Volume 4, No. 9, p663–664, September 2017
DOI: http://dx.doi.org/10.1016/S2215-0366(17)30316-4
Marc N Potenza, Mateusz Gola, Valerie Voon, Ariel Kor, Shane W Kraus
In their Comment in The Lancet Psychiatry, John B Saunders and colleagues1 aptly described current debates regarding the consideration and classification of gambling and gaming disorders as addictive disorders, which occurred during the generation of DSM-52 and in anticipation of ICD-11.3 Compulsive sexual behaviour disorder is being proposed as an impulse-control disorder for ICD-11.3 However, we believe the logic applied by Saunders and colleagues1 might also apply to compulsive sexual behaviour disorder.
Compulsive sexual behaviour disorder (operationalised as hypersexual disorder) was considered for inclusion in DSM-5 but ultimately excluded, despite the generation of formal criteria and field trial testing.2 This exclusion has hindered prevention, research, and treatment efforts, and left clinicians without a formal diagnosis for compulsive sexual behaviour disorder.
Research into the neurobiology of compulsive sexual behaviour disorder has generated findings relating to attentional biases, incentive salience attributions, and brain-based cue reactivity that suggest substantial similarities with addictions.4 Compulsive sexual behaviour disorder is being proposed as an impulse-control disorder in ICD-11, consistent with a proposed view that craving, continued engagement despite adverse consequences, compulsive engagement, and diminished control represent core features of impulse-control disorders.5 This view might have been appropriate for some DSM-IV impulse-control disorders, specifically pathological gambling. However, these elements have long been considered central to addictions, and in the transition from DSM-IV to DSM-5, the category of Impulse Control Disorders Not Elsewhere Classified was restructured, with pathological gambling renamed and reclassified as an addictive disorder.2 At present, the ICD-11 beta draft site lists the impulse-control disorders, and includes compulsive sexual behaviour disorder, pyromania, kleptomania, and intermittent explosive disorder.3
There are both pros and cons regarding the classification of compulsive sexual behaviour disorder as an impulse-control disorder. On one hand, inclusion of compulsive sexual behaviour disorder in ICD-11 could improve consistency in diagnosis, treatment, and study of individuals with this disorder. On the other hand, classification of compulsive sexual behaviour disorder as an impulse-control disorder as opposed to an addictive disorder might negatively influence treatment and study by limiting treatment availability, treatment training, and research efforts. Compulsive sexual behaviour disorder seems to fit well with non-substance addictive disorders proposed for ICD-11, consistent with the narrower term of sex addiction currently proposed for compulsive sexual behaviour disorder on the ICD-11 draft website.3 We believe that classification of compulsive sexual behaviour disorder as an addictive disorder is consistent with recent data and might benefit clinicians, researchers, and individuals suffering from and personally affected by this disorder.
VV reports grants from the Medical Research Council. MNP reports grants and other support from the National Center for Responsible Gaming and the National Center on Addiction and Substance Abuse. All other authors declare no competing interests.
References
- Saunders, JB, Degenhardt, L, and Farrell, M. Excessive gambling and gaming: addictive disorders?. Lancet Psychiatry. 2017; 4: 433–435
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Association Publishing, Arlington; 2013
- WHO. ICD-11 beta draft. ((accessed July 18, 2017).) http://apps.who.int/classifications/icd11/browse/l-m/en Date: 2017
- Kraus, SW, Voon, V, and Potenza, MN. Should compulsive sexual behavior be considered an addiction?. Addiction. 2016; 111: 2097–2106
- Grant, JE, Atmaca, M, Fineberg, NA et al. Impulse control disorders and “behavioural addictions” in the ICD-11. World Psychiatry. 2014; 13: 125–127
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