Compulsive Sexual Behavior Inventory

1. Abstract

The Compulsive Sexual Behavior Inventory (CSBI) is a standardized, self-report psychometric instrument designed to assess the presence and severity of compulsive sexual behavior (CSB). Initially developed by Dr. Eli Coleman and colleagues at the University of Minnesota Medical School’s Program in Human Sexuality, the scale operationalizes CSB as a multifaceted clinical syndrome characterized by recurrent, intrusive, and unmanageable sexual urges, fantasies, and behaviors that persist despite adverse personal, relational, social, legal, or occupational consequences. Originally formulated as an exploratory 42-item measure capturing dimensions of behavioral dysregulation, interpersonal violence, and sexual abuse, the instrument underwent extensive psychometric refinement to produce a psychometrically robust 22-item self-report scale spanning two empirically validated factors: Control (Items 1–13) and Violence (Items 14–22).

Administered via a 5-point Likert-type response format ranging from 1 (Never) to 5 (Very Frequently), the CSBI provides both dimension-specific subscale scores and a composite severity index ranging from 22 to 110. The instrument has been rigorously validated across diverse clinical and non-clinical cohorts, including men diagnosed with nonparaphilic compulsive sexual behavior, individuals with paraphilic disorders (e.g., pedophilic disorder), community control populations, and high-risk demographic groups such as sexual minority men. Extensive psychometric investigations demonstrate excellent reliability, with internal consistency estimates consistently exceeding α = .90 for the full scale and the Control subscale, and test-retest stability coefficients reaching r = .86 for the English version and r = .93 for the validated Spanish adaptation over short-term administration intervals. Construct, convergent, and criterion-related validities are strongly supported by significant correlations with measures of sexual compulsivity, negative emotionality (e.g., depression and psychological distress), and risk-taking profiles, including elevated rates of unprotected sexual encounters and substance use during intercourse. The CSBI represents an indispensable screening, assessment, and diagnostic outcome measure in psychiatric, sexological, and public health settings.

2. Keywords

Compulsive Sexual Behavior Inventory, CSBI, sexual compulsivity, hypersexuality, out-of-control sexual behavior, behavioral addictions, sex addiction, sexual impulsivity, psychometrics, Eli Coleman

3. Authors

The Compulsive Sexual Behavior Inventory was conceptualized, developed, and validated through the collaborative work of academic researchers and clinical sexologists affiliated with the Institute for Sexual and Gender Health (formerly the Program in Human Sexuality) within the Department of Family Medicine and Community Health at the University of Minnesota Medical School:

• Eli Coleman, Ph.D. — Professor Emeritus and Former Director, Program in Human Sexuality, Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN, USA. Contact: [email protected].
• Rebecca E. Swinburne Romine, Ph.D. — Research Associate and Methodologist, Program in Human Sexuality, University of Minnesota Medical School, Minneapolis, MN, USA.
• Michael H. Miner, Ph.D. — Professor and Director of Research, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA.
• Frank Ohlerking, Ph.D. — Clinical Investigator and Contributing Researcher, University of Minnesota, Minneapolis, MN, USA.
• Nancy C. Raymond, M.D. — Professor of Psychiatry and Family Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
• Bruce A. Center, Ph.D. — Statistical Consultant and Psychometrician, Department of Family Practice and Community Health, University of Minnesota, Minneapolis, MN, USA.
• Michael W. Ross, Ph.D., M.D. — Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA.
• B. R. Simon Rosser, Ph.D., MPH — Professor, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

4. Purpose

The principal objective of the Compulsive Sexual Behavior Inventory is to provide clinicians, researchers, and public health practitioners with a psychometrically sound, standardized self-report instrument capable of screening, identifying, and evaluating the severity of compulsive sexual behavior across both clinical and epidemiological populations. Clinical interest in out-of-control sexual behaviors escalated significantly over the late 20th and early 21st centuries, characterized by intense debate surrounding the nosological status of excessive, unmanaged sexual manifestations. Historically classified under terms such as sexual addiction, hypersexuality, sexual impulsivity, or out-of-control sexual behavior, these manifestations are conceptually unified by the patient’s subjective inability to regulate their sexual impulses, resulting in considerable functional impairment, emotional distress, and dangerous physical or interpersonal sequelae.

