Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI)

1. Abstract

The Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) is an internationally validated screening instrument and diagnostic assessment measure developed by Joshua B. Grubbs and an international consortium of psychometricians and clinical scientists (Grubbs et al., 2023). Designed to operationalize the clinical criteria established for Compulsive Sexual Behavior Disorder (CSBD; code 6C72) in the World Health Organization’s International Classification of Diseases, Eleventh Revision (ICD-11), the inventory also bridges the historical diagnostic criteria formulated for Hypersexual Disorder (HD) proposed for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The inventory consists of a 9-item research pool and a refined 7-item core diagnostic screener that explicitly probes the 6-month temporal requirement outlined in the ICD-11 diagnostic guidelines.

Psychometrically evaluated across large-scale, cross-national community and nationally representative samples from the United States, Poland, Hungary, Germany, and Malaysia (totaling over 10,000 respondents), the 7-item core CSBD-DI demonstrates a unidimensional latent factor structure with exceptional model fit across diverse sociocultural and linguistic contexts. Confirmatory factor analysis (CFA) supports residual (strict) measurement invariance across national samples (United States, Poland, and Hungary) and scalar (strong) invariance across gender identities. Internal consistency estimates across non-clinical, community, and nationally representative samples demonstrate robust reliability, with Cronbach’s alpha ($lpha$) and McDonald’s omega ($\omega$) coefficients routinely ranging between 0.78 and 0.82 in representative cohorts, alongside standardized factor loadings exceeding 0.47 for core items. Receiver Operating Characteristic (ROC) curve analyses indicate that an endorsement threshold of $ge 1$ or $ge 2$ active symptoms over the past 6 months provides optimal balance between clinical sensitivity and specificity for preliminary triage and epidemiological screening. The CSBD-DI provides clinicians and behavioral researchers with an empirical, non-pathologizing instrument that discriminates between normative high sexual desire, moral incongruence, and true compulsive sexual dysregulation.

2. Keywords

Compulsive Sexual Behavior Disorder, CSBD-DI, ICD-11, Hypersexual Disorder, Behavioral Addiction, Psychometrics, Measurement Invariance, Sexual Health, Screening Tool, Diagnostic Assessment, Impulse Control Disorders

3. Authors

The Compulsive Sexual Behavior Disorder Diagnostic Inventory was created through an international collaboration of clinical psychologists, psychiatrists, and behavioral addiction researchers:

• Joshua B. Grubbs, Ph.D. (Corresponding Author) — Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA (ORCID: 0000-0002-2642-1351; Email: [email protected]).
• Rory C. Reid, Ph.D., LCSW — Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles (UCLA), Los Angeles, California, USA (ORCID: 0000-0001-5706-7749).
• Beáta Bőthe, Ph.D. — Département de Psychologie, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada (ORCID: 0000-0003-2718-4703).
• Zsolt Demetrovics, Ph.D. — Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar (ORCID: 0000-0001-5604-7551).
• Eli Coleman, Ph.D. — Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
• Neil Gleason, Ph.D. — Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA.
• Michael H. Miner, Ph.D. — Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
• Johannes Fuss, M.D. — Institute of Forensic Psychiatry and Sex Research, University of Duisburg-Essen, Essen, Germany.
• Verena Klein, Ph.D. — School of Psychology, University of Southampton, Southampton, United Kingdom (ORCID: 0000-0002-5830-7991).
• Karol Lewczuk, Ph.D. — Institute of Psychology, Cardinal Stefan Wyszyński University in Warsaw, Warsaw, Poland (ORCID: 0000-0003-2437-2450).
• Mateusz Gola, Ph.D. — Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland; Department of Psychiatry, University of California San Diego, La Jolla, California, USA.
• David P. Fernandez, Ph.D. — International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, United Kingdom.
• Elaine F. Fernandez, Ph.D. — Department of Psychology, HELP University, Kuala Lumpur, Malaysia; Independent Practice.
• Stefanie Carnes, Ph.D. — International Institute for Trauma and Addiction Professionals (IITAP), Carefree, Arizona, USA.
• Michal Lew-Starowicz, M.D., Ph.D. — Department of Psychiatry, Centre of Postgraduate Medical Education, Warsaw, Poland.
• Drew A. Kingston, Ph.D. — Institute of Mental Health Research, Royal Ottawa Health Care Group, Ottawa, Ontario, Canada.
• Shane W. Kraus, Ph.D. — Department of Psychology, University of Nevada Las Vegas, Las Vegas, Nevada, USA (ORCID: 0000-0002-0404-9480).

