It's official - "Compulsive Sexual Behavior Disorder" is now in the World Health Org's diagnostic manual

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CSBD is an umbrella term that can be used to diagnose people struggling with porn addiction and sex addiction.

The ICD-11 is the most recent edition of the WHO's International Classification of Diseases, used by doctors worldwide. No doubt the DSM-5 (the mental health manual often promoted/used in the States...because the APA makes money from holding its copyright) will have to follow suit...eventually.

Text here (no longer "beta draft"):

Compulsive sexual behaviour disorder is characterized by a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behaviour. Symptoms may include repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health and personal care or other interests, activities and responsibilities; numerous unsuccessful efforts to significantly reduce repetitive sexual behaviour; and continued repetitive sexual behaviour despite adverse consequences or deriving little or no satisfaction from it. The pattern of failure to control intense, sexual impulses or urges and resulting repetitive sexual behaviour is manifested over an extended period of time (e.g., 6 months or more), and causes marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. Distress that is entirely related to moral judgments and disapproval about sexual impulses, urges, or behaviours is not sufficient to meet this requirement.


Good to know.

It is good to see this, Marnia. I am familiar with the DSM-5 but not so much with the ICD-11, but I know they both adhere to a medical model. I have studied and used the DSM-5 in my short stint as an addiction counselor. Things are not always so black and white when it comes to diagnosing individuals, so the criteria I feel (the standards) are only a guide. The approach of the medical model is not the only way to conceptualize disorders, and it can tend to be disempowering, IMO. I would personally rather a holistic approach, though I can certainly see the usefulness of the DSM-5 and the ICD-11 and how they might contribute to a diagnosis. Of course, there is a difference between sex addiction and sexual compulsion mainly having to do with motivation and level of awareness. This is something I'd like to learn more about. Thanks for the info!

I should add that

although the "implementation version" of the ICD-11 (considered "stable" and "complete" by the ICD-11) has just come out, it will be "blessed officially" next May by the World Health Assembly to take effect in 2022.

However, this diagnosis will have a powerful effect long before that. Researchers are already using the criteria for their research. Naysayers (with any integrity) will have to stop claiming the ICD has "rejected" a diagnosis for compulsive sexual behavior (whether its called "hypersexuality" "out of control sexual behavior" "porn addiction" or "sexual behavior addiction"), and I think that clinicians will also be less hesitant to diagnose using the existing "make-shift" DSM & ICD diagnoses they've been using up till now, knowing that the wind is clearly blowing toward recognizing this as a pathology.

Thanks again, Marnia

I find this all very interesting. It brought up some issues I'm dealing with internally due to my recent negative experience in the field of addictions. Perhaps I am still sort of cynical in a not so good way. I am very open though to what you are sharing.

I missed what you said about CBSD being an umbrella term. The description is very clear in stating what makes this a pathology. I'd be interested in knowing more about the treatment aspect of this diagnosis. Is there something similar to the ASAM (American Society of Addiction Medicine) that is used in connection with the ICD-11? (Maybe not such a good question, but there is a lot I don't know.)

I can certainly see the significance of this diagnosis, but I wonder what makes it so for you. This might be an odd question (maybe not), but do you think karezza can be a treatment consideration for CBSD?

icd-11 and billing insurance

I don't know about Karezza being offered as a treatment - but that would be lovely...

One thing that strikes me is that the ICD codes are important to the area of medical diagnosis and treatment because insurance companies pay (or don't pay) for procedures based on which ICD codes were used. In other words, now that CSBD has an actual ICD code, maybe folks who are struggling with extreme cases of it can have more treatment options available to them. I don't know how long it takes for something like that to filter down to insurance policies, but I could see it happening at some point.

Wouldn't that be cool if Karezza (as a treatment option) could get an ICD code too? Fact is, I don't need an insurance company to pay me to do is reward enough!

Not sure what's troubling you

But here's a short piece by two experts we respect describing why this diagnosis is useful:

Among other things, this diagnosis helps stop the "sexology denial" that results in some people with severe symptoms being told by irresponsible sexologists, "You don't have a problem; you just have high sexual desire."

It's an interesting commentary. Among other points it calls for research funding from porn sites and other stakeholders to investigate porn's effects. The gambling industry does something similar...with a double firewall to prevent industry influence.

We attended the ICBA 2018 in Cologne in April. Many believe that CSBD will eventually end up under "Disorders due to addictive behaviors," or maybe both there and under "Impulse control disorders" where it now resides. Gaming and gambling are currently under both.

There are prominent academics working toward a single set of criteria for addiction "as one disease" along the lines that ASAM promulgated in 2011. It's slow work, due to the stiff head winds blowing from large industries that benefit from hooked users (porn aggregators, gaming interests, and, of course, sexual enhancement drug mfgrs). It's easier for them to "divide and conquer." But inch by inch they are being pushed toward reality (and this new diagnosis is a big shove). As that happens, the propaganda just gets louder of course.