The CSBI was specifically developed to bridge an empirical gap in the assessment landscape. Many earlier instruments relied exclusively on addiction-model paradigms without establishing distinct discriminant boundaries between conventional nonparaphilic behaviors and coercive or violent paraphilic behaviors. The CSBI captures the phenomenology of both nonparaphilic sexual compulsivity (e.g., compulsive masturbation, excessive pornography consumption, anonymous sex encounters, cybersex) and paraphilic or coercive variants (e.g., sexual dominance, physical aggression during sex, unconsented exposure). Clinically, the instrument functions as an evaluation tool to establish baseline severity, formulate customized psychotherapeutic and psychopharmacological treatment plans, track longitudinal therapeutic outcomes, and appraise relapse risk over time.

In epidemiological and sexual health research, the CSBI serves as a vital measurement vehicle for investigating the psychosocial, neurobiological, and behavioral correlates of sexual dysregulation. Extensive public health inquiry has demonstrated that elevated sexual compulsivity frequently co-occurs with high-risk sexual practices, such as condomless intercourse with casual or anonymous partners, sexual activity while intoxicated with alcohol or illicit drugs, and an elevated vulnerability to sexually transmitted infections (STIs), including HIV. By isolating the distinct components of dysregulated sexual behavior, the CSBI enables researchers to parse out whether transmission risks are mediated by impaired self-regulatory control or by violent, coercive interpersonal dynamics.

5. Psychological Construct

The theoretical construct underlying the CSBI is Compulsive Sexual Behavior (CSB). Within psychiatric and sexological literature, CSB is operationalized as an ongoing syndrome characterized by intense, distressing, and recurrent sexual urges, fantasies, and associated behaviors that systematically override the individual’s self-control mechanisms and severely disrupt their psychosocial functioning. A core phenotypic feature is the ego-dystonic nature of the behavior: individuals frequently report an earnest, desperate desire to moderate, curtail, or cease their sexual activities, yet experience repeated failure when attempting to do so. The CSBI explicitly bifurcates this broad clinical construct into two primary, empirically derived dimensions:

1. The Control Dimension (Items 1–13)

The Control subscale reflects the neurocognitive and behavioral failure of sexual self-regulation and impulse inhibition. This dimension encompasses the core symptomatology associated with conventional or nonparaphilic sexual compulsivity, featuring several interrelated psychological dynamics:

• Impaired Behavioral and Affective Regulation: Captured by direct statements regarding difficulty controlling sexual urges, actions, and subjective feelings (e.g., Item 1: "How often have you had trouble controlling your sexual urges?"; Item 2: "Have you felt unable to control your sexual behavior?").
• Maladaptive Emotional Coping (Negative Reinforcement): Utilizing sexual fantasies, masturbation, or casual sexual encounters as an avoidant coping mechanism to soothe, distract from, or alleviate negative emotional states, chronic stress, anxiety, or interpersonal strain (Item 3: "How often have you used sex to deal with worries or problems in your life?").
• Affective Sequelae (Guilt and Shame): Pervasive post-behavioral remorse, characterized by profound self-condemnation, emotional demoralization, and perceived violation of personal, ethical, or spiritual values (Item 4: "How often have you felt guilty or shameful about aspects of your sexual behavior?").
• Secrecy, Concealment, and Rationalization: The progressive development of double lives, dishonesty, elaborate deception to conceal sexual pursuits from partners, employers, or family, alongside defensive cognitive rationalizations (Item 5: "How often have you concealed or hidden your sexual behavior from others?"; Item 9: "How often have you developed excuses and reasons to justify your sexual behavior?").
• Repeated Broken Resolutions: Cyclical episodes of making solemn promises, vows, or cognitive pledges to stop or alter out-of-control sexual acts, promptly followed by relapse (Item 7: "How often have you made pledges or promises to change or alter your sexual behavior?").
• Functional and Relational Impairment: Tangible functional disruptions across interpersonal, financial, social, and vocational spheres (Item 8: interference with friendships; Item 10: lost productivity and opportunities; Item 11: financial distress due to commercial sex or pornography; Item 12: emotional detachment during intimacy).
• Excessive Behavioral Frequency: Participating in sexual encounters or masturbatory acts beyond personal desire, accompanied by physical discomfort or exhaustion (Item 13: "How often have you had sex or masturbated more than you wanted to?").