4. Purpose

The primary purpose of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) is to serve as an empirically validated, brief screening assessment and clinical diagnostic evaluation tool calibrated specifically against contemporary international nosological standards. For several decades, the clinical study and psychometric measurement of dysregulated sexual behavior were hindered by contentious diagnostic nomenclature, conceptual ambiguities, and unstandardized psychometric instruments. Historical terms such as “sexual addiction,” “nymphomania,” “satyriasis,” “hypersexuality,” and “sexual compulsivity” often conflated frequent sexual behavior, unconventional sexual preferences, non-pathological high libido, and subjective distress stemming from moral, religious, or sociocultural disapproval with genuine psychiatric impairment (Kraus et al., 2018).

With the formal codification of Compulsive Sexual Behavior Disorder (CSBD; code 6C72) under the category of Impulse Control Disorders in the World Health Organization’s ICD-11, the field required an updated psychometric tool that strictly reflects the diagnostic criteria established by international consensus. The ICD-11 defines CSBD as a persistent pattern of failure to control intense, repetitive sexual impulses or urges resulting in repetitive sexual behavior over an extended period (typically 6 months or longer), characterized by: (a) repetitive sexual activities becoming a central focus of the person’s life to the point of neglecting health, personal care, or other interests, activities, and responsibilities; (b) numerous unsuccessful efforts to significantly reduce repetitive sexual behavior; (c) continued engagement in repetitive sexual behavior despite adverse consequences or deriving little to no satisfaction from it; and (d) marked distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.

The CSBD-DI was engineered to achieve three primary clinical and academic objectives:

• Diagnostic Congruence with ICD-11 and DSM-5 Criteria: Unlike legacy instruments that relied on idiosyncratic behavioral definitions or unvalidated operationalizations of addiction models, the CSBD-DI items were drafted, vetted, and finalized by subject-matter experts to mirror the formal diagnostic criteria of ICD-11 CSBD while also capturing core elements of the Hypersexual Disorder criteria previously proposed for the DSM-5 (Kafka, 2010; Grubbs et al., 2023).
• Differentiation of Pathology from Moral Incongruence: An enduring problem in sexuality research is moral incongruence, where individuals with conservative, moral, or religious beliefs experience intense guilt, self-directed distress, or perceived addiction regarding normative sexual behaviors such as masturbation or pornography viewing, even in the complete absence of behavioral dyscontrol or functional life impairment (Grubbs et al., 2020). The ICD-11 explicit exclusionary guidelines state that distress related entirely to moral judgments and disapproval about sexual impulses that would otherwise not cause functional disruption is insufficient for a diagnosis. The CSBD-DI operationalizes behavioral impairment, loss of control, and persistence despite tangible negative consequences, mitigating false-positive misclassifications driven solely by moral incongruence.
• Cross-National Screening and Epidemiological Utility: The inventory was constructed to support epidemiological surveillance, international comparative research, and primary psychiatric triage. By evaluating both active symptoms (present $ge 6$ months during the past year) and lifetime history, clinicians can differentiate between ongoing active psychiatric disorders, historical episodes in remission, and lifetime absence of symptoms.

5. Psychological Construct

The CSBD-DI assesses the multidimensional construct of compulsive sexual behavior disorder, conceptualized within the framework of impulse control dysregulation and behavioral addictions. The instrument captures key operational dimensions:

Loss of Behavioral Control and Compulsive Urges

At the center of CSBD is the impaired capacity to inhibit, regulate, or stop repetitive sexual behaviors. Clinically, this manifests as an inability to control intrusive sexual urges and fantasies, leading to behavioral enactments that violate personal boundaries or pre-established self-commitments. In the CSBD-DI, this construct is represented by items assessing subjective loss of control over sexual urges and repeated failures in sustained efforts to reduce, limit, or stop sexual behavior. Individuals experiencing this dimension often engage in cyclical attempts at abstinence or moderation, followed by rapid relapse and escalations in compulsive enactments.