I don't think we need to hold our breath that karezza will be proposed as an intervention anytime soon. But it's great that it has quietly helped so many. I try to keep some accounts here: Karezza is for addicts (too)


This diagnosis also means that psychologists and psychiatrists will now receive training about this diagnosis and the problems it addresses. Without this, many publicly denied the existence of such problems.

My problem is not with CSBD

or the ICD-11, it is with the treatment industry. I just have some cynicism and wariness about it, having worked in it as an intern and having witnessed how things are done. As long as there is a profit involved there is likely to be some kind of corruption, I feel.

The sex industry (and any other industry that profits from consumers becoming addicted) and the treatment industry just seem to be a kind of feed-back loop. They support each other. I know that's a terribly cynical thing to say, but from my own experience I feel there is some truth to that. At the same time, I know that there are some very good treatment centers, clinicians, counselors, and therapists out there. But I think the industry could use some cleaning up and some reorientation from too much of a profit motive to something more altruistic, or more genuinely geared toward healing the client.

Where I once worked, for instance, I noticed how eager the staff was to get certain people into treatment simply because they had insurance, or some way to pay for it. I noticed as well how ineffective the treatments seemed to be.

That's just where I am with it. As for the two articles you posted, I think they are excellent!

Skepticism is always appropriate

But don't overlook the even larger amounts of money being made by the porn aggregators (via ads) and sexual enhancement drug mfgrs - whose paid "thought leaders" are saying nasty things about all treatment providers. What's the alternative? Denial of the problem? Discouraging people from seeking any professional help? It's messy.

Did you work in the sexual field?

Not per se,

but we did ask about sex abuse and/or sexual issues when doing the intake assessment. We were asked not to go in depth with those questions though if we felt it made the client uncomfortable. (At least a couple of the counselors/clinicians I worked with told me they would just skip that section altogether, which I thought was bizarre). Usually the "prospective" clients don't want to talk about sexual issues, or they just flat out deny they've had any abuse (or did anything abusive to someone else), which we later find out about as they begin to talk more in sessions. It's almost a rarity to find an addict or alcoholic who wasn't sexually abused as a child or an adolescent, or later in life. I am one of them. I was not repeatedly abused but the one incident that did occur with me had a strong negative effect on me (even though for many years I would block it out of my mind, or I would rationalize it as unimportant). I still get angry about it when I start to think about it, though not nearly as much as I used to. I didn't start talking about the abuse till just four years ago when I started seeing my current therapist. I've made a lot of progress with it, I feel.

Actually, now that I think of it, there were a couple of other incidents (maybe more) of sexual abuse in my 20's on occasions that I strongly suspect occurred when I'd had way too much to drink, or I was in a black out. I am and have always been heterosexual, but I found myself in some pretty strange (to me) places during those years when I was drinking and doing drugs.

Anyway, I may digressing. I hope that answers your question.

Forgot to mention

I was diagnosed as an alcoholic when I was 26 and I went to a treatment center. I had a relapse at the age of 30 and again went into treatment. Since then I have remained sober. I've been sober now for 31 years. I relied on AA for 10 years and by the age of 40 I became a Buddhist and relied on meditation to stay sober and to continue to grow spiritually.

A lot of clients at the treatment center where I was doing my intern last summer would end up with a dual diagnosis. I know that some who had sexual addiction were asked to attend Sexaholics Anonymous along with either Narcotics Anonymous or Alcoholics Anonymous, or some other alternative group.


on pulling yourself out of that powerful rut. Well done.

I've seen the stats on comorbidity between sex addiction and substance abuse. I think it was 40-60%. But recently, I heard a researcher report that among those with internet porn problems the rates of substance abuse were no more than in the general population. It seems sex addiction and porn addiction may turn out to be somewhat different (on the whole) - despite overlap.

It's a shame counselors shy away from asking such important questions. I'm sorry for what you went through.


It literally took moving across country to be in an environment suitable enough to accommodate my recovery. I moved from a rat race alcoholic environment to one surrounded by wilderness. I really believe being able to get out in the wild was a huge contributing factor in my success with overcoming the addictions.

As for CSA, it seems men are less likely to report their childhood sexual abuse and there are varying statistics on sexual assault that I've seen, from what I can remember. What I'm aware of now is that it is one in four women and one in six men who may be sexually assaulted in a lifetime.

This makes me think of the "adverse consequences" of CSBD. I wonder how much of that is linked with sexual assault perpetrators. Even the survivors go on to develop serious problems. Some survivors become perpetrators themselves. Sometimes whole families are involved, as with one case I just recently heard of.

Gabor Mate, a doctor who treats addicts up in Vancouver, BC, reported a very high rate of drug addiction among those who were sexually abused. I don't have the numbers off hand. I would think any kind of addiction, whether drugs, alcohol, porn or sex, can be driven by this, as well as other kinds of dysfunction among individuals, in families and in society as a whole.

So much for the "pursuit of happiness."

Had it backwards

I meant to say G. Mate reported a very high rate of sexual abuse among those who were addicts, not a high rate of addicts among those who were sexually abused.