Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder

Murugavel Veeramani; Farsana Banu; Akshay Ajith

doi:doi:10.11648/j.ajpn.20251304.12

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Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder

Murugavel Veeramani^*

, Farsana Banu

, Akshay Ajith

Published in American Journal of Psychiatry and Neuroscience (Volume 13, Issue 4)

Received: 11 October 2025 Accepted: 22 October 2025 Published: 26 November 2025

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Abstract

Compulsive Sexual Behaviour Disorder (CSBD), newly recognized in ICD-11, is characterized by a persistent inability to control intense sexual impulses, leading to repetitive behaviours that cause significant distress or impairment. Previously misclassified as “sex addiction,” CSBD is now understood as an impulse-control disorder, with emerging evidence challenging addiction-based models and emphasizing emotional dysregulation and psychiatric comorbidities as key factors. Such factors play a pivotal role in informing our assessment and tailoring the therapeutic approach. This case series presents three adult males diagnosed with Compulsive Sexual Behavior Disorder (CSBD), each exhibiting distinct clinical profiles and comorbidities. Case 1 involved a 45-year-old with coronary artery disease, seizure disorder, and a history suggestive of conduct disorder, who presented with hypersexuality and moderate depressive symptoms; remission was achieved with sertraline (150 mg) over 14 weeks. Case 2 described a 25-year-old factory worker experiencing distress due to escalating sexual urges post-marriage; he responded well to fluoxetine (60 mg) and six sessions of cognitive behavioral therapy within 8 weeks. Case 3 featured a 55-year-old with schizophrenia and longstanding paraphilic interests, who achieved remission following inpatient treatment with long-acting antipsychotics and fluoxetine (60 mg) over 18 weeks. These cases highlight CSBD’s diverse manifestations and underscore the importance of nuanced diagnosis and individualized treatment with a significant role for the medication class SSRIs. Recognizing CSBD as distinct from addiction reshapes clinical perspectives and informs more effective interventions.

Published in	American Journal of Psychiatry and Neuroscience (Volume 13, Issue 4)
DOI	10.11648/j.ajpn.20251304.12
Page(s)	128-131
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Compulsive Sexual Behaviour Disorder, ICD-11, SSRIs, CBT, Impulse-control, Psychiatric Comorbidity, Schizophrenia, Depression

