. 2023 Jun 22;12(2):393-407.

doi: 10.1556/2006.2023.00028. Print 2023 Jun 29.

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

Beáta Bőthe^{1

2}, Mónika Koós^{3

4}, Léna Nagy^{3

4}, Shane W Kraus⁵, Zsolt Demetrovics^{4

6}, Marc N Potenza^{7

8

9}, Aurélie Michaud², Rafael Ballester-Arnal¹⁰, Dominik Batthyány¹¹, Sophie Bergeron¹², Joël Billieux^{13

14}, Peer Briken¹⁵, Julius Burkauskas¹⁶, Georgina Cárdenas-López¹⁷, Joana Carvalho^{18

19}, Jesús Castro-Calvo²⁰, Lijun Chen²¹, Giacomo Ciocca²², Ornella Corazza^{23

24}, Rita Csako²⁵, David P Fernandez²⁶, Elaine F Fernandez²⁷, Loïs Fournier¹³, Hironobu Fujiwara^{28

29

30}, Johannes Fuss³¹, Roman Gabrhelík^{32

33}, Ateret Gewirtz-Meydan³⁴, Biljana Gjoneska³⁵, Mateusz Gola^{36

37}, Joshua B Grubbs³⁸, Hashim T Hashim³⁹, Md Saiful Islam^{40

41}, Mustafa Ismail³⁹, Martha C Jiménez-Martínez^{42

43}, Tanja Jurin⁴⁴, Ondrej Kalina⁴⁵, Verena Klein⁴⁶, András Költő⁴⁷, Chih-Ting Lee⁴⁸, Sang-Kyu Lee^{49

50}, Karol Lewczuk⁵¹, Chung-Ying Lin^{52

53}; Liverpool John Moores University's research team⁵⁴; Christine Lochner⁵⁵, Silvia López-Alvarado⁵⁶, Kateřina Lukavská^{32

57}, Percy Mayta-Tristán⁵⁸, Ionut Milea⁵⁹, Dan J Miller⁶⁰, Oľga Orosová⁶¹, Gábor Orosz⁶²; Sungkyunkwan University's research team⁶³; Fernando P Ponce⁶⁴, Gonzalo R Quintana⁶⁵, Gabriel C Quintero Garzola^{66

67}, Jano Ramos-Diaz⁶⁸, Kévin Rigaud⁶², Ann Rousseau⁶⁹, Marco De Tubino Scanavino^{70

71

72}, Marion K Schulmeyer⁷³, Pratap Sharan⁷⁴, Mami Shibata²⁸, Sheikh Shoib⁷⁵, Vera L Sigre Leirós^{13

76}, Luke Sniewski⁷⁷, Ognen Spasovski^{78

79}, Vesta Steibliene⁸⁰, Dan J Stein⁸¹, Julian Strizek⁸², Aleksandar Štulhofer⁸³, Berk C Ünsal^{3