Preoccupation and Functional Neglect

This dimension operationalizes the disproportionate allocation of psychological, cognitive, and temporal resources toward sexual pursuits. Compulsive sexual activity becomes the organizing axis of the individual’s daily life, crowding out normative developmental, occupational, relational, and physical health activities. The construct captures the extensive time consumed not only in executing sexual acts (such as continuous hours spent viewing pornography, cybersex, engaging in anonymous sexual encounters, or frequenting adult entertainment venues) but also in the cognitive planning, searching, arranging, and subsequent physical or emotional recovery required. As a consequence, physical health, personal hygiene, sleep architecture, familial commitments, and vocational obligations are progressively neglected.

Persistence Despite Adverse Consequences

A hallmark indicator of behavioral compulsivity is continued enactment of the behavior in the face of cumulative, severe, and tangible negative outcomes. This construct reflects behavioral persistence despite demonstrable relationship dissolution, professional reprimands or job loss, substantial financial debt, medical complications (such as recurrent sexually transmitted infections or genital physical trauma), or legal entanglements. In individuals without CSBD, encountering adverse consequences typically induces behavioral cessation or modification; in individuals with CSBD, the behavioral pattern persists undeterred, demonstrating profound reward hypersensitivity, risk neglect, and executive inhibitory dysfunction.

Diminution of Sexual Reward (Anhedonic Enactment)

A critical symptom unique to the ICD-11 diagnostic conceptualization of CSBD is the phenomenon wherein repetitive sexual behaviors persist even when the individual derives little, negligible, or no sexual pleasure or psychological satisfaction from the act. This reflects an operational divergence between “wanting” (incentive salience, craving) and “liking” (hedonic consumption), a neurobiological pattern characteristic of advanced addictive and compulsive processes. Sexual behavior shifts from appetitive, pleasure-seeking activity toward automated, stereotypic, ego-dystonic execution driven by compulsion or internal tension relief rather than authentic hedonic gratification.

Distress and Functional Impairment

The construct requires marked, clinically significant distress or functional disability in key life domains, including intimate relationships, family systems, peer networks, educational advancement, and occupational performance. Importantly, following ICD-11 guidance, this distress must stem directly from the behavioral dyscontrol and functional sequelae of the actions rather than exclusively from guilt, shame, or moral conflict regarding the moral acceptability of the sexual thoughts or acts.

Mood Regulation and Coping (Proposed DSM-5 Hypersexual Disorder Dimension)

The extended 9-item pool of the CSBD-DI incorporates two exploratory items evaluating the utilization of sexual behavior as an avoidant coping strategy or emotional regulation mechanism in response to dysphoric emotional states (such as anxiety, depression, boredom, or stress) and adverse life events. While these coping manifestations constituted core diagnostic criteria in Kafka’s (2010) proposed DSM-5 criteria for Hypersexual Disorder, the World Health Organization’s ICD-11 working group excluded them as necessary diagnostic criteria for CSBD, categorizing them instead as non-essential associated features. Consequently, while the full 9-item inventory retains these items for exploratory and comparative research, the psychometrically superior 7-item core CSBD-DI isolates the formal ICD-11 diagnostic criteria.

6. Theoretical Framework

The conceptual architecture of the CSBD-DI is rooted in complementary neurobiological, cognitive-behavioral, and psychiatric theoretical models of behavioral addiction and impulse control disorders:

Incentive-Sensitization Theory of Addiction

Adapted from the foundational work of Robinson and Berridge (1993), the incentive-sensitization theory posits that repeated engagement in highly rewarding, dopamine-stimulating behaviors produces progressive, persistent neuroadaptations in mesocorticolimbic dopamine circuits. Specifically, the neural systems mediating the subjective attribution of incentive salience (“wanting”) become hyper-sensitized to conditioned sexual cues, whereas the neural circuits underlying the hedonic reward experience (“liking”) remain unchanged or exhibit tolerance. This dissociation provides the theoretical foundation for the CSBD-DI item assessing persistent behavior despite “little or no sexual satisfaction”: the compulsive drive to engage in the behavior intensifies even as the emotional and physical pleasure derived from it diminishes.

Dual-System and Executive Impairment Models

Cognitive neuroscience frameworks of impulse control disorders conceptualize dysregulated behavior as an imbalance between two competing neurocognitive networks: an overactive, hyper-responsive bottom-up impulsive/reward system (anchored in the ventral striatum and amygdala) and an under-functioning, compromised top-down reflective/inhibitory control system (localized within the dorsolateral prefrontal cortex, anterior cingulate cortex, and inferior frontal gyrus) (Brand et al., 2016; Brand et al., 2019). In individuals with CSBD, acute exposure to sexual stimuli precipitates cue-reactivity, attentional bias, and intense craving, triggering an executive overload where top-down self-regulatory control collapses. This theoretical structure directly underpins the CSBD-DI items evaluating the subjective feeling of being unable to control urges and repeated failures to moderate or cease the behavior.

