Compulsive sexual behavior disorder: clinical characteristics and treatment with Naltrexone

Abstract: Background: Compulsive Sexual Behavior Disorder (CSBD) is characterized by sexual preoccupation and loss of control of sexual behaviors causing distress, negative consequences, and impairment. Despite its high prevalence, the condition is understudied in terms of background factors and treatment. Aims: The overall aim of this thesis is to investigate clinical characteristics with a specific focus on self-reported experience of interpersonal violence and various dimensions of impulsivity, and to evaluate treatment with naltrexone in help-seeking men with CSBD. Methods: In Study I, 67 men with CSBD were compared with 40 healthy, age-matched controls concerning interpersonal violence measured with the Karolinska Interpersonal Violence Scale (KIVS). In Study II, clinical, neurocognitive, and self-reported measures of impulsivity were compared between men with CSBD (n=20), a clinical control cohort with pedophilic disorder (n=55), and a healthy male control cohort (n=57). In Study III, 20 men with CSBD received four weeks of treatment with the opioid antagonist naltrexone, followed by a four-week follow-up phase. Adverse effects, adherence to treatment, and changes in compulsive sexual behavior were assessed. Study IV is an ongoing randomized controlled trial in which 80 individuals with CSBD receive either naltrexone or the selective serotonin reuptake inhibitor (SSRI) fluoxetine for eight weeks, followed by a six-week follow-up phase. The primary outcome measure is Hypersexual Disorder: Current Assessment Scale (HD:CAS), also used in Study III.Results: In Study I, men with CSBD had higher scores on self-reports of exposure to violence in childhood and use of violence as adults, as well as higher KIVS total scores compared with healthy controls. Those who had made a suicide attempt (n=8, 12%) reported higher scores of sexual abuse in childhood as well as the highest value of total experience of interpersonal violence. In Study II, neurodevelopmental disorders were common in both clinical cohorts, both of which also reported more compulsive sexuality and attentional impulsivity than controls. Self-reported attentional impulsivity was the only independent positive predictor of compulsive sexual behavior. In Study III, despite initial adverse effects being common, naltrexone was found tolerable and the study procedures were feasible. Self-reported measures of compulsive sexual behavior decreased during treatment with naltrexone. Conclusion: Interpersonal violence may be related to suicidal behavior in CSBD; and attentional impulsivity is linked to the level of compulsive sexual behavior. Screening for interpersonal violence and neurodevelopmental disorders should be part of routine assessment in disorders of problematic sexuality. Treatment with naltrexone was tolerable and might be a suitable option for treatment in CSBD if found efficacious in the ongoing randomized controlled trial.