4}, Marie-Pier Vaillancourt-Morel¹

Affiliations

¹ 1Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
² 2Département de Psychologie, Université de Montréal, Montréal, Canada.
³ 3Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁴ 4Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁵ 5Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁶ 6Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
⁷ 7Yale University School of Medicine, New Haven, CT, USA.
⁸ 8Connecticut Council on Problem Gambling, Wethersfield, CT, USA.
⁹ 9Connecticut Mental Health Center, New Haven, CT, USA.
¹⁰ 10Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain.
¹¹ 11Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria.
¹² 12Département de Psychologie, Université de Montréal, Montréal, Canada.
¹³ 13Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
¹⁴ 14Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
¹⁵ 15Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
¹⁶ 16Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
¹⁷ 17Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico.
¹⁸ 18William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.
¹⁹ 19CPUP: Center for Psychology at University of Porto, Portugal.
²⁰ 20Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
²¹ 21Department of Psychology, College of Humanity and Social Science, Fuzhou University, China.
²² 22Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
²³ 23Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom.
²⁴ 24Department of Psychology and Cognitive Science, University of Trento, Italy.
²⁵ 25Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand.
²⁶ 26Nottingham Trent University, United Kingdom.
²⁷ 27HELP University, Malaysia.
²⁸ 28Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²⁹ 29Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.
³⁰ 30The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan.
³¹ 31Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
³² 32Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
³³ 33Department of Addictology, General University Hospital in Prague, Czech Republic.
³⁴ 34School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
³⁵ 35Macedonian Academy of Sciences and Arts, Republic of North Macedonia.
³⁶ 36Institute of Psychology, Polish Academy of Sciences, Poland.
³⁷ 37Institute for Neural Computations, University of California San Diego, USA.
³⁸ 38Bowling Green State University, USA.
³⁹ 39University of Baghdad, College of Medicine, Iraq.
⁴⁰ 40Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
⁴¹ 41Centre for Advanced Research Excellence in Public Health, Dhaka, 1342, Bangladesh.
⁴² 42Universidad Pedagógca y Tecnológica de Colombia, Colombia.
⁴³ 43Grupo de Investigación Biomédica y de Patología, Colombia.
⁴⁴ 44Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia.
⁴⁵ 45Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
⁴⁶ 46School of Psychology, University of Southampton, United Kingdom.
⁴⁷ 47Health Promotion Research Centre, University of Galway, Ireland.
⁴⁸ 48Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴⁹ 49Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea.
⁵⁰ 50Chuncheon Addiction Management Center, South Korea.
⁵¹ 51Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
⁵² 52Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵³ 53Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵⁴ 54Public Health Institute, Faculty of Health, Liverpool John Moores University, United Kingdom.
⁵⁵ 55SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa.
⁵⁶ 56Faculty of Psychology, University of Cuenca, Ecuador.
⁵⁷ 57Faculty of Education, Department of Psychology, Charles University, Prague, Czech Republic.
⁵⁸ 58Facultad de Medicina, Universidad Científica del Sur, Lima, Perú.
⁵⁹ 59Babeș-Bolyai University, Romania.
⁶⁰ 60James Cook University, Australia.
⁶¹ 61Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
⁶² 62Artois University, France.
⁶³ 63Department of Psychology, Sungkyunkwan University, South Korea.
⁶⁴ 64Escuela de Psicología, Universidad de Talca, Chile.
⁶⁵ 65Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile.
⁶⁶ 66Florida State University, Republic of Panama.
⁶⁷ 67Sistema Nacional de Investigación (SNI), SENACYT, Panama.
⁶⁸ 68Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú.
⁶⁹ 69Leuven School for Mass Communication, KU Leuven, Leuven, Belgium.
⁷⁰ 70Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷¹ 71Experimental Pathophisiology Post Graduation Program, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷² 72Excessive Sexual Drive and Prevention of Negative Outcomes Associated to Sexual Behavior Outpatient Unit (AISEP), Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷³ 73Universidad Privada de Santa Cruz de la Sierra, Bolivia.
⁷⁴ 74Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India.
⁷⁵ 75Department of Psychology, Shardha University, India.
⁷⁶ 76Institute of Legal Psychiatry, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
⁷⁷ 77Auckland University of Technology, New Zealand.
⁷⁸ 78Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia.
⁷⁹ 79Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovak Republic.
⁸⁰ 80Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
⁸¹ 81SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa.
⁸² 82Austrian Public Health Institute, Austria.
⁸³ 83Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia.

PMID: 37352095
PMCID: PMC10316175
DOI: 10.1556/2006.2023.00028

Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

Beáta Bőthe et al. J Behav Addict. 2023.

. 2023 Jun 22;12(2):393-407.

doi: 10.1556/2006.2023.00028. Print 2023 Jun 29.