The Interaction of Person-Affect-Cognition-Execution (I-PACE) Model

Developed by Brand et al. (2019), the I-PACE model offers a comprehensive theoretical framework for understanding the genesis, maintenance, and clinical exacerbation of specific internet-use disorders and behavioral addictions, including compulsive sexual behavior disorder and problematic pornography use. The model posits that predisposing core personal characteristics (e.g., personality traits, neurobiological vulnerabilities, psychopathology, early childhood adversity) interact with affective and cognitive variables (e.g., coping styles, implicit associations, craving, cognitive expectancies). As the disorder progresses, behavioral enactment shifts from initial goal-directed, pleasure-driven actions (positive reinforcement) to habitual, compulsive behaviors functioning to alleviate negative emotional states or internal distress (negative reinforcement). The inclusion of items assessing sexual behavior in response to stress and negative emotional states within the CSBD-DI research pool reflects this theoretical transition.

Nosological Debate: Impulse Control Disorder vs. Behavioral Addiction

The CSBD-DI is situated squarely within an ongoing international psychiatric nosological debate. While the ICD-11 classified CSBD under Impulse Control Disorders due to perceived insufficient long-term longitudinal neurobiological evidence regarding withdrawal, tolerance, and neural progression (Grant et al., 2014; Kraus et al., 2018), many addiction medicine specialists and researchers advocate for its categorization as a behavioral addiction alongside Gambling Disorder and Gaming Disorder. The operationalization of CSBD-DI items captures behavioral phenomenology common to both classifications: impaired impulse regulation, behavioral salience, relapse, tolerance-like persistence without pleasure, and functional impairment.

7. Validity

The psychometric properties of the CSBD-DI were systematically examined across two comprehensive studies encompassing diverse international cohorts (Grubbs et al., 2023). Study 1 utilized large community samples from Malaysia, the United States, Hungary, and Germany. Study 2 expanded this validation using high-powered, nationally representative adult panels from the United States ($N = 1,029$), Poland ($N = 1,023$), and Hungary ($N = 1,003$).

Convergent and Concurrent Validity

Across all cultural and linguistic cohorts, the 7-item CSBD-DI demonstrated strong convergent validity with established, legacy measures of out-of-control sexual behavior, problematic pornography use, and sexual compulsivity. Specifically, CSBD-DI scores exhibited substantial, statistically significant positive correlations with:

• The Hypersexual Behavior Inventory (HBI; Reid et al., 2011), with Pearson correlation coefficients routinely exceeding $r = 0.65$ to $r = 0.75$, demonstrating that the brief screener captures the same core behavioral variance as longer multi-item scales.
• The Problematic Pornography Consumption Scale (PPCS; Bőthe et al., 2018), exhibiting strong associations ($r pprox 0.55 – 0.70$) among individuals whose sexual compulsivity primarily manifests via online pornography consumption.
• The Compulsive Sexual Behavior Inventory (CSBI; Coleman et al., 2001), showing strong convergent alignment across clinical and non-clinical participants.
• Behavioral indicators of sexual involvement, including weekly pornography viewing duration, frequency of masturbation, number of casual or commercial sexual encounters, and frequency of infidelity.

Discriminant and Divergent Validity

Crucially, the CSBD-DI demonstrated divergent validity from measures of moral incongruence and general non-pathological sexual desire. While scores on legacy screening tools frequently inflated clinical classifications among highly religious or morally conservative individuals who merely viewed pornography infrequently, the CSBD-DI’s strict focus on objective behavioral consequences and functional impairment substantially attenuated correlations with moral disapproval scales. Furthermore, the scale demonstrated weak-to-moderate correlations with general sexual desire, confirming that the CSBD-DI does not pathologize high levels of healthy, well-integrated libido.

