Boundary with Bipolar or Related Disorders: Increased sexual impulses, urges or behaviors and impaired ability to control them can occur during Manic, Mixed, or Hypomanic Episodes. A diagnosis of Compulsive Sexual Behavior Disorder should only be assigned if there is evidence of persistent failure to control intense, repetitive sexual impulses, urges or behaviors and the presence of all other diagnostic requirements outside of Mood Episodes.
Boundary with Obsessive-Compulsive Disorder: Although the word ‘compulsive’ is included in the name of this condition, sexual behavior in Compulsive Sexual Behavior Disorder is not considered to be a true compulsion. Compulsions in Obsessive-Compulsive Disorder are almost never experienced as inherently pleasurable and commonly occur in response to intrusive, unwanted, and typically anxiety-provoking thoughts, which is not the case with sexual behavior in Compulsive Sexual Behavior Disorder.***
Boundary with Personality Disorder: Some individuals with Personality Disorder may engage in repetitive sexual behavior as a maladaptive regulation strategy (e.g., to prevent or reduce emotional distress or to stabilize their sense of self). Although both diagnoses can be assigned together, if the sexual behavior is entirely accounted for by emotion dysregulation or other core features of Personality Disorder, an additional diagnosis of Compulsive Sexual Behavior Disorder is not warranted.
Boundary with Paraphilic Disorders: The core feature of Compulsive Sexual Behavioral Disorder is a persistent pattern of failure to control intense repetitive sexual impulses or urges resulting in repetitive sexual behavior that results in marked distress or impairment in functioning. Paraphilic Disorders, on the other hand, are characterized by persistent and intense patterns of atypical sexual arousal manifested by sexual thoughts, fantasies, urges, or behaviors and have resulted in actions toward individuals whose age or status renders them unwilling or unable to consent or are associated with marked distress or significant risk of injury or death. If an individual with a Paraphilic Disorder is able to exercise some degree of control over the behavioral expressions of the arousal pattern, an additional diagnosis of Compulsive Sexual Behavioral Disorder is generally not warranted. If, however, the diagnostic requirements of both Compulsive Sexual Behavioral Disorder and a Paraphilic Disorder are met, both diagnoses may be assigned.
Boundary with the effects of psychoactive substances, including medications: Use of specific prescribed medications or illicit substances (e.g., dopamine agonists such as pramipexole for Parkinson Disease or Restless Legs Syndrome or illicit substances such as methamphetamine) can sometimes cause impaired control over sexual impulses, urges or behaviors due to their direct effects on the central nervous system, with onset corresponding to use of the substance or medication. Compulsive Sexual Behavior Disorder should not be diagnosed in such cases.
Boundary with Disorders Due to Substance Use: Episodes of impulsive or disinhibited sexual behavior may occur during substance intoxication. At the same time, co-occurrence of Compulsive Sexual Behavior Disorder and substance use is common, and some individuals with Compulsive Sexual Behavior Disorder use substances with the intention of engaging in sexual behavior or to enhance pleasure from it. Distinguishing between Compulsive Sexual Behavior Disorder and repetitive patterns of substance use with associated sexual behavior is therefore a complex clinical judgment based on an assessment of the sequencing, context, and motivations of the relevant behaviors. A diagnosis of Compulsive Sexual Behavior Disorder may be assigned together with a Disorder Due to Substance Use if the diagnostic requirements for both disorders are met.
Boundary with Dementia and medical conditions not classified under Mental, Behavioral or Neurodevelopmental Disorders: Some individuals with Dementia, Diseases of the Nervous System, or other medical conditions that have effects on the central nervous system may exhibit failure to control sexual impulses, urges or behaviors as a part of a more general pattern of disinhibition of impulse control due to neurocognitive impairment. A separate diagnosis of Compulsive Sexual Behavior Disorder should not be assigned in such cases.