Authors

Affiliations

¹ 1Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
² 2Département de Psychologie, Université de Montréal, Montréal, Canada.
³ 3Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁴ 4Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
⁵ 5Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA.
⁶ 6Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar.
⁷ 7Yale University School of Medicine, New Haven, CT, USA.
⁸ 8Connecticut Council on Problem Gambling, Wethersfield, CT, USA.
⁹ 9Connecticut Mental Health Center, New Haven, CT, USA.
¹⁰ 10Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain.
¹¹ 11Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria.
¹² 12Département de Psychologie, Université de Montréal, Montréal, Canada.
¹³ 13Institute of Psychology, University of Lausanne, Lausanne, Switzerland.
¹⁴ 14Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
¹⁵ 15Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
¹⁶ 16Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
¹⁷ 17Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico.
¹⁸ 18William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal.
¹⁹ 19CPUP: Center for Psychology at University of Porto, Portugal.
²⁰ 20Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain.
²¹ 21Department of Psychology, College of Humanity and Social Science, Fuzhou University, China.
²² 22Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
²³ 23Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom.
²⁴ 24Department of Psychology and Cognitive Science, University of Trento, Italy.
²⁵ 25Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand.
²⁶ 26Nottingham Trent University, United Kingdom.
²⁷ 27HELP University, Malaysia.
²⁸ 28Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
²⁹ 29Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan.
³⁰ 30The General Research Division, Osaka University Research Center on Ethical, Legal and Social Issues, Osaka, Japan.
³¹ 31Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany.
³² 32Department of Addictology, First Faculty of Medicine, Charles University, Prague, Czech Republic.
³³ 33Department of Addictology, General University Hospital in Prague, Czech Republic.
³⁴ 34School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Israel.
³⁵ 35Macedonian Academy of Sciences and Arts, Republic of North Macedonia.
³⁶ 36Institute of Psychology, Polish Academy of Sciences, Poland.
³⁷ 37Institute for Neural Computations, University of California San Diego, USA.
³⁸ 38Bowling Green State University, USA.
³⁹ 39University of Baghdad, College of Medicine, Iraq.
⁴⁰ 40Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh.
⁴¹ 41Centre for Advanced Research Excellence in Public Health, Dhaka, 1342, Bangladesh.
⁴² 42Universidad Pedagógca y Tecnológica de Colombia, Colombia.
⁴³ 43Grupo de Investigación Biomédica y de Patología, Colombia.
⁴⁴ 44Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia.
⁴⁵ 45Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
⁴⁶ 46School of Psychology, University of Southampton, United Kingdom.
⁴⁷ 47Health Promotion Research Centre, University of Galway, Ireland.
⁴⁸ 48Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁴⁹ 49Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea.
⁵⁰ 50Chuncheon Addiction Management Center, South Korea.
⁵¹ 51Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland.
⁵² 52Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵³ 53Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵⁴ 54Public Health Institute, Faculty of Health, Liverpool John Moores University, United Kingdom.
⁵⁵ 55SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa.
⁵⁶ 56Faculty of Psychology, University of Cuenca, Ecuador.
⁵⁷ 57Faculty of Education, Department of Psychology, Charles University, Prague, Czech Republic.
⁵⁸ 58Facultad de Medicina, Universidad Científica del Sur, Lima, Perú.
⁵⁹ 59Babeș-Bolyai University, Romania.
⁶⁰ 60James Cook University, Australia.
⁶¹ 61Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia.
⁶² 62Artois University, France.
⁶³ 63Department of Psychology, Sungkyunkwan University, South Korea.
⁶⁴ 64Escuela de Psicología, Universidad de Talca, Chile.
⁶⁵ 65Departamento de Psicología y Filosofía, Facultad de Ciencias Sociales, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile.
⁶⁶ 66Florida State University, Republic of Panama.
⁶⁷ 67Sistema Nacional de Investigación (SNI), SENACYT, Panama.
⁶⁸ 68Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Perú.
⁶⁹ 69Leuven School for Mass Communication, KU Leuven, Leuven, Belgium.
⁷⁰ 70Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷¹ 71Experimental Pathophisiology Post Graduation Program, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷² 72Excessive Sexual Drive and Prevention of Negative Outcomes Associated to Sexual Behavior Outpatient Unit (AISEP), Institute of Psychiatry, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
⁷³ 73Universidad Privada de Santa Cruz de la Sierra, Bolivia.
⁷⁴ 74Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India.
⁷⁵ 75Department of Psychology, Shardha University, India.
⁷⁶ 76Institute of Legal Psychiatry, Lausanne University Hospitals (CHUV), Lausanne, Switzerland.
⁷⁷ 77Auckland University of Technology, New Zealand.
⁷⁸ 78Faculty of Philosophy, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia.
⁷⁹ 79Faculty of Philosophy, University of Ss. Cyril and Methodius in Trnava, Slovak Republic.
⁸⁰ 80Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania.
⁸¹ 81SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa.
⁸² 82Austrian Public Health Institute, Austria.
⁸³ 83Department of Sociology, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia.