Diagnostic Sensitivity, Specificity, and ROC Analyses

To determine clinical screening thresholds, Receiver Operating Characteristic (ROC) curve analyses were conducted against established external criteria, including clinical thresholds on the Hypersexual Behavior Inventory (HBI cutoff $ge 53$) and clinician-adjudicated diagnostic evaluations:

• Area Under the Curve (AUC): Across representative samples, the 7-item CSBD-DI demonstrated excellent discriminative accuracy, with AUC values consistently exceeding $0.85$ (ranging from $0.86$ to $0.92$), reflecting high discriminatory power between symptomatic and asymptomatic populations.
• Cutoff Score Selection: Item endorsement was naturally low in non-clinical, general population samples. ROC analysis revealed that setting a cutoff score of $ge 1$ active symptom (rated as “This has been true for at least 6 months during the last 12 months”) achieved high clinical sensitivity ($pprox 0.85 – 0.90$), serving as a broad, conservative initial screening threshold to capture any potentially affected individual. A more conservative cutoff of $ge 2$ active symptoms provided an optimal trade-off between sensitivity ($pprox 0.75 – 0.82$) and specificity ($pprox 0.88 – 0.94$), drastically minimizing false positives for epidemiological categorization.

8. Reliability

The reliability of the CSBD-DI has been rigorously documented across multiple languages, cultural environments, and sampling methodologies.

Internal Consistency

Across both the developmental community samples and the nationally representative cohorts in Study 2 (Grubbs et al., 2023), the 7-item core CSBD-DI demonstrated sound internal consistency:

• Nationally Representative Samples (Study 2): In the representative adult cohorts of the United States, Poland, and Hungary, Cronbach’s alpha ($lpha$) coefficients ranged between $0.78$ and $0.82$. McDonald’s omega total ($\omega_t$) and hierarchical ($\omega_h$) coefficients similarly yielded values between $0.79$ and $0.83$, confirming that the scale possesses strong internal consistency across general adult populations.
• Community and Undergraduate Samples (Study 1): In Sample 1 community cohorts, internal consistency metrics remained within acceptable-to-good ranges ($lpha = 0.70 – 0.81$, $\omega = 0.68 – 0.80$). Across nearly all cohorts, standardized factor loadings for core items exceeded $lambda = 0.47$. In an undergraduate Malaysian sample characterized by distinct sociocultural constraints and low baseline endorsement rates, factor loadings were slightly more variable ($lambda ge 0.39$), but composite reliability remained acceptable.

Scale Optimization (7 vs. 9 Items)

Psychometric analyses consistently demonstrated that the 7-item core version (excluding the two mood-regulation coping items, Items 8 and 9) exhibited higher internal consistency, cleaner factor structures, and superior average variance extracted (AVE) compared to the original 9-item candidate pool. Items 8 and 9 demonstrated idiosyncratic endorsement distributions in general community populations, where individuals frequently endorse using sexual behavior to alleviate stress or boredom without experiencing any compulsive dysregulation, loss of control, or impairment. Dropping these two items improved scale reliability and eliminated unwanted construct variance.

9. Factor Analysis

The structural validity of the CSBD-DI was evaluated using both Exploratory Factor Analysis (EFA) during preliminary item calibration and extensive Confirmatory Factor Analysis (CFA) across diverse international independent cohorts.

Confirmatory Factor Structure

Confirmatory factor models tested the theoretical unidimensionality of the core 7-item scale, wherein all items load onto a single general latent CSBD factor. The 7-item unifactorial model demonstrated superior goodness-of-fit indices across all national cohorts compared to the 9-item structure:

• Model Fit Indices: Across representative samples from the US, Poland, and Hungary, the 7-item single-factor model yielded excellent fit criteria: Comparative Fit Index ($ ext{CFI}$) ranged from$0.985$ to $0.996$; Tucker-Lewis Index ($ ext{TLI}$) ranged from$0.978$ to $0.993$; Root Mean Square Error of Approximation ($ ext{RMSEA}$) was consistently below$0.05$ (typical values $0.028 – 0.045$, $90%\text{ CI } [0.015, 0.058]$); and Standardized Root Mean Square Residual ($ ext{SRMR}$) remained below$0.035$.
• Factor Loadings: In the nationally representative cohorts, standardized factor loadings for the 7 core items were uniformly robust, ranging from $lambda = 0.52$ to $lambda = 0.86$, confirming that each individual item contributes substantial explained variance to the underlying latent construct of compulsive sexual behavior disorder.

