out-of-control sexual behavior to the clinical diagnosis of CSBD. This suggests that the clinically relevant levels of distress and impairment associated with difficulty controlling one’s sexual feelings, urges, and behaviors may represent both a sociocultural problem and a clinical disorder (ie, a manifestation of sociocultural and intrapersonal conflicts around sexual values vs a clinical diagnosis of CSBD). Thus, health care professionals should be alert to the high number of people who are distressed about a lack of control over their sexual behavior and carefully assess the nature of the problem, consider its possible etiology, and find appropriate treatments for both men and women.
In other words, not all who are above the clinical cut off might be viewed as out of control in their behavior by a qualified assessor, but the individuals are clearly reporting a clinical level of distress about their behavior.
In terms of the closer gender difference than expected, researchers point to the changing cultural shifts in gender and sexuality but also point out that…
…one possible explanation for the smaller gender differences found in our study is that the prevalence of difficulty controlling sexual behaviors among women may be increasing.
For either, they suggest clinicians take care to not overlook distress in females.
Is this a measure of sexual addiction?
Care should be taken to NOT equate this with sexual addiction or hypersexuality. While even Medscape used “Sex Addiction” in the the headline when reporting this study((https://www.medscape.com/viewarticle/904398)), I have discussed earlier the possible differences between CSBD and Sex Addiction. Someone being distressed about their sexual behavior, or ability to control it, can be a definite clinical issue that needs to be addressed but it doesn’t mean the individual is a sex addict or hypersexual. They may be highly distressed about normative sexual behavior or a particular sexual fantasy or behavior.
Compulsive Sexual Behavior in ICD-11 is not Sexual Addiction
Read more here.
Probably the best conclusion is to simply quote part of the research conclusion.
The high prevalence of this sexual symptom has major public health relevance as a sociocultural problem and indicates a significant clinical problem that warrants attention from health care professionals. … Health care professionals should be alert to the high number of people who are distressed about their sexual behavior, carefully assess the nature of the problem, and find appropriate treatments for both men and women.
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