Mental Health
Compulsive sexual behavior disorder (CSBD) and problematic pornography use (PPU): A comprehensive, interdisciplinary, and expert-informed narrative review with suggested future directions.
Open Access: Yes.
Abstract
Background and aims
The nature and classification of dysregulated sexual behaviors remain widely debated. Compulsive Sexual Behavior Disorder (CSBD) and Problematic Pornography Use (PPU) are the two most commonly studied constructs in this area, each carrying significant implications for mental health, interpersonal functioning, and broader well-being. Although scientific output on these topics has expanded rapidly in the past decade, recent reviews have tended to focus on specific subthemes, single constructs, or narrow disciplinary perspectives. Accordingly, this review provides an updated and interdisciplinary overview of empirical and theoretical knowledge.
Methods
In this narrative review, we summarize current knowledge regarding CSBD and PPU, with contributions from diverse experts across multiple disciplines (e.g., psychology, psychiatry, sexology, addiction science, neuroscience). We provide research and clinical perspectives to ensure a comprehensive and balanced discussion.
Results
We extensively summarize eleven key areas, namely historical context, conceptualization and symptomatology, assessment and measurement, epidemiology, co-occurring disorders, etiology, potential negative consequences, intervention, treatment, and policy considerations. Additionally, we consider underrepresented populations and contexts, including adolescents, LGBTQ+ (i.e., lesbian, gay, bisexual, trans, queer, and other diverse identities) individuals, women, and cultural factors. The review concludes with a critical discussion of prevailing controversies, methodological challenges, and key directions for future research.
Discussion and Conclusions
By providing a comprehensive and integrative overview, this work aims to advance scientific discourse, promote interdisciplinary collaborations, inform clinical practice, and support public health initiatives in the field of CSBD and PPU.
Relevance
Various studies and report link, and provisionally, link, CSBD/PPU with a range of health problems and disorders, including: sleep deficits, cognitive difficulties, low self-esteem, dysphoria, irritability, negative perceptions of self, psychological distress, rumination, lower sexual satisfaction, erectile dysfunction, increased risk for HIB and sexually transmitted infections, reduced concentration, missed tasks, increased loneliness, lower perceived social support, poor romantic bond quality, insecure attachment, attachment anxiety, and maladaptive coping strategies for interpersonal stress.
CSBD/PPU also are reported to have co-occurring mental health disorders: attention-deficit/hyperactivity disorder, depression, anxiety, obsessive-compulsive disorder, sexual trauma, post-traumatic stress disorder, substance abuse, suicidality, paraphilias, and other problematic online behaviors (e.g., gambling, gaming, shopping, social media
Among adolescents, “desire thinking, metacognitions about sex, verbal perseveration, impulsivity, mental health, negative mood, shame, life satisfaction, sexual thoughts, sexual drive, sexual arousal, sexual distress, moral disapproval, and parental practices and characteristics may relate to CSBD/PPU among adolescents.”
Among LGBTQ+ individuals, a key informing the research on PPU is “minority stress theory,” such that LGBTQ+ individuals “experience unique stress related to societal responses to their identity,” such as discrimination (e.g., peer rejection) and “stress reactions” (e.g., internalized stigma).
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