References

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[2]	Lew-Starowicz M, Coleman E. Mental and sexual health perspectives of the International Classification of Diseases (ICD-11) Compulsive Sexual Behavior Disorder •. J Behav Addict [Internet]. 2022 July 13; 11(2): 226-9.
[3]	Braun-Harvey D, Vigorito MA. Treating Out of Control Sexual Behavior: Rethinking Sex Addiction. Springer Publishing Company; 2015. 459 p.
[4]	Lew-Starowicz M, Lewczuk K, Nowakowska I, Kraus S, Gola M. Compulsive Sexual Behavior and Dysregulation of Emotion. Sexual Medicine Reviews [Internet]. 2020 Apr; 8(2): 191-205.
[5]	Defining a Framework for Those with Compulsive Sexual Behavior Disorder: A Narrative Synthesis [Internet].
[6]	Sassover E, Kushnir T, Weinstein AM. Investigating mood-modification, withdrawal, and sensitization in compulsive sexual behaviour. Front Psychiatry [Internet]. 2024 Oct 11; 15.
[7]	Coleman E, Dickenson JA, Girard A, Rider GN, Candelario-Pérez LE, Becker-Warner R, et al. An Integrative Biopsychosocial and Sex Positive Model of Understanding and Treatment of Impulsive/Compulsive Sexual Behavior. Sexual Addiction & Compulsivity [Internet]. 2018 July 3: 125-52.
[8]	Bittoni C, Kiesner J. Sexual Desire in Women: Paradoxical and Nonlinear Associations with Anxiety and Depressed Mood. Arch Sex Behav [Internet]. 2022 Nov 1.
[9]	Fischer VJ, Andersson G, Billieux J, Vögele C. The Relationship Between Emotion Regulation and Sexual Function and Satisfaction: A Scoping Review. Sexual Medicine Reviews [Internet]. 2022 Apr 1; 10(2): 195-208.
[10]	Hesse M. Why compulsive sexual behavior is not a form of addiction like drug addiction. Sexual Medicine [Internet]. 2024 Feb 1; 12(1): qfae006.
[11]	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 [Internet]. 2018 Nov 9; 1(7): e184468.
[12]	Fuss J, Briken P, Stein DJ, Lochner C. Compulsive sexual behavior disorder in obsessive-compulsive disorder: Prevalence and associated comorbidity. J Behav Addict;8(2): 242-8.
[13]	Castro-Calvo J, Gil-Llario MD, Giménez-García C, Gil-Juliá B, Ballester-Arnal R. Occurrence and clinical characteristics of Compulsive Sexual Behavior Disorder (CSBD): A cluster analysis in two independent community samples. J Behav Addict. 2020 June; 9(2): 446-68.
[14]	Compulsive Sexual Behavior Disorder and Problematic Pornography Use in the Context of Social Ties. ResearchGate. 2025 Aug 6.
[15]	Auctores. Sexual Disorders in ICD-11. Innovations and their Discussion. https://doi.org/10.31579/2637-8892/315
[16]	Briken P, Bőthe B, Carvalho J, Coleman E, Giraldi A, Kraus SW, et al. Assessment and treatment of compulsive sexual behavior disorder: a sexual medicine perspective.
[17]	Antons S, Engel J, Briken P, Krüger THC, Brand M, Stark R. Treatments and interventions for compulsive sexual behavior disorder with a focus on problematic pornography use: A preregistered systematic review. J Behav Addict. 2022 Sept 9; 11(3): 643-66.

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APA Style

Veeramani, M., Banu, F., Ajith, A. (2025). Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. American Journal of Psychiatry and Neuroscience, 13(4), 128-131. https://doi.org/10.11648/j.ajpn.20251304.12

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ACS Style

Veeramani, M.; Banu, F.; Ajith, A. Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. Am. J. Psychiatry Neurosci. 2025, 13(4), 128-131. doi: 10.11648/j.ajpn.20251304.12

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AMA Style

Veeramani M, Banu F, Ajith A. Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. Am J Psychiatry Neurosci. 2025;13(4):128-131. doi: 10.11648/j.ajpn.20251304.12

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@article{10.11648/j.ajpn.20251304.12,
  author = {Murugavel Veeramani and Farsana Banu and Akshay Ajith},
  title = {Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder
},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {13},
  number = {4},
  pages = {128-131},
  doi = {10.11648/j.ajpn.20251304.12},
  url = {https://doi.org/10.11648/j.ajpn.20251304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20251304.12},
  abstract = {Compulsive Sexual Behaviour Disorder (CSBD), newly recognized in ICD-11, is characterized by a persistent inability to control intense sexual impulses, leading to repetitive behaviours that cause significant distress or impairment. Previously misclassified as “sex addiction,” CSBD is now understood as an impulse-control disorder, with emerging evidence challenging addiction-based models and emphasizing emotional dysregulation and psychiatric comorbidities as key factors. Such factors play a pivotal role in informing our assessment and tailoring the therapeutic approach. This case series presents three adult males diagnosed with Compulsive Sexual Behavior Disorder (CSBD), each exhibiting distinct clinical profiles and comorbidities. Case 1 involved a 45-year-old with coronary artery disease, seizure disorder, and a history suggestive of conduct disorder, who presented with hypersexuality and moderate depressive symptoms; remission was achieved with sertraline (150 mg) over 14 weeks. Case 2 described a 25-year-old factory worker experiencing distress due to escalating sexual urges post-marriage; he responded well to fluoxetine (60 mg) and six sessions of cognitive behavioral therapy within 8 weeks. Case 3 featured a 55-year-old with schizophrenia and longstanding paraphilic interests, who achieved remission following inpatient treatment with long-acting antipsychotics and fluoxetine (60 mg) over 18 weeks. These cases highlight CSBD’s diverse manifestations and underscore the importance of nuanced diagnosis and individualized treatment with a significant role for the medication class SSRIs. Recognizing CSBD as distinct from addiction reshapes clinical perspectives and informs more effective interventions.
},
 year = {2025}
}

