Other Paraphilic Disorders and Compulsive Sexual Behaviour Disorder
Beyond the eight main conditions there are other paraphilias, and there is compulsive sexual behaviour disorder (CSBD), which is a different thing altogether. This article explains the difference and how they are treated.
Key points
- Other paraphilias follow the same principle as the main ones: they become a condition worth treating when they cause distress, damage your life or involve non-consenting people.
- CSBD (ICD-11 6C72) is a persistent failure to control sexual behaviour that damages your life. It does not depend on what you are into, and moral guilt alone does not count.
- The main treatment is psychotherapy and education. Medication is considered only for some people, by specialists.
Many patients come to see me saying, "I think I'm addicted to sex," or "I have an interest that's not like anyone else's, and I don't know which group it belongs to." This article brings together two things that are often confused: other paraphilias that are not among the eight main conditions, and compulsive sexual behaviour disorder (CSBD), which is not a paraphilia at all.
It is the final part of the Paraphilic Disorders series.
Other paraphilic disorders in DSM-5-TR
DSM-5-TR (2022) has two categories for cases that do not fit the eight main conditions:
- Other Specified Paraphilic Disorder is used when there is intense paraphilic sexual arousal lasting at least 6 months that causes distress or damage to daily life, and the clinician can name the type. Examples given in textbooks include obscene phone calls or messages to non-consenting people (telephone scatologia), sexual interest in animals (zoophilia), in corpses (necrophilia), or in certain bodily fluids, some of which are close to a fetish.
- Unspecified Paraphilic Disorder is used when the symptoms are clear but the clinician has not specified the type, or there is not yet enough information.
ICD-11 divides these by consent: 6D35 is other paraphilic disorder involving non-consenting individuals, and 6D36 is paraphilic disorder involving solitary behaviour or consenting individuals, which is used only when there is marked distress (not simply due to rejection by others) or a significant risk of serious injury or death.
A preference vs a condition that needs treatment
The same principle as every article in this series:
| Not a condition that needs treatment | Should be assessed |
|---|---|
| An unusual interest that stays within yourself or between consenting adults | Involves people who have not consented or cannot consent, such as children, animals or unconscious people |
| No distress, normal life | Marked distress, preoccupation that costs you work, money or relationships |
| Physically safe | Risk of infection, injury or danger to life |
Sending obscene messages or images to people who did not ask for them, which is similar to exhibitionistic disorder in the digital world, is sexual harassment. Since 30 December 2025 it has been an offence under Section 284/1 of the Thai Criminal Code, with heavier penalties when done online or towards a child. Sexual acts with animals count as animal cruelty, because animals cannot consent.
What is compulsive sexual behaviour disorder (CSBD)?
ICD-11 classifies CSBD under code 6C72, in the group of impulse control disorders, not among the paraphilias, and it does not call it an "addiction". Its key features are:
- A persistent failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behaviour.
- Sexual activity becoming the centre of life, to the point of neglecting health, self-care or other responsibilities.
- Many unsuccessful attempts to cut down.
- Continuing despite negative consequences, or even when it brings little or no satisfaction any more.
- A pattern that lasts a long time (for example, 6 months or more) and causes marked distress or damage to daily life.
A very important point is that distress that comes entirely from moral judgments or disapproval of your own sexual behaviour does not meet the criteria for CSBD. Research on moral incongruence (Grubbs et al., 2019) found that many people who feel they are "addicted to porn" do not watch more than others, but feel guilty because it conflicts with their own values. That needs a different kind of care.
DSM-5-TR has no diagnosis of CSBD or "hypersexual disorder". One was proposed, but it was not included.
How does CSBD differ from a paraphilia?
- A paraphilia asks "what are you aroused by?": the pattern or target of sexual interest.
- CSBD asks "how much control do you have?", whether or not the interest is a common one.
Some people have both, and a doctor will assess them separately.
DSM-5-TR has no diagnosis of CSBD or hypersexual disorder.