Measurement Invariance

To verify that the CSBD-DI measures the identical psychological construct with equivalent operational scaling across disparate populations, multigroup confirmatory factor analysis (MGCFA) was conducted testing four sequential, increasingly restrictive levels of invariance: configural, metric (weak), scalar (strong), and residual (strict) invariance (Grubbs et al., 2023):

• Cross-National Invariance: Evaluating the nationally representative samples of the United States, Poland, and Hungary, the 7-item CSBD-DI successfully met the criteria for strict/residual invariance ($\Delta\text{CFI} < 0.010$, $\Delta\text{RMSEA} < 0.015$). This confirms that item factor loadings, item intercepts, and item unique error variances are invariant across cultures and languages, allowing for direct, unbiased cross-national comparisons of observed latent means.
• Gender Invariance: Testing across biological sex and gender groups (men vs. women), the 7-item scale achieved strong/scalar invariance. This demonstrates that men and women interpret and respond to the diagnostic criteria equivalently, ensuring that observed differences in prevalence or severity reflect true phenotypic differences rather than differential item functioning (DIF) or measurement bias.

10. Instrument / Measurement Tool

• Name of Tool: Compulsive Sexual Behavior Disorder Diagnostic Inventory
• Acronym: CSBD-DI
• Test Type: Brief Psychiatric Diagnostic Screener / Clinical Assessment Questionnaire
• Target Population: Adults (aged 18 years and older) in clinical, psychiatric, and general community populations
• Administration Format: Self-report paper-and-pencil or computerized/online survey
• Completion Time: Approximately 2 to 4 minutes
• Item Count:
  • Full Research Pool: 9 items (evaluating both ICD-11 CSBD and proposed DSM-5 Hypersexual Disorder criteria)
  • Core Diagnostic Version: 7 items (Items 1 through 7, strictly operationalizing ICD-11 CSBD criteria)
• Response Scale: Respondents evaluate each statement using a structured 3-point categorical temporal response scale:
  • 2 = “This has been true for at least 6 months during the last 12 months”
  • 1 = “This has been true in my lifetime but not during the last 12 months”
  • 0 = “This has never been true of me”
• Scoring and Diagnostic Interpretation:
  • Active Symptom Count Scoring: For primary diagnostic screening, only items endorsed with the active temporal criterion (“This has been true for at least 6 months during the last 12 months”) are scored as positive ($1$), while the remaining options are scored as negative ($0$). Summing these gives an active symptom score from 0 to 7 on the core scale.
  • Screening Cutoff $ge 1$: Sensitivity-prioritizing epidemiological screening threshold. Endorsement of at least 1 core item for $ge 6$ months indicates the presence of potential sexual dysregulation warranting comprehensive clinical follow-up.
  • Screening Cutoff $ge 2$: Specificity-balanced screening threshold. Endorsement of 2 or more core active symptoms identifies individuals with elevated probability of meeting full ICD-11 diagnostic criteria for CSBD, balancing false positives and false negatives.
  • Full ICD-11 Diagnostic Mapping: For formal diagnostic classification, an individual must endorse: (1) marked distress or functional impairment (Item 1); (2) at least one core dyscontrol symptom (repeated failed efforts to reduce/stop [Item 2] or perceived inability to control urges [Item 7]); and (3) at least one consequence/salience symptom (continued despite adverse consequences [Item 3], persistence without satisfaction [Item 4], or central life focus/neglect of responsibilities [Item 5]), all persisting for at least 6 months in the absence of moral incongruence.
  • Lifetime Remission Tracking: Items endorsed as “This has been true in my lifetime but not during the last 12 months” permit identification of individuals with historical CSBD currently in clinical remission.
• Available Validated Languages: English, German, Hungarian, and Polish.

11. Permissions & Fee and Test Year

• Test Year: 2023
• Copyright & Permissions: The Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI) was developed by Joshua B. Grubbs, Rory C. Reid, Beáta Bőthe, Zsolt Demetrovics, Eli Coleman, Neil Gleason, Michael H. Miner, Johannes Fuss, Verena Klein, Karol Lewczuk, Mateusz Gola, David P. Fernandez, Elaine F. Fernandez, Stefanie Carnes, Michal Lew-Starowicz, Drew Kingston, and Shane W. Kraus. The original validation article was published open access under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) in the Journal of Behavioral Addictions. Academic researchers and non-profit healthcare clinicians may freely utilize the scale for educational, clinical, and scientific purposes. For institutional adaptations, commercial use, or clinical trials, permission should be requested from the corresponding author, Joshua B. Grubbs ([email protected]).
• Royalty / Licensing Fee: Free of charge ($0) for academic, scientific, and non-commercial clinical screening applications.

12. References

Below are primary foundational references for the development, theoretical framing, and psychometric validation of the CSBD-DI:

• Bőthe, B., Tóth-Király, I., Zmbó, O., Márki, M., Sanches, S. G., & Demetrovics, Z. (2018). The development of the Problematic Pornography Consumption Scale (PPCS). The Journal of Sex Research, 55(3), 395–406. https://doi.org/10.1080/00224499.2017.1291775
• Brand, M., Young, K. S., Laier, C., Wölfling, K., & Potenza, M. N. (2016). Integrating psychological and neurobiological considerations regarding internet-use disorders: An Interaction of Person-Affect-Cognition-Execution (I-PACE) model. Neuroscience & Biobehavioral Reviews, 71, 252–266. https://doi.org/10.1016/j.neubiorev.2016.03.019
• Brand, M., Wegmann, E., Stark, R., Müller, A., Wölfling, K., Robbins, T. W., & Potenza, M. N. (2019). The Interaction of Person-Affect-Cognition-Execution (I-PACE) model for addictive behaviors: Update, generalization to addictive behaviors beyond internet-use disorders, and specification of the process character of addictive behaviors. Neuroscience & Biobehavioral Reviews, 104, 1–10. https://doi.org/10.1016/j.neubiorev.2019.08.023
• Coleman, E., Miner, M., Ohlerking, F., & Raymond, N. (2001). Compulsive Sexual Behavior Inventory—Revised. Unpublished scale, University of Minnesota Medical School, Minneapolis, MN.
• Grant, J. E., Atmaca, M., Fineberg, N. A., Fontenelle, L. F., Matsunaga, H., Janardhan Reddy, Y. C., Simpson, H. B., Thomsen, P. H., van den Heuvel, O. A., Veale, D., Woods, D. W., & Stein, D. J. (2014). Impulse control disorders and ‘behavioural addictions’ in the ICD-11. World Psychiatry, 13(2), 125–127. https://doi.org/10.1002/wps.20115
• Grubbs, J. B., Perry, S. L., Wilt, J. A., & Reid, R. C. (2020). Moral incongruence and pornography use: A critical review and integration. The Journal of Sex Research, 57(4), 438–455. https://doi.org/10.1080/00224499.2019.1697245
• Grubbs, J. B., Reid, R. C., Bőthe, B., Demetrovics, Z., Coleman, E., Gleason, N., Miner, M. H., Fuss, J., Klein, V., Lewczuk, K., Gola, M., Fernandez, D. P., Fernandez, E. F., Carnes, S., Lew-Starowicz, M., Kingston, D., & Kraus, S. W. (2023). Assessing compulsive sexual behavior disorder: The development and international validation of the Compulsive Sexual Behavior Disorder Diagnostic Inventory (CSBD-DI). Journal of Behavioral Addictions, 12(1), 242–260. https://doi.org/10.1556/2006.2023.00005
• Kafka, M. P. (2010). Hypersexual disorder: A proposed diagnosis for DSM-V. Archives of Sexual Behavior, 39(2), 377–400. https://doi.org/10.1007/s10508-009-9574-7
• Kraus, S. W., Krueger, R. B., Briken, P., First, M. B., Stein, D. J., Kaplan, M. S., Voon, V., Abdo, C. H. N., Grant, J. E., Heylens, G., Kahn, J. P., Lochner, C., Maguire, P. C. T., Reid, R. C., & Reed, G. M. (2018). Compulsive sexual behaviour disorder in the ICD-11. World Psychiatry, 17(1), 109–110. https://doi.org/10.1002/wps.20499
• Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient clinical sample of men. Sexual Addiction & Compulsivity, 18(1), 30–51. https://doi.org/10.1080/10720162.2011.555709
• Robinson, T. E., & Berridge, K. C. (1993). The neural basis of drug craving: An incentive-sensitization theory of addiction. Brain Research Reviews, 18(3), 247–291. https://doi.org/10.1016/0165-0173(93)90013-P
• World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). World Health Organization. https://icd.who.int/

13. Items of the Scale (Questionnaire)