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 have ever sought treatment for these behaviors, according to the study, which was recently published in the Journal of Behavioral Addictions.
CSBD (sometimes also referred to as sex addiction or hypersexuality) is included in the 11th revision of the International Classification of Diseases (ICD-11). According to these new diagnostic guidelines, a diagnosis of CSBD may apply when someone engages in sexual impulses and behaviors repetitively with little or no control over them, and these behaviors subsequently result in significant distress and negative consequences (e.g., loss of job, relationship conflict).
However, this diagnosis is still relatively new, and some potential issues have yet to be addressed in scientific studies. One of these issues relates to the relative absence of data about CSBD outside Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries, among women and gender-diverse individuals (e.g., non-binary people), and sexually diverse individuals (e.g., bisexual people) as well. This is despite preliminary studies showing important gender-, sexual orientation-, and culture-based differences in sexual behaviors in general, and in CSBD specifically.
Therefore, to provide a picture of CSBD across different cultures, genders, and sexual orientations, we conducted a large-scale study across 42 countries in five continents—the International Sex Survey. First, we took the necessary step of checking whether the scales currently used to assess CSBD were valid and reliable in all the different groups we wanted to compare. Then, we compared CSBD across the aforementioned groups, and examined differences in a variety of sexual behaviors between individuals at low versus high risk of experiencing CSBD.
More than 82,000 adults completed our anonymous, online survey, including almost 47,000 women, 2,800 gender-diverse individuals, and more than 25,000 sexually diverse individuals (i.e., those reporting sexual orientations other than heterosexual, such as lesbian or gay). Our findings indicate that 4.8% of individuals might experience CSBD worldwide, though a wide range of rates was observed among different countries, genders, and sexual orientations.
The highest levels of CSBD were reported in Turkey, followed by China and Peru. These findings highlight the importance of examining CSBD in diverse populations outside the realm of WEIRD countries, as sexuality and related values might be associated with one’s cultural background and norms.
Concerning gender differences, as shown in previous studies, men reported the highest levels of CSBD, followed by gender-diverse individuals, and then women. Previous studies have not examined sexual orientation-based differences in CSBD extensively without merging groups of individuals with different sexual orientations. This is quite problematic as, for example, there is ample evidence that bisexual individuals face more mental health challenges than lesbian/gay or exclusively same-gender attracted individuals.
So we compared CSBD levels across eight sexual-orientation-based groups (i.e., heterosexual, gay or lesbian, bisexual, queer and pansexual, homo- and heteroflexible, asexual, questioning, and individuals identifying with other sexual orientations), and did not see any significant differences between their CSBD levels.
Lastly, 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 frequently, masturbated more frequently, had more sexual partners in their life, had more casual sexual partners in the past year, and engaged in sexual activities with casual sexual partners more frequently than 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 high-risk CSBD group had ever sought treatment for CSBD, with an additional 33% not having sought treatment due to various structural and personal reasons (e.g., stigma, treatment costs).
One of the main take-home messages from our study is that with a worldwide occurrence rate of almost 5%, CSBD seems 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 estimates provide evidence for the need for more inclusive research in this area. Also, given the low rates of treatment-seeking for CSBD among high-risk individuals, there is a need to raise awareness around CSBD, including affordable, accessible, evidence-based treatment options, in a culturally-sensitive manner.
Like all research, our study included some limitations. For example, even though we were able to collect data from diverse populations (e.g., sexually diverse individuals) in 42 countries, the findings are not representative of all populations in each country, limiting the findings’ broader generalizability, especially in countries with relatively small sample sizes. Future studies are needed to further examine CSBD in other populations, including nationally representative, longitudinal, and clinical samples.
However, the present study was the first step in a more thorough examination of CSBD and other sexual behaviors using the data collected in the International Sex Survey.
The study, “Compulsive sexual behavior disorder in 42 countries: Insights from the International Sex Survey and introduction of standardized assessment tools”, was authored by Beáta Bőthe, Mónika Koós, Léna Nagy, Shane Kraus, Marc Potenza, Zsolt Demetrovics, and others from the collaborating countries.
