Exploring Psychiatric Heterogeneity in Compulsive Sexual Behaviour Disorder

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.