COSRT’s Board of Trustees are mindful that terminology plays a crucial role in effective therapeutic practice. Diagnostic language shapes how conditions, symptoms, and experiences are understood. Terms may evolve through research, be debated, overlap in meaning, be used inconsistently or culturally insensitively – sometimes resulting in confusion.
This has been particularly evident in discussions concerning sex addiction and compulsive sexual behaviours (or hypersexuality and out of control sexual behaviour and similar). These are terms that have at times been used interchangeably, at times treated as distinct and often surrounded by debate blending academic inquiry with values-based perspectives.
The publication of ICD-11 represented a significant development in this area. For the first time, the World Health Organisation included Compulsive Sexual Behaviour Disorder (CSBD) as a formal diagnosis. CSBD is defined with specific criteria. It does not incorporate features typically associated with addictions, such as withdrawal or tolerance.
ICD-11 did not include a diagnostic category for sex addiction. That decision reflected neither endorsement nor rejection of the concept. It indicated that the existing evidence did not, at that time, meet the threshold for formal classification. Future revisions of the ICD may introduce new categories should sufficient evidence emerge.
Implementation of ICD-11 is ongoing. It is not yet in use in England (expected 2028) and is at varying stages of adoption elsewhere, including Scotland. As a result, we are in a transitional period that gives an opportunity for clarity and adaptation. Where two informal terms were previously used, there will – at least temporarily – be one formal disorder (CSBD) and one informal term that serves only as a descriptive, informal label.
Psychotherapists will increasingly encounter Service Users who have been diagnosed with CSBD by regulated professionals. These individuals should receive care grounded in evidence-based approaches aligned with the diagnostic criteria.
Simultaneously Service Users, the media and others will likely continue to use the term sex addiction in ways not supported by formal systems or evidence. Researchers will use the term as a way of describing lived experiences or framing emerging scholarship. It remains part of public and professional discourse.
Our position is that:
- Therapists should only use and refer to formally codified conditions and disorders in clinical work.
- The term sex addiction should only be used in other contexts with appropriate clarification.
- In the past it was sometimes applied to experiences now formally classified as CSBD and such conflation is no longer viable.
- The term now refers to a proposed condition that requires further evidence before potential any future acceptance or adoption.
- Sex addiction and CSBD should not be treated as interchangeable terms. They refer to different constructs regardless of their past, current or future diagnostic status.
- Where Service Users present with symptoms typically associated with addiction disorders, therapists should refer them to an appropriately regulated professional – such as a practising psychologist or psychiatrist – for assessment and diagnosis.
- Research into the concept of sex addiction should be supported to strengthen understanding and improve future clinical practice.
- The term sex addition should not be stigmatised and professionals should not be vilified for advocating its eventual adoption as a formal diagnosis – provided their work and research is rigorous, evidence-based, and ethically conducted.
Our intention is that therapists can endorse and uphold this clear, balanced approach. With time, such clarity will benefit Service Users – who will gain a better understanding of their experiences – and support practitioners in delivering accurate assessment and appropriate treatment.