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      Promoting educational, classification, treatment, and policy initiatives : Commentary on: Compulsive sexual behaviour disorder in the ICD-11 (Kraus et al., 2018)


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          The letter by Kraus et al. (2018) published recently in World Psychiatry presents diagnostic criteria for compulsive sexual behaviors (CSBs). Here, we discuss the potential impact of including CSB disorder in ICD-11 for four areas: educational efforts related to CSB (for both clinicians and patients), investigation of underlying mechanisms and subtypes, development of personalized treatment frameworks, and answering socially important questions and advancing important prevention efforts and effective policies. Each of these four areas has their own challenges that should be addressed, and we briefly describe and discuss them. We hope that this information will help continue a dialog and provide a framework for moving forward in this area.

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          Hypersexual disorder: a proposed diagnosis for DSM-V.

          Hypersexual Disorder is proposed as a new psychiatric disorder for consideration in the Sexual Disorders section for DSM-V. Historical precedents describing hypersexual behaviors as well as the antecedent representations and proposals for inclusion of such a condition in the previous DSM manuals are reviewed. Epidemiological as well as clinical evidence is presented suggesting that non-paraphilic "excesses" of sexual behavior (i.e., hypersexual behaviors and disorders) can be accompanied by both clinically significant personal distress and social and medical morbidity. The research literature describing comorbid Axis I and Axis II psychiatric disorders and a purported relationship between Axis I disorders and Hypersexual Disorder is discussed. Based on an extensive review of the literature, Hypersexual Disorder is conceptualized as primarily a nonparaphilic sexual desire disorder with an impulsivity component. Specific polythetic diagnostic criteria, as well as behavioral specifiers, are proposed, intended to integrate empirically based contributions from various putative pathophysiological perspectives, including dysregulation of sexual arousal and desire, sexual impulsivity, sexual addiction, and sexual compulsivity.
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            Compulsive sexual behaviour disorder in the ICD-11

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              Neural Correlates of Sexual Cue Reactivity in Individuals with and without Compulsive Sexual Behaviours

              Although compulsive sexual behaviour (CSB) has been conceptualized as a “behavioural” addiction and common or overlapping neural circuits may govern the processing of natural and drug rewards, little is known regarding the responses to sexually explicit materials in individuals with and without CSB. Here, the processing of cues of varying sexual content was assessed in individuals with and without CSB, focusing on neural regions identified in prior studies of drug-cue reactivity. 19 CSB subjects and 19 healthy volunteers were assessed using functional MRI comparing sexually explicit videos with non-sexual exciting videos. Ratings of sexual desire and liking were obtained. Relative to healthy volunteers, CSB subjects had greater desire but similar liking scores in response to the sexually explicit videos. Exposure to sexually explicit cues in CSB compared to non-CSB subjects was associated with activation of the dorsal anterior cingulate, ventral striatum and amygdala. Functional connectivity of the dorsal anterior cingulate-ventral striatum-amygdala network was associated with subjective sexual desire (but not liking) to a greater degree in CSB relative to non-CSB subjects. The dissociation between desire or wanting and liking is consistent with theories of incentive motivation underlying CSB as in drug addictions. Neural differences in the processing of sexual-cue reactivity were identified in CSB subjects in regions previously implicated in drug-cue reactivity studies. The greater engagement of corticostriatal limbic circuitry in CSB following exposure to sexual cues suggests neural mechanisms underlying CSB and potential biological targets for interventions.

                Author and article information

                Journal of Behavioral Addictions
                J Behav Addict
                Akadémiai Kiadó (Budapest )
                12 June 2018
                June 2018
                : 7
                : 2
                : 208-210
                [ 1 ]Clinical Neuroscience Laboratory, Institute of Psychology, Polish Academy of Sciences , Warsaw, Poland
                [ 2 ]Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego , San Diego, CA, USA
                [ 3 ]Departments of Psychiatry and Neurobiology, Child Study Center and CASAColumbia, Yale School of Medicine , New Haven, CT, USA
                [ 4 ] Connecticut Mental Health Center , New Haven, CT, USA
                Author notes
                [* ]Corresponding author: Mateusz Gola, PhD; Swartz Center for Computational Neuroscience, Institute for Neural Computations, University of California San Diego, 9500 Gilman Drive, San Diego, CA 92093 0559, USA; Phone: +1 858 500 2554; Office phone: +1 858 822 7543; E-mail: mgola@ 123456ucsd.edu
                © 2018 The Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium for non-commercial purposes, provided the original author and source are credited, a link to the CC License is provided, and changes – if any – are indicated.

                : 27 February 2018
                : 16 May 2018
                : 19 May 2018
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 3
                Funding sources: This commentary was supported by the Polish National Science Centre grant for MG (project number: 2014/15/B/HS6/03792). Dr. MNP’s involvement was supported by the National Center for Responsible Gaming Center of Excellence in Gambling Research grant. The content of the manuscript reflects the views of the authors and not necessarily the funding agencies. The funding agencies did not have input into the content of the manuscript.

                Evolutionary Biology,Medicine,Psychology,Educational research & Statistics,Social & Behavioral Sciences
                sex addiction,hypersexual disorder,ICD-11,compulsive sexual behavior,problematic pornography use


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