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TY  - JOUR
T1  - Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder

AU  - Murugavel Veeramani
AU  - Farsana Banu
AU  - Akshay Ajith
Y1  - 2025/11/26
PY  - 2025
N1  - https://doi.org/10.11648/j.ajpn.20251304.12
DO  - 10.11648/j.ajpn.20251304.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 128
EP  - 131
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20251304.12
AB  - Compulsive Sexual Behaviour Disorder (CSBD), newly recognized in ICD-11, is characterized by a persistent inability to control intense sexual impulses, leading to repetitive behaviours that cause significant distress or impairment. Previously misclassified as “sex addiction,” CSBD is now understood as an impulse-control disorder, with emerging evidence challenging addiction-based models and emphasizing emotional dysregulation and psychiatric comorbidities as key factors. Such factors play a pivotal role in informing our assessment and tailoring the therapeutic approach. This case series presents three adult males diagnosed with Compulsive Sexual Behavior Disorder (CSBD), each exhibiting distinct clinical profiles and comorbidities. Case 1 involved a 45-year-old with coronary artery disease, seizure disorder, and a history suggestive of conduct disorder, who presented with hypersexuality and moderate depressive symptoms; remission was achieved with sertraline (150 mg) over 14 weeks. Case 2 described a 25-year-old factory worker experiencing distress due to escalating sexual urges post-marriage; he responded well to fluoxetine (60 mg) and six sessions of cognitive behavioral therapy within 8 weeks. Case 3 featured a 55-year-old with schizophrenia and longstanding paraphilic interests, who achieved remission following inpatient treatment with long-acting antipsychotics and fluoxetine (60 mg) over 18 weeks. These cases highlight CSBD’s diverse manifestations and underscore the importance of nuanced diagnosis and individualized treatment with a significant role for the medication class SSRIs. Recognizing CSBD as distinct from addiction reshapes clinical perspectives and informs more effective interventions.

VL  - 13
IS  - 4
ER  -

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Author Information

Murugavel Veeramani

Department of Psychiatry, ESIC Medical College & Hospital, Chennai, India

Contact Email

http://orcid.org/0000-0001-5635-5212
Farsana Banu

Department of Psychiatry, ESIC Medical College & Hospital, Chennai, India

Contact Email

http://orcid.org/0009-0001-3636-1081
Akshay Ajith

Department of Psychiatry, ESIC Medical College & Hospital, Chennai, India

Contact Email

http://orcid.org/0009-0004-3276-7318

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Plain Text BibTeX RIS

APA Style

Veeramani, M., Banu, F., Ajith, A. (2025). Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. American Journal of Psychiatry and Neuroscience, 13(4), 128-131. https://doi.org/10.11648/j.ajpn.20251304.12

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ACS Style

Veeramani, M.; Banu, F.; Ajith, A. Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. Am. J. Psychiatry Neurosci. 2025, 13(4), 128-131. doi: 10.11648/j.ajpn.20251304.12

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AMA Style

Veeramani M, Banu F, Ajith A. Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder. Am J Psychiatry Neurosci. 2025;13(4):128-131. doi: 10.11648/j.ajpn.20251304.12