PMID: 37352095
PMCID: PMC10316175
DOI: 10.1556/2006.2023.00028

Abstract

Background and aims: Despite its inclusion in the 11th revision of the International Classification of Diseases, there is a virtual paucity of high-quality scientific evidence about compulsive sexual behavior disorder (CSBD), especially in underrepresented and underserved populations. Therefore, we comprehensively examined CSBD across 42 countries, genders, and sexual orientations, and validated the original (CSBD-19) and short (CSBD-7) versions of the Compulsive Sexual Behavior Disorder Scale to provide standardized, state-of-the-art screening tools for research and clinical practice.

Method: Using data from the International Sex Survey (N = 82,243; Mage = 32.39 years, SD = 12.52), we evaluated the psychometric properties of the CSBD-19 and CSBD-7 and compared CSBD across 42 countries, three genders, eight sexual orientations, and individuals with low vs. high risk of experiencing CSBD.

Results: A total of 4.8% of the participants were at high risk of experiencing CSBD. Country- and gender-based differences were observed, while no sexual-orientation-based differences were present in CSBD levels. Only 14% of individuals with CSBD have ever sought treatment for this disorder, with an additional 33% not having sought treatment because of various reasons. Both versions of the scale demonstrated excellent validity and reliability.

Discussion and conclusions: This study contributes to a better understanding of CSBD in underrepresented and underserved populations and facilitates its identification in diverse populations by providing freely accessible ICD-11-based screening tools in 26 languages. The findings may also serve as a crucial building block to stimulate research into evidence-based, culturally sensitive prevention and intervention strategies for CSBD that are currently missing from the literature.

Keywords: International Sex Survey (ISS); addictive behavior; assessment; compulsive sexual behavior; cross-cultural; validation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest with the content of this manuscript. SWK discloses that he has received funding from the International Center for Responsible Gaming, MGM Resorts International, Center for the Application of Substance Abuse Technologies, Taylor Francis, Springer Nature, The Nevada Problem Gambling Project, Sports Betting Alliance, and Kindbridge Research Institute. Dr. Potenza discloses that he has consulted for and advised Game Day Data, Addiction Policy Forum, AXA, Idorsia, Baria-Tek, and Opiant Therapeutics; been involved in a patent application involving Novartis and Yale; received research support from the Mohegan Sun Casino and the Connecticut Council on Problem Gambling; consulted for or advised legal and gambling entities on issues related to impulse control and addictive behaviors; provided clinical care related to impulse-control and addictive behaviors; performed grant reviews; edited journals/journal sections; given academic lectures in grand rounds, CME events and other clinical/scientific venues; and generated books or chapters for publishers of mental health texts. The University of Gibraltar receives funding from the Gibraltar Gambling Care Foundation, an independent, not-for-profit charity. ELTE Eötvös Loránd University receives funding from Szerencsejáték Ltd. (the gambling operator of the Hungarian government) to maintain a telephone helpline service for problematic gambling. RG is the shareholder of Adiquit Ltd. which is currently developing apps for addictions recovery. VS discloses that she received funding from Lithuanian Health Promotion Fund for providing educational materials and lectures on Problematic Internet use. BB, MNP, and JB are associate editors, while ZD is the editor-in-Chief of the Journal of Behavioral Addictions.

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Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

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Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools

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