2. The Violence and Coercion Dimension (Items 14–22)

The Violence subscale captures coercive, physically aggressive, victimizing, or severely nonconventional manifestations intersecting with sexual behavioral patterns. Unlike purely nonparaphilic compulsivity, this dimension probes behaviors where sexual expression violates physical autonomy, consent boundaries, or safety parameters. It incorporates elements of sexual aggression, perpetration of non-consensual sexual acts, interpersonal violence within sexual encounters (hitting, kicking, choking, or restraining partners), commercial sexual exploitation (paying or receiving funds for sexual acts), and personal experiences of sexual victimization or non-consensual surveillance. This dimension isolates deviant, paraphilic, and abusive behavioral patterns from typical normative hypersexuality, granting the clinician critical diagnostic clarity regarding potential forensic and safety implications.

6. Theoretical Framework

The development of the CSBI was guided primarily by the behavioral conceptualizations of Dr. Eli Coleman, who integrated elements from obsessive-compulsive spectrum disorders, impulse-control disorder models, and behavioral addiction models into a unified biopsychosocial framework. Coleman argued that sexual behavior becomes compulsive when it is transformed into an automated coping strategy designed to regulate intolerable psychological affect, such as profound anxiety, social isolation, depression, or developmental trauma.

Impulsivity vs. Compulsivity Dual-Process Model

Historically, excessive sexual behaviors have been framed within a tension between impulsivity and compulsivity. Impulsive sexual behavior is characterized by sensation seeking, immediate gratification, novelty seeking, and a failure to consider long-term negative consequences, primarily driven by positive reinforcement. Conversely, compulsive sexual behavior is characterized by repetitive, stereotyped actions aimed at reducing mounting internal psychological distress or tension, driven primarily by negative reinforcement. Coleman and colleagues proposed that clinical CSB often initiates as an impulsive search for pleasure or stress relief, which over time, through neurobiological sensitization and conditioning, consolidates into a rigid compulsive cycle wherein the individual experiences an irresistible urge to act out sexual behaviors even when no authentic pleasure or gratification is derived.

Nosological Alignment with ICD-11 and DSM-5

The conceptual framework underlying the CSBI directly foreshadowed modern psychiatric taxonomies. While the DSM-5 declined to formalize "hypersexual disorder" due to debates concerning empirical consensus, the World Health Organization formally introduced Compulsive Sexual Behavior Disorder (CSBD) into the ICD-11 (code 6C72) classified under Impulse Control Disorders. The diagnostic criteria outlined in ICD-11 mirror the core constructs evaluated by the CSBI: persistent failure to control repetitive, intense sexual impulses; sexual behavior becoming the central focus of life to the neglect of health, personal care, and other responsibilities; numerous unsuccessful attempts to significantly decrease the behavior; and continued participation despite adverse consequences and marked distress.

7. Validity

The psychometric validity of the CSBI has been established through several clinical and empirical investigations evaluating construct, criterion, convergent, and discriminant validity across diverse demographic and clinical populations:

Known-Groups and Construct Validity

The primary validation study conducted by Coleman, Miner, Ohlerking, and Raymond (2001) assessed the construct validity of the inventory by comparing three clearly differentiated cohorts: adult men formally diagnosed with nonparaphilic compulsive sexual behavior (clinical CSB group, n = 36), men clinically diagnosed with pedophilic disorder (paraphilic clinical group, n = 40), and an asymptomatic community control sample (n = 23). The clinical CSB group scored significantly higher on the CSBI Control subscale and full scale than the community control cohort (p < .001), demonstrating the scale’s sensitivity to clinically diagnosed sexual dysregulation. Furthermore, men in the pedophilia group demonstrated distinct score elevations on specific paraphilic and coercive markers, confirming the inventory’s discriminant capacity to distinguish nonparaphilic compulsive syndromes from paraphilic disorders.

Criterion-Related and Behavioral Validity

Subsequent psychometric investigations by Miner, Coleman, Center, Ross, and Rosser (2007) examined the inventory’s criterion validity within a large epidemiological cohort of 1,106 Latino men who have sex with men (MSM) recruited through online health venues. Participants scoring above the median on the CSBI exhibited robust, statistically significant associations with several objective behavioral risk indices:

• Elevated Partner Numbers: High scorers reported significantly greater numbers of male sexual partners over lifetime and recent intervals compared to low scorers.
• High-Risk Sexual Encounters: High CSBI scores were strongly correlated with increased frequencies of unprotected anal intercourse (both receptive and insertive) with casual partners.
• Substance-Involved Intercourse: Respondents with elevated CSBI scores demonstrated higher probabilities of engaging in sexual activity while intoxicated by alcohol or illicit drugs.
• Driven and Distressed Sexual Affect: Higher scores were positively associated with subjective feelings of feeling driven, isolated, depressed, and detached during sexual acts.