Paraphilia
What arouses
- The pattern or target of sexual interest
- ICD-11 block 6D30–6D3Z
- A disorder when distressing, harmful or involving non-consenting people
CSBD
How controllable
- Interest may be ordinary or not
- ICD-11 6C72, impulse-control group
- Not called an "addiction"
Some people have both. Doctors assess them separately.
What often comes with CSBD
Depression, anxiety, ADHD, alcohol or substance use, and using sex to cope with stress or loneliness. Some people use stimulants with sex, which raises the risks to both mental health and infection. Read more in What is chemsex and how to reduce harm. If you often have sexual risk, it is worth knowing about PrEP for HIV prevention and testing for sexually transmitted infections.
Assessment and treatment
Assessment looks at the behaviour, its duration, its effect on your life and co-occurring conditions, and separates out whether the distress comes from genuine loss of control or from a conflict with your values.
Education and psychotherapy are always the first-line approach, according to the WFSBP guidelines on CSBD (Turner et al., 2022).
- CBT to understand the cycle of triggers and practise skills to manage urges.
- Acceptance and commitment therapy (ACT) and mindfulness training help you sit with urges without acting on them. See Mindful sex.
- Couples therapy when the relationship has been affected.
- Treating co-occurring conditions such as depression, ADHD or substance use.
Medication: there is no medicine specifically approved for CSBD. The WFSBP (2022) guidelines state that SSRIs and naltrexone are the options with the most supporting evidence, chosen according to severity and co-occurring conditions. Hormone-lowering medication is considered only when there is also a high-risk paraphilic disorder. In every case, medication must be assessed and prescribed by a doctor. For the effects of antidepressants on your sex life, read Antidepressants killed my sex drive: what can I do?
Where to get help
- Talk confidentially with a clinical sexologist. See When to see a clinical sexologist.
- 1323, Thailand's free mental-health hotline (Thai language; ask for English support), when you are distressed or feel you cannot control yourself.
- If you have sexual feelings involving children, read Pedophilic disorder: prevention and getting help and seek help right away.
Dr. Kris Clinic offers clinical sexology consultations, initial screening and referral to a psychiatrist when needed, at the clinic and online, including in English, without judgment.
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Frequently asked questions
Is sex addiction a real condition?
ICD-11 includes compulsive sexual behaviour disorder (6C72) for people who persistently cannot control their sexual behaviour to the point that it damages their life. It is not called an addiction, and DSM-5-TR does not have this diagnosis.
If I watch a lot of porn and feel guilty, does that mean I have CSBD?
Not necessarily. If the distress comes only from a conflict with your values, it does not meet the criteria for CSBD. It is still something you can talk through with a professional.
What is the difference between CSBD and a paraphilia?
A paraphilia is an unusual pattern of sexual interest. CSBD is a loss of control over sexual behaviour, whatever the interest is.
Can CSBD be treated with medication?
The main approach is psychotherapy and education. For some people, a doctor may consider an SSRI or naltrexone after assessment.
อ่านบทความนี้เป็นภาษาไทย
Paraphilic Disorder รูปแบบอื่น และ Compulsive Sexual Behavior Disorder →
References
- American Psychiatric Association. DSM-5-TR. 2022. Other Specified Paraphilic Disorder; Unspecified Paraphilic Disorder.
- World Health Organization. ICD-11 MMS. 6C72 Compulsive sexual behaviour disorder; 6D35 and 6D36.
- Kraus SW, Krueger RB, Briken P, et al. Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry. 2018;17(1):109–110.
- Turner D, Briken P, Grubbs J, et al. The WFSBP guidelines on the assessment and pharmacological treatment of compulsive sexual behaviour disorder. Dialogues in Clinical Neuroscience. 2022;24(1):10–69.
- Grubbs JB, Perry SL, Wilt JA, Reid RC. Pornography Problems Due to Moral Incongruence: An Integrative Model with a Systematic Review and Meta-Analysis. Archives of Sexual Behavior. 2019;48(2):397–415.
This article is for education and does not replace diagnosis or treatment by a doctor. If you have symptoms or concerns, please see a doctor.