Copy | Download

@article{10.11648/j.ajpn.20251304.12,
  author = {Murugavel Veeramani and Farsana Banu and Akshay Ajith},
  title = {Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder
},
  journal = {American Journal of Psychiatry and Neuroscience},
  volume = {13},
  number = {4},
  pages = {128-131},
  doi = {10.11648/j.ajpn.20251304.12},
  url = {https://doi.org/10.11648/j.ajpn.20251304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajpn.20251304.12},
  abstract = {Compulsive Sexual Behaviour Disorder (CSBD), newly recognized in ICD-11, is characterized by a persistent inability to control intense sexual impulses, leading to repetitive behaviours that cause significant distress or impairment. Previously misclassified as “sex addiction,” CSBD is now understood as an impulse-control disorder, with emerging evidence challenging addiction-based models and emphasizing emotional dysregulation and psychiatric comorbidities as key factors. Such factors play a pivotal role in informing our assessment and tailoring the therapeutic approach. This case series presents three adult males diagnosed with Compulsive Sexual Behavior Disorder (CSBD), each exhibiting distinct clinical profiles and comorbidities. Case 1 involved a 45-year-old with coronary artery disease, seizure disorder, and a history suggestive of conduct disorder, who presented with hypersexuality and moderate depressive symptoms; remission was achieved with sertraline (150 mg) over 14 weeks. Case 2 described a 25-year-old factory worker experiencing distress due to escalating sexual urges post-marriage; he responded well to fluoxetine (60 mg) and six sessions of cognitive behavioral therapy within 8 weeks. Case 3 featured a 55-year-old with schizophrenia and longstanding paraphilic interests, who achieved remission following inpatient treatment with long-acting antipsychotics and fluoxetine (60 mg) over 18 weeks. These cases highlight CSBD’s diverse manifestations and underscore the importance of nuanced diagnosis and individualized treatment with a significant role for the medication class SSRIs. Recognizing CSBD as distinct from addiction reshapes clinical perspectives and informs more effective interventions.
},
 year = {2025}
}

Copy | Download

TY  - JOUR
T1  - Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder

AU  - Murugavel Veeramani
AU  - Farsana Banu
AU  - Akshay Ajith
Y1  - 2025/11/26
PY  - 2025
N1  - https://doi.org/10.11648/j.ajpn.20251304.12
DO  - 10.11648/j.ajpn.20251304.12
T2  - American Journal of Psychiatry and Neuroscience
JF  - American Journal of Psychiatry and Neuroscience
JO  - American Journal of Psychiatry and Neuroscience
SP  - 128
EP  - 131
PB  - Science Publishing Group
SN  - 2330-426X
UR  - https://doi.org/10.11648/j.ajpn.20251304.12
AB  - Compulsive Sexual Behaviour Disorder (CSBD), newly recognized in ICD-11, is characterized by a persistent inability to control intense sexual impulses, leading to repetitive behaviours that cause significant distress or impairment. Previously misclassified as “sex addiction,” CSBD is now understood as an impulse-control disorder, with emerging evidence challenging addiction-based models and emphasizing emotional dysregulation and psychiatric comorbidities as key factors. Such factors play a pivotal role in informing our assessment and tailoring the therapeutic approach. This case series presents three adult males diagnosed with Compulsive Sexual Behavior Disorder (CSBD), each exhibiting distinct clinical profiles and comorbidities. Case 1 involved a 45-year-old with coronary artery disease, seizure disorder, and a history suggestive of conduct disorder, who presented with hypersexuality and moderate depressive symptoms; remission was achieved with sertraline (150 mg) over 14 weeks. Case 2 described a 25-year-old factory worker experiencing distress due to escalating sexual urges post-marriage; he responded well to fluoxetine (60 mg) and six sessions of cognitive behavioral therapy within 8 weeks. Case 3 featured a 55-year-old with schizophrenia and longstanding paraphilic interests, who achieved remission following inpatient treatment with long-acting antipsychotics and fluoxetine (60 mg) over 18 weeks. These cases highlight CSBD’s diverse manifestations and underscore the importance of nuanced diagnosis and individualized treatment with a significant role for the medication class SSRIs. Recognizing CSBD as distinct from addiction reshapes clinical perspectives and informs more effective interventions.

VL  - 13
IS  - 4
ER  -

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