Convergent and Discriminant Validity

Convergent validity has been established through substantial positive correlations between the CSBI Control subscale and concurrent psychological symptom inventories, notably the Sexual Compulsivity Scale (SCS) and standardized depression indices (such as the CES-D and BDI). Discriminant validity was supported in the Miner et al. (2007) study: while depressive affect significantly correlated with both the total CSBI score and the Control subscale, depression was not significantly related to the Violence subscale, demonstrating that interpersonal coercion and affective self-regulatory failure represent distinct constructs.

8. Reliability

The Compulsive Sexual Behavior Inventory demonstrates strong psychometric reliability across internal consistency, split-half, and test-retest modalities in both its primary English version and its translated Spanish validation (Inventario de Comportamiento Sexual Compulsivo):

Internal Consistency

In standard validation samples, the internal consistency of the overall CSBI has consistently yielded elevated coefficients. In the psychiatric development cohort (Coleman et al., 2001), Cronbach’s alpha for the complete instrument reached α = .92. In large community and high-risk cohort evaluations (Miner et al., 2007), the 13-item Control factor displayed high internal reliability, with alpha coefficients hovering between α = .89 and α = .93 across independent language groups. The 9-item Violence factor, reflecting lower base-rate behaviors in community settings, demonstrated adequate internal consistency (α = .72 to .78), consistent with psychometric expectations for specialized forensic and coercive item sets.

Test-Retest Stability

Temporal stability of the instrument was systematically tested by Miner and colleagues (2007) across both English and Spanish cohorts over a two-to-four-week retest window:

• English Version: The test-retest correlation coefficient for the composite CSBI was r = .86 (p < .001), indicating high temporal reproducibility of symptom reporting.
• Spanish Version: The test-retest correlation coefficient for the Spanish adaptation was r = .93 (p < .001), demonstrating excellent cross-cultural stability across temporal assessments.

9. Factor Analysis

The structural dimensionality of the CSBI was clarified through rigorous exploratory (EFA) and confirmatory factor analyses (CFA) during its developmental refinement from a 42-item preliminary instrument to its validated 22-item standardized format:

Initial Extraction and Exploratory Factor Analysis (EFA)

During the initial item generation phase (Coleman et al., 2001), clinical sexologists generated 42 items tapping three conceptual domains: control failure, interpersonal violence, and sexual abuse. Principal components analysis (PCA) with varimax rotation revealed that items measuring past histories of childhood sexual abuse loaded irregularly, generated confounding cross-loadings, and undermined the instrument’s structural stability. Psychometric optimization led to the complete elimination of historical sexual abuse items, retaining items exclusively addressing contemporary behavioral patterns and dysregulation. This refinement condensed the scale to 22 items, reliably extracting two dominant, orthogonal factors accounting for the majority of shared variance:

• Factor 1: Control (Items 1–13) — This factor captures primary behavioral dysregulation, unsuccessful cessation efforts, psychological conflict, and emotional distress associated with excessive sexual behavior. Item-factor loadings for this domain are consistently robust, typically ranging between .58 and .84. Items such as "Have you felt unable to control your sexual behavior?" and "How often have you had trouble controlling your sexual urges?" represent the highest-loading core indicators of the underlying latent construct.
• Factor 2: Violence (Items 14–22) — This factor captures coercive sexual behavior, physical force, sadomasochistic behaviors involving non-consent or physical injury, and commercial sex transactions. Standard factor loadings range between .46 and .79 across validation cohorts.

Confirmatory Factor Analysis (CFA) and Cross-Linguistic Invariance

Confirmatory factor analytic investigations conducted by Miner et al. (2007) assessed the two-factor structural model across 1,106 respondents. The hypothesized two-factor structure demonstrated adequate to superior model fit across independent cohorts:

• Comparative Fit Index (CFI): Ranged from .91 to .94 across calibration groups.
• Root Mean Square Error of Approximation (RMSEA): Maintained favorable parameter estimates (≤ .06, 90% CI [.052, .068]), affirming that a two-factor latent formulation provides a theoretically sound structural fit for the data.
• Cross-Linguistic Invariance: Structural equation modeling established that the two-factor model demonstrated factor form equivalence and metric invariance across both English-speaking and Spanish-speaking cohorts, verifying that the instrument operates equivalently across divergent linguistic groups.

10. Instrument / Measurement Tool

The Compulsive Sexual Behavior Inventory is formatted as follows:

• Instrument Type: Standardized self-report psychometric rating inventory.
• Target Population: Adults (aged 18 and older) evaluated within clinical sexology, psychiatric clinics, forensic assessment centers, and epidemiological research cohorts.
• Item Count: 22 items.
• Subscale Breakdown:
  • Control Subscale: Items 1 through 13 (measures behavioral loss of control, failed cessation, and psychosocial distress).
  • Violence Subscale: Items 14 through 22 (measures coercive actions, aggression, violence, and transactional sex).
• Response Format: 5-point Likert-type rating scale scored as follows:
  • 1 = Never
  • 2 = Rarely
  • 3 = Occasionally
  • 4 = Frequently
  • 5 = Very Frequently
• Scoring Procedures:
  • Responses are scored from 1 to 5 for each item. There are no reverse-coded items.
  • Control Subscale Score: Calculated by summing Items 1 through 13 (Theoretical range: 13 to 65).
  • Violence Subscale Score: Calculated by summing Items 14 through 22 (Theoretical range: 9 to 45).
  • Total CSBI Score: Calculated by summing all 22 items (Theoretical range: 22 to 110).
  • Interpretation: Higher numerical scores indicate more severe compulsive sexual behavior and associated functional impairment. In research screening applications, median splits or top quartile cutoffs have frequently been used to classify high versus low compulsivity cohorts.
• Administration Modality: Available in traditional paper-and-pencil formats and digitized web-based survey software; completion time is approximately 10 minutes.

11. Permissions & Fee and Test Year

The Compulsive Sexual Behavior Inventory was formally published in its initial empirical peer-reviewed format in 2001 by Dr. Eli Coleman and colleagues, with its psychometric refinement and cross-cultural evaluation published in 2007. The instrument is copyrighted by Dr. Eli Coleman and the Program in Human Sexuality at the University of Minnesota Medical School.

The instrument is widely accessible for academic, clinical, and non-commercial scientific research purposes. Clinicians and scholars interested in utilizing the CSBI in scientific trials, epidemiological projects, or clinical translation are encouraged to contact the corresponding author to request formal authorization and confirm relevant scoring guidelines:

• Corresponding Developer: Eli Coleman, Ph.D.
• Institutional Affiliation: Program in Human Sexuality, Department of Family Practice and Community Health, Medical School, University of Minnesota
• Physical Address: 1300 South 2nd Street, Suite 180, Minneapolis, MN 55454, USA
• Electronic Mail: [email protected]

12. References

Below are primary references documenting the conceptualization, validation, and clinical application of the Compulsive Sexual Behavior Inventory:

• Coleman, E. (1990). The obsessive-compulsive model for describing compulsive sexual behaviors. American Journal of Preventive Psychiatry & Neurology, 2(3), 9–14.
• Coleman, E. (1992). Is your patient suffering from compulsive sexual behavior? Psychiatric Annals, 22(8), 414–418. https://doi.org/10.3928/0048-5713-19920801-07
• Coleman, E., Miner, M., Ohlerking, F., & Raymond, N. (2001). Compulsive Sexual Behavior Inventory: A preliminary study of reliability and validity. Journal of Sex & Marital Therapy, 27(4), 325–332. https://doi.org/10.1080/009262301317081070
• Kalichman, S. C., & Rompa, D. (1995). Sexual sensation seeking and sexual compulsivity scales: Reliability, validity, and predicting HIV risk behavior. Journal of Personality Assessment, 65(3), 586–601. https://doi.org/10.1207/s15327752jpa6503_16
• 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, M., Mataix-Cols, D., Messina, P. R., Monteiro, V., Rassovsky, Y., Roeca, 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
• Miner, M. H., Coleman, E., Center, B. A., Ross, M., & Rosser, B. R. S. (2007). The Compulsive Sexual Behavior Inventory: Psychometric properties. Archives of Sexual Behavior, 36(4), 579–587. https://doi.org/10.1007/s10508-006-9114-1
• Reid, R. C., Garos, S., & Carpenter, B. N. (2011). Reliability, validity, and psychometric development of the Hypersexual Behavior Inventory in an outpatient sample of men. Addiction Research & Theory, 19(6), 531–541. https://doi.org/10.3109/16066359.2011.564619
• World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/

13. Items of the Scale (Questionnaire)