WHO-Dunnit! ICD-11 and Compulsive Sexual Behavior Disorder

‘Compulsive Sexual Behavior Disorder’ Will Soon Be Diagnosable Using the ICD 

SASH, sex addiction, Marnia Robinson
Marnia Robinson, sexual health advocate.

In 2013 the editors of the Diagnostic and Statistical Manual (DSM-5), manual of mental health diagnoses, declined to add a disorder called “Hypersexual Disorder.” This has caused major problems, according to experts:

This exclusion has hindered prevention, research, and treatment efforts, and left clinicians without a formal diagnosis for compulsive sexual behaviour disorder.

The World Health Organization (WHO) publishes its own diagnostic manual, known as the International Classification of Diseases (ICD), which includes diagnostic codes for all known diseases, including mental health disorders. It is used worldwide, and it is published under an open copyright.

The APA promotes the use of the DSM instead of the ICD. Elsewhere in the world, however, most practitioners rely on the free ICD. The code numbers in both manuals conform to the ICD.

The next edition of the ICD, the ICD-11, is due out sometime in 2018. Unlike the DSM-5 editors, the editors of the ICD-11 propose to include a new diagnosis that would encompass those with disorders relating to sexual behavior addictions. Here’s the current proposed language:

ICD, SASH, sex addiction

6C92 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.

This new “Compulsive sexual behaviour disorder” (CSBD) diagnosis is critically important. In addition to offering caregivers a suitable diagnosis for those who require treatment, the existence of a formal diagnosis in the world’s premier medical manual will facilitate future research. Without a formal diagnosis, some sexology journals and professional magazines have not published related research and commentary. This has hindered mainstream recognition of the risks of this disorder.

So, has the ICD-11 “rejected” sexual behavior addictions? Not for now. In fact, experts who serve on the ICD-11 (including Geoffrey Reed who is in charge of all of the mental disorder diagnoses for the ICD-11) clarified the ICD-11 position in a new piece in World Psychiatry (the world’s top-ranked psychiatry journal).

The authors make it clear that the ICD-11 has not ruled out that compulsive sexual behaviors may indeed be addictions (by whatever name). Instead, the ICD-11 has adopted a conservative, wait-and-see approach while further research is published.

...Currently, there is an active scientific discussion about whether compulsive sexual behaviour disorder can constitute the manifestation of a behavioural addiction. For ICD-11, a relatively conservative position has been recommended, recognizing that we do not yet have definitive information on whether the processes involved in the development and maintenance of the disorder are equivalent to those observed in substance use disorders, gambling and gaming. For this reason, compulsive sexual behaviour disorder is not included in the ICD-11 grouping of disorders due to substance use and addictive behaviours, but rather in that of impulse control disorders. The understanding of compulsive sexual behaviour disorder will evolve as research elucidates the phenomenology and neurobiological underpinnings of the condition.

This is the same strategy once used with respect to “gambling disorder.” When gambling was first given a medical diagnosis it too was characterized as an “impulse control disorder” while it was further investigated. Many hundreds of studies later, gambling disorder has now been characterized in the ICD-11 as a ‘disorder due to addictive behavior’.

Who knows what will become of CSBD in the future? The important point is that when the new ICD-11 is published those with problematic sexual behavior (by whatever name) will be diagnosable using the new CSBD. How insurance companies will respond is another matter, of course.

Marnia Robinson is a former corporate attorney who writes about the effects of evolutionary biology on intimate relationships and blogs on Huffington